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Sample records for acquired reactive perforating

  1. Reactive perforating collagenosis

    Yadav Mukesh

    2009-01-01

    Full Text Available Reactive perforating collagenosis is a rare cutaneous disorder of unknown etiology. We hereby describe a case of acquired reactive perforating collagenosis in a patient of diabetes and chronic renal failure.

  2. Reactive perforating collagenosis

    Yadav Mukesh; Sangal B; Bhargav Puneet; Jai P; Goyal Mukul

    2009-01-01

    Reactive perforating collagenosis is a rare cutaneous disorder of unknown etiology. We hereby describe a case of acquired reactive perforating collagenosis in a patient of diabetes and chronic renal failure.

  3. Tacalcitol in the Treatment of Acquired Perforating Collagenosis

    Escribano-Stablé, J.C.; Doménech, C.; Matarredona, J.; Pascual, J.C.; Jaen, A; Vicente, J.

    2014-01-01

    Acquired perforating collagenosis (APC) is a rare perforating dermatosis characterized by transepidermal collagen elimination. We describe a 65-year-old patient, with long-standing type 2 diabetes mellitus and a 2-year history of itchy hyperkeratotic nodules situated on the back, who was subsequently diagnosed with APC. Treatment included topical corticosteroids and antihistamines, without improvement of the lesions. However, therapy with topical tacalcitol administered for 2 months produced ...

  4. Tacalcitol in the Treatment of Acquired Perforating Collagenosis

    J.C. Escribano-Stablé

    2014-02-01

    Full Text Available Acquired perforating collagenosis (APC is a rare perforating dermatosis characterized by transepidermal collagen elimination. We describe a 65-year-old patient, with long-standing type 2 diabetes mellitus and a 2-year history of itchy hyperkeratotic nodules situated on the back, who was subsequently diagnosed with APC. Treatment included topical corticosteroids and antihistamines, without improvement of the lesions. However, therapy with topical tacalcitol administered for 2 months produced a significant response leading to complete remission of APC.

  5. A rare case of familial reactive perforating collagenosis

    Rajesh Verma

    2013-01-01

    Full Text Available A 4 year old boy presented with history of itchy raised lesions on body of 2 years duration. Though parental consanguinity was not present, his elder brother had similar complaints. Dermatological examination revealed multiple hyperpigmented papules with a central keratotic plug distributed mainly over face and extensors of upper and lower extremities. Koebnerisation was present. Skin biopsy revealed perforating collagen bundles in the upper dermis and epidermis which was confirmed by Van Gieson staining. Patient was being treated with topical retinoids and intralesional corticosteroids with minimal relief.

  6. Dermatose perfurante adquirida associada à insuficiência hepática em paciente transplantado de fígado Acquired perforating dermatosis associated with hepatic failure in a liver-transplanted patient

    Daniela Badziak

    2007-02-01

    Full Text Available A dermatose perfurante adquirida é entidade clinicopatológica caracterizada por eliminação transepitelial de material dérmico degenerado, ocorrendo em muitas condições, entre elas diabetes mellitus, insuficiência renal crônica e colangite esclerosante. Relata-se o caso de paciente de 17 anos, com dermatose perfurante adquirida associada à insuficiência hepática crônica, conseqüente à complicação hepática de transplante de fígado para tratamento de sua doença de base, a glicogenose tipo I.Acquired perforating dermatosis is characterized by transepithelial elimination of degenerated dermal substances. It occurs in many conditions, such as: diabetes mellitus, chronic renal failure and sclerosing cholangitis. This article describes a 17-year-old Caucasian female with type I glucogenosis and acquired perforating dermatosis due to chronic hepatic failure caused by hepatic complication of liver transplant.

  7. Perforated monolayers

    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.

  8. A naturally-occurring histone acetyltransferase inhibitor derived from Garcinia indica impairs newly acquired and reactivated fear memories.

    Stephanie A Maddox

    Full Text Available The study of the cellular and molecular mechanisms underlying the consolidation and reconsolidation of traumatic fear memories has progressed rapidly in recent years, yet few compounds have emerged that are readily useful in a clinical setting for the treatment of anxiety disorders such as post-traumatic stress disorder (PTSD. Here, we use a combination of biochemical, behavioral, and neurophysiological methods to systematically investigate the ability of garcinol, a naturally-occurring histone acetyltransferase (HAT inhibitor derived from the rind of the fruit of the Kokum tree (Garcina indica, to disrupt the consolidation and reconsolidation of Pavlovian fear conditioning, a widely studied rodent model of PTSD. We show that local infusion of garcinol into the rat lateral amygdala (LA impairs the training and retrieval-related acetylation of histone H3 in the LA. Further, we show that either intra-LA or systemic administration of garcinol within a narrow window after either fear conditioning or fear memory retrieval significantly impairs the consolidation and reconsolidation of a Pavlovian fear memory and associated neural plasticity in the LA. Our findings suggest that a naturally-occurring compound derived from the diet that regulates chromatin function may be useful in the treatment of newly acquired or recently reactivated traumatic memories.

  9. Does C-reactive protein independently predict mortality in adult community-acquired bacteremia patients with known sepsis severity?

    Gradel, Kim O; Jensen, Thøger G; Kolmos, Hans J;

    2013-01-01

    characteristic curve (AUC) to evaluate 30-day mortality in four models: (i) age, gender, comorbidity, bacteria, and ward. (ii) Model 1 and sepsis severity. (iii) Model 1 and CRP. (iv) Model 1, sepsis severity, and CRP. Altogether, 416 of 1999 patients died within 30 days. CRP independently predicted 30-day...... mortality [Model 4, odds ratio (95% CIs) for 100 mg/L: 1.16 (1.06-1.27)], but it did not contribute to the AUC (Model 2 vs Model 4: p = 0.31). In the 963 non-severe sepsis patients, CRP independently predicted 30-day mortality [Model 4: 1.42 (1.20-1.69)] and it increased the AUC (Model 2 vs Model 4: p = 0......We evaluated whether sepsis severity and C-reactive protein (CRP) level on admission prognostically corroborated or annulled each other in adult patients with incident community-acquired bacteremia (Funen, Denmark, 2000-2008). We used logistic regression and area under the receiver operating...

  10. A naturally-occurring histone acetyltransferase inhibitor derived from Garcinia indica impairs newly acquired and reactivated fear memories.

    Maddox, Stephanie A; Watts, Casey S; Doyère, Valérie; Schafe, Glenn E

    2013-01-01

    The study of the cellular and molecular mechanisms underlying the consolidation and reconsolidation of traumatic fear memories has progressed rapidly in recent years, yet few compounds have emerged that are readily useful in a clinical setting for the treatment of anxiety disorders such as post-traumatic stress disorder (PTSD). Here, we use a combination of biochemical, behavioral, and neurophysiological methods to systematically investigate the ability of garcinol, a naturally-occurring histone acetyltransferase (HAT) inhibitor derived from the rind of the fruit of the Kokum tree (Garcina indica), to disrupt the consolidation and reconsolidation of Pavlovian fear conditioning, a widely studied rodent model of PTSD. We show that local infusion of garcinol into the rat lateral amygdala (LA) impairs the training and retrieval-related acetylation of histone H3 in the LA. Further, we show that either intra-LA or systemic administration of garcinol within a narrow window after either fear conditioning or fear memory retrieval significantly impairs the consolidation and reconsolidation of a Pavlovian fear memory and associated neural plasticity in the LA. Our findings suggest that a naturally-occurring compound derived from the diet that regulates chromatin function may be useful in the treatment of newly acquired or recently reactivated traumatic memories. PMID:23349897

  11. Microglial reactivity correlates to the density and the myelination of the anterogradely degenerating axons and terminals following perforant path denervation of the mouse fascia dentata

    Jensen, M B; Hegelund, I V; Rom Poulsen, Frantz;

    1999-01-01

    Transection of the entorhino-dentate perforant path is a well known model for lesion-induced axonal sprouting and glial reactions in the rat. In this study, we have characterized the microglial reaction in the dentate molecular layer of the SJL/J and C57Bl/6 mouse. The morphological transformatio...

  12. Fos protein expression in olfactory-related brain areas after learning and after reactivation of a slowly acquired olfactory discrimination task in the rat

    Roullet, Florence; Liénard, Fabienne; Datiche, Frédérique; Cattarelli, Martine

    2005-01-01

    Fos protein immunodetection was used to investigate the neuronal activation elicited in some olfactory-related areas after either learning of an olfactory discrimination task or its reactivation 10 d later. Trained rats (T) progressively acquired the association between one odor of a pair and water-reward in a four-arm maze. Two groups of pseudotrained rats were used: PO rats were not water restricted and were submitted to the olfactory stimuli in the maze without any reinforcement, whereas P...

  13. Pedicled perforator flaps

    Demirtas, Yener; Ozturk, Nuray; Kelahmetoglu, Osman; Demir, Ahmet

    2009-01-01

    Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap to...... reconstruct the defect. The perforators are marked with a hand-held Doppler probe and multiple flaps are designed. The appropriate flap is elevated after identifying the perforator(s). Dissection of the perforator(s) or complete incision of the flap margins are not mandatory if the flap is mobilized...... adequately to cover the defect. Defects measuring 3 x 3 cm up to 20 x 20 cm at diverse locations were successfully reconstructed in 20 of 21 patients with 26 flaps. Pedicled perforator flaps offer us reliable and satisfactory results of reconstruction at different anatomic territories of the body. It sounds...

  14. Antenatal appendicular perforation.

    Narasimharao, K. L.; Mitra, S. K.; Pathak, I. C.

    1987-01-01

    Antenatal appendicular perforation leading to localized meconium peritonitis and intestinal obstruction is reported in a premature neonate. The baby was successfully treated by a limited ileocaecal resection.

  15. Iatrogenic neonatal bladder perforation

    Lilia Trigui

    2011-01-01

    Full Text Available Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of a 3-day-old infant with ascites due to bladder perforation secondary probably to manual decompression of the bladder. The infant underwent successful surgical repair of the perforation.

  16. Strategies in Perforated Diverticulitis

    J. Vermeulen (Jefrey)

    2010-01-01

    textabstractAlthough diverticulitis is a common disease affecting the gastrointestinal tract, few is known about the optimal surgical treatment of its most severe form: perforated diverticulitis. Regardless of the selected operation, perforated diverticulitis is associated with mortality rates up to

  17. Perforating Thin Metal Sheets

    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.

  18. Spontaneous Perforation of Pyometra.

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

    2016-04-01

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

  19. Rat Endovascular Perforation Model

    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.

  20. Spontaneous Perforation of Pyometra

    Sharma, Nalini; 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 perfor...

  1. Biomineralization in perforate foraminifera

    L. J. de Nooijer; H. J. Spero; Erez, J.; Bijma, J.; Reichart, G. J.

    2014-01-01

    In this paper, we review the current understanding of biomineralization in perforate foraminifera. Ideas on the mechanisms responsible for the flux of Ca2 + and inorganic carbon from seawater into the test were originally based on light and electron microscopic observations of calcifying foraminifera. From the 1980s onward, tracer experiments, fluorescent microscopy and high-resolution test geochemical analysis have added to existing calcification models. Despite recent insights, no general c...

  2. A composite score combining procalcitonin, C-reactive protein and temperature has a high positive predictive value for the diagnosis of intensive care-acquired infections

    2013-01-01

    Background Nosocomial infection diagnosis in the intensive care unit (ICU) remains a challenge. We compared routine measurements of procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and temperature in the detection of ICU-acquired infections. Method Prospective observational cohort study in a University hospital Medicosurgical ICU. All patients admitted to the ICU ≥ 5 days (n = 141) were included into two groups, either infected (documented infection, n = 25) or non-infected (discharged from the ICU without diagnosis of infection, n = 88). Results PCT, CRP, WBC and temperature progression from day −4 (D-4) to day 0 (D0) (day of infection diagnosis or ICU discharge) was analysed. Differences (Δ) were calculated as D0 levels minus the lowest preceding value. D0 PCT and CRP were significantly increased in infected compared to non-infected patients (median, 1st and 3rd quartiles): 3.6 ng/mL (0.92-25) for PCT, 173 mg/L (126–188) for CRP versus 0.02 ng/mL (0.1-0.9) and 57 mg/mL (31–105) respectively (p  38.6°C, PCT > 1.86 ng/mL, and CRP > 88 mg/L, performed well (AUCs of 0.88, 0.84, and 0.88 respectively). The sensitivity/specificity profiles of each marker (76%/94% for temperature, 68%/91% for PCT, and 92%/70% for CRP) led to a composite score (0.068 × D0 PCT + 0.005 × D0 CRP + 0.7 × temperature) more highly specific than each component (AUC of 0.90 and sensitivity/specificity of 80%/97%). Conclusion Combining CRP, PCT and temperature is an approach which may increase of nosocomial infection detection in the ICU. PMID:23547830

  3. Oesophageal perforation in extreme prematurity

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

    2012-01-01

    Management of oesophageal perforation in extremely premature babies is a challenge and carries a high morbidity. The authors report their experience of three separate cases of oesophageal perforation they encountered over the last 18 months in extremely premature neonates. In the first case, the diagnosis of oesophageal perforation was known in an otherwise stable baby who was treated conservatively with a good outcome. In the second and third cases, the patients proceeded to thoracotomy befo...

  4. Rare cause of oesophagus perforation

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

    2014-01-01

    INTRODUCTION Oesophagus perforations, which are generally caused by iatrogenic injuries, are a serious clinical event. There are still high rates of mortality and morbidity and there is no gold standard of surgical treatment. PRESENTATION OF CASE The case is here presented of a 54-year old female with complaints of dysphagia after having swallowed a bone in food, who was determined with oesophagus perforation on CT examination. DISCUSSION Oesophagus perforation generally occurs secondary to i...

  5. Post Stamp Perforation Recognition

    Koníček, Vladimír

    2008-01-01

    Rozpoznávání zoubkování poštovních známek je důležitým faktorem při posuzování pravosti poštovní známky. Typ a rozměr zoubkování mají výrazný vliv na cenu poštovní známky. Tato práce se zabývá navrhem detektoru zoubkování poštovních známek. Cílem práce je vytvořit aplikaci, která z fotografie určí zoubkování zobrazené poštovní známky. Aplikace pro práci s obrazy využívá knihovnu OpenCV. Post stamp perforation recognition is important factor in authentication of post stamps. Type and perfor...

  6. Spontaneous Perforation of Pyometra

    Begüm Yildizhan

    2006-01-01

    Full Text Available 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.

  7. CT findings of exophageal perforation

    Heo, Jeong Nam; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Hahm, Chang Kok [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2002-09-01

    To determine which CT findings are useful for the early disgnosis of esophageal perforation, and on the basis of these findings, to assess the accuracy of prediction of the perforation site. A review of medical records indicated that between January 1995 and December 2001, 36 patients with esophageal perforation were admitted to our hospital. Thirteen of these [M:F=8:5, age; 28-69 (mean, 52.4) years], who had undergone CT chest scanning, were included in this study. The causes of esophageal perforation were trauma (n=5), infectious diseases (n=4), Boerhaave syndrome (n=1), lung cancer (n=1), esophageal cancer (n=1), and idiopathic. Two chest radiologists unaware of the clinical findings reviewed the CT scans and predicted whether the upper or lower esophagus was perforated. The most common CT finding was extraluminal air at the posterior mediastinum (n=11), while other findings included pulmonary consolidation (n=10), pleural effusion (n=7), discontinuity of the esophageal wall (n=6) and subcutaneous emphysema (n=4), fluid collection around the esophagus (n-4), esophageal wall thickening (n=4), pneumothorax (n=2), and lung abscess (n=2). The perforation site was accurately predicted in 76.9% of cases (10/13). The CT findings which help the diagnosis of esophageal perforation, and prediction of the sites at which it occurs, are extraluminal air of fluid collection, focal defect of the esophageal wall, and esophageal wall thickening.

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

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

    2016-07-01

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

  9. Treatment of oesophageal perforation by intubation.

    Quayle, A R; Moore, P. J.; Jacob, G.; Griffith, C D; Rogers, K

    1985-01-01

    The mortality following oesophageal perforation ranges from 25% to 100% depending on the delay in diagnosis and treatment. Although the treatment recommended for thoracic perforations is emergency thoracotomy and suture of the perforation, the avoidance of this approach in elderly patients is desirable. We therefore describe 6 cases of oesophageal perforation which were treated by insertion of a Celestin tube at laparotomy.

  10. Perforated midgut diverticulitis: Revisited

    Milan Spasojevic

    2012-01-01

    Full Text Available AIM: To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis. METHODS: Three data sources were used: the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel’s diverticulitis excluded that were published after 1995. The inclusion criterion was sufficient individual patient data in the article. Both indexed and non-indexed journals were used. Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group. Data on symptoms, laboratory and radiology results, treatment modalities, surgical access, procedures, complications and outcomes were collected. The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007. The data collected were age, sex, mode of access, surgical procedure performed and number of patients per year. Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data. Statistical analysis was done with SPSS software. RESULTS: Group I: 106 patients (48 men were found. Mean age was 72.2 ± 13.1 years (mean ± SD. Age or sex had no impact on outcomes (P = 0.057 and P = 0.771, respectively. Preoperative assessment was plain radiography in 53.3% or computed tomography (CT in 76.1%. Correct diagnosis was made in 77.1% with CT, 5.6% without (P = 0.001. Duration of symptoms before hospitalization was 3.6 d (range: 1-35 d, but longer duration was not associated with poor outcome (P = 0.748. Eighty-six point eight percent of patients underwent surgery, 92.4% of these through open access where 90.1% had bowel resection. Complications occurred in 19.2% of patients and 16.3% underwent reoperation. Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm. At surgery, no peritonitis was found in 29.7% of patients, local

  11. Spontaneous Intestinal Perforation in Neonates

    Charu Tiwari

    2015-03-01

    Full Text Available Background: The term Spontaneous Intestinal Perforation (SIP suggests a perforation in the gastrointestinal tract of a newborn with no demonstrable cause.Methods: Four neonates presenting with spontaneous bowel perforation were analyzed with respect to clinical presentation, management and outcome.Results: The mean age at presentation was 11.4 days. There were three males and one female. One of the neonates was preterm, very low birth weight and the other three were full term. Two neonates underwent emergency exploratory laparotomy and two were initially managed by peritoneal drainage in view of poor general condition; one of them improved and did not require further operative intervention. The preterm very low birth weight neonate was stabilized and explored after 48 hours. Intra-operatively, two of them had two ileal perforations each which required ileostomy; one had single perforation in the transverse colon which was primarily repaired. All four had an uneventful recovery.Conclusion: SIP is a distinct clinical entity and has better outcome than neonates with intestinal perforation secondary to Necrotizing Enterocolitis (NEC.

  12. Medical image of the week: tracheal perforation

    Parsa N

    2014-12-01

    Full Text Available A 45 year old Caucasian man with a history of HIV/AIDS was admitted for septic shock secondary to right lower lobe community acquired pneumonia. The patient’s respiratory status continued to decline requiring emergency intubation in a non-ICU setting. Four laryngoscope intubation attempts were made including an inadvertent esophageal intubation. Subsequent CT imaging revealed a tracheal defect (Figure 1, red arrow with communication to the mediastinum and air around the trachea consistent with pneumomediastinum (Figure 2, orange arrow and figure 3, yellow arrow. Pneumopericardium (figure 4, blue arrow was also evident post-intubation. The patient’s hemodynamic status remained stable. Two days following respiratory intubation subsequent chest imaging revealed resolution of the pneumomediastinum and pneumopericardium and patient continued to do well without hemodynamic compromise or presence of subcutaneous emphysema. Post-intubation tracheal perforation is a rare complication of traumatic intubation and may be managed with surgical intervention or conservative treatment (1.

  13. Acquired Techniques

    Lunde Nielsen, Espen; Halse, Karianne

    2013-01-01

    Acquired Techniques - a Leap into the Archive, at Aarhus School of Architecture. In collaboration with Karianne Halse, James Martin and Mika K. Friis. Following the footsteps of past travelers this is a journey into tools and techniques of the architectural process. The workshop will focus upon...

  14. Acquired blepharoptosis

    Oosterhuis, HJGH

    1996-01-01

    A review is given of the aetiology and possible treatment of acquired (non-congenital) blepharoptosis, which is a common but not specific sign of neurological disease: The diagnostic categories of upper eyelid drooping are scheduled as (a) pseudo-ptosis due to a local process or overactivity of eye

  15. CLINICAL STUDY OF DUODENAL PERFORATION

    Sambasiva Rao

    2016-04-01

    Full Text Available BACKGROUND The duodenal injury can pose a formidable challenge to the surgeon and failure to manage it properly may have devastating results. Over the centuries, there was little to offer the patient of acute abdomen beyond cupping, purgation and enemas, all of which did more harm than good. It was not until 1884 that Mikulicz made an attempt to repair a perforation. Recent statistics indicate roughly 10% of population develop gastric or duodenal ulcer in life time. Roughly 1-3% of population above the age of 20 years have some degree of peptic ulcer activity during any annual period. A detailed history with regards to the signs and symptoms of the patient, a meticulous examination, radiological and biochemical investigations help to arrive at a correct preoperative diagnosis. In this study, a sincere effort has been put to understand the demographic patterns, to understand the underlying aetiology and to understand the effectiveness of the standard methods of investigation and treatment in use today. METHODS This is a 24 months prospective study i.e., from September 2011 to September 2013 carried out at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation. The study included the patients presenting to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation to emergency ward with signs and symptoms of hollow viscus perforation. The sample size included 30 cases of duodenal perforation. RESULTS Duodenal ulcer perforation commonly occurs in the age group of 30-60 years, but it can occur in any age group. Majority of the patients were male. Smoking and alcohol consumption were risk factors in most cases (53.3% for the causation of duodenal ulcer perforation. Sudden onset of abdominal pain, situated at epigastrium and right hypochondrium was a constant symptom (100%. Vomiting, constipation and fever were not so common. CONCLUSION The emergency surgical management for perforated duodenal ulcer is by

  16. Posterior repair with perforated porcine dermal graft

    G. Bernard Taylor

    2008-02-01

    Full Text Available OBJECTIVE: 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. MATERIALS AND METHODS: 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 (PelvicolTM 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. RESULTS: 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. CONCLUSION: Perforated porcine dermal grafts retain their tensile properties and are associated with fewer vaginal incision dehiscences.

  17. The reactive oxygen species network pathways: an essential prerequisite for perception of pathogen attack and the acquired disease resistance in plants

    Simeon O Kotchoni; Emma W Gachomo

    2006-09-01

    Availability of complete Arabidopsis (Arabidopsis thaliana) and rice (Oryza sativa) genome sequences, together with molecular recourses of functional genomics and proteomics have revolutionized our understanding of reactive oxygen species (ROS) signalling network mediating disease resistance in plants. So far, ROS have been associated with aging, cellular and molecular alteration in animal and plant cells. Recently, concluding evidences suggest that ROS network is essential to induce disease resistance and even to mediate resistance to multiple stresses in plants. ROS are obligatory by-products emerging as a result of normal metabolic reactions. They have the potential to be both beneficial and harmful to cellular metabolism. Their dual effects on metabolic reactions are dosage specific. In this review we focus our attention on cellular ROS level to trigger beneficial effects on plant cells responding to pathogen attack. By exploring the research related contributions coupled with data of targeted gene disruption, and RNA interference approaches, we show here that ROS are ubiquitous molecules of redox-pathways that play a crucial role in plant defence mechanism. The molecular prerequisites of ROS network to activate plant defence system in response to pathogen infections are here underlined. Bioinformatic tools are now available to scientists for high throughput analysis of cellular metabolisms. These tools are used to illustrate crucial ROS-related genes that are involved in the defence mechanism of plants. The review describes also the emerging findings of ROS network pathways to modulate multiple stress resistance in plants.

  18. Perforator Flaps for Perineal Reconstructions

    Niranjan, Niri S.

    2006-01-01

    Whenever there is soft tissue loss from the perineum there are many options for reconstruction. These include allowing the wound to heal by secondary intention and the use of local random or axial pattern flaps, regional flaps, or free flaps. The axial skin flap can be defined as a flap based on known constant vessels of the subcutaneous tissue and its vena comitantes. The perforator flap on the other hand is a randomly selected perforator consisting of an artery with vena comitantes, which p...

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

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

    2013-12-01

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

  20. Perforation of aluminium alloy thin plates

    ANTOINAT, Léonard; Kubler, Régis; BAROU, Jean Luc; VIOT, Philippe; BARRALLIER, Laurent

    2015-01-01

    Low velocity perforation of aeronautical aluminium alloy sheets 2024 T3 is studied in this paper. After a literature review on recent experiments and models of plate’s perforation, experimental results for 2 thicknesses (2 mm and 4 mm) of plates are presented. Perforation tests are performed with an instrumented drop test. The striker has a large diameter and a conical shape nose. Two models for perforation are presented and calibrated to bring a better understanding of the experiments. The f...

  1. Early Management Experience of Perforation after ERCP

    Guohua Li

    2012-01-01

    Full Text Available Background and Aim. Perforation after endoscopic retrograde cholangiopancreatography (ERCP is a rare complication, but it is associated with significant mortality. This study evaluated the early management experience of these perforations. Patients and Methods. Between November 2003 and December 2011, a total of 8504 ERCPs were performed at our regional endoscopy center. Sixteen perforations (0.45% were identified and retrospectively reviewed. Results. Nine of these 16 patients with perforations were periampullary, 3 duodenal, 1 gastric fundus, and 3 patients had a perforation of an afferent limb of a Billroth II anastomosis. All patients with perforations were recognized during ERCP by X-ray and managed immediately. One patient with duodenal perforation and three patients with afferent limb perforation received surgery, others received medical conservative treatment which included suturing lesion, endoscopic nasobiliary drainage (ENBD, endoscopic retrograde pancreatic duct drainage (ERPD, gastrointestinal decompression, fasting, broad-spectrum antibiotics, and so on. All patients with perforation recovered successfully. Conclusions. We found that: (1 the diagnosis of perforation during ERCP may be easy, but you must pay attention to it. (2 Most retroperitoneal perforations can recover with only medical conservative treatment in early phase. (3 Most peritoneal perforations need surgery unless you can close the lesion up under endoscopy in early phase.

  2. Perforated Peptic Ulcer: new insights

    M.J.O.E. Bertleff (Marietta)

    2011-01-01

    textabstractMuch has been written on perforated peptic ulcer (PPU) during the last hundred years. In 1500, when necropsies were first allowed, often a small hole was found in the anterior wall of the stomach, giving an explanation for symptoms of acute abdominal pain, nausea, vomiting which often le

  3. The effects of perforation sizes on laminar heat transfer characteristics of an array of perforated fins

    Highlights: ► Thermal effects of perforation sizes and numbers are studied in perforated fins. ► Flow is laminar and perforations are along the length of fins. ► Porosity is defined as volume of perforations divided by volume of a solid fin. ► At a constant porosity, fins with fewer perforations have higher heat transfer rates. ► At a constant porosity, perforated fins do not affect total drag. - Abstract: Shaeri and Yaghoubi [25] reported the highest heat transfer rate in a laminar flow for a perforated fin with the most perforations (porosity), regardless of investigation on the effects of perforation sizes. In this study, the effects of size and number of perforations on laminar heat transfer characteristics of an array of perforated fins at the highest porosity of the study of Shaeri and Yaghoubi [25] have been numerically investigated. The Navier–Stokes and energy equations are solved by the finite volume procedure using the SIMPLE algorithm. Results show that at a specific porosity, the thermal entrance length of each perforation of a fin with a lower number of perforations is larger than that of each perforation of a fin with a higher number of perforations. Therefore, in a laminar flow and at a constant porosity, a fin with fewer perforations is more efficient to enhance the heat transfer rate compared with a fin with more perforations. Although perforated fins have higher friction drag and lower pressure drag with respect to solid fins, perforated fins do not affect total drag.

  4. Maxillary sinus perforation by orthodontic anchor screws.

    Motoyoshi, Mitsuru; Sanuki-Suzuki, Rina; Uchida, Yasuki; Saiki, Akari; Shimizu, Noriyoshi

    2015-06-01

    To facilitate safe placement of orthodontic anchor screws (miniscrews), we investigated the frequency of maxillary sinus perforation after screw placement and the effect of sinus perforation on screw stability. Maxillary sinus perforations involving 82 miniscrews (diameter, 1.6 mm; length, 8 mm) were evaluated using cone-beam computed tomography. All miniscrews were placed in maxillary alveolar bone between the second premolar and first molar for anchorage for anterior retraction in patients undergoing first premolar extraction. The placement torque and screw mobility of each implant were determined using a torque tester and a Periotest device, and variability in these values in relation to sinus perforation was evaluated. Eight of the 82 miniscrews perforated the maxillary sinus. There was no case of sinusitis in patients with miniscrew perforation and no significant difference in screw mobility or placement torque between perforating and non-perforating miniscrews. The sinus floor was significantly thinner in perforated cases than in non-perforated cases. A sinus floor thickness of 6.0 mm or more is recommended in order to avoid miniscrew perforation of the maxillary sinus. PMID:26062857

  5. A CLINICAL STUDY ON ILEAL PERFORATION

    Kishore Babu

    2016-03-01

    Full Text Available INTRODUCTION Ileal perforation is a common problem seen in tropical countries, the commonest cause being typhoid fever. In western countries the causes are malignancy, trauma and mechanical aetiology, in the order of frequency.1,2,3 Over the years a definite changing trend has been observed in ileal perforations both in terms of causes, treatment and prognosis. Better antibiotics, aggressive surgery and the elimination of conservative treatment, better preoperative and postoperative care have all significantly contributed to the improvement in patient outcome.4,5 But still cases of ileal perforation cause a significant morbidity and mortality that persists despite the significant changes in health care over the years. AIMS AND OBJECTIVES To study the aetiology, presentation, management outcome and the factors influencing prognosis and outcome in ileal perforations. MATERIAL & METHODS Study Setting S. V. Medical College, Department of General Surgery, Tirupati. Study Period Patients attending S. V. Medical College, Department of General Surgery with perforation during the period from November 2012 to October 2015. Inclusion Criteria Patients between age group of more than 14 years presenting with pain abdomen and who are diagnosed to have ileal perforation in the intra operative period are selected. Exclusion Criteria Patients with peritonitis due to other causes like gastric, duodenum or large bowel perforation are excluded. Study Method The present study is a prospective study done on 28 patients of ileal perforation due to typhoid complication, nonspecific and traumatic perforations. History, clinical examination, investigations, operative findings, post-operative complications were recorded. In patients with non-traumatic perforations Widal test was done. CONCLUSION Typhoid fever and traumatic aetiology are the most common cause of Ileal perforation, followed by TB. Patients are more of male gender and are in reproductive age group. Widal

  6. The Evolution of Perforator Flaps

    Khan, Farah N.; Spiegel, Aldona J.

    2006-01-01

    Perforator flaps have recently become ubiquitous in the field of plastic surgery. To understand and appreciate their unique nature, it is necessary to compare and contrast them with the development of other types of flaps. A complete yet abridged version of the history of flap surgery is presented in this article. Beginning with Sushruta's Indian cheek flap method for nasal reconstruction, a trip through time and space is taken to highlight the milestones leading to the evolution of the perfo...

  7. Colonic perforation in Behcet's syndrome

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

    2008-01-01

    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.

  8. Combining rhinoplasty with septal perforation repair.

    Foda, Hossam M T; Magdy, Emad A

    2006-11-01

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

  9. CT in acute perforated sigmoid diverticulitis

    Lohrmann, Christian [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany)]. E-mail: lohrmann@mrs1.ukl.uni-freiburg.de; Ghanem, Nadir [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Pache, Gregor [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Makowiec, Frank [Department of Surgery, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Kotter, Elmar [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Langer, Mathias [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany)

    2005-10-01

    Background: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. Methods: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification. Results: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. Conclusions: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning.

  10. CT in acute perforated sigmoid diverticulitis

    Background: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. Methods: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification. Results: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. Conclusions: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning

  11. Free thin paraumbilical perforator-based flaps.

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

    1992-07-01

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

  12. Comparison of the Multidetector-row Computed Tomographic Angiography Axial and Coronal Planes' Usefulness for Detecting Thoracodorsal Artery Perforators

    Jong Gyu Kim

    2012-07-01

    Full Text Available Background During the planning of a thoracodorsal artery perforator (TDAP free flap,preoperative multidetector-row computed tomographic (MDCT angiography is valuablefor predicting the locations of perforators. However, CT-based perforator mapping of thethoracodorsal artery is not easy because of its small diameter. Thus, we evaluated 1-mm-thickMDCT images in multiple planes to search for reliable perforators accurately.Methods Between July 2010 and October 2011, 19 consecutive patients (13 males, 6females who underwent MDCT prior to TDAP free flap operations were enrolled in this study.Patients ranged in age from 10 to 75 years (mean, 39.3 years. MDCT images were acquired ata thickness of 1 mm in the axial, coronal, and sagittal planes.Results The thoracodorsal artery perforators were detected in all 19 cases. The reliableperforators originating from the descending branch were found in 14 cases, of which 6 hadtransverse branches. The former were well identified in the coronal view, and the latter in theaxial view. The location of the most reliable perforators on MDCT images corresponded wellwith the surgical findings.Conclusions Though MDCT has been widely used in performing the abdominal perforatorfree flap for detecting reliable perforating vessels, it is not popular in the TDAP free flap.The results of this study suggest that multiple planes of MDCT may increase the probabilityof detecting the most reliable perforators, along with decreasing the probability of missingavailable vessels.

  13. A CALCULUS CHOLECYSTITIS PERFORATING AT THE NECK

    Jayashri

    2014-08-01

    Full Text Available Gallbladder perforation is a rare complication of cholecystitis and cholelithiasis. The high morbidity and mortality rates associated with this condition are due to delays in diagnosis and treatment since signs and symptoms of perforation do not differ significantly from those of uncomplicated cholecystitis. We report a case of 17 year old boy who presented with perforation at the neck of gall bladder with extrusion of a stone. It was associated with bile infected with S. typhi.

  14. LAPAROSCOPIC REPAIR OF PERFORATED PEPTIC ULCER

    S. Lunca; N.S. Romedea; C. Moroşanu

    2007-01-01

    Since 1990 when Mouret reported the first laparoscopic sutureless repair for a perforated duodenal ulcer and Nathanson the first successful laparoscopic suture repair for perforated peptic ulcer, laparoscopic approach became a widespread procedure. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late eventration. Laparoscopic approach is indicated in any case of suspected ga...

  15. Spontaneous ileal perforation complicating low anorectal malformation

    TiJesuni Olatunji

    2015-01-01

    Full Text Available Anorectal malformation is a common anomaly in neonates. Although colorectal perforations have been reported as a complication, ileal perforation is rarely encountered. This is a report of a 2-day-old boy presenting with a low anorectal malformation, complicated with ileal perforation, necessitating laparotomy and ileal repair. Anoplasty was done for the low anomaly. Early presentation and prompt treatment of anorectal malformations is important to prevent such potential life threatening complication.

  16. Perforation Peritonitis: A Two Year Experience

    Shyam Kumar Gupta, Rajan Gupta, Gurdev Singh, Sunil Gupta

    2010-07-01

    Full Text Available Four hundred patients who presented in the emergency of GMC Jammu as a case of perforation peritonitisover a period of two years were studied. In most of the cases diagnosis was made by clinical examinationsupplemented by investigations in the form of standing X-ray chest PA view with domes of diaphragm,Ultrasound abdomen and abdominal paracentesis. Contrast enhanced CT scans of abdomen wereconducted on patients where the diagnosis of perforation peritonitis was doubtful. After resuscitation,Laparotomy was done in all the patients and thorough peritoneal lavage was done. A note of the site,size, type, number of perforations was made and biopsy was taken from the edge of the perforationwhenever indicated. The most common cause of gastrointestinal perforation in our study was duodenalulcer perforation, followed by appendicitis, typhoid perforation, blunt/penetrating trauma, gastric perforation,obstruction, iatrogenic, malignancy, and recurrent perforation. Primary closure of the perforation wasmost commonly done procedure, followed by appendectomy, resection anastomosis of the gut andexteriorization of the gut. The overall mortality was 6 % and morbidity in the form of wound infection,fever, respiratory complications, residual abscess, dyselectrolytemia, burst abdomen, jaundice, sepsis,cardiac complications, anastomotic disruption was present

  17. Reactive Orthotropic Lattice Diffuser for Noise Reduction

    Khorrami, Mehdi R. (Inventor)

    2016-01-01

    An orthotropic lattice structure interconnects porous surfaces of the flap with internal lattice-structured perforations to equalize the steady pressure field on the flap surfaces adjacent to the end and to reduce the amplitude of the fluctuations in the flow field near the flap end. The global communication that exists within all of the perforations provides the mechanism to lessen the pressure gradients experienced by the end portion of the flap. In addition to having diffusive effects (diffusing the incoming flow), the three-dimensional orthogonal lattice structure is also reactive (acoustic wave phase distortion) due to the interconnection of the perforations.

  18. [Surgical treatment of duodenal perforation].

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

    2000-04-01

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

  19. Hyperbilirubinemia as a predictor for appendiceal perforation

    Burcharth, J; Pommergaard, H C; Rosenberg, J; Gögenur, I

    2013-01-01

    Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum...

  20. Barrett's ulcer: cause of spontaneous oesophageal perforation.

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

    1989-01-01

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

  1. Bowel perforation detection using metabolic fluorescent chlorophylls

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

    2016-03-01

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

  2. High power laser perforating tools and systems

    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.

  3. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Full Text Available ... surgery each of them chose to undergo. The deep inferior epigastric perforator flap technique allows surgeons to rebuild breasts in the ... areolar-sparing mastectomy and immediate reconstruction using the deep inferior epigastric perforator flap, or the DIEP flap. I'm pleased to ...

  4. Analysis of bowel perforation in necrotizing enterocolitis

    Frey, E.E.; Smith, W.; Franken, E.A. Jr.; Wintermeyer, K.A.

    1987-07-01

    The most severe complication of necrotizing enterocolitis (NEC) is bowel perforation. Identification of neonates at high risk for perforation and optimization of radiologic imaging to identify bowel perforation are necessary to reduce the high mortality rate associated with this catastrophic event. One hundred 55 cases of NEC were seen at our institution during a 5.5 year period. Nineteen (12%) progressed to perforation. A review of surgical findings, autopsy results and radiographs from these patients shows only 63% had radiographic evidence of free air in the peritoneal cavity at the time of perforation. Twenty-one percent had radiographic evidence of ascites but no pneumoperitoneum, and 16 percent had neither free air nor ascites. Thus purely radiographic criteria for bowel perforation in NEC are imprecise, and paracentesis is mandatory in NEC patients with ascites or clinical findings indicative of peritonitis. Timing of radiographic studies and site of bowel involvement are also important. Seventy-nine percent of perforations occurred by 30 h from confirmation of diagnosis (by clinical or radiographic criteria). Surgery or autopsy revealed involvement of the ileo-cecal region in 89% of cases with the actual site of perforation occurring in this area in 58% of patients.

  5. LAPAROSCOPIC REPAIR OF PERFORATED PEPTIC ULCER

    S. Lunca

    2007-04-01

    Full Text Available Since 1990 when Mouret reported the first laparoscopic sutureless repair for a perforated duodenal ulcer and Nathanson the first successful laparoscopic suture repair for perforated peptic ulcer, laparoscopic approach became a widespread procedure. Treatment for perforated ulcer can be performed laparoscopically in 85% of cases, making it possible to avoid a median laparotomy which can lead to wound infection and late eventration. Laparoscopic approach is indicated in any case of suspected gastroduodenal perforation and seems to offer the same advantages as for the vast majority of laparoscopic procedures. Nowadays laparoscopic repair of duodenal perforation seems to be a useful method for reducing hospital stay, complications and return to normal activity if carried on in proper manner. With better training in minimal access surgery and better ergonomics now available the time has arrived for it to take its place in the surgeon’s repertoire.

  6. SPONTANEOUS ESOPHAGEAL PERFORATION: WHEN NOT TO OPERATE

    Shenthil Prabhu

    2015-10-01

    Full Text Available Spontaneous Oesophageal perforation is lethal unless managed appropriately. Oesophageal perforation can be spontaneous (Boerhaeve, post traumatic, malignant or foreign body induced. Appropriate treatment depends on the size of perforation, time of presentation between rupture and diagnosis and general condition of the patient. Not all patients need surgical management and when carefully selected there are subset of patients who can be managed medically. CASE REPORT: A case of spontaneous oesophageal perforation due to intense retching following alcohol intake in a 35year old male is described here with a review of pertinent literature. The patient had presented with intense retching followed by vomiting which contained undigested food particles initially only to be followed by hematemesis, chest pain, fever with left sided pleural effusion. Computed tomographic scan demonstrated a pneumomediastinum, and left sided pleural effusion. The patient was managed successfully by conservative treatment. CONCLUSION:Spontaneous oesophageal perforation can be managed conservatively in a selected set of patients .

  7. CHEMICAL CAUTERISATION OF TYMPANIC MEMBRANE PERFORATIONS

    Vikramjit Singh

    2015-04-01

    Full Text Available Cauterisation of 144 ear perforations ( R ight and L eft with 20 percent TCA ( T richloracetic acid was tried in patients having 2 to 6mm perforations . Per forations were dry for 3 weeks - 3 months or more. 30 patients were having traumatic perforations such as slap on face, blast injuries or associated with head injuries. Most of the patients were having perforations due to inflammation. Few of them had recent attack of otitis media which were effectively treated by suitable antibiotics, anti - histamines and subs equently taken for cauterization of perforation. Site of perforation was mostly on the anteroinferior quadrant, next the inferior quadrants. Still less number in the entire four quadrant, least no. in P. S. quadrant. Traumatic perforations were irr egular i n shape varying from 2 - 6 mm in size and were elliptical in shape. Hearing loss ranged from 15dB - 45dB ( D epending upon size and site of perforation. Main presenting symptoms in inflammation cases were intermittent discharge as well as deafness. In traumatic case history of pain and deafness was the main symptom. We did wait for 1 month in traumatic cases to achieve spontaneous closure. In inflammatory cases cautery was considered first line of treatment. It has to be done several times at 10 days interval. Mo st of the times closure of perforation was achieved with 3 attempts, inflammatory cases 5 th or 6 th attempt. In one case as many as 23 attempts. In 6 cases of perforation after partial take of graft in myringoplasty occurred after 3 months cauterization was attempted and we got closure in 5 of them. In one case re myringoplasty had to be done.

  8. Optimization of geometrical characteristics of perforated plates

    Highlights: ► Perforated plate are tested against 12.7 mm API projectile. ► Perforations similar to the projectile diameter offer more efficient core fracture. ► Larger perforations gave a more efficient core fragmentation. ► SEM microscopy analysis has shown a ductile fracture mode at impact point. - Abstract: In this paper, an attempt was made to design effective non-homogenous armor in form of perforated plate mounted at close distance from basic armor plate. Perforated plate with three perforation diameters: 9, 10 and 11 mm, two ligaments length: 3.5 and 4.5 mm ligaments, set at 0° and 28° angles, were combined to 13 mm basic plate and tested against 12.7 mm API ammunition. It has been shown that larger perforations gave a more efficient core fragmentation, while angled specimens were the only ones that offer full protection against five API shots when the perforated plate was placed at 100 mm from the basic plate. Perforations that are similar in size to the penetrating core diameter offer a more efficient core fracture, leading to a faster fragment separation. This may enable a smaller distance between the add-on perforated and basic plate to be used. Scanning electron microscopy analysis has shown a ductile fracture mode at impact point, with hardness values on plate basic level. On the other hand, a brittle fracture mode with a rise in local hardness measured near impact point is a result of intensive high speed plastic deformation produced by bending stresses. A drop in local hardness measured near impact point, may be the result of intensive cracking that occur due to repeated projectile impact

  9. The freestyle pedicle perforator flap

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S; Thomsen, Jorn Bo

    2015-01-01

    not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle...... aspects in the context of current literature. RESULTS: The reconstructive goals were achieved in all cases without any total flap loss or major complications. Minor complications occurred in 7/34 (21 %) cases consisting of venous congestion leading to distal tip necrosis or epidermolysis; partial flap...... loss was significant in 4 cases, however never more than 10 % of the total flap size. Reconstruction was performed on the lower limb in 13 cases, upper limb in 12, and 9 cases were on the truncus. The angle of rotation was 90° in 21 cases and 180° in 13 cases. The most common indication was...

  10. Daqing Perforation Charges Enjoy Good Market Reputation

    2003-01-01

    @@ Founded in 1965, Daqing Perforation Charge Plant is the earliest oil perforation charge factory in China. The products,which are branded as "Qingmao" and enjoy good market reputation, are now sold to more than 20 domestic oil fields and 11 countries in the world. To meet the different demands by customers, the plant has developed some new products for market expansion with the penetration capability boosted 1130mm from 700mm five years ago. The large-calibration perforation charge filled a blank in the country.

  11. Septum nasal perforation: treatments and literature' review

    Martinez Neto, Eulógio Emílio

    2010-03-01

    Full Text Available Introduction: The present study consists in a bibliographical' review concerning the articles related to the different manifestations and forms of the septum nasal perforation, with a main emphasis in the description of its techniques of surgical correction. As the etiology, that is fundamentally iatrogenic, accordingly surgical trauma. Other causes include exhibition to chemical industrial reagents, cocaine use, intranasal steroidal therapeutic, neoplasia and, infectious conditions. There is a few data concerning the prevalence of septum perforation in the general population. The decision making about surgical correction or medical treatment depend on the anatomic characteristics and of the pathogenesis of the septal perforation.

  12. Inferior Gluteal Perforator Flaps for Breast Reconstruction

    Allen, Robert J.; LoTempio, Maria M.; Granzow, Jay W.

    2006-01-01

    Perforator flaps represent the latest in the evolution of soft tissue flaps. They allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor-site morbidity. The powerful perforator flap concept allows transfer of tissue from numerous, well-described donor sites to almost any distant site with suitable recipient vessels. The inferior gluteal artery perforator (I-GAP) flap is one option that allows a large volume of tissue to be used for breast reconstruction w...

  13. Traumatic prenatal sigmoid perforation due to amniocentesis

    Fines, B.; Ben-Ami, T.E.; Yousefzadeh, D.K. [Dept. of Radiology, Univ. of Chicago, IL (United States)

    2001-06-01

    A variety of fetal injuries, including those inflicted to the gastrointestinal tract by amniocentesis, have been reported before. This brief report describes the first documented case of sigmoid perforation owing to the common procedure of amniocentesis that manifested as abdominal distention at birth. A potential link between this complication and a recent increased incidence of ''intrauterine spontaneous perforation'' of the gastrointestinal tract has been mentioned. Practicing radiologists are encouraged to inquire directly about the history of amniocentesis in unexplained cases of intrauterine intestinal perforation. (orig.)

  14. Perforation of the gallbladder diagnosed preoperatively

    Wilson, D.G.; Lieberman, L.M.

    1983-04-01

    A 69-year-old white male was admitted to the hospital for right upper quadrant pain, fever, and vomiting. Acute cholecystitis was not thought to be present because of a negative ultrasonogram and oral cholecystogram. A sup(99m)Tc-PIPIDA hepatobiliary study showed definite evidence of gallbladder perforation, with pockets of radiolabeled bile in the abdomen. Immediate surgery confirmed the scan diagnosis. In patients who are at high risk for gallbladder perforation the technetium-99m-labeled iminodiacetic acid hepatobiliary scan should be considered as a first procedure to rule out acute cholecystitis and possible gallbladder perforation.

  15. Perforation of the Gallbladder diagnosed preoperatively

    A 69-year-old white male was admitted to the hospital for right upper quadrant pain, fever, and vomiting. Acute cholecystitis was not thought to be present because of a negative ultrasonogram and oral cholecystogram. A sup(99m)Tc-PIPIDA hepatobiliary study showed definite evidence of gallbladder perforation, with pockets of radiolabeled bile in the abdomen. Immediate surgery confirmed the scan diagnosis. In patients who are at high risk for gallbladder perforation the technetium-99m-labeled iminodiacetic acid hepatobiliary scan should be considered as a first procedure to rule out acute cholecystitis and possible gallbladder perforation. (orig.)

  16. Retrocardiac pneumomediastinum in association with tracheal and esophageal perforations

    Retrocardiac pneumomediastinum was encountered in two premature infants; one had a tracheal perforation and one an esophageal perforation. Contrast studies showed communication between the sites of perforation and the retrocardiac air. Clinical signs suggestive of such perforation include abnormal course of tubes on plain chest films and bloody aspirates. (orig.)

  17. Effect of Perforation Area and Arrangement Pattern on Structural Behaviour of Nature Inspired Perforated Hollow Structure

    Woo Yian Peen

    2013-01-01

    Full Text Available The Cholla cactus skeleton has been the inspiration source for this study, in our effort to search forlight and more structural effective structures. This woody skeleton of Cholla with oval shaped perforationsarranged in spiral pattern is found strong enough to support the cactus self weight. This research has beencarried out to investigate the effects of percentage of perforations and perforations arrangements on structuralbehaviour of cylindrical hollow section. A total of eleven models consisting of one cylindrical hollow sectionwithout perforation as the control model and ten simplified perforated cylindrical hollow sections have beenconstructed using a finite element method software. The perforated models have been assigned with 10 to 50percent of perforations area by fixing the number of perforations to twenty and altering the perforation size toachieve the percentage variable. Computational analyses have been carried out for three loading conditions:compressive, flexural and torsional. Findings have shown that the increment in percentage of perforationsproduces higher stresses to the cylindrical hollow section. This has effects on the structural capacity of thecylindrical hollow section. Array arrangement of the perforations shows better structural performance incompression and flexural loading conditions while spiral arrangement exhibits better structural performanceunder torsional loading condition.

  18. Stercoral perforation in a 17-year old.

    McHugh, S

    2012-02-01

    INTRODUCTION: Stercoral perforation is a rare cause of perforation. This is the first reported case where a partial eating disorder (ED) is the primary causative differential. CASE PRESENTATION: We present the case of a 17-year-old girl who presented to her local Emergency Department with a 24-h history of left-sided abdominal pain. She subsequently deteriorated and a computed tomography scan of her abdomen showed gross distension of the large bowel with a sigmoid perforation. She underwent total colectomy with end ileostomy. Histology reported stercoral perforation but normal bowel ganglia. While an inpatient she was reviewed by the Psychiatric team who were concerned she was suffering from a partial ED. CONCLUSION: This case highlights the importance of a multidisciplinary approach in optimally treating patients such as these. Aggressive medical management with involvement of a psychiatric team and dietetics addresses any underlying causative psychiatric issues and helps prevent recurrence.

  19. Stercoral perforation in a 17-year old.

    McHugh, S

    2009-04-02

    INTRODUCTION: Stercoral perforation is a rare cause of perforation. This is the first reported case where a partial eating disorder (ED) is the primary causative differential. CASE PRESENTATION: We present the case of a 17-year-old girl who presented to her local Emergency Department with a 24-h history of left-sided abdominal pain. She subsequently deteriorated and a computed tomography scan of her abdomen showed gross distension of the large bowel with a sigmoid perforation. She underwent total colectomy with end ileostomy. Histology reported stercoral perforation but normal bowel ganglia. While an inpatient she was reviewed by the Psychiatric team who were concerned she was suffering from a partial ED. CONCLUSION: This case highlights the importance of a multidisciplinary approach in optimally treating patients such as these. Aggressive medical management with involvement of a psychiatric team and dietetics addresses any underlying causative psychiatric issues and helps prevent recurrence.

  20. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Full Text Available ... usually in that setting, we'll proceed as planned with the deep inferior epigastric perforator technique. 00: ... revision of the reconstruction. So it's almost a planned two-stage process. We like to do as ...

  1. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Full Text Available ... think it's important for us to acknowledge the impact of a breast cancer diagnosis on patients. We' ... So even if you use several perforators, the impact on the abdominal wall musculature is still minimal. ...

  2. Laparoscopic Repair for Perforated Duodenal Ulcer

    A. Cotirleţ

    2015-01-01

    Full Text Available Perforated peptic ulcer (PPU, despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

  3. Current management of peptic ulcer perforations

    Perforation is a life-threatening complication of peptic ulcer disease. Smoking and use of non-steroidal anti-inflammatory drugs are important risk factors for perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum on radiographs. Nonoperative management is successful in patients identified to have a spontaneously sealed perforation proven by water-soluble contrast gastroduodenogram. Operative management consists of the time-honoured practice of mental patch closure, but now this can be done by laparoscopic methods. The practice of addition of acid-reducing procedures is currently being debated though it continues to be recommended in good-risk patients. Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patients with < 10 mm perforation size presenting within the first 24 hours of onset of pain. The role of Helicobacter pylori in duodenal ulcer perforation is controversial and more studies are needed to answer this question though recent indirect evidence suggests that eradicating H pylori may reduce the necessity for adding acid reducing procedures and the associated morbidity. Perforation is a life-threatening complication of peptic ulcer disease. The management of peptic ulcer disease has evolved over the decades, due to advances in operative techniques, bacteriology and pharmacology. While the recognition of the role of Helicobacter pylori (H. pylori) in peptic ulceration has resulted in a paradigm shift in the management of uncomplicated peptic ulcers, debate continues about the appropriate management of perforated duodenal bulb and prepyloric ulcers. A new dimension has been added to this controversy by the advent of laparoscopic techniques for closing the perforation. A Medline search of all articles dealing with the management of peptic ulcer perforation published after 1985 was undertaken. The short listed articles were

  4. Perforated fairings for landing gear noise control

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

    2008-01-01

    Landing gears of commercial aircraft make an important contribution to total aircraft noise in the approach configuration. Using fairings to shield components from high speed impingement reduces noise. Furthermore, perforating these fairings has been confirmed by flight tests to further enable noise reduction. Following a more fundamental study on the application of perforated fairings, a study has been performed to investigate and optimize the benefits of bleeding air through landing gear fa...

  5. Traumatic oesophageal perforation due to haematoma

    Grønhøj Larsen, Christian; Brandt, Bodil

    2014-01-01

    thoracic trauma leading to perforation on the 18th day. DISCUSSION: In treatment of oesophageal haematoma in patients on vitamin-K antagonists, strict control of the International Normalized Ratio (INR) is essential along with total parenteral nutrition therapy and refrainment through nasogastric tubes...... intramural hematoma gradually lysed and causing late perforation. CONCLUSION: Although extremely rare, an oesophageal haematoma and late complications must be considered in patients on anti-coagulant therapy following blunt thoracic trauma and complaining only of chest pain....

  6. Delayed bowel perforation following suprapubic catheter insertion

    Mehta Ajay; Ahmed Shwan J; Rimington Peter

    2004-01-01

    Abstract Background Complications of suprapubic catheter insertion are rare but can be significant. We describe an unusual complication of a delayed bowel perforation following suprapubic catheter insertion. Case presentation A gentleman presented with features of peritonitis and feculent discharge along a suprapubic catheter two months after insertion of the catheter. Conclusion Bowel perforation is the most feared complication of suprapubic catheter insertion especially in patients with low...

  7. Evaluation of urgent esophagectomy in esophageal perforation

    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 re...

  8. Delayed Esophageal Perforation after Cervical Spine Plating

    Kim, Seong Jung; Ju, Chang Il; Kim, Dong Min; Kim, Seok Won

    2013-01-01

    Although anterior approaches to the cervical spine are popular and safe, they cause some of complications. Esophageal perforation after anterior spinal fusion is a rare but potentially life-threatening complication. We present a rare case of delayed esophageal perforation caused by a cervical screw placed via the anterior approach. A 43-year-old man, who had undergone surgery for complete cord injury at another orthopedic department 8 years previously, was admitted to our institute due to pai...

  9. Surgical treatment of perforated gastric ulcer

    Korica Milan

    2002-01-01

    Full Text Available Introduction Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. Material and methods This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. Results During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53±8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%, excision of the ulcer with a pyloroplasty and vagotomy (35.29% as nonresection surgical procedures and stomach resection after Billroth II (8.83%. The postoperative mortality was 4.41%. Conclusions The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

  10. Complication of endoscopic tattooing: a case report of covered perforation

    FALCO, N.; FONTANA, T.; TUTINO, R.; LICARI, L.; RASPANTI, C.; MASCOLINO, A.; MELFA, I.; SCERRINO, G.; SALAMONE, G.; GULOTTA, G.

    2016-01-01

    Aim Laparoscopy is considered a good approach in treatment of colorectal neoplastic diseases; the endoscopic tattooing is then recommended (Evidence Level III and grade of recommendation A) to mark a lesion or a polypectomy site for intraoperative identification. We describe the case of perforation after tattoing treated conservatively. Case report 63 years old woman, underwent colonoscopy for lipoma tattooing with India ink SPOT® solution kit and saline test. Immediately after the procedure the patient has been referred the appearance of colic epi-mesogastric pain and fever; Computed Tomography (CT) without MDC identified an irregular thickening of transverse colon with some microbubbles compatible with focal peritonitis. Initial paralytic ileus was present too. The blood count and metabolic panel examinations reveal a neutrophil leucocytosis (WBC: 11.000/mmc, 80% neutrophils). Results On the base of WSES sepsis severity score and recent literature patient was treated conservatively with total parenteral nutrition, and intravenous antibiotic therapy. After the resolution of fever and reactivation of peristalsis. The discharge occurred after six days with no early complications. Conclusion India ink tattooing with SPOT® solution kit and saline test represent the first choice. It is a feasible technique although perforation is a possible complication. It may need an immediately surgical operation but in most cases a conservative management is a good and safe tool even if surgery may be attempted too. PMID:27381693

  11. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  12. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    Choi, Gyu Chang [Dept. of Radiology, Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of)

    2011-07-15

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p < 0.001). The sensitivity of circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  13. Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

    To evaluate mutidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time. One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection. The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups. MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction. (orig.)

  14. Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

    Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won [Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of); Park, Seong Jin [Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of)

    2014-06-15

    To evaluate mutidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time. One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection. The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups. MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction. (orig.)

  15. Spontaneous Esophageal Perforation in a Patient with Mixed Connective Tissue Disease

    Lyman, David

    2011-01-01

    Spontaneous esophageal perforation is a rare and life-threatening disorder. Failure to diagnosis within the first 24-48 hours of presentation portends a poor prognosis. A patient with mixed connective tissue disease (MCTD) on low-dose prednisone and methotrexate presented moribund with chest and shoulder pain, a left hydropneumothorax, progressive respiratory failure and shock. Initial management focussed on presumed community acquired pneumonia (CAP) in a patient on immunosuppressants. Bilat...

  16. Surgical Treatment of Perforation Esophageal Carcinoma

    Depu Duan; Jihua Zou; Zhigang Cai; Shengyong Wu; Haibo Xiao; Yiyong Zhou; Xiang Liang; Dekui Sun; Songchang Wu

    2006-01-01

    OBJECTIVE To determine the ideal method of surgical preoperative treatment for perforation with esophageal carcinoma.METHODS 36 cases of perforation with esophageal carcinoma were treated surgically in this series.Perforations occurred into the right lung in14 cases ,the mediastinum in 17 cases and trachea in 5 cases.Open thoracic surgery was performed in 34 cases,in which the right thoracic approach using a 3-incision method was applied in 16 cases,and operation by stages in 15 cases.Of the 34 cases,retrosternal substitution of the esophagus with stomach or colon was performed in 26 cases.RESULTS Surgery was successful in 31 cases and operative death occurred in 3 cases.The postoperative follow up study was from 3~72months.Of these cases 15 wree alive at 7~12 months, 2 at 24 months,and 1 at 72 months. The results can be considered satisfactory.CONCLUSION The therapeutic results of surgical treatment of perforation with esophageal carcinoma were markedly superior to that of conventional conservative treatment. The authors suggest that surgical intervention without delay should be undertaken for patients having a perforation with carcinoma of the esophagus. A right thoracic approach with a 3-incision method (retrosternal replacement of esophagus with stomach or colon) or operation by stages is preferable.

  17. Basic Perforator Flap Hemodynamic Mathematical Model

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

    2016-01-01

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

  18. WAVE INTERACTION WITH PERFORATED CAISSON BREAKWATERS

    Chen Xue-feng

    2003-01-01

    The reflection coefficient of perforated caissons and the total horizontal forces acting on them were experimentally and numerically analyzed and discussed when wave propagates normally. To consider the viscosity effect of fluid and nonlinear action of waves on structures, the VOF (Volume Of Fluid) method combined with the k-ε turbulence model was used to simulate the interaction between waves and structures. Governing equations were solved with the finite difference method. Through 2D experimental study in the wave flume, the empirical relationship between the reflection coefficient of perforated caissons and the main affecting factors were obtained from the experimental data using the least square method. Also the correlation between the ratio of the total horizontal force acting on perforated caisson and the force acting on solid caisson and the main affecting factors were regressed from the experimental data.

  19. Hospital-acquired pneumonia

    ... this page: //medlineplus.gov/ency/article/000146.htm Hospital-acquired pneumonia To use the sharing features on this page, please enable JavaScript. Hospital-acquired pneumonia is an infection of the lungs ...

  20. Evaluation of urgent esophagectomy in esophageal perforation

    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

  1. Delayed bowel perforation following suprapubic catheter insertion

    Mehta Ajay

    2004-12-01

    Full Text Available Abstract Background Complications of suprapubic catheter insertion are rare but can be significant. We describe an unusual complication of a delayed bowel perforation following suprapubic catheter insertion. Case presentation A gentleman presented with features of peritonitis and feculent discharge along a suprapubic catheter two months after insertion of the catheter. Conclusion Bowel perforation is the most feared complication of suprapubic catheter insertion especially in patients with lower abdominal scar. The risk may be reduced with the use of ultrasound scan guidance.

  2. Duodenal perforation precipitated by scrub typhus

    Raghunath Rajat

    2015-01-01

    Full Text Available 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.

  3. Duodenal Perforation Precipitated by Scrub Typhus.

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

    2015-01-01

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

  4. Perforated Plates as Passive Mitigation Systems

    G.S. Langdon

    2008-03-01

    Full Text Available This paper presents the results of tests on fully-clamped circular plates subjected to blastloading directed down a tube. Four series of tests were performed. In one set of experiments,the blast wave was allowed to progress unhindered down the tube to impinge upon the plate,and in the other tests, perforated plates were placed in the path of the blast wave to hinderprogression down the tube, disrupting the blast and absorbing some of the kinetic energy.Results of the tests indicate that the perforated plates can be used as a form of passive mitigation.

  5. Duodenal perforation associated with norovirus and rotavirus gastroenteritis

    Ueda, Norishi; Shimotake, Takashi; Ohama, Kazunori

    2013-01-01

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

  6. Perforated duodenal ulcer: an unusual complication of gastroenteritis.

    Wilson, J. M.; Darby, C. R.

    1990-01-01

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

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

    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.

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

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

    2012-01-01

    The study was carried out to compare the efficacy of subfascial endoscopic perforator surgery (SEPS) and open subfascial ligation of perforators in varicose veins. This study was conducted on 100 patients of varicose veins from January 2006 to December 2010. Clinical scoring and color Doppler were performed in all the patients before surgery. Patients were divided into two groups: Group A and Group B alternately. Management of the perforators was done by subfascial endoscopic perforator surge...

  9. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Full Text Available ... tough decisions these and other women made after learning they had breast cancer. You will also see the breast reconstruction surgery each of them chose to undergo. The deep inferior epigastric perforator flap technique allows surgeons to rebuild breasts in the most ...

  10. Infantile perforated appendicitis: A forgotten diagnosis

    Katherine W. Gonzalez

    2015-04-01

    Full Text Available Acute appendicitis in the infant is a rare surgical diagnosis despite its frequency in older patients. The clinical presentation is often vague and can be misleading. We present the successful diagnosis and treatment of a 3 month old female with perforated appendicitis.

  11. Intestinal perforation caused by multiple magnet ingestion

    Nergul Corduk

    2014-01-01

    Full Text Available Multiple magnet ingestion is rare, but can cause serious gastrointestinal complications. We report a case of 7-year-old girl with multiple intestinal perforations caused by multiple magnet ingestion. The aim of this report is to draw attention to magnetic toys, results of magnet ingestion and the importance of timing of operation.

  12. Concrete wall perforation by rigid missile

    Tests were performed to study the perforation risk of reinforced concrete by industrial accidental missile. An empiric formula is established from shots of cylindrical missile with flat nose and its validity range is set. Some shots with different missile shape have given correction to introduce then in the formula. Calculation with finite elements are compared with tests results

  13. Diagnosis and management of iatrogenic endoscopic perforations

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc;

    2014-01-01

    expertise available at the center. A switch to carbon dioxide insufflation, the diversion of luminal content, and decompression of tension pneumoperitoneum or tension pneumothorax should also be done. 5 After closure of an iatrogenic perforation using an endoscopic method, ESGE recommends that further...

  14. Breast Reconstruction: Deep Inferior Epigastric Perforator

    Full Text Available ... that the lower blood supply, which is the deep inferior epigastric artery and vein, comes up from underneath the muscle ... the vein but there isn't an adequate artery, so usually in that setting, we'll proceed as planned ... perforator technique. 00:18:40 WILLIAM SAMSON, MD: ...

  15. Stercoral Perforation of the Colon in Pregnancy

    Atkinson AL; Pepe A

    2010-01-01

    We report a 37 year old multi-parous lady, who in her third trimester of pregnancy, presented to the emergency room with acute diffuse abdominal pain and involuntary guarding. Findings on physical examination were consistent with peritonitis and a decision was made by the admitting team to perform an urgent laparotomy which surprisingly showed a stercoral perforation of the colon.

  16. Concrete wall perforation by rigid missile

    Tests were performed to study the perforation risk of reinforced concrete by industrial accidental missile. An empiric formula is established from shots of cylindrical missile with flat nose and its validity range is set. Some shots with different missile shape have given correction to introduce then in the formula. Calculation with finite elements are compared with test results. (orig.)

  17. Clinical applications of preoperative perforator planning using CT angiography in the anterolateral thigh perforator flap transplantation

    Aim: To evaluate the reliability and utility of preoperative perforator planning using computed tomography angiography (CTA) in anterolateral thigh perforator flap (ALTPF) transplantation. Materials and methods: Thirty-two consecutive patients who underwent extremity reconstruction using the ALTPF were retrospectively reviewed from 2008 to 2012. These patients were divided into two groups. In group I (n = 16), suitable perforators were designed based on four criteria using CTA. These were used for the operation and compared with the intraoperative findings. In group II (n = 16), all patients underwent operation using conventional methods without preoperative perforator planning. The surgical results of all patients were evaluated for flap complications, alteration of the donor site, donor site morbidity, and the incidence of reoperation. Results: In group I, there were no statistically significant differences between the parameters, including the calibre and location of the origin (perpendicular and horizontal distance from the origin of the perforator to both the superior lateral border of the patella and the lateral region of the thigh) of all planning perforators and the operative measurement results (p-values were 0.3, 0.422, and 0.129, respectively). The types were consistent with the operative findings; the rate of the septocutaneous type was 31.25% (5/16), and the rate of the musculocutaneous type was 68.75% (11/16). The use of preoperative perforator planning in group I was associated with a significant reduction in flap complications (p = 0.009) compared with group II. There was no difference between the two groups in alteration of the donor site, donor site morbidity, or the incidence of reoperation (p-values were 0.225, 0.225, and 0.33, respectively). Conclusion: Preoperative perforator planning using CTA in ALTPF transplantation is a reliable and useful method resulting in safer operation with optimal outcome

  18. Load-bearing capacity of perforated trapezoidal sheeting

    Misiek, Thomas; Saal, Helmut

    2010-01-01

    Thin-walled perforated sheeting is used for sound absorption in buildings. The perforation may extend over the whole surface or only parts of the sheeting, e.g. webs. So far only reduction factors for the in-plane stiffness and the bending stiffness of fully perforated sheets with an equilateral triangular perforation pattern are included in EN 1993-1-3 and EN 1999-1-4. These factors only apply to perforation patterns in form of equilateral triangles, because of the isotropy assumed during de...

  19. Use of pulsed neutron logging to evaluate perforation washing

    This invention relates to the use of pulsed neutron logging techniques before and after perforation washing operations are performed to evaluate the degree of success of the perforation washing operations. Well logging operations of a type designed to respond to the difference between a formation immediately behind the well sheath and voids in the formation are performed both before and after the perforation washing operation. differences between the two resulting logs are then indicative of voids created by perforation washing. In a preferred embodiment, pulsed neutron logging is used as the logging technique, while a weighted brine having a high absorption cross section to pulsed neutrons is used as the perforation washing fluid

  20. CLINICAL STUDY OF ABDOMINAL HOLLOW VISCERAL PERFORATION-NON TRAUMATIC

    Vinod Kumar

    2014-07-01

    Full Text Available : INTRODUCTION: Perforation of any part of gastrointestinal track usually gives rise to a life threatening emergency. A high index of suspicion is essential to diagnose visceral perforation early as significant morbidity and mortality results from diagnostic delay. This study was undertaken to analyse regarding sex incidence, seasonal factors, etiological factors, clinical features, investigations, treatment, complications of hollow perforation and results were compared with results of previous similar studies. METHODS: The total number 31 cases of hollow visceral perforation in abdomen have been studied prospectively in detail during the period from October 2009 to September 2011. RESULTS: Among the 31cases of gastrointestinal perforation, perforation of duodenal ulcer 9 cases (29.3% was the commonest, there was male predominance constituting 21(67.7%, peptic ulcer perforation maximum is seen between June and September. The most common complication recorded was wound infection 5 cases (16.1%, death 4 cases (12.9%.Median length of the stay was 13days (2-44days. CONCLUSION: From our study of 31 cases of hollow viscous perforation the following can be concluded most common age group affected is 40-60 years, more commonly seen in males. Duodenum is the most common site perforation. In general peptic ulcer perforation maximum is seen between June and September, in rainy season. Most presented with hollow viscous perforation after 24 hours to the hospital. Wound infection, septicemia was, most common cause of morbidity and mortality respectively.

  1. Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis

    Masood, Irfan; Majid, Zain; Rafiq, Ali; Rind, Waqas; Zia, Aisha; Raza, Sajjad

    2015-01-01

    Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Herein, we describe a case of a 25-year-old male who presented with generalized peritonitis requiring an emergency exploratory laparotomy, which revealed pan-enteric perforation characterized by multiple perforations of the small bowel extending 10–15 cm from the DJ flexure up to the terminal ileum. The perforations were primarily closed, while 6–8 cm of the diseased terminal ileum was resected and the two ends were brought out as double-barreled ostomy. To the best of our knowledge, such an extensive tuberculous perforation of the small bowel has not been previously reported in the literature before. PMID:26798540

  2. The management of large perforations of duodenal ulcers

    Sharma Rajeev

    2005-06-01

    Full Text Available Abstract Background Duodenal ulcer perforations are a common surgical emergency, but literature is silent on the exact definition, incidence, management and complications of large perforations of duodenal ulcers. Methods The case files of 162 patients who underwent emergency laparotomy for duodenal ulcer perforations over a period of three years (2001 – 2003 were retrospectively reviewed and sorted into groups based on the size of the perforations – one group was defined as 'small 'perforations (less than 1 cm in diameter, another 'large' (when the perforation was more than 1 cm but less than 3 cms, and the third, 'giant'(when the perforation exceeded 3 cm. These groups of patients were then compared with each other in regard to the patient particulars, duration of symptoms, surgery performed and the outcome. Results A total of 40 patients were identified to have duodenal ulcer perforations more than 1 cm in size, thus accounting for nearly 25 % of all duodenal ulcer perforations operated during this period. These patients had a significantly higher incidence of leak, morbidity and mortality when compared to those with smaller perforations. Conclusion There are three distinct types of perforations of duodenal ulcers that are encountered in clinical practice. The first, are the 'small' perforations that are easy to manage and have low morbidity and mortality. The second are the 'large' perforations, that are also not uncommon, and omental patch closure gives the best results even in this subset of patients. The word 'giant' should be reserved for perforations that exceed 3 cms in diameter, and these are extremely uncommon.

  3. Spontaneous corneal perforation in ocular rosacea.

    Al Arfaj, Khalid; Al Zamil, Waseem

    2010-04-01

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

  4. Spontaneous corneal perforation in ocular rosacea

    Al Arfaj Khalid

    2010-01-01

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

  5. Vitrectomy in double-perforation gunshot injury

    Abd El Alim Mohamed A

    2013-11-01

    Full Text Available Ahmed Abd El Alim MohamedOphthalmology department, Ain Shams University, Cairo, EgyptObjective: This study sought to evaluate the result of pars plana vitrectomy in patients with gunshot wounds involving double perforation.Methods: This was a retrospective, noncomparative, interventional case series.Results: Eighteen patients (18 eyes with double-perforation gunshot injuries were treated from February 2010 to March 2012. The group included 16 men (88% and two women (11%; the mean age was 24 (15–33 years. In each case, vitrectomy was scheduled 1–6 weeks after repair of the entrance site. Associated retinal detachments were observed in two eyes (11%, retinal incarceration was observed surrounding the exit site in three eyes (16%, and retention of an intraocular foreign body was observed in two cases. After a follow-up period of 8 ± 2 months, two eyes (11% had achieved visual acuity (VA of 0.5, nine eyes (50% had achieved VA between 0.5 and 0.1, and seven eyes (38% had achieved VA between 0.1 and hand movement. The main reasons for functional failure (VA 0.1 to hand movement were macular dragging (due to fibrosis at the exit site near the macula in seven cases (38%, submacular hemorrhage in four cases (22%, and epimacular fibrosis in five cases (27%. All cases developed postoperative exotropia. One case (5% developed postoperative hemorrhage. No cases exhibited signs of postoperative redetachment.Conclusion: The outcome of pars plana vitrectomy in cases with double perforations is variable. Factors including the surgeon's skill level, the time to surgery, and the efficacy of the intraocular tamponade affect the postoperative outcome.Keywords: pars plana vitrectomy, gunshot injury, double perforation

  6. Diagram of the uranium prospection perforation

    We call diagrams to the drawn up one continuous of parameters physicists of the formation trimmed by a perforation based on the depth. The method is interesting not only for the putting in evidence of the mineralized levels but also it stops to determine the variations of lithology had by one part to the intrinsic properties of minerals (quartz, clays, carbonates) and to their variation of tenor and by another one, to variations of porosity and permeability of the formation

  7. A laser device for perforating materials

    Domankevitz, Yacov; Kwok, Hoi S.; Copley, John A.

    1995-12-01

    A Nd:YAG laser device for perforating materials was developed. The device generates a modified temporal pulse structure of both free-running and Q-switched laser irradiation. This modified structure enhances drilling efficiency by a factor of 2 compared to free-running irradiation and is achieved by mechanical blow-off of preheated material. Such a device is well suited for compact portable field applications.

  8. Liquid nitrogen ingestion followed by gastric perforation.

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

    2010-01-01

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

  9. Homogenization of eigenvalue problems in perforated domains

    Vanninathan, M.

    1981-01-01

    In this paper, we treat some eigenvalue problems in periodically perforated domains and study the asymptotic behaviour of the eigenvalues and the eigenvectors when the number of holes in the domain increases to infinity Using the method of asymptotic expansion, we give explicit formula for the homogenized coefficients and expansion for eigenvalues and eigenvectors. If we denote by ε the size of each hole in the domain, then we obtain the following aysmptotic expansion for the eigenvalues: Dir...

  10. Perforation of the palate in secondary syphilis

    Pavithran K

    1994-01-01

    Full Text Available A middle aged woman with secondary syphilis-diagnosed clinically and serologically was prescribed oral tetracyline. She did not complete the course of treatment. Recurrent mucosal erosions in the mouth she developed subsequently as manifestation of relapsing secondary syphilis were wrongly diagnosed as ′aphthous stomatitis′ and were treated with betamethasone gargling. The erosions progressed to ulcerations and finally resulted in perforation of the soft palate.

  11. PERFORATED PEPTIC ULCER: A CLINICAL ANALYSIS AND OUTCOME

    Bijit

    2016-03-01

    Full Text Available BACKGROUND The incidence of perforated peptic ulcer is approximately 7-10 cases per one lakh population per year. Perforation is seen in about 7% of patients hospitalized for peptic ulcer disease. Peptic ulcer perforation, which can be gastric/duodenal perforation can be a serious life-threatening condition if not detected early and treated urgently. Peptic ulcer disease has decreased considerably worldwide with the advent of potent anti-ulcer medicines, but its complication like peptic ulcer perforation has not. Our study is to analyse the clinical, radiological and management related findings in influencing the outcome of patients of peptic ulcer perforation after surgery. MATERIALS AND METHODS A series of 47 patients of peptic ulcer perforation were evaluated. Patients expiring within six hours of admission were not included in this study. RESULTS Age of the patients ranged from 17-80 years. The incidence of perforation was highest in the age group of 41-50 years (31.9%. Out of 47 patients, 41 (87.2% survived. CONCLUSION The incidence of perforation was highest in the age group of 41-50 years. Prognosis becomes poor with age, delayed treatment, shock at admission and concomitant diseases. Direct repair of the perforation with pedicled omentum gave excellent results.

  12. Conservative treatment of perforated upper gastrointestinal tract

    In order to clarify the validity of indication criteria of the conservative treatment for perforated upper gastrointestinal tract, a retrospective study was carried out. We enrolled 28 patients with perforation of the gastrointestinal tract who were determined to receive conservative treatment at the time of hospitalization from January 2000 to December 2007. When the following criteria were satisfied, we treated the patients by the conservative treatment after informed consent was gained from them and their families: stable condition of vital signs; peritoneal signs localized in the upper abdomen; and no or slight fluid collection at the Douglas' pouch determined by computed tomography. Patients who showed changes for the worse of peritonitis or increased fluid collection during follow-up were promptly converted to surgery. Six patients were converted to surgery, but all of them were discharged very much improved. We compared patient's data of the conservative treatment group and the converted surgery group at the time of consultation. All data were not statistically different between two groups. If all criteria are satisfied, it seemed that we can start conservative treatment for perforated gastrointestinal tract with careful observation and the system of prompt conversion to operation for patients who showed changes for the worse of peritonitis or increased fluid collection. (author)

  13. Medical image of the week: eosphageal perforation

    Bilal J

    2015-04-01

    Full Text Available No abstract available. Article truncated after 150 words. A 74 year old man with a past medical history of esophageal strictures status post dilatation, coronary artery disease status post CABG, and atrial fibrillation presented to hospital with complaints of severe chest pain that began after the consumption of tortilla chips one hour prior to presentation. Electrocardiogram and cardiac enzymes were not consistent with acute coronary syndrome. Chest X-ray was consistent with a widened mediastinal silhouette. Contrast esophogram was negative for extra luminal extravasation. CT scan of the chest with oral contrast demonstrated thickening of the mid-thoracic esophagus with an extra-luminal focus of gas in the mediastinum along with fluid along the inferior aspect of the esophagus (Figures 1 and 2. These findings were concerning for esophageal perforation. The patient was taken to the operating room for endoscopy which showed micro perforation in mid-esophagus. Esophageal perforation remains a highly morbid condition. Mortality rates are based predominantly on time of ...

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

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

    2009-01-01

    The deep circumflex iliac artery (DCIA) provides a dependable option for use as an osteo-musculo-cutaneous flap, particularly in mandibular reconstruction. Modifications to flaps based on DCIA perforators have been sought to prevent donor site morbidity as a consequence of muscle cuff harvest. Previous studies have been inconsistent in their descriptions of perforator anatomy, and means of assessing these preoperatively have not been widely described. A clinical anatomical study was undertaken, with a cohort of 44 hemiabdominal walls in 22 consecutive patients undergoing preoperative computed tomographic angiography (CTA) before free flap surgery. The feasibility of CTA and the regional vascular anatomy were both assessed. The use of CTA was shown to demonstrate DCIA perforators with high resolution and to be able to assess vessel size and location. In 44 hemiabdominal walls, there were 44 perforators of >0.8 mm diameter. There were no suitable perforators in 40% of sides, with 32% of sides having one perforator >0.8 mm diameter, 16% having two perforators, DCIA perforators, and for selecting patients who may be suitable for a DCIA perforator flap given the variable perforator anatomy. PMID:19296521

  15. Laboratory-acquired brucellosis

    Fabiansen, C.; Knudsen, J.D.; Lebech, A.M.

    2008-01-01

    Brucellosis is a rare disease in Denmark. We describe one case of laboratory-acquired brucellosis from an index patient to a laboratory technician following exposure to an infected blood culture in a clinical microbiology laboratory Udgivelsesdato: 2008/6/9......Brucellosis is a rare disease in Denmark. We describe one case of laboratory-acquired brucellosis from an index patient to a laboratory technician following exposure to an infected blood culture in a clinical microbiology laboratory Udgivelsesdato: 2008/6/9...

  16. Intrauterine devices and risk of uterine perforation: current perspectives

    Rowlands S

    2016-03-01

    Full Text Available Sam Rowlands,1 Emeka Oloto,2 David H Horwell3 1Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Dorset, UK; 2Staffordshire and Stoke on Trent Partnership NHS Trust, Leicester, UK; 3Spire Harpenden Hospital, Harpenden, UK Abstract: Uterine perforation is an uncommon complication of intrauterine device insertion, with an incidence of one in 1,000 insertions. Perforation may be complete, with the device totally in the abdominal cavity, or partial, with the device to varying degrees within the uterine wall. Some studies show a positive association between lactation and perforation, but a causal relationship has not been established. Very rarely, a device may perforate into bowel or the urinary tract. Perforated intrauterine devices can generally be removed successfully at laparoscopy. Keywords: uterine perforation, intrauterine device, intrauterine system

  17. Low-Cost Control Problems on Perforated and Non-Perforated Domains

    S Kesavan; T Muthukumar

    2008-02-01

    We study the homogenization of a class of optimal control problems whose state equations are given by second order elliptic boundary value problems with oscillating coefficients posed on perforated and non-perforated domains. We attempt to describe the limit problem when the cost of the control is also of the same order as that describing the oscillations of the coefficients. We study the situations where the control and the state are both defined over the entire domain or when both are defined on the boundary.

  18. Aeroacoustic control of landing gear noise using perforated fairings

    Boorsma, Koen

    2008-01-01

    A study was performed to investigate and optimize the application of perforated fairings for landing gear noise control. The sparse knowledge about this new subject has necessitated a more fundamental study involving a basic fairing-strut configuration, followed by wind tunnel tests on a simplified landing gear configuration incorporating perforated fairings. For the basic configuration, various exchangeable perforated half-cylindrical shells shrouding a circular cylinder we...

  19. Nature of formation damage around perforations in petroleum wells

    Rahman, M.A.; Koksal, M.; Islam, M.R. [Dalhousie Univ., Halifax, NS (Canada)

    2003-07-01

    Perforation of an oil well is an important aspect of petroleum production. The shooting method can damage the formation around the perforation, resulting in a significant decline in productivity. The propagation of a high-amplitude shock wave into the rock matrix around a new perforation tunnel and its impulsive action, results in the shattering of rock grains and cementation. The mechanical strength of the rock is thereby reduced by the shock wave. Fines from cracked grains are generated in close proximity to the tunnel. The three perforating conditions are: under-balanced, balanced, and overbalanced perforation techniques. There is migration of originally undisturbed fines towards the tunnel in an under-balanced perforation as a result of the surge flow. The pore throat is plugged and permeability impaired. The primary source of perforation damage is this region of high fines concentration also known as the compacted or crushed zone. The residual debris left in the tunnel is another source of damage. The surge can be prevented using balanced shot. In this case, the fines concentrate in the immediate vicinity of the liner debris. Overbalanced perforating suffers from a lack of back surge, which negatively affects production. The nature of compacted zones around a perforation tunnel was reviewed, and a detailed description of perforation techniques, including the effect of different parameters in perforating, was provided. The perforation by drilling system (PDS) is the newly proposed drilling method that does not involve shooting. It thereby minimizes the problems associated with rock shattering. A second option could involve melting the casing by laser beam pulse, followed immediately by drilling the rock. A third option is to use water jets. 32 refs., 7 figs.

  20. Local and distortional buckling of perforated steel wall studs

    Kesti, Jyrki

    2000-01-01

    The local and distortional buckling behaviour of flange and web-stiffened compression members was investigated. In particular, the behaviour of web-perforated sections was investigated both numerically and experimentally. Perforation reduces the perpendicular flexural stiffness of the web and thus particularly reduces the distortional buckling strength of the section. The main task of the research was to develop a design method for estimating the compression capacity of a perforated steel wal...

  1. Perforation of the duodenum by an ingested toothbrush

    2008-01-01

    We report a rare case of duodenal perforation caused by an ingested 12-cm long toothbrush handle. A 22-year-old female presented with intermittent epigas- tric pain for 6 d after swallowing a broken toothbrush. The swallowed toothbrush could not be removed from the second portion of the duodenum by endoscopy. Laparotomy revealed a perforation in the anterior wall of the duodenal bulb. The toothbrush was removed via the perforation which was debrided and closed. There were no postoperative complications.

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

    Aditya Pratap Singh

    2016-04-01

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

  3. Effect of Perforated Plates on the Acoustics of Annular Combustors

    Gullaud, Elsa; Nicoud, Franck

    2012-01-01

    This paper aims to show the influence of perforated plates on the acoustic modes in aeronautical gas turbine combustion chambers. The analytical model was implemented in a three-dimensional acoustic Helmholtz solver to account for the effect of perforated plates. First, an analytic test case is used to validate the coding in the acoustic solver. Then, a computation of the acoustic modes in an actual industrial chamber is conducted, taking into account the perforated liners. For both cases, a ...

  4. Perforated duodenal diverticulum caused by Bezoar: A case report

    Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae [Dept. of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2013-11-15

    Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

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

    Lajinian, S; Margono, F; Mroueh, J

    1994-11-01

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

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

    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 pe...

  7. Spontaneous Uterine Perforation Caused by Pyometra: A Case Report

    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. Conclusi...

  8. Spontaneous Uterine Perforation Due to Pyometra Presenting as Acute Abdomen

    Sahoo, Sarada Prasanna; Dora, Arun Kumar; Harika, M.; Kumar, K. Ramesh

    2011-01-01

    Spontaneous perforation of uterus is rare, its incidence being about 0.01%-0.5%. We report a rare case of diffuse peritonitis and pneumoperitoneum caused by spontaneously perforated pyometra. A 50-year postmenopausal lady with abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy about 1,500 ml of pus present in peritoneal cavity and whole of alimentary tract and gallbladder we...

  9. Aortic Pseudoaneurysm Secondary to Mediastinitis due to Esophageal Perforation

    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

  10. PERFORATION OF PLASTIC SPHERICAL SHELLS UNDER IMPACT BY CYLINDRICAL PROJECTILES

    NING Jian-guo; SONG Wei-dong

    2006-01-01

    The objective is to study the perforation of a plastic spherical shell impacted by a cylindrical projectile. First, the deformation modes of the shell were given by introducing an isometric transformation. Then, the perforation mechanism of the shell was analyzed and an analytical model was advanced. Based on Hamilton principle, the governing equation was obtained and solved using Runge-Kuta method. Finally, some important theoretical predictions were given to describe the perforation mechanism of the shell. The results will play an important role in understanding the perforation mechanism of spherical shells impacted by a projectile.

  11. Imaging gastrointestinal perforation in pediatric blunt abdominal trauma

    Objective. To assess the role of imaging, in particular CT, in the early detection of GI perforation. Subjects and methods. In a 10-year period, 43 patients with surgically confirmed GI perforation were identified from hospital records; 22 of these had preoperative CT evaluation. Medical records and radiology were retrospectively reviewed and CT studies were particularly assessed for extraluminal air, free intraperitoneal fluid, bowel wall thickening, bowel wall enhancement, and bowel dilatation. During the study period an additional 12 trauma patients were identified who had CT studies demonstrating the above findings, but who had hypovolemic shock bowel or nondisrupting bowel injury without perforation evident. Results. Extraluminal air was demonstrated in 47 % of the imaged perforations. There was one false-positive extraluminal air. Perforation was confirmed in patients who had all five of the above CT findings, but this was the case for only 18 % of patients with perforation. One or more of the five specified CT findings were present in all CT studies reviewed. No false-negative CT study was performed in the study period. Conclusion. Separating nondisrupting bowel injury from perforation is diagnostically difficult; however, CT remains a good modality for assessing GI perforation in pediatric blunt trauma, but it cannot replace diligent and repeated clinical evaluation of all potential perforation victims. (orig.). With 4 figs., 1 tab

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

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

    2016-04-01

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

  13. Processed pseudogenes acquired somatically during cancer development

    Cooke, Susanna L.; Shlien, Adam; Marshall, John; Pipinikas, Christodoulos P; Martincorena, Inigo; Tubio, Jose M. C.; Li, Yilong; Menzies, Andrew; Mudie, Laura; Ramakrishna, Manasa; Yates, Lucy; Davies, Helen; Bolli, Niccolo; Bignell, Graham R; Tarpey, Patrick S.

    2014-01-01

    Cancer evolves by mutation, with somatic reactivation of retrotransposons being one such mutational process. Germline retrotransposition can cause processed pseudogenes, but whether this occurs somatically has not been evaluated. Here we screen sequencing data from 660 cancer samples for somatically acquired pseudogenes. We find 42 events in 17 samples, especially non-small cell lung cancer (5/27) and colorectal cancer (2/11). Genomic features mirror those of germline LINE element retrotransp...

  14. Frequency of wound infection in non-perforated appendicitis with use of single dose perforative antibiotics

    Antibiotics are used both pre and post-operatively in acute appendicitis for preventing wound infection. It has been observed that the routine use of post-operative antibiotics is not necessary in cases of non-perforated appendicitis as only prophylactic antibiotics are sufficient to prevent wound infection. The aim of this study was to see the frequency of wound infection in non-perforated appendicitis with single dose preoperative antibiotics only. Method: This observational study was conducted at the Department of Surgery, Ayub Medical College, Abbottabad from May to November 2014. A total of 121 patients with non-perforated appendicitis were included in the study. Only single dose preoperative antibiotics were used. The patients were followed for wound infection till 8th post-operative day. Results: 121 patients, 56(46.28%) male and 65(53.72%) female were included in the study. The mean age of patients was 27.41 ± 7.12 years with an age range of 18 to 45 years. In the entire series, 7(5.78%) patients developed wound infection. The infection was minor which settled with conservative therapy. Prophylactic antibiotics were found efficacious in 114(94.21%) patients. There was no significant association between wound infection and age and gender. Conclusion: Single dose preoperative antibiotics were found effective in controlling post-operative wound infection without the need of extending the antibiotics to post-operative period in cases of non-perforated appendicitis. (author)

  15. High-Resolution Ultrasonography (US) of Appendiceal Specimens: Differentiation of Acute Non-perforated Appendicitis from Perforated Appendicitis

    To analyze surgical specimens from patients with acute non-perforated and perforated appendicitis using high-resolution ultrasonography (US), and to correlate the US features with the pathologic findings. One hundred and six surgical appendix specimens obtained from patients with suspected acute appendicitis were evaluated. The following US features were evaluated for differentiating acute non-perforated appendicitis from perforated appendicitis: circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, the sum of opposing walls ≥ 9 mm and the presence of appendicoliths. The sensitivity and specificity of the US findings for diagnosing perforated appendicitis were determined. All US features were detected significantly more often in the perforated appendicitis group of specimens. The disruption of the serosal layer was the most significant independent predictor of perforation (p < .001). The sensitivity for circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, wall thickness ≥ 9 mm, and the presence of appendicoliths individually was 84.6%, 69.2%, 61.5%, 73.1% and 46.2%, respectively. The specificity for all of these findings was 86.3%, 98.7%, 95.0%, 85.0% and 85.0%, respectively. High-resolution US of appendiceal specimens was very useful for differentiating acute non-perforated from perforated appendicitis

  16. Small bowel perforation during suprapubic tube exchange.

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

    2009-02-01

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

  17. Intertwined Multiple Spiral Fracture in Perforated Sheets

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

    2016-04-01

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

  18. Bladder Perforation Secondary to Primary Systemic Amyloidosis

    Christopher J. Dru

    2014-01-01

    Full Text Available Amyloidosis is a disorder of protein folding characterized by extracellular aggregation and deposition of amyloid protein fibrils. Light-chain amyloidosis, also known as primary systemic amyloidosis, is the most common form of the disease. We present a case of an 84-year-old male with a history of systemic primary amyloidosis causing genitourinary, cardiac, and autonomic dysfunction who presented with hematuria and hypotension secondary to bladder perforation. He underwent open repair of a large extraperitoneal bladder defect. He ultimately died as a result of medical complications from his disease.

  19. Transhepatic perforation of the gallbladder: rare complication of a common disease

    Shrestha KR; Paudel G; Khaniya S; Agrawal CS; Shakya VC; Adhikary S

    2010-01-01

    Acute cholecystitis leading to gallbladder perforation is relatively common. However, transhepatic perforation of the gallbladder leading to biliary peritonitis is very rare. We present a rare case of biliary peritonitis caused by transhepatic perforation of the gallbladder.

  20. When is arthritis reactive?

    Hamdulay, S S; Glynne, S J; Keat, A

    2006-07-01

    Reactive arthritis is an important cause of lower limb oligoarthritis, mainly in young adults. It is one of the spondyloarthropathy family; it is distinguishable from other forms of inflammatory arthritis by virtue of the distribution of affected sites and the high prevalence of characteristic extra-articular lesions. Many terms have been used to refer to this and related forms of arthritis leading to some confusion. Reactive arthritis is precipitated by an infection at a distant site and genetic susceptibility is marked by possession of the HLA-B27 gene, although the mechanism remains uncertain. Diagnosis is a two stage process and requires demonstration of a temporal link with a recognised "trigger" infection. The identification and management of "sexually acquired" and "enteric" forms of reactive arthritis are considered. Putative links with HIV infection are also discussed. The clinical features, approach to investigation, diagnosis, and management of reactive arthritis are reviewed. PMID:16822921

  1. Perforation rate in acute appendicitis: association with different risk facotrs

    B. Khorasani

    2006-08-01

    Full Text Available Background: The early diagnosis of acute appendicitis before progression to gangrene or abscess formation is recognized as important to minimize morbidity from this common disease process. The aim of this study was to assess the value of different risk factors in the diagnosis of perforation. Methods: This descriptive-analytic and retrospective study was conducted to investigate epidemiological characteristics in patients with perforated and non-perforated appendicitis. A series of 1311 patients who were operated on for acute appendicitis between years 1380-1382 in Shahid Beheshti and Yahya-nejad hospitals were reviewed.. Data gathered included age at operation, gender, care sought prior to admission for appendectomy including antibiotic and analgesic therapy, time of presentation in the year, duration of symptoms, signs and symptoms at the time of admission, and the patient’s living area. Results: One hundred twenty one of 1311 patients (9% had perforated appendicitis and 1190 patients (91% had unperforated appendicitis. Presentation and referral in the first 6-month was associated with higher perforation rate. Patients from rural area showed a higher rate of perforations. The perforation rate was significantly higher in elderly patients (>65 year. When the duration of symptoms was more than 12 hours at presentation, the risk of perforation showed a five-fold increase. 30.7% of perforated cases had used antibiotic or sedative before referring to the hospital. Conclusion: Appendiceal perforation continues to be a complication in patients with acute appendicitis and increased in the frequency as the age of the patients increase and the duration of symptoms lengthen. We also found that the perforation rate is higher in patients from rural area and in whom present in the first 6-month of the year, a finding that was not reported so far.

  2. ENVIRONMENTAL MODIFICATION CAUSED BY PERFORATED TRANSPARENT POLYETHYLENE LOW TUNNELS CULTIVATED WITH LETTUCE

    Galileo Adeli Buriol; Flavio Miguel Schneider; Nereu Augusto Streck; Sandro Luís Petter Medeiros

    1993-01-01

    Environmental modifications caused by low tunnels made of perforated transparent polyethylene were determineted in an area alocated at the Federal University of Santa Maria, RS. The perforation densities were 100, 200, 300 and 400 perforations per square meter, corresponding respectively to 0.78% (T1), 1.57% CT2), 2.35% (T3) and 3.14% (T4) of area perforated. The results indicated that perforation density did not significantly affected solar energy availability. As perforation density increas...

  3. Experimental heat transfer on the windward surface of a perforated flat plate

    Dorignac, E.; Vullierme, J.J.; Broussely, M.; Foulon, C.; Mokkadem, M. [Laboratoire d' Etudes Thermiques, UMR CNRS 6608, Ecole Nationale Superieure de Mecanique et d' Aerotechnique, 1, Av. Clement Ader BP 40109, 86961 Futuroscope Chasseneuil cedex (France)

    2005-09-01

    Two techniques are described in this paper to determine convective transfer on a multi-perforated plate; the perforations diameter can be small or large (from 1 millimeter to 1 centimeter). This study reports on heat transfer due to the air flow before it goes through the perforations. These perforations are perpendicular to the wall. For a large range of perforations spacings, an empirical relation is proposed for heat exchange at the windward surface of a perforated flat plate. (authors)

  4. Pneumonia - adults (community acquired)

    ... breathing (respiratory) condition in which there is an infection of the lung. This article covers community-acquired pneumonia (CAP). This type of pneumonia is found in persons who have not recently been in the hospital or another health care facility such as a ...

  5. Etiopathology of acquired cholesteatoma

    Prabodh Karnik

    2011-01-01

    Full Text Available The etiopathology of acquired cholesteatoma has undergone numerous changes over the past 150 years. However, certain facts stand out with clarity. The presence of cytokeratins in acquired cholesteatoma, which are akin to those found in the tympanic membrane and external auditory canal, shows that these are probably the site of origin of acquired cholesteatoma. The cholesteatoma sac also shows its greatest growth at its tympanic membrane attachment into the middle ear. Implantations of squamous epithelium due to trauma or surgery could be another originating factor. The basic pathology is the formation of papillary cones from the tympanic membrane or external auditory canal, which progress from microcholesteatoma to frank cholesteatoma with keratin collections. There is an altered matrix metalloproteinase pathway. Tumor necrosis factor activation with altered wound healing process contributes to the collateral destruction of bone. Trisomy and aneuploidy of chromosome 8 predispose to cholesteatoma formation in affected individuals. In this article, we present the etiopathology of acquired cholesteatoma as it stands today.

  6. Perforation af rectum med faekal peritonitis efter staplet haemorideoperation

    Beuke, Anna-Christina; Pedersen, Mark Ellebaek; Qvist, Niels

    2008-01-01

    Rectal perforation and faecal peritonitis after stapled operation for grade IV haemorrhoids is described. The complication is rare, but surgeons performing the procedure must be familiar with potential risk factors.......Rectal perforation and faecal peritonitis after stapled operation for grade IV haemorrhoids is described. The complication is rare, but surgeons performing the procedure must be familiar with potential risk factors....

  7. Case report: Stercoral sigmoid colonic perforation with fecal peritonitis

    Chronic constipation can lead to fecal impaction. It can also rarely lead to catastrophic complications like perforation, colonic obstruction, and fecal peritonitis. We report a rare case of stercoral sigmoid colonic perforation with fecal peritonitis and pneumoperitoneum, which was diagnosed on preoperative CT scan

  8. Stercoral perforation of the colon: case report and literature review

    José Francisco Camacho Aguilera

    2015-03-01

    Full Text Available INTRODUCTION Colon perforation has several causes, including stercoral perforation of the colon, which was first described in 1894. Currently, reported cases are fewer than 100. CASE REPORT Male patient of 67 years old, treated at Huichapan General Hospital, Hidalgo, Mexico, with abdominal pain, bloating and no bowel movements. He referred being constipated for the last ten years. Imaging revealed an extremely dilated sigmoid colon with fecal matter as well as free gas in the peritoneal cavity. The suspicion of stercoral colonic perforation is established. Exploratory laparotomy was performed immediately, finding a perforation and a hard scybalum protruding in the ascending colon. Colectomy, ileostomy and Hartmann´s pouch are performed. After surgery, the condition of the patient worsened and progressed to septic shock and respiratory failure. The patient died four hours after surgery, with the diagnosis of organ failure due to sepsis. LITERATURE REVIEW Stercoral perforation accounts for 3.2% of all colon perforations and is caused by a rupture of the intestinal wall through direct pressure of a fecaloma on the colon. It occurs especially in patients older than 70 years with severe chronic constipation, weakened and/or are hospitalized with multiple medications and immobilized. CONCLUSIONS Stercoral perforation of the colon is a rare cause of bowel perforation, which should be suspected in patients with a history of chronic constipation, acute abdominal pain, bloating and sepsis, in order to intervene in a timely fashion.

  9. Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation

    Park, Hanaro; Hong, Seung No; Kim, Hyo Sang; Han, Jae Joon; Chung, Juyong; Seo, Myung-Whan; Oh, Seung-Ha; Chang, Sun-O

    2015-01-01

    Objectives Tympanic membrane perforations are common, but there have been few studies of the factors determining the extent of the resulting conductive hearing loss. The aims of this study were to determine whether the size of tympanic membrane perforation, pneumatization of middle ear & mastoid cavity, and location of perforation were correlated with air-bone gap (ABG) of patients. Methods Forty-two patients who underwent tympanoplasty type I or myringoplasty were included and preoperative audiometry were analyzed. Digital image processing was applied in computed tomography for the estimation of middle ear & mastoid pneumatization volume and tympanic membrane photograph for the evaluation of perforation size and location. Results Preoperative mean ABG increased with perforation size (P=0.018), and correlated inversely with the middle ear & mastoid volume (P=0.005). However, perforations in anterior versus posterior locations showed no significant differences in mean ABG (P=0.924). Conclusion The degree of conductive hearing loss resulting from a tympanic membrane perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid. PMID:26045905

  10. Computed Tomography Features of Spontaneously Perforated Pyometra: A Case Report

    Chan, K.S.; Tan, C.K.; Mak, C.W.; Chia, C.C.; Kuo, C.Y.; Yu, W.L. [Chi-Mei Medical Center, Tainan, Taiwan (China). Depts. of Intensive Care Medicine, Radiology, Obstetrics and Gynecology, and Surgery

    2006-03-15

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

  11. Silent uterine perforation by an IUCD inserted during the puerperium

    Harvey, Hugh; Richenberg, Jonathan

    2011-01-01

    A 38-year-old lady, with a history of recent caesarean section, was diagnosed with a silent uterine perforation by a copper intrauterine contraceptive device under fluoroscopic examination. The incidence of uterine perforation and the increased risk in the puerperium are discussed. The use of ultrasound as the first line investigation is recommended.

  12. An Incarcerated Colon Inguinal Hernia That Perforated into the Scrotum and Exhibited an Air-Fluid Level

    Seisuke Ota

    2015-01-01

    Full Text Available There are few reports of a transverse colon inguinal hernia; furthermore, an inguinal hernia perforating the scrotum is rare. Here we report the case of a 79-year-old man who died after developing an incarcerated colon inguinal hernia that perforated the scrotum and exhibited an air-fluid level. The patient was referred to our hospital in November 2011 with a complaint of inability to move. Physical examination revealed an abnormally enlarged left scrotum and cold extremities. He reported a history of gastric cancer that was surgically treated more than 30 years ago. His white blood cell count and C-reactive protein level were elevated. Abdominal and inguinal computed tomography revealed that his transverse colon was incarcerated in the left inguinal canal. Free air and air-fluid level were observed around the transverse colon, suggestive of a perforation. The patient and his family refused any surgical intervention; therefore, he was treated with sultamicillin tosilate hydrate and cefotiam hydrochloride. However, he succumbed to panperitonitis 19 days after admission. The findings from this case indicate that the transverse colon can perforate into an inguinal hernia sac.

  13. CFD Simulations of Oscillating Flow around Solid and Perforated Plates

    2007-01-01

    Damping plates have been used for truss spars in gulf of Mexico to reduce the heave motions. The plates are usually perforated with holes for the passage of marine risers, but the effects of the perforation have not been examined thoroughly. In the present study, a computational fluid dynamics investigation into the hydrodynamic forces is carried out by using FLUENT, which is on two-dimensional perforated plates with varying degrees of perforation in oscillating flow under small Keulegan-Carpenter (KC) number. The numerical results of the hydrodynamic coefficients are presented. The effects of both the perforation ratio (PR) and KC number on the hydrodynamic coefficients of the plates are discussed. Some results of the simulated flow patterns around the plates were also given and discussed.

  14. Pneumoscrotum: A rare manifestation of perforation associated with therapeutic colonoscopy

    Kuang-I Fu; Takahiro Fujimori; Yasushi Sano; Shigeharu Kato; Takahiro Fujii; Masanori Sugito; Masato Ono; Norio Saito; Kiyotaka Kawashima; Shigeaki Yoshida

    2005-01-01

    Pneumoscrotum is uncommon and also rarely reported as a complication associated with colonic perforation. A case of colonic perforation in delayed fashion associated with EMR, revealed by pneumoscrotum, is reported and the associated literatures are reviewed. A 52-year-old male received piecemeal EMR for a laterally spreading tumor 35 mm in size in our hospital. He complained of enlargement of the scrotum and revisited our hospital the day after the procedure. A diagnosis of pneumoscrotum was made, and as most such cases have been reported to be associated with pneumoperitoneum, colonic perforation was suspected. Free air but no fluid collection was found by abdominal computed tomography, and delayed colonic perforation was diagnosed. However, as there were no clinical signs of peritoneal irritation,conservative treatment was administered and the patient recovered uneventfully. Pneumoscrotum could be a sign of colonic perforation after EMR, and treatment should be carefully chosen.

  15. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

    Loabat Geranpayeh

    2006-01-01

    Full Text Available 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.

  16. Acquired cystic kidney disease

    Choyke, P.L. [National Institutes of Health, Bethesda, MD (United States). Dept. of Diagnostic Radiology

    2000-11-01

    Acquired cystic kidney disease (ACKD), also known as acquired renal cystic disease (ARCD,) occurs in patients who are on dialysis for end-stage renal disease. It is generally accepted that ACKD develops as a consequence of sustained uremia and can first manifest even before dialysis is initiated while the patient is still in chronic renal failure. The role of immune suppression, particularly in transplant recipients, in the development of ACKD, is still under investigation. The prevalence of ACKD is directly related to the duration of dialysis and the risk of cancer is directly related to the presence of cysts. Herein we review the current understanding of the pathophysiology and imaging implications of ACKD. (orig.)

  17. Acquired cystic kidney disease

    Acquired cystic kidney disease (ACKD), also known as acquired renal cystic disease (ARCD,) occurs in patients who are on dialysis for end-stage renal disease. It is generally accepted that ACKD develops as a consequence of sustained uremia and can first manifest even before dialysis is initiated while the patient is still in chronic renal failure. The role of immune suppression, particularly in transplant recipients, in the development of ACKD, is still under investigation. The prevalence of ACKD is directly related to the duration of dialysis and the risk of cancer is directly related to the presence of cysts. Herein we review the current understanding of the pathophysiology and imaging implications of ACKD. (orig.)

  18. Acquired epidermolysis bullosa

    Maricel Sucar Batista; Yanier Serrano García; Taimí Miranda Vergara

    2015-01-01

    Epidermolysis bullosa is a group of diseases or skin disorders genetically transmitted and it is characterized by the appearance of bullae, ulcers and skin wounds. It usually appears at birth or in the first months of life. This is a case of a 72-year-old female patient who comes to the dermatology department with skin lesions of 6 months of evolution. A skin biopsy was performed, taking a sample for direct and indirect immunofluorescence. Acquired epidermolysis bullosa of unknown etiology wa...

  19. Acquired hypertrichosis lanuginosa

    Kumar Pramod

    1993-01-01

    Full Text Available Acquired hypertirichosis lanuginose developed rapidly in a patient with no detectable malignancy. Soft, fine, downy hair growth was noticed on the face, ears, limbs and trunk. Bilaterally symmetrical vitiliginous macules were present on the ear and preauricular region. This case is reported because of its rarity, absence of any detectable malignancy and development of vitiligo, which to our knowledge has not been reported earlier.

  20. AIDS: acquired immunodeficiency syndrome

    Gilmore, N. J.; Beaulieu, R.; Steben, M.; Laverdière, M.

    2002-01-01

    Acquired immunodeficiency syndrome, or AIDS, is a new illness that occurs in previously healthy individuals. It is characterized by immunodeficiency, opportunistic infections and unusual malignant diseases. Life-threatening single or multiple infections with viruses, mycobacteria, fungi or protozoa are common. A rare neoplasm, Kaposi's sarcoma, has developed in approximately one third of patients with AIDS. More than 800 cases of AIDS have been reported in North America, over 24 of them in Ca...

  1. [Focal spontaneous colic perforation in term or near-term neonates: rare and potentially insidious].

    Bartoli, F; Vasseur Maurer, S; Giannoni, E; Osterheld, M-C; Laubscher, B

    2011-04-01

    Two cases of neonatal focal spontaneous colic perforations are reported. The 1st infant, born at 36 3/7 weeks gestational age, presented on day 3 with crying, abdominal distension, and liquid stools. Clinical examination showed a slightly irritable hypothermic (35.7 °C) infant with a distended abdomen and few bowel sounds. Blood tests were normal apart from an elevated C-reactive protein level (59 mg/l). The abdomen x-ray was erroneously considered normal. The infant's condition remained stable for nearly 3 days. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was started on antibiotics and operated. Macroscopically, the entire gut was normal apart from a focal sigmoid perforation, which was stitched. A transmural colic biopsy revealed focal vascular dilation but was negative for necrotising enterocolitis or Hirschsprung disease. The infant recovered quickly. She is now a healthy, normal 3-year-old. The 2nd infant, born at 38 5/7 weeks gestational age, presented between day 1 and 2 with clinical signs of infection associated with slowly progressive ileus. The chest and abdomen x-ray was mistakenly considered normal. Frank septicemia developed. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was operated. Macroscopically, the small intestine was normal, the ascending and transverse colons were dilated, and the descending and sigmoid colons were narrow. Three cecal perforations were discovered and stitched. An ileostomy and multiple colic biopsies were also performed. The postoperative course was complicated by persistent septic ileus due to descending and sigmoid colon leaks, which led to colic resections with end-to-end anastomosis. Rectal aspiration biopsies were also performed. At 1 month of age, the infant was discharged from the hospital. The ileostomy was closed in two steps at 2 and 5 months

  2. Learning-By-Being-Acquired

    Colombo, Massimo G.; Moreira, Solon; Rabbiosi, Larissa

    -categorization theories, we argue that R&D team reorganization increases the acquired inventors’ use of the prior stock of technological knowledge of the acquiring firm after the acquisition. Furthermore, this effect is enhanced if acquired inventors have higher innovation ability relative to their acquiring peers but is...

  3. Intrathoracic Caecal Perforation Presenting as Dyspnea

    Vincent Granier

    2010-01-01

    Full Text Available 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.

  4. Spontaneous Perforation of Pyometra: A Case Report

    2006-01-01

    Full Text Available 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.

  5. Preliminary Clinical Study on Perforating Prosthokeratoplasty

    Jian Chen; Jintang Xu; SA Yakimenko; Guanghui Hou; Bingji Sun; Aning Zheng; Songbin Zhao

    2003-01-01

    Purpose: To observe the effects of perforating prosthokeratoplasty on patients with leucoma who failed in keratoplasty or were not suitable for keratoplasty, and improved their vision.Methods:Five cases with leucoma (4 with chemical burn and 1 with blast) received Yakimenko Style keratoprosthesis implantation. Preoperative examination showed the visual acuity in 4 of the 5 cases was light perception, and that of the other one was FC/20 crm.The light orientation in 3 patients was definite, and that in the other two was indefinite.Results: The vision improved in 4 of 5 patients in the follow-up period of 9 months to 3 years. Their visual acuity showed 0.09 to 0.8. And there was no change of vision in the other 1 case.Conclutions :Prosthokeratoplasty is the first choice for rehabilitation of the blind that have leucoma but are not suitable for or failed in penetrating keratoplasty.

  6. Laser-mediated perforation of plant cells

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

    2007-07-01

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

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

    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

  8. Premixed Combustion of Coconut Oil on Perforated Burner

    I.K.G. Wirawan

    2013-10-01

    Full Text Available Coconut oil premixed combustion behavior has been studied experimentally on perforated burner with equivalence ratio (φ varied from very lean until very rich. The results showed that burning of glycerol needs large number of air so that the laminar burning velocity (SL is the highest at very lean mixture and the flame is in the form of individual Bunsen flame on each of the perforated plate hole. As φ is increased the  SL decreases and the secondary Bunsen flame with open tip occurs from φ =0.54 at the downstream of perforated flame. The perforated flame disappears at φ = 0.66 while the secondary Bunsen flame still exist with SL increases following that of hexadecane flame trend and then extinct when the equivalence ratio reaches one or more. Surrounding ambient air intervention makes SL decreases, shifts lower flammability limit into richer mixture, and performs triple and cellular flames. The glycerol diffusion flame radiation burned fatty acids that perform cellular islands on perforated hole.  Without glycerol, laminar flame velocity becomes higher and more stable as perforated flame at higher φ. At rich mixture the Bunsen flame becomes unstable and performs petal cellular around the cone flame front. Keywords: cellular flame; glycerol; perforated flame;secondary Bunsen flame with open tip; triple flame

  9. Thoracodorsal artery perforator flap for upper limb reconstruction

    Thoracodorsal artery perforator flap (TAP) is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required. Methods: This case series was carried out at department of Plastic and Reconstructive Surgery Combined Military Hospital Rawalpindi. A total of 5 patients with upper limb defects were reconstructed with thoracodorsal artery musculocutaneous perforator flaps. Among them, 3 were pedicled and two free TAP flaps. All flaps except one pedicled flap were raised on a single perforator pedicle. Recipient sites were one axilla, two shoulder regions and two hands. The soft tissue defects in the patients had resulted from burns, trauma, wide local excision of synovial sarcoma and surgery for hidradenitis suppurativa. Preoperative hand held Doppler ultrasound was used to locate and mark the perforator. Results: All flaps survived without significant complications. All flaps were hyperemic in the immediate postoperative period. We designed and raised all the five flaps on eccentrically placed perforators. All the raised perforators originated from the descending branch of the thoracodorsal artery. The donor sites were closed primarily with linear scars in all cases except one, in which partial closure was accomplished with split thickness skin grafting (STSG). Conclusion: The thoracodorsal artery perforator flap has great potential for reconstructing large, relatively shallow, defects of upper limb because of its suitable skin quality, texture and appropriate thickness, as well as hidden donor site, a reliable pedicle and sparing of muscle unit. (author)

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

    Bruna Schwingel Schmidt

    2016-01-01

    Full Text Available 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 (1,024Χ 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.

  11. A Comparison between Amalgam and MTA in Repairing Furcal Perforation

    H. Ghanbari

    2008-09-01

    Full Text Available Objective: The purpose of this study was to investigate the histological response to delib-erate perforation repaired using amalgam or MTA either immediately or with delay on cats’ molars.Materials and Methods: Twenty-eight molar teeth from four cats were used in this ex-perimental randomized study. After preparing the access cavity, the floor of pulp cham-bers were deliberately perforated with a round bur No. 5. The teeth were randomly divided into four groups of seven. In groups one and two,the perforation was immediately sealed with amalgam and MTA, respectively. In groups three and four, the perforations were leftexposed to saliva for six weeks and then sealed with amalgam or MTA. The animals were sacrificed four months later and the specimens processed. The samples were blindly exam-ined for inflammatory reaction and healing process under light microscope. The data were analyzed with Mann-Whitney U and Fisher exact tests.Results: The type of the materials used has no significant effect on the severity of in-flammation; while, immediate or delayed repair of furcal perforation has, and immediate application of, MTA produced less inflammation than that of amalgam (P<0.05. No dif-ferences were found in vasodilatation, abscess formation or healing process between the immediate and the delayed repair groups (P=0.13.Conclusion: MTA is a more suitable material than amalgam for perforation repair, par-ticularly when used immediately after perforation.

  12. Acquired von Willebrand Syndrome

    郭涛

    2005-01-01

    @@ Acquired von Willebrand syndrome (AvWS) is kind of bleeding disorder with laboratory findings similar to those in congenital yon Willebrand disease (vWD).AvWS doesn's have any personal or family history of bleeding, but is associated with certain diseases or abnormal conditions or drugs. Although AvWS is being stated as a rare disease, it has gained more and more attention during the past years. Not because of the severity of the disease, but it is more common than we thought and most patients don' t have a proper diagnosis.

  13. Acquired epidermolysis bullosa

    Maricel Sucar Batista

    2015-12-01

    Full Text Available Epidermolysis bullosa is a group of diseases or skin disorders genetically transmitted and it is characterized by the appearance of bullae, ulcers and skin wounds. It usually appears at birth or in the first months of life. This is a case of a 72-year-old female patient who comes to the dermatology department with skin lesions of 6 months of evolution. A skin biopsy was performed, taking a sample for direct and indirect immunofluorescence. Acquired epidermolysis bullosa of unknown etiology was diagnosed. Treatment was started with low-dose colchicine to increase it later, according to the patient’s tolerance and disease progression.

  14. Oral antibiotics for perforated appendicitis is not recommended

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...... was to give an overview of studies on acute perforated appendicitis with postoperative oral antibiotics. Five studies were found in a database search covering the 1966-2009 period. There is no evidence to support a conversion of the postoperative antibiotic regimen from intravenous to oral...... administration in patients with acute perforated appendicitis....

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

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

    2010-01-01

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

  16. MISSED CONGENITAL PYLORIC ATRESIA WITH GASTRIC PERFORATION IN A NEONATE

    Yousuf Aziz Khan

    2012-04-01

    Full Text Available Congenital pyloric atresia is a rare anomaly accounting for less than 1% of upper GI atresias. It may occur in isolation or in association with other congenital anomalies, epidermolysis bullosa being the most frequent. It presents with upper abdominal distension, non-bilious vomiting or rarely with complications as aspiration pneumonia, electrolyte imbalance or gastric perforation. Though iatrogenic gastric perforations secondary to aggressive resuscitation with bag-mask ventilation and nasogastric intubation are the most frequent in newborns, neonatal gastric perforation due to congenital outlet obstruction have rarely been reported.

  17. Nasal Septal Perforation Caused by Invasive Fungal Sinusitis

    Wai-Tin Kuo

    2002-11-01

    Full Text Available Nasal septal perforation presents a distinct challenge to otorhinolaryngologists, and is aproblem for patients. Although it has a variety of causes, previous septal surgery is the mostcommon reason. We present a 57-year-old woman who had recurrent chronic sinusitis. Aleft nasal mass was noted and excised via endoscopic sinus surgery. Invasive aspergillosissinusitis was proven both grossly and histopathologically, and a nasal septal perforation wasalso noted during the operation. Although there has been only a single other case presentedby Siberry in 1997, we postulate that perforation of the nasal septum as with the casedescribed herein is a rare complication of invasive fungal sinusitis.

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

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

    2016-01-01

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

  19. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

    Loabat Geranpayeh; Mohsen Fadaei-Araghi; Behnam Shakiba

    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, li...

  20. External perforated Solar Screens for daylighting in residential desert buildings: Identification of minimum perforation percentages

    Sherif, Ahmed

    2012-06-01

    The desert climate is endowed by clear sky conditions, providing an excellent opportunity for optimum utilization of natural light in daylighting building indoor spaces. However, the sunny conditions of the desert skies, in countries like Egypt and Saudi Arabia, result in the admittance of direct solar radiation, which leads to thermal discomfort and the incidence of undesired glare. One type of shading systems that is used to permit daylight while controlling solar penetration is " Solar Screens" Very little research work addressed different design aspects of external Solar Screens and their influence on daylighting performance, especially in desert conditions, although these screens proved their effectiveness in controlling solar radiation in traditional buildings throughout history.This paper reports on the outcomes of an investigation that studied the influence of perforation percentage of Solar Screens on daylighting performance in a typical residential living room of a building in a desert location. The objective was to identify minimum perforation percentage of screen openings that provides adequate illuminance levels in design-specific cases and all-year-round.Research work was divided into three stages. Stage one focused on the analysis of daylighting illuminance levels in specific dates and times, while the second stage was built on the results of the first stage, and addressed year round performance using Dynamic Daylight Performance Metrics (DDPMs). The third stage addressed the possibility of incidence of glare in specific cases where illuminance levels where found very high in some specific points during the analysis of first stage. The research examined the daylighting performance in an indoor space with a number of assumed fixed experimentation parameters that were chosen to represent the principal features of a typical residential living room located in a desert environment setting.Stage one experiments demonstrated that the screens fulfilled the

  1. External perforated window Solar Screens: The effect of screen depth and perforation ratio on energy performance in extreme desert environments

    Sherif, A.

    2012-09-01

    In hot arid desert environments, the solar radiation passing through windows increases the cooling loads and the energy consumption of buildings. Shading of windows can reduce these loads. Unlike the woven solar screens, wooden solar screens have a thickness that provides selective shading properties. Perforated wooden solar screens were traditionally used for windows shading. Developing modern types of these shading systems can lead to significant energy savings. The paper addresses the influence of changing the perforation percentage and depth of these screens on the annual energy loads, hence defining the optimum depth/perforation configurations for various window orientations. Series of experiments were performed using the EnergyPlus simulation software for a typical residential building in the Kharga Oasis, located in the Egyptian desert. A range of perforation percentages and depths were tested. Conclusions prove that external fixed deep perforated solar screens could effectively achieve energy savings up to 30% of the total energy consumption in the West and South orientations. Optimum range of depths and perforation percentages were recommended. These are: 80-90% perforation rate and 1:1 depth/opening width ratio. These lighter and deeper solar screen configurations were found to be more efficient in energy consumption in comparison with the traditional ones. © 2012 Elsevier B.V. All rights reserved.

  2. CT findings of hepatic abscess arising from perforated acute cholecystitis

    Choi, Sang Hee; Lee, Kyoung Soo; Lee, Jin Seoung; Lee, Moon Gyu; Chung, Young Hwa; Lee, Young Sang; Lee, Sung Gyu; Auh, Yong Ho [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    The purpose of this study was to report the CT findings of four patients with hepatic abscess secondary to perforated acute cholecystitis. We retrospectively reviewed the CT findings of four patients with surgically proven hepatic abscess secondary to perforated acute cholecystitis. CT findings were analysed with respect to the observation of the gallbladder, pericholecystic space, hepatic lesions, and peritoneal cavity. All patients underwent cholecystectomy, with drainage of the hepatic abscess. CT findings of hepatic abscess secondary to perforated acute cholecystitis were hypodense mass formation in the pericholecystic space(n=3), irreguarity and wall defect of Gallbladder(n=4), thickened Gallbladder wall(n=4), stone with debris(n=4), and local or diffuse infiltration of the pericholecystic area(n=3), omentum, and mesentery. CT was helpful in diagnosing the hepatic abscess secondary to perforated acute cholecystitis.

  3. Wave Damping over a Perforated Plate with Water Chambers

    ZHU Shutang

    2006-01-01

    The movement of waves propagating over a horizontally submerged perforated plate with waterfilled chambers bellow the plate was investigated by using linear potential theory. The analytical solution was compared with laboratory experiments on wave blocking. The analysis of the wave energy dissipation on the perforated bottom surface shows that the effects of the perforated plate on thewave motion depend mainly on the plate porosity, the wave height, and the wave period. The wave number is a complex number when the wave energy dissipation on the perforated plate is considered. The real part of the wave number refers to the spatial periodicity while the imaginary part represents the damping modulus. The characteristics of the wave motion were explored for several possible conditions.

  4. Colon perforation after esophagogastroduodenoscopy in an asymptomatic diverticulitis patient

    Li-Wen Huang

    2016-03-01

    Full Text Available Esophagogastroduodenoscopy (EGD is regarded as a relatively safe procedure; however, it carries a very low incidence of severe adverse events. Perforation is a rare complication of EGD, and it may further lead to pneumoperitoneum or pneumoretroperitoneum. The occurrence of large bowel perforation after EGD is extremely rare, and it has never been reported in the international literature. Herein, we present a case of concurrence of pneumoperitoneum and pneumoretroperitoneum as a result of sigmoid perforation after EGD. In our case, the probable mechanism of the perforation may have stemmed from the excessive inflation of air that passed through the gastrointestinal tract to the sigmoid colon, causing the increased intraluminal pressure, and then prompting a healed asymptomatic diverticulitis leak again.

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

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

    2015-09-01

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

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

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

    2016-09-01

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

  7. Laparoscopic lavage for perforated diverticulitis: a population analysis.

    Rogers, Ailín C

    2012-09-01

    Laparoscopic lavage has shown promising results in nonfeculent perforated diverticulitis. It is an appealing strategy; it avoids the complications associated with resection. However, there has been some reluctance to widespread uptake because of the scarcity of large-scale studies.

  8. Acquired Blaschkoid dermatitis

    Mercy P

    2007-01-01

    Full Text Available Acquired Blaschkoid dermatitis characterised by unilateral relapsing inflammatory disease along the lines of Blaschko. A 40-year-old Indian male presented with unilateral erythematous, itchy grouped papules on the left side of the chest, abdomen, back and left arm of 15 days duration. The eruption stopped abruptly at the midline of the torso, completely sparing the right side of the body. The lesions were arranged in whorls and streaks corresponding to the lines of Blaschko. Skin biopsy showed hyperkeratosis and features suggestive of sub-acute spongiotic dermatitis with lymphocytic infiltrate around the blood vessels in the dermis. Patient was diagnosed as a case of Blaschkoid dermatitis. To the best of our knowledge, this is the first case of this condition being reported from India.

  9. Radiologic findings of perforated jejunal diverticulitis: a case report

    We report a case of perforated jejunal diverticulitis in a 68-year-old man with iatrogenic Cushing's syndrome. The patient presented with right upper abdominal pain. Ultrasonography showed a hypoechoic structure connected to a small bowel loop, and subsequent CT examination showed multiple diverticula in proximal jejunal loops with free air trapped within the mesenteric leaf. Segmental resection of the jejunal loop confirmed jejunal diverticulitis with perforation

  10. Radiologic findings of perforated jejunal diverticulitis: a case report

    Kong, Jeong Hwa; Lee, Dong Ho; Kim, Hyoung Jung; Lim, Joo Won; Ko, Young Tae; Park, Yong Koo [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2006-04-15

    We report a case of perforated jejunal diverticulitis in a 68-year-old man with iatrogenic Cushing's syndrome. The patient presented with right upper abdominal pain. Ultrasonography showed a hypoechoic structure connected to a small bowel loop, and subsequent CT examination showed multiple diverticula in proximal jejunal loops with free air trapped within the mesenteric leaf. Segmental resection of the jejunal loop confirmed jejunal diverticulitis with perforation.

  11. Effects of Aging Temperature on Moisture Absorption of Perforated GFRP

    Farid Taheri; Fathollah Taheri-Behrooz; Shiva Eslami

    2012-01-01

    This paper examines the effects of aging on the flexural stiffness and bending loading capacity of a perforated glass fiber-reinforced epoxy composite subjected to combined moisture and elevated temperature. Specimens, in the configuration of one-quarter of a perforated GFRP tube, were aged in 60% humidity and temperatures of 40, 60, and 80°C, respectively. Moisture absorptions of the specimens were measured during the aging process, and bending tests were conducted on the specimens after agi...

  12. To drain or not to drain in perforated peptic ulcer

    Zafer Kilbas; Nail Ersoz

    2012-01-01

    In their study, published in the current issue of the Journal of Experimental and Integrative Medicine, Ansari et al investigated the role of prophylactic abdominal drain usage in perforated peptic ulcer (PPU), a frequently performed surgical procedure in the emergency departments. Surgical treatment of PPU has not changed much, i.e. primary closure of the perforation and careful cleansing of the abdominal cavity, since it was described by Johann von Mikulicz-Radecki (1850-1905). There have b...

  13. Gallstone spillage caused by spontaneously perforated hemorrhagic cholecystitis

    2007-01-01

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

  14. Delayed lead perforation: a rare cause of pacemaker dysfunction.

    dos Santos, Luís Ferreira; Costa, Filipa; Correia, Emanuel; Rodrigues, Bruno; Moreira, Davide; Correia, Hugo; Nunes, Luís; Pipa, João; Costa, António; de Carvalho, Lopes; Cabral, Costa; Ribeiro, Nuno; de Olival, Ramos; Santos, Oliveira

    2011-06-01

    A 65-year-old woman with a dual-chamber pacemaker implanted in 2006 for symptomatic carotid sinus hypersensitivity was incidentally found to have loss of ventricular capture on routine pacemaker interrogation. A chest X-ray raised the suspicion of perforation and migration of the right ventricular lead, confirmed by three-dimensional echocardiogram and CT scan. On the basis of this case, we review myocardial lead perforation, including predisposing factors, pathophysiological mechanisms, diagnostic approach and therapeutic options. PMID:21874925

  15. Endometriosis of the Appendix Resulting in Perforated Appendicitis

    Hasegawa, Toru; Yoshida, Koichi; Matsui, Kazuhiro

    2007-01-01

    Endometriosis is a relatively common disease among women of reproductive age. However, gastrointestinal endometriosis is rare and endometriosis of the appendix resulting in perforated appendicitis is even rarer. We experienced a case of endometriosis of the appendix manifesting as panperitonitis caused by perforation of the appendix. The patient was a 35-year-old woman who was hospitalized with an acute abdomen. She was diagnosed with panperitonitis and underwent urgent laparotomy. When perfo...

  16. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

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

    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 ...

  17. A RETROSPECTIVE STUDY ON DUODENAL ULCER PERFORATION AND OUTCOME

    Parameshwara Chaldiganahalli

    2016-02-01

    Full Text Available INTRODUCTION Duodenal ulcer disease which was once so common 3-4 decades ago has drastically decreased in its incidence due to invent of PPIs and anti H. Pylori therapy. But percentage of patients with complications of duodenal ulcer has not shown a similar decline. In spite of understanding the disease effective resuscitation and prompt surgery there is still High incidence of morbidity and mortality. Hence in this study an attempt is made to analyse the various factors which effect the morbidity, mortality of patients with duodenal ulcer perforation and management of the same. AIMS The objective is to study, 1. The factors responsible for duodenal ulcer perforation. 2. The factors that affect the post-operative outcome. 3. Morbidity, mortality after surgery. MATERIALS AND METHODS Fifty patient’s case sheets were selected retrospectively who were diagnosed as duodenal ulcer perforation, admitted in MIMS Hospital, Mandya. Between 2012 to 2014 patients underwent Graham's omentoplasty. All the data related to the objectives of the study were collected. RESULTS Majority of patients belong to the. Age group of 30-50 years and commonly males Most of the perforations occur in first part of duodenum low socio-economic group, O+ve blood group with maximum seasonal incidence in October-January All cases were managed by Graham's omentoplasty. Four per cent of mortality noted. CONCLUSION Duodenal ulcer perforation is one of the common acute abdominal emergencies. The peak incidence between 30 and 50 years, majority cases males, common in lower socio–economic group, unskilled workers, maximum incidence period October-January, increased morbidity and mortality when perforation time period >24 hours, maximum in patient with blood group o+, early diagnosis and septicaemia management necessary for patients better prognosis, emergency procedure is Graham’s omentoplasty (perforations<2cm with H. pylori eradication treatment. Mortality noticed in longer

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

    Samantha M. Field

    2014-01-01

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

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

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

    2014-01-01

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

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

    Korambayil Pradeoth

    2010-01-01

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

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

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

    2010-01-01

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

  2. Simulating Perforation Permeability Damage and Cleanup; TOPICAL

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

  3. Intraocular cilia associated with perforating injury

    Gopal Lingam

    2000-01-01

    Full Text Available Purpose: To report a case series of penetrating injury complicated by occurrence of intraocular cilia. Methods: Retrospective analysis of charts of 11 eyes of 11 patients with penetrating injury and intraocular cilia, presenting between September 1978 and November 1998. Ten eyes underwent surgery for trauma-related problems such as cataract, vitritis, retinal detachment etc., at which time intraocular cilia were removed. One eye did not have surgery and continues to harbour cilia at the posterior perforation site. Results: Metallic wire was responsible for injury in 6 of 11 eyes with intraocular cilia. Five eyes had significant intraocular inflammation. The cilia were located in the anterior segment in 4 eyes; in the posterior segment in 6 eyes and in both in one eye. At the last follow up, 72.7% had 6/18 or better vision. Poor vision in the rest was due to recurrent retinal detachment (2 eyes and macular scarring (1 eye. Conclusion: Intraocular cilia are more commonly associated with injury by a metallic wire. The presentation and management of an injured eye does not seem to be influenced by the presence of cilia in the eye.

  4. [Intraperitoneal perforation of hepatic hydatid cyst].

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

    2006-10-01

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

  5. Neonatal gastric perforation: A single center experience

    Jeik; Byun; Hyun; Young; Kim; Seung; Yeon; Noh; Soo; Hong; Kim; Sung; Eun; Jung; Seong; Cheol; Lee; Kwi; Won; Park

    2014-01-01

    AIM: To determine the etiology and prognostic factors for neonatal gastric perforation(NGP), a rare but life-threatening disease.METHODS: Between 1980 and 2011, nine patients un-derwent surgical intervention for NGP at Seoul National University Children’s Hospital. The characteristics and prognosis of the patients were retrospectively analyzed.RESULTS: Among the nine patients, three(33.3%) were preterm babies and five(55.5%) had associated anomalies, which included diaphragmatic eventration(n = 2), congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, and antral web. Three(33.3%) patients were born before 1990 and three(33.3%) had a birth weight < 2500 g. Pneumo-peritoneum was found on preoperative images in six(66.7%) patients, and incidentally in the other three(33.3%) patients. Surgery was performed within 24 h after the onset of symptoms in seven(77.8%) patients. The overall mortality rate was 22.2%(2/9). The time between symptoms and surgical intervention was the only prognostic factor for survival, whereas premature birth and birth weight were not.CONCLUSION: Early detection and advances in neo-natal intensive care may improve the prognosis of NGP.

  6. Tensor fascia latae perforator flap: An alternative reconstructive choice for anterolateral thigh flap when no sizable skin perforator is available

    Federico Contedini

    2013-01-01

    Full Text Available Introduction: The anterolateral thigh flap (ALT is a versatile flap and very useful for the reconstruction of different anatomical districts. The main disadvantage of this flap is the anatomical variability in number and location of perforators. In general, absence of perforators is extremely rare. In literature, it is reported to be from 0.89% to 5.4%. If no sizable perforators are found, an alternative reconstructive strategy must be considered. Tensor fascia lata (TFL perforator flap can be a good alternative in these cases: Perforator vessels are always present, the anatomy is more constant and it is possible to harvest it through the same surgical access. The skin island of the flap can be very large and can be thinned removing a large part of the muscle allowing its use for almost the same indications of the ALT flap. Materials and Methods: We report 11 cases of reconstruction firstly planned with the ALT flap, then converted into TFL perforator flap. Results and Conclusion: The result was always satisfactory in terms of the donor site morbidity and reconstructive outcome.

  7. Intercontrole acquiring by Framatome

    The Framatome group, as the worldwide leader in nuclear power plant construction, has reinforced his competences in nuclear services thanks to the acquiring of the Intercontrole company, specialized in non-destructive testing in nuclear and industrial environments. After a presentation of the functioning principle and of the safety aspects of a PWR reactor, this press dossier presents in a first part the role of nuclear services and in particular of non-destructive testing in nuclear power plants (in-service inspection, regulatory aspects, testing processes). This part is illustrated with some examples of inspection performed on some components of the primary coolant loop (steam generators, reactor vessel, pressurizer, pipes, primary pumps). A second part presents the technical centres and units of Framatome in charge of performing non-destructive inspections, while a third part describes the industrial policy and strategy of the group in this domain (market of nuclear park maintenance in France, in the USA and worldwide, creation of the 'inspection and control' centre of Framatome). A last part presents the activities of the Intercontrole company and of its daughter companies with some examples of actions realized in the nuclear and natural gas domains. (J.S.)

  8. Small Bowel Perforation Caused by Pancreaticojejunal Anastomotic Stent Migration after Pancreaticoduodenectomy for Periampullary Carcinoma

    Giulio Mari

    2015-05-01

    Full Text Available Context Pancreaticoduodenectomy is the gold standard for patients with resectable periampullary carcinoma. The protection of the anastomosis by positioning of an intraluminal stent is a technique used to lower the frequency of anastomotic fistulas. However the use of anastomotic stents is still debated and stent related complications are reported. Case report A fifty-three-year old male underwent pancreaticoduodenectomy (PD for a T2N0 periampullary carcinoma with a pancreaticojejunal (duct to mucosa anastomosis protected by a free floating 6 Fr Nelaton stent in the Wirsung duct. Twenty-three months after surgery the patient accessed Emergency Department for severe abdominal pain associated to temperature, high white blood cell count and an significant increase in C reactive protein. Method Abdominal CT scan shown the presence of a tubular stent in the mesogastrium/lower right quadrant. No evident free intra-abdominal air was detected. The patient was submitted to explorative laparotomy. After debridement for localized peritonitis the Nelaton trans anastomotic stent was found in the abdomen. There was no evidence of bowel perforation, but intestinal loops covered with fibrin and suspect for impending perforation were resected. Conclusion There is a lack of evidence about the true rate of post-operative complications related to pancreatic stenting. We believe that in patients presenting with abdominal pain or peritonitis that previously underwent PD with stentguided pancreaticojejunal anastomosis, the hypothesis of stent migration should at least be taken into consideration.

  9. CORRELATION BETWEEN TYMPANIC MEMBRANE PERFORATION AND HEARING LOSS

    Lidija RISTOVSKA

    2016-04-01

    Full Text Available Introduction: Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. The perforation causes conductive hearing loss by reducing the surface area available for sound transmission to the ossicular chain. Objective: The objective was to analyze the characteristics of tympanic membrane perforations in relation to hearing loss and to determine the type and degree of hearing loss. Materials and methods: We analyzed audiometric, otoscopic findings and medical reports of 218 patients, 114 males (52.3% and 104 females (47.7%, aged 9 to 75 years (mean age of 47.9 years, examined during the period of November 2012 to October 2015. For statistical data analysis we used Chi-square test with level of significance p<0.05. Results: Most of the patients had unilateral perforations (89% with right ear predominance and involvement of two quadrants of pars tensa (37.2%. Mean air-bone gap was 23.9 dB. The largest air-bone gap was at frequency of 250 Hz. Most of the patients (73.1% had mixed hearing loss (p=0.032, and average hearing thresholds from 21 to 40 dB. Conclusion: Mean air-bone gap is largest at the lower frequencies, and decreases as frequency increases. Size of the perforation has effect on hearing loss. Mean air-bone gap increases with increasing size of the perforation. There is no big difference between the mean air-bone gap in posterior versus anterior perforations.

  10. Peptic Perforation of the 4th Duodenal Segment. Case Report

    Cimpean Sorin

    2015-03-01

    Full Text Available Introduction: Even if the prevalence of peptic ulcer disease has decreased in the last years, duodenal perforation remains a life threatening complication. The duodenum is the second most common site of gastrointestinal perforations after the colon and perforation of the 4th portion is very rare. Case Presentation: A 67-yers-old man was admitted to the emergency department of the Annecy Hospital with intense abdominal pain, vomiting and no transit for the last 24 hours. The laboratory count showed an inflammatory syndrome. A CT scan revealed free air and fluid near the Treitz’s angle. An exploratory laparotomy was performed that revealed a perforation of the forth portion of the duodenum. A duodenal resection with duodeno-jejunal anastomosis was performed. Discussions: Peptic ulcer disease is a common disease and the perforation is one of its most life threatening complications. The localization of the DP on the forth segment of the duodenum is very unusual. The most frequent localization of DP is the first duodenal segment. Abdominal CT scan is the most sensitive radiological exam if there is suspicion of a DP. A Zollinger-Ellison syndrome must be taken into count. Peritonitis is an indication for immediate laparoscopy or laparotomy, taking into account the patient’s condition. Despite the successful medication therapy and the progress in treatment of duodenal ulcer, perforation remains a serious complication, requiring an emergency surgical treatment. Conclusion: Duodenal perforation of the fourth portion is an extremely rare complication of the peptic ulcer disease and the surgery is the primary modality of treatment.

  11. Jet Screech Reduction with Perforated Flat Reflector

    2008-01-01

    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.

  12. Does Ramadan Fasting Increase duodenal ulcer perforation?

    Abdoulhossein Davoodabadi

    2016-03-01

    Full Text Available Introduction: In Ramadan, healthy adult Muslims are obliged to fast. Prolonged fasting increase gastric acid and pepsin levels, which promote the risk of duodenal ulcer perforation (DUP. Effects of Ramadan fasting on DUP have not been thoroughly studied yet, and the limited number of studies investigating the impact of Ramadan fasting on DUP yielded discrepant results. This study aimed to evaluate DUP frequency during Ramadan 2011-2015 and compare it with other months. Methods: This cross-sectional study was performed in 82 patients undergoing surgery due to DUP during July 2011-September 2015. The demographics, history of addiction, use of nonsteroidal and antiinflammatory drugs, previous history of acid peptic disease, as well as complications and outcomes of treatment were recorded and analyzed, and the obtained results were compared between Ramadan and other lunar months. Results: The majority of patients were male (86.6%, 71 patients, with a mean age of 43.9±16.5 years (age range: 20-75 years. Male to female ratio was 6:1. Cases with less than 30 years of age were less frequent (22%, 18 patients. DUP was more frequent during Rajab with nine cases (11%, while during Ramadan, six cases were reported, the difference between Ramadan and other months regarding the incidence of DUP was not significant (P=0.7. Risk factors such as smoking (60% and addiction (44%; especially to crystal and crack were noted. Consumption of nonsteroidal antiinflammatory drugs in 20 (24% patients, and use of antacids in 17 (25% patients. Distribution of DUP in different blood types was as follows: O+=41%, A+=28%, B+=23%, AB=5%, and O-=3%; moreover, post-operative Helicobacter pylori antibody was present in 67% of the patients. Conclusion: Ramadan fasting did not escalate DUP incidence, and those with DUP risk factors can fast with the use of antacids.

  13. Bladder perforation in a peritoneal dialysis patient

    M Ounissi

    2012-01-01

    Full Text Available The dysfunction of the catheter in peritoneal dialysis (PD is a frequent compli-cation. However, perforation of organs are rare, particularly that of the urinary bladder. This re-quires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.

  14. A CLINICAL STUDY ON PATIENTS WITH DUODENAL ULCER PERFORATION

    Kishore Babu

    2016-03-01

    Full Text Available INTRODUCTION Perforated duodenal ulcer, the most catastrophic complication was Associated with high mortality in the past due to late presentation of the patients, delay in surgery and lack of antibiotics. Various authors state that the incidence of peptic ulcer disease and perforation has been declining for the past 3 decades. Because of advances in the medical therapy of peptic ulcer with a wide range of drugs the management of peptic ulcer disease has been changing and the role of surgery has been declining. Perforation is usually seen in 3rd and 4th decades with a male preponderance and the epidemiological trend is not the same worldwide. Incidence is slightly declining in western countries. The present study has been done during the period between 2013 and 2014 in S. V. R. R. Government general hospital Tirupati. AIMS AND OBJECTIVES The aim of the present study is to analyze the probable factors for increase in incidence of duodenal ulcer perforation, with particular emphasis on assessment of impact of H2 receptor antagonists and Proton Pump inhibitors on the incidence of perforation. STUDY SETTING S. V. Medical College, Department of General Surgery, Tirupati. STUDY PERIOD Patients attending S. V. Medical College, Department of General Surgery with perforation during the period from November 2013 to October 2014. INCLUSION CRITERIA Patients between age group of more than 14 years presenting with pain abdomen and who are diagnosed to have peritonitis due to duodenal ulcer perforation. EXCLUSION CRITERIA Patients with peritonitis due causes other than duodenal ulcer. STUDY METHOD Prospective Observational study among the selected patients. Total numbers of peptic ulcer cases that were admitted in this hospital and treated either medically or surgically were noted. The details of their clinical history and findings, investigation reports, operative findings, post-operative complications were recorded. Simple closure was performed for all the

  15. Laparoscopic Management of Perforated Meckel's Diverticulum in Adults

    Yinlu Ding, Yong Zhou, Zhipeng Ji, Jianliang Zhang, Qisan Wang

    2012-01-01

    Full Text Available Objective: To determine the role of laparoscopy in diagnosis and surgical treatment of perforated Meckel's diverticulum (MD in adults.Methods: Between July 2003 and July 2011, fifteen patients were seen with perforated MD. Eleven were male and four were female. The median age was 38 years (range, 21-68. All patients presented with a sudden onset of pain. Among them 9 had a past medical history of bloody stools and /or chronic recurrent abdominal pain. 2 were preoperatively diagnosed with perforated MD confirmly and 4 suspiciously, 9 with perforated acute appendicitis. All 15 patients underwent exploratory laparoscopy.Results: 4 patients with broad-base(≧ 2 cm and 2 patients with narrow-base(<2 cm whose perforative site was near the base underwent laparoscopically assisted extracorporal bowel segment resection, the other 9 patients with narrow-base(<2 cm underwent laparoscopically intraabdominal wedge resection of the MD. No intraoperative or postoperative complications occurred. The median hospital stay was 4 days (range, 2-7days. The histopathologic studies showed heterotopic gastric mucosa (HGM in 10 cases (66.7%. All patients recovered uneventfully.Conclusion: To patients with sudden abdomen pain mimic acute appendicitis accompanied by a past medical history of bloody stools and/or chronic recurrent abdominal pain, proferated MD should be kept in mind as a differential diagnosis. Laparoscopy is a safe and effective surgical modality for diagnosis of proferated MD and has a therapeutic role that results in an excellent cosmetic result.

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

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

    2015-09-10

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

  17. Perforated duodenal ulcer: A rare complication of deferasirox in children

    Sunil Kumar Yadav

    2013-01-01

    Full Text Available 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.

  18. Changing trend in emergency surgery for perforated duodenal ulcer

    Objective: To evaluate changes in the emergency surgery of the duodenal ulcer. Subjects and Methods: Hospital records of 523 surgically treated patients, with duodenal ulcer perforation, during the period of 25 years 91975-1999) in the same surgical department, was retrospectively analysed. Changing aspects of emergency surgery of peptic ulcer disease, in the recent period, were determined in respect to number of operations per year and in the choice of operative methods. Results: The average number of patients and emergency operations per year was 21. No significant change was observed during the study period. Elective operations gradually decreased in the last ten years, and none was performed in the last 4 years. On the other hand, 226 emergency interventions for duodenal ulcer perforation were performed in the last ten years and 84 interventions in the last 4 years. Definitive anti-ulcer surgery was performed in 42% of patients between 1985 and 1994. Simple closure of the perforation plus treatment with proton pump inhibitors and with anti-Helicobacter pylori medication was the method in 80% during the last year. Conclusion: Emergency surgery for perforated duodenal ulcer preserves its steady rate despite disappearance of elective operations after tremendous progress in medical control of peptic ulcer disease. There is an obvious return from definitive anti-ulcer surgery to simple closure of the perforation followed by antisecretory and antibacterial medications in the recent years. (author)

  19. Reactive Arthritis

    Eren Erken

    2013-06-01

    Full Text Available Reactive arthritis is an acute, sterile, non-suppurative and inflammatory arthropaty which has occured as a result of an infectious processes, mostly after gastrointestinal and genitourinary tract infections. Reiter syndrome is a frequent type of reactive arthritis. Both reactive arthritis and Reiter syndrome belong to the group of seronegative spondyloarthropathies, associated with HLA-B27 positivity and characterized by ongoing inflammation after an infectious episode. The classical triad of Reiter syndrome is defined as arthritis, conjuctivitis and urethritis and is seen only in one third of patients with Reiter syndrome. Recently, seronegative asymmetric arthritis and typical extraarticular involvement are thought to be adequate for the diagnosis. However, there is no established criteria for the diagnosis of reactive arthritis and the number of randomized and controlled studies about the therapy is not enough. [Archives Medical Review Journal 2013; 22(3.000: 283-299

  20. Reactive Safety

    Rüdiger Ehlers; Bernd Finkbeiner

    2011-01-01

    The distinction between safety and liveness properties is a fundamental classification with immediate implications on the feasibility and complexity of various monitoring, model checking, and synthesis problems. In this paper, we revisit the notion of safety for reactive systems, i.e., for systems whose behavior is characterized by the interplay of uncontrolled environment inputs and controlled system outputs. We show that reactive safety is a strictly larger class of properties than standard...

  1. Intestinal perforation management using T-tube drainage

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

    2016-01-01

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

  2. Primary tubercular caecal perforation: a rare clinical entity

    Moses Sonia

    2010-03-01

    Full Text Available Abstract Background Intestinal tuberculosis is a common problem in endemic areas, causing considerable morbidity and mortality. An isolated primary caecal perforation of tubercular origin is exceptionally uncommon. Case presentation We report the case of a 39 year old male who presented with features of perforation peritonitis, which on laparotomy revealed a caecal perforation with a dusky appendix. A standard right hemicolectomy with ileostomy and peritoneal toileting was done. Histopathology revealed multiple transmural caseating granulomas with Langerhans-type giant cells and acid-fast bacilli, consistent with tuberculosis, present only in the caecum. Conclusions We report this extremely rare presentation of primary caecal tuberculosis to sensitize the medical fraternity to its rare occurrence, which will be of paramount importance owing to the increasing incidence of tuberculosis all over the world, especially among the developing countries.

  3. Suprapubic catheter change resulting in terminal ileal perforation

    Chih-Peng Chang

    2014-06-01

    Full Text Available Suprapubic cystostomy is commonly performed in patients with neurogenic bladder or bladder outlet obstruction. The most serious complication is bowel injury, which usually occurs during catheter insertion. Bowel perforation during suprapubic catheter exchange is rare. We herein report an extremely rare case of terminal ileal perforation resulting from a change of suprapubic catheter. After insertion of the suprapubic catheter, a feculent material was noted in the terminal ileum. A cystography revealed that the contrast medium passed directly into the terminal ileum and colon. A computed tomographic scan confirmed the presence of a balloon tip in the terminal ileum. Terminal ileum perforation was diagnosed. Emergent laparotomy and loop ileostomy were performed. The patient's recovery was uneventful.

  4. The Versatile Extended Thoracodorsal Artery Perforator Flap for Breast Reconstruction

    Jacobs, Jordan; Thomsen, Jørn Bo; Børsen-Koch, Mikkel; Gunnarsson, Gudjon Leifur; Tos, Tina; Siim, Elsebeth; Udesen, Ann; Hölmich, Lisbet Rosenkrantz; Salzberg, Andrew

    2016-01-01

    flap in reconstructive surgery. METHODS: A multicenter, retrospective review was performed on all patients undergoing TAP flap reconstruction from August 2011 to November 2014. Data were collected from patient records as well as outpatient interviews. RESULTS: A total of 106 TAP flaps were performed in...... reconstruction as well as breast conserving surgery. This large, multicenter series describes our techniques of preoperative perforator mapping and a fast, reliable harvest. Reconstructive goals are accomplished in the great majority of patients.......BACKGROUND: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP...

  5. Perforation of the sinus membrane during sinus floor elevation

    von Arx, Thomas; Fodich, Ivo; Bornstein, Michael M; Jensen, Simon S

    2014-01-01

    PURPOSE: To analyze the frequency of perforation of the sinus membrane during maxillary sinus floor elevation (SFE) and to assess possible risk factors. MATERIALS AND METHODS: Seventy-seven cases of SFE performed with a lateral window approach were evaluated retrospectively. Clinical and...... radiographic variables potentially influencing the risk of sinus membrane perforation were evaluated and divided into patient-related factors (age, sex, smoking habit); surgery-related factors (type of surgical approach, side, units, sites, and technique of osteotomy); and maxillary sinus-related factors...... (presence and height of septum, height of residual ridge, thickness of lateral sinus wall, width of antrum, and thickness and status of sinus membrane). RESULTS: The following factors presented with at least a 10% difference in rates of perforations: smokers (46.2%) versus nonsmokers (23.4%), simultaneous...

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

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

    2011-10-01

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

  7. Microsporidium infection and perforation peritonitis: A rare association

    Nadeem Tanveer

    2015-01-01

    Full Text Available 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.

  8. INCIDENCE, RISK FACTORS AND COMPLICATIONS OF ACUTE PERFORATED AND NON - PERFORATED APPENDICITIS IN A RURAL SETUP OF ANDHRA PRADESH

    Anil Kumar

    2015-05-01

    Full Text Available Appendicitis is one of the most common surgical emergencies. The incidence of appendicitis and chances of complication in the form of perforation are dependent on both the patients and non - patient factors . There are various studies conducted to address this problem, but there are no studies conducted to look in to the incidence of appendicitis in east Godavari district of Andhra Pradesh. Our study was aimed to bridge thi s gap. METHOD S AND MATERIALS: this was a retrospective study, patient data from 2009 - 2014 was analyzed and the age, distance from hospital, educational and socioeconomic background of the patients was collected. The duration between first appearance of sy mptoms and hospitalization was recorded. The incidence of post - op complication was also recorded. RESULTS: T he incidence of perforation was 15% in our study population, most of the patients were from low socioeconomic group and having income less than 5000 /month. The middle age group between 30 - 40 years was commonly affected by the appendicitis. The time laps between appearance of symptoms and hospitalization was found to be a predominant factor in the perforation. Surgical site infection was most common co mplication in the patients treated. CONCLUSION: T he incidence of perforation is still high and the time laps between first appearance of symptoms and hospitalization is a major determinant of perforation or complication in the appendicitis.

  9. Reactivity measurements

    Digital reactivity meter, realized as an off-line Fortran program, the input to which is a record of 500 consecutive values of n(tsub(i)) obtained by on-line program on CDC 1700 from the linear power channel of the TRIGA reactor, has been tested at low powers at which the reactor fuel temperature feedback reactivity is negligible. Calibration of the meter by the regulating rod, the reactivity of which has been determined by the assymptotic reactor period, shows that the absolute error is below 1,6% for reactivities up to 1 $. The accuracy of the reactivity meter is proportional to the square of the product of the sampling interval and the period at which the neutron density changes. So the relative error of the reactivity remains at all operational states below 0.2% at 1 second sampling intervals and even at 3 seconds sampling it does not rises above 2.0%. The meter is useful for measurements of control rod drops into the reactor at sampling intervals of 0.1 sec. The meter sensitivity is 0.5 c/s at 1 sec sampling

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

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

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

  11. Non-invasive vascular imaging in perforator flap surgery

    Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered

  12. Numerical Simulation of Wave Interaction with Perforated Caisson Breakwaters

    陈雪峰; 李玉成; 王永学; 董国海; 白雪

    2003-01-01

    The volume of fluid (VOF) method is presented to determine the reflection coefficient of and the total horizontal wave force on perforated caisson breakwaters. The present numerical model is compared with a linear analytic solution obtained by Sahoo et al. (2000). Also this model is verified with the authors′ laboratory data. It is found that the numerical model is in good agreement with the regression equations obtained from the experimental data. The present numerical method is further discussed to relate porosity, the relative wave absorbing chamber depth, the reflection coefficient of perforated caissons and the total horizontal force on them.

  13. Non-invasive vascular imaging in perforator flap surgery

    Saba, Luca; Piga, Mario [Dept. of Radiology, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)], e-mail: lucasaba@tiscali.it; Atzeni, Matteo; Ribuffo, Diego [Dept. of Surgery, Section of Plastic Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy); Rozen, Warren Matthew [Jack Brockhov Reconstructive Plastic Surgery Research Unit, Dept. of Anatomy and Cell Biology, The Univ. of Melbourne, Parkville, Victoria (Australia); Alonso-Burgos, Alberto [Dept. of Radiology, Clinica Univ., Univ. de Navarra, Pamplona (Spain); Bura, Raffaella [Dept. of Surgery, Section of Vascular Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)

    2013-02-15

    Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered.

  14. Perforation of a reinforced concrete slab by a missile

    The results of a large experimental programme is presented. Shots were performed with steel cylindrical missiles on reinforced concrete slabs. The scales used in this modeling were mainly one-third of the wall of a nuclear reactor but the effects of variation of following parameters were studied: missile velocity, its mass, ratio of the missile diameter to the thickness of the slab and characteristics of the steel reinforcement. An homogeneous perforation formula is proposed for the computation of the thickness of the reinforced concrete wall which is perforated by a given missile, and its validity range is specified. A comparison with others formulae found in the literature is made

  15. Furcal perforation repair using calcium enriched mixture cement

    Asgary Saeed

    2010-01-01

    Full Text Available 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.

  16. Non-operative management of perforated peptic ulcer

    Objective: The aim of this study was to see the morbidity and mortality in peptic ulcer perforation cases by non-operative management in selected cases. Results: In the selected 54 patients, male: female were 49:05. Nine had history of NSAID intake. There was no mortality. Morbidity analysis showed that three had hepatic abscess, four had pelvic abscess, six took prolonged time for improvement, in two cases conservative treatment had to be abandoned and laparotomy was done in the same hospital admission. Conclusion: Non-operative procedure is a safe and effective measure for the management of perforated peptic ulcer in selected cases. (author)

  17. Gastric Perforation and Phlegmon Formation by Foreign Body Ingestion

    Albert Alejandro Avila Alvarez

    2014-08-01

    Full Text Available 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.

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

    Aziz; Sümer; zgür; Kemik; Ahmet; Cumhur; Dülger; Aydemir; Olmez; Ismail; Hasirci; Erol; Kisli; Vedat; Bayrak; Gulay; Bulut; etin; Kotan

    2010-01-01

    AIM:To represent our clinical experience in the treatment of intestinal perforation arising from typhoid fever.METHODS:The records of 22 surgically-treated patients with typhoid intestinal perforation were evaluated retrospectively.RESULTS:There were 18 males and 4 females,mean age 37 years(range,8-64 years).Presenting symptoms were fever,abdominal pain,diarrhea or constipation.Sixteen cases were subjected to segmental resection and end-to-end anastomosis,while 3 cases received 2-layered primary repair foll...

  19. ENVIRONMENTAL MODIFICATION CAUSED BY PERFORATED TRANSPARENT POLYETHYLENE LOW TUNNELS CULTIVATED WITH LETTUCE

    Galileo Adeli Buriol

    1993-12-01

    Full Text Available Environmental modifications caused by low tunnels made of perforated transparent polyethylene were determineted in an area alocated at the Federal University of Santa Maria, RS. The perforation densities were 100, 200, 300 and 400 perforations per square meter, corresponding respectively to 0.78% (T1, 1.57% CT2, 2.35% (T3 and 3.14% (T4 of area perforated. The results indicated that perforation density did not significantly affected solar energy availability. As perforation density increased there was a decrease on the average diurnal air temperature which demonstrated the viability of ventilating low tunnels with perforated plastic. It was also observed that inside the perforated tunnels the averages values for soil, air minimun and diurnal temperatures and air relative humidity were higher than on the external environment.

  20. Plasminogen initiates and potentiates the healing of acute and chronic tympanic membrane perforations in mice

    Shen, Yue; Guo, Yongzhi; Wilczynska, Malgorzata; Li, Jinan; Hellström, Sten; Ny, Tor

    2014-01-01

    Background: Most tympanic membrane (TM) perforations heal spontaneously, but approximately 10-20% remain open as chronic TM perforations. Chronic perforations can lead to an impaired hearing ability and recurrent middle ear infections. Traditionally, these perforations must be surgically closed, which is costly and time consuming. Therefore, there is a need for simpler therapeutic strategies. Previous studies by us have shown that plasminogen (plg) is a potent pro-inflammatory regulator that ...

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

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

    2010-01-01

    Duodenal perforation during endoscopic retrograde cholangiopancreatography(ERCP) is a rare complication,but it has a relatively high mortality risk.Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation.The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma.However,the current standard treatment for duodenal free wall perforation is surgical repair.Recently,several case reports of endosco...

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

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

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergenc...

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

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

    2016-01-01

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

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

    Zubair, M; Habib, L; Mirza, M R;

    2010-01-01

    gall bladder, presence of adhesions in the right upper quadrant, timing of perforation, site of perforation, cause of perforation and spillage of stones were recorded. Data was entered and analyzed on SPSS 15. Pearson Chi Square test was applied to check the significance of these factors in IGBP where...

  5. And the Winner is - Acquired

    Henkel, Joachim; Rønde, Thomas; Wagner, Marcus

    2015-01-01

    New entrants to a market tend to be superior to incumbents in originating radical innovations. We provide a new explanation for this phenomenon, based on markets for technology. It applies in industries where successful entrepreneurial firms, or their technologies, are acquired by incumbents that...... lower probability accompanies higher value in case of success—that is, a more radical innovation. In the second stage, successful entrants bid to be acquired by the incumbent. We assume that entrants cannot survive on their own, so being acquired amounts to a prize in a contest. We identify an...

  6. Reactive arthritis.

    Keat, A

    1999-01-01

    Reactive arthritis is one of the spondyloarthropathy family of clinical syndromes. The clinical features are those shared by other members of the spondyloarthritis family, though it is distinguished by a clear relationship with a precipitating infection. Susceptibility to reactive arthritis is closely linked with the class 1 HLA allele B27; it is likely that all sub-types pre-dispose to this condition. The link between HLA B27 and infection is mirrored by the development of arthritis in HLA B27-transgenic rats. In this model, arthritis does not develop in animals maintained in a germ-free environment. Infections of the gastrointestinal, genitourinary and respiratory tract appear to provoke reactive arthritis and a wide range of pathogens has now been implicated. Although mechanistic parallels may exist, reactive arthritis is distinguished from Lyme disease, rheumatic fever and Whipple's disease by virtue of the distinct clinical features and the link with HLA B27. As in these conditions both antigens and DNA of several micro-organisms have been detected in joint material from patients with reactive arthritis. The role of such disseminated microbial elements in the provocation or maintenance of arthritis remains unclear. HLA B27-restricted T-cell responses to microbial antigens have been demonstrated and these may be important in disease pathogenesis. The importance of dissemination of bacteria from sites of mucosal infection and their deposition in joints has yet to be fully understood. The role of antibiotic therapy in the treatment of reactive arthritis is being explored; in some circumstances, both the anti-inflammatory and anti-microbial effects of certain antibiotics appear to be valuable. The term reactive arthritis should be seen as a transitory one, reflecting a concept which may itself be on the verge of replacement, as our understanding of the condition develops. Nevertheless it appropriately describes arthritis that is associated with demonstrable

  7. Covalent targeting of acquired cysteines in cancer.

    Visscher, Marieke; Arkin, Michelle R; Dansen, Tobias B

    2016-02-01

    The thiolate side chain of cysteine has a unique functionality that drug hunters and chemical biologists have begun to exploit. For example, targeting cysteine residues in the ATP-binding pockets of kinases with thiol-reactive molecules has afforded increased selectivity and potency to drugs like imbrutinib, which inhibits the oncogene BTK, and CO-1686 and AZD9291 that target oncogenic mutant EGFR. Recently, disulfide libraries and targeted GDP-mimetics have been used to selectively label the G12C oncogenic mutation in KRAS. We reasoned that other oncogenes contain mutations to cysteine, and thus screened the Catalog of Somatic Mutations in Cancer for frequently acquired cysteines. Here, we describe the most common mutations and discuss how these mutations could be potential targets for cysteine-directed personalized therapeutics. PMID:26629855

  8. A unique strain of community-acquired Clostridium difficile in severe complicated infection and death of a young adult

    Heslop, Orville D; Roye-Green, Karen; Coard, Kathleen; Mulvey, Michael R

    2013-01-01

    Background Clostridium difficile is the major cause of nosocomial antibiotic-associated diarrhoea with the potential risk of progressing to severe clinical outcomes including death. It is not unusual for Clostridium difficile infection to progress to complications of toxic megacolon, bowel perforation and even Gram-negative sepsis following pathological changes in the intestinal mucosa. These complications are however less commonly seen in community-acquired Clostridium difficile infection th...

  9. Perforated jejunal diverticulitis as a rare cause of acute abdomen

    Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed. (orig.)

  10. Duodenal Perforation Caused by an Inferior Vena Cava Filter

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

    2012-01-01

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

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

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

    2012-02-01

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

  12. Colorectal cancer complicated by perforation. Specific features of surgical tactics

    S. N. Shchaeva

    2015-01-01

    Full Text Available Objective: to assess the immediate results of surgical interventions for colorectal cancer complicated by perforation.Materials and methods. The immediate results of surgical treatment were retrospectively analyzed in 56 patients with colorectal cancer complicated by perforated colon cancer, who had been treated at Smolensk surgical hospitals in 2001 to 2013. Patients with diastatic perforation of the colon in the presence of decompensated obturation intestinal obstruction of tumor genesis were not included into this investigation.Results. The immediate results of uni- and multistage surgical interventions were analyzed in relation to the extent of peritonitis and the stage of colon cancer. More satisfactory immediate results were observed after multistage surgical treatment. Following these interventions, a fatal outcome of disseminated peritonitis in the presence of performed colorectal cancer was recorded in 8 (53.3 % cases whereas after symptomatic surgery there were 11 (67.8 % deaths. A fatal outcome was noted in 1 case (7.7 % after multistage surgery.Discussion. The results of surgical treatment in the patients with perforated colorectal cancer are directly related to the degree of peritonitis and the choice of surgical tactics.

  13. Numerical Method for Wave Forces Acting on Partially Perforated Caisson

    姜峰; 唐晓成; 金钊; 张莉; 陈洪洲

    2015-01-01

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

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

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

    2010-01-01

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

  15. Perforated jejunal diverticulitis as a rare cause of acute abdomen

    Peters, R.; Grust, A.; Fuerst, G. [Department of Radiology, Heinrich-Heine-University, Duesseldorf (Germany); Gerharz, C.D. [Department of Pathology, Heinrich-Heine-University, Duesseldorf (Germany); Dumon, C. [Department of Surgery, Heinrich-Heine-University, Duesseldorf (Germany)

    1999-09-01

    Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed. (orig.) With 3 figs., 13 refs.

  16. Mitral valve perforation appearing years after radiofrequency ablation

    Fisch-Thomsen, Marie; Jensen, Jesper K; Egeblad, Henrik;

    2011-01-01

    The case is reported of a young adult with Wolff-Parkinson-White (WPW) syndrome who, three years after a complicated radiofrequency (RF) catheter ablation procedure, developed dyspnea on exertion. Echocardiography revealed severe mitral valve regurgitation caused by a perforation of the posterior...... leaflet. Echocardiographic follow up is recommended after a complicated course of left-sided catheter ablation....

  17. Laparoscopic repair in children with traumatic bladder perforation

    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

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

    Sasapu Kishore K; Powell Matthew J; Macklin Christopher

    2008-01-01

    Abstract 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.

  19. Chrome induced nasal septal perforation-An occupational hazard

    Krishna, N. Joshi

    2004-01-01

    86 patients, working in a chemical factory dealing with Chrome manufacturing job, were referred by Health Inspectai to F S 1 S Hospital O PD 32 patients out of above were found to be having Nasal septal perforation and were recommended to Medical Board for consideration of compensation as cases of Occupational hazard

  20. Incidence and management of colonoscopic perforations: 8 years' experience

    Hagit Tulchinsky; Osnat Madhala-Givon; Nir Wasserberg; Shlomo Lelcuk; Yaron Niv

    2006-01-01

    AIM: To review the experience of a major medical teaching center with diagnostic and therapeutic colonoscopies and to assess the incidence and management of related colonic perforations.METHODS: All colonoscopies performed between January 1994 and December 2001 were studied. Data on patients, colonoscopic reports and procedure-related complications were collected from the departmental computerized database. The medical records of the patients with post procedural colonic perforation were reviewed.RESULTS: A total of 12 067 colonoscopies were performed during the 8 years of the study. Seven colonoscopic perforations (4 females, 3 males) were diagnosed (0.058%). Five occurred during diagnostic and two during therapeutic colonoscopy. Six were suspected during or immediately after colonoscopy. All except one had signs of diffuse tenderness and underwent immediate operation with primary repair done in 4patients. No deaths were reported.CONCLUSION: Perforation rate during colonoscopy is low. Nevertheless, it is a serious complication and its early recognition and treatment are essential to optimize outcome. In patients with diffuse peritonitis early operative intervention makes primary repair a safe option.

  1. Laparoscopic repair in children with traumatic bladder perforation.

    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

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

    Sasapu Kishore K

    2008-03-01

    Full Text Available Abstract 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.

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

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

    2015-04-01

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

  4. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

    Toshihiro Kitai

    2014-01-01

    Full Text Available 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.

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

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

    2014-01-01

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

  6. Ascaris lumbricoides: an unusual aetiology of gastric perforation

    Gupta, Shahana; Kumar, Sanjeev; Satapathy, Ayusman; Ray, Udipta; Chatterjee, Souvik; Choudhury, Tamal Kanti

    2012-01-01

    Gastrointestinal (GI) infestation with Ascaris lumbricoides is common in the tropical countries, particularly in children. A wide range of clinical presentations are reported for GI ascariasis in both adults and children. We report a case of gastric perforation due to Ascaris, a rare presentation.

  7. Colonic perforations caused by migrated plastic biliary stents

    Virgilio, Edoardo; Pascarella, Agauido; Scandavini, Chiara Maria; Frezza, Barbara; Bocchetti, Tommaso; Balducci, Genoveffa [Faculty of Medicine and Psychology ' Sapienza' , St. Andrea Hospital, Rome (Italy)

    2015-04-15

    Endoscopic insertion of plastic endoprostheses has become an integral part of the management of many benign and malignant diseases affecting the hepatobiliary and pancreatic system. Clogging and dislocation into the duodenum are the most frequently described complications following stent placement. Distal migration with or without perforation of the colon is an exceedingly rare phenomenon and the treatment is not well defined, as discussed below.

  8. Gastrointestinal Perforation in Neonates: Aetiology and Risk Factors

    Ekwunife Okechukwu Hyginus

    2013-07-01

    Full Text Available Background: Gastrointestinal perforation (GIP in neonates presents important challenges and mortality can be high. This is a report of recent experience with GIP in neonates in a developing country. Patients and methods: A retrospective review of 16 neonates treated for GIP in a 3 year period. Results: There were 9 males and 7 females, aged 0-28 days (median age =7days. Their weights at presentation ranged from 0.9 - 4.7kg (median =2.6. Five infants were premature. Twelve infants presented more than 72 hours after onset of symptoms. Plain abdominal radiographs showed peumoperitoneum in 9 infants. The cause of perforation was necrotising enterocolitis 6, intestinal obstruction 6, iatrogenic 3 and spontaneous 1. The site of perforation was ileum in 12 infants, stomach in 4 and colon in 4; 4 patients had involvement of more than one site. All the neonates underwent exploratory laparotomy with primary closure ( n=5 , resection and anastomosis( n=6, colostomy (n=3, Ileostomy ( n=2, partial gastrectomy (n=2 ,or gastrojejunostomy ( n=1. Two neonates had multiple procedures. Two very sick preterm babies had an initial peritoneal lavage. Surgical site infection is the commonest postoperative complication occurring in 9 infants. Anaesthesia sepsis and malnutrition is responsible for the seven deaths recorded.Conclusions: Neonatal GIP has multiple aetiologies; NEC is the most common cause. Major mortality risk factors include NEC, multiple perforations, delayed presentation and prematurity.

  9. Gastrointestinal Perforation in Neonates: Aetiology and Risk Factors

    Hyginus Okechukwu Ekwunife

    2013-06-01

    Full Text Available Background: Gastrointestinal perforation (GIP in neonates presents important challenges and mortality can be high. This is a report of recent experience with GIP in neonates in a developing country.Patients and methods: A retrospective review of 16 neonates treated for GIP in a 3 year period.Results: There were 9 males and 7 females, aged 0-28 days (median age =7days. Their weights at presentation ranged from 0.9 - 4.7kg (median =2.6. Five infants were premature. Twelve infants presented more than 72 hours after onset of symptoms. Plain abdominal radiographs showed peumoperitoneum in 9 infants. The cause of perforation was necrotising enterocolitis 6, intestinal obstruction 6, iatrogenic 3 and spontaneous 1. The site of perforation was ileum in 12 infants, stomach in 4 and colon in 4; 4 patients had involvement of more than one site. All the neonates underwent exploratory laparotomy with primary closure ( n=5 , resection and anastomosis( n=6, colostomy (n=3, Ileostomy ( n=2, partial gastrectomy (n=2 ,or gastrojejunostomy ( n=1. Two neonates had multiple procedures. Two very sick preterm babies had an initial peritoneal lavage. Surgical site infection is the commonest postoperative complication occurring in 9 infants. Anaesthesia sepsis and malnutrition is responsible for the seven deaths recorded.Conclusions: Neonatal GIP has multiple aetiologies; NEC is the most common cause. Major mortality risk factors include NEC, multiple perforations, delayed presentation and prematurity.

  10. Oral antibiotics for perforated appendicitis is not recommended

    Gögenur, Ismail; Rosenberg, Jacob; Alamili, Mahdi

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...

  11. Perforator plus flaps: Optimizing results while preserving function and esthesis

    Mehrotra Sandeep

    2010-01-01

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

  12. Gut perforation after orthotopic liver transplantation in adults

    Jun Xiong; Shen You; Xiao-Shun He

    2007-01-01

    AIM: To describe cases of gut perforation after orthotopic liver transplantation.METHODS: Data were colleted from our center database and medical records. Six of 187 patients (3.2%)who underwent orthotopic liver transplantation from January to December 2005 developed gut perforation.All patients were male with an average age of 46 years.Modified piggyback liver transplantation was performed at the Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University.RESULTS: Previous operation, steroid therapy, and prolonged portal venous cross clamp time, poor nutritional status and iatrogenic injury were found to be its ecological factors. The patients with gut perforation were found to have fever, increased leukocytes, mild abdominal pain and tenderness. The median portal venous clamp time was 63 min (range 45-72 min),median cold ischaemia time was 11.3 h (range 7-15 h).Median intraoperative blood loss was 500 mL (range 100-1200 mL) and median operation time was 8.8 h (range 6-12 h). None of the six patients developed acute cellular rejection. White cell count was above 18 × 109/L in five patients (neutrophilic leukocytes were above 90%) and 1.5 × 109/L in one patient. Bacterial culture in drainage liquid revealed enterococci in five patients. Of the 6 patients undergoing orthotopic liver transplantation, 3 survived and 3 died after modified piggyback liver transplantation.CONCLUSION: Gut perforation occurs after orthotopic liver transplantation in adults. A careful and minimal dissection during OLT, longer retention of the stomach tube, and reducing the portal clamp time and steroid dose should be taken into consideration. If gut perforation is not prevented, then early diagnosis,preferably through detection of enterococci may ensure better survival.

  13. Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia

    Ming-Tzung Lin; Wei-Chen Tai; King-Wah Chiu; Yeh-Pin Chou; Ming-Chao Tsai; Tsung-Hui Hu; Chuan-Mo Lee; Chi-Sin Changchien; Seng-Kee Chuah

    2009-01-01

    Pneumatic dilation (PD) is considered to be a safe and effective first line therapy for achalasia. The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation. It has been reported that delayed management of perforation for more than 24 h is associated with high mortality. Surgery is the treatment of choice within 24 h, but the management of delayed perforation remains controversial. Hereby, we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia. She completely recovered after intensive medical care. A review of the literature is also discussed.

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

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

    2006-12-01

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

  15. ENHANCEMENT OF NATURAL CONVECTION HEAT TRANSFER FROM RECTANGULAR FINS BY CIRCULAR PERFORATIONS

    Wadhah Hussein Abdul Razzaq Al- Doori

    2011-12-01

    Full Text Available The importance of heat transfer by natural convection in enclosures can be found in many engineering applications, such as energy transfer in buildings, solar collectors, nuclear reactors and electronic packaging. An experimental study was conducted to investigate heat transfer by natural convection in a rectangular fin plate with circular perforations as heat sinks. The patterns of the perforations included 24 circular perforations (holes for the first fin; the number of perforations increased by eight for each fin to 56 in the fifth fin. These perforations were distributed in 6-14 rows and four columns. Experiments were carried out in an experimental facility that was specifically designed and constructed for this purpose. It was observed that the temperature along the non-perforated fin dropped from 30 to 25°C, but the temperature drop for the perforated fins was from 30 to 23.7°C at low power (6 W. The drop in temperature between the fin base and the tip increased as the diameter of the perforations increased. The temperature drop at the highest power (220 W was from 250 to 49°C for the non-perforated fin and from 250 to 36°C for the perforated fins. The heat transfer rate and the coefficient of heat transfer increased with an increased number of perforations.

  16. Mediastinitis and pneumomediastinum in a preterm infant with iatrogenic esophageal perforation: a case report

    Kim, Min Ji; Kim, Ok Hwa [College of Medicine, Ajou University, Suwon (Korea, Republic of)

    2006-06-15

    Introgenic esophageal perforation is very rare in pediatric patients. Preterm infants or low birth weight babies are more susceptible to esophageal perforation due to performing frequent tracheal intubation and/or gastric tube installation. When perforation occurs, it may present as pneumothorax and pulmonary interstitial emphysema. However, isolated pneumomediastinum without pneumothorax is a rare finding. Furthermore, the mediastinitis after esophageal perforation is rare complication, but it can be a critical complication. Therefore, making an immediate and precise diagnosis as well as instituting proper treatment of esophageal perforation and mediastinitis are important. To the best of our kowledge, few reports have described mediastinitis after pneumomediastinum that was secondary to esophageal perforation. We describe here the radiologic findings of a rare case of mediastinitis after pneumomediastinum is a preterm infant with esophageal perforation.

  17. Two-dimensional simulations of steady perforated-plate stabilized premixed flames

    Altay, H. Murat

    2010-03-17

    The objective of this work is to examine the impact of the operating conditions and the perforated-plate design on the steady, lean premixed flame characteristics. We perform two-dimensional simulations of laminar flames using a reduced chemical kinetics mechanism for methane-air combustion, consisting of 20 species and 79 reactions. We solve the heat conduction problem within the plate, allowing heat exchange between the gas mixture and the solid plate. The physical model is based on a zero-Mach-number formulation of the axisymmetric compressible conservation equations. The results suggest that the flame consumption speed, the flame structure, and the flame surface area depend significantly on the equivalence ratio, mean inlet velocity, the distance between the perforated-plate holes and the plate thermal conductivity. In the case of an adiabatic plate, a conical flame is formed, anchored near the corner of the hole. When the heat exchange between themixture and the plate is finite, the flame acquires a Gaussian shape stabilizing at a stand-off distance, that grows with the plate conductivity. The flame tip is negatively curved; i.e. concave with respect to the reactants. Downstream of the plate, the flame base is positively curved; i.e. convex with respect to the reactants, stabilizing above a stagnation region established between neighboring holes. As the plate\\'s thermal conductivity increases, the heat flux to the plate decreases, lowering its top surface temperature. As the equivalence ratio increases, the flame moves closer to the plate, raising its temperature, and lowering the flame stand-off distance. As the mean inlet velocity increases, the flame stabilizes further downstream, the flame tip becomes sharper, hence raising the burning rate at that location. The curvature of the flame base depends on the distance between the neighboring holes; and the flame there is characterized by high concentration of intermediates, like carbon monoxide. © 2010 Taylor

  18. Experimental Study on the Feasibility of Methane Drainage in Coal Seams with Compound Technique of Perforating and Fracturing

    Luo Yong; Shen Zhaowu

    2007-01-01

    Compound technique of perforating and fracturing can effectively control the perforating direction and the fracturing expansion. The feasibility of this technique used in fracturing coal seams is analyzed. In this paper, the experiments of perforating and fracturing are carried out on samples of coal and the experimental effects are satisfactory. Compound technique of perforating and fracturing is promising in coal seams.

  19. Reactive Systems

    Aceto, Luca; Ingolfsdottir, Anna; Larsen, Kim Guldstrand;

    A reactive system comprises networks of computing components, achieving their goals through interaction among themselves and their environment. Thus even relatively small systems may exhibit unexpectedly complex behaviours. As moreover reactive systems are often used in safety critical systems......, the need for mathematically based formal methodology is increasingly important. There are many books that look at particular methodologies for such systems. This book offers a more balanced introduction for graduate students and describes the various approaches, their strengths and weaknesses, and when...... they are best used. Milner's CCS and its operational semantics are introduced, together with the notions of behavioural equivalences based on bisimulation techniques and with recursive extensions of Hennessy-Milner logic. In the second part of the book, the presented theories are extended to take timing issues...

  20. Optimization of the process of steel strip perforation and nickel platting for the purpose of elimination of trichloroethylene from the cleaning process of perforated steel strip

    Petrović Aleksandra B.

    2009-01-01

    Full Text Available In the production of pocket type electrodes for Ni-Cd batteries perforation of proper steel strips and then nickel platting of perforated steel strips were made. In the nickel platting process, the organic solvent, trichloroethylene, has previously been used for cleaning. Due to the carcinogenic nature of trichloroethylene and the many operations previously required during cleaning, it was considered to do cleaning of perforated steel strips without use of the mentioned organic solvent. In the purpose of elimination of trichloroethylene from the cleaning process of perforated steel strips, the tests of perforation of steel strips with use of oils of different viscosity were made. It was shown that there was no dysfunction during the work of the perforation plants, meaning there was no additional heating of the strips, deterring of the steel filings, nor excessive wearing of the perforation apparatus. The perforation percent was the same irrelevant of the viscosity of the used oil. Before being perforated using the oils with different viscosity, the nickel platting steel strips were cleaned in different degreasers (based on NaOH as well as on KOH. It was shown that efficient cleaning without the use of trichloroethylene is possible with the use of oil with smaller viscosity in the perforated steel strips process and the degreaser based on KOH in the cleaning process, before nickel platting. It also appeared that the alkali degreaser based on KOH was more efficient, bath corrections were made less often and the working period of the baths was longer, which all in summary means less quantity of chemicals needed for degreasing of perforated steel strips.

  1. The mTOR Inhibitor Rapamycin Mitigates Perforant Pathway Neurodegeneration and Synapse Loss in a Mouse Model of Early-Stage Alzheimer-Type Tauopathy.

    Robert Siman

    Full Text Available The perforant pathway projection from layer II of the entorhinal cortex to the hippocampal dentate gyrus is especially important for long-term memory formation, and is preferentially vulnerable to developing a degenerative tauopathy early in Alzheimer's disease (AD that may spread over time trans-synaptically. Despite the importance of the perforant pathway to the clinical onset and progression of AD, a therapeutic has not been identified yet that protects it from tau-mediated toxicity. Here, we used an adeno-associated viral vector-based mouse model of early-stage AD-type tauopathy to investigate effects of the mTOR inhibitor and autophagy stimulator rapamycin on the tau-driven loss of perforant pathway neurons and synapses. Focal expression of human tau carrying a P301L mutation but not eGFP as a control in layer II of the lateral entorhinal cortex triggered rapid degeneration of these neurons, loss of lateral perforant pathway synapses in the dentate gyrus outer molecular layer, and activation of neuroinflammatory microglia and astroglia in the two locations. Chronic systemic rapamycin treatment partially inhibited phosphorylation of a mechanistic target of rapamycin substrate in brain and stimulated LC3 cleavage, a marker of autophagic flux. Compared with vehicle-treated controls, rapamycin protected against the tau-induced neuronal loss, synaptotoxicity, reactive microgliosis and astrogliosis, and activation of innate neuroimmunity. It did not alter human tau mRNA or total protein levels. Finally, rapamycin inhibited trans-synaptic transfer of human tau expression to the dentate granule neuron targets for the perforant pathway, likely by preventing the synaptic spread of the AAV vector in response to pathway degeneration. These results identify systemic rapamycin as a treatment that protects the entorhinal cortex and perforant pathway projection from tau-mediated neurodegeneration, axonal and synapse loss, and neuroinflammatory reactive

  2. Acquiring taste in home economics?

    Stenbak Larsen, Christian

    2015-01-01

    that the pupils were encouraged to use their senses: listen to things frying, touch the meat to check if it was done and taste the food in the process of seasoning it. But while some children learned what the teachers expected: to produce well tasting food, others learned to cook very salty and hot food...... appreciated by the group of boys, and others again learned to stick with their idiosyncrasies when pressured by the teacher. Conclusions: Children were acquiring taste in the home economic lessons, but not only the kind of tastes that the teacher had planned for. This leads to reflections on the very complex...... process of taste acquiring and to a call for further research into taste acquiring in complex real life contexts as home economics lessons....

  3. Capacity limits in columns pulsed with stain steel perforated plates

    This paper includes part of the second stage of the pulsed columns development program, using a water-nitric acid system as continuous phase and tri-n-butyl phosphate dissolved in kerosene at 30% v/v as disperse phase. Two kits of different geometry perforated plates (different diameter of perforation and free area percentage) were used. Due to the affinity importance of the plates' material with the continuous phase, in all the cases the continuous aqueous phase was used. The relation of flows varied, thus obtaining in each case a curve of characteristic 'flood'. The influence of the geometrical variables, the relation of flows, the medium acidity and the pulse's amplitude was applied in the capacity of the column. Besides, the dimensional correlation of Swift W.H. on the results obtained from 'flood' with both kits of plates to relate flows 1:1 and a minimum deviation was observed. (Author)

  4. Perforated transverse vaginal septum: a rare case report

    Ramaraj Sasikala

    2015-08-01

    Full Text Available 20 year old nulliparous woman married since 1 and frac12; years attended the gynaecology OPD with history of inability to conceive. She had regular menstrual cycles with normal menstrual flow. Local examination revealed blind vagina with a small opening in the centre. On per rectal examination, uterus was felt and normal in size. Based on history and clinical examination finding, a provisional diagnosis of perforated transverse vaginal septum was made. MRI revealed transverse vaginal septum in the lower 1/3rd of vagina with a small fenestration without haematocolpos or haematometra. Transverse vaginal septum resection was done. Vagina healed well without stricture formation. Transverse vaginal septum in the lower 1/3rd of vagina (perforating type is a rare entity and hence it is presented. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1217-1219

  5. Study of a new railgun configuration with perforated sidewalls

    Zhang, J.; Kim, K.; King, T.L. (Fusion Technology and Charged Particle Research Lab., Urbana, IL (United States))

    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.

  6. Directional bending wave propagation in periodically perforated plates

    Andreassen, Erik; Manktelow, Kevin; Ruzzene, Massimo

    2015-01-01

    We report on the investigation of wave propagation in a periodically perforated plate. A unit cell with double-C perforations is selected as a test article suitable to investigate two-dimensional dispersion characteristics, group velocities, and internal resonances. A numerical model, formulated...... using Mindlin plate elements, is developed to predict relevant wave characteristics such as dispersion, and group velocity variation as a function of frequency and direction of propagation. Experimental tests are conducted through a scanning laser vibrometer, which provides full wave field information....... The analysis of time domain wave field images allows the assessment of plate dispersion, and the comparison with numerical predictions. The obtained results show the predictive ability of the considered numerical approach and illustrate how the considered plate configuration could be used as the basis...

  7. A RARE CASE OF SPONTANEOUS POSTPARTUM MULTIPLE BLADDER PERFORATIONS

    Manjunath

    2015-03-01

    Full Text Available A 22 year s old female presented with ascites five months after delivery . She had repeated attacks in the past and had been treated conservatively elsewhere . On examination she was poorly nourished , with tachypnoea , tachycardia and gross ascites . Raised blood urea and serum creatinine . Had raised urea and creatinine level more than 3 times the serum level in the ascitic fluid . With a provisional diagnosis of intraperitonial bladder rupture she was subjected to CT cyst ogram - showed rent in the posterior left lateral wall of bladder with urinary ascites . Cystoscopy showed multiple perforations with multiple sacculations and trabuclations . Laparotomy done , perforation closed and abdominal toileting done with SPC placemen t . Postoperative recovery was good . Follow - up cystogram at two months was normal .

  8. Multiple Small Intestine Perforations after Organophosphorous Poisoning: A Case Report

    Rajan, Sudha Jasmine; Peter, John Victor; Suryawanshi, Mayur Keshav

    2016-01-01

    Organophosphate poisoning has significant gastrointestinal manifestations including vomiting, diarrhea, cramps and increased salivation. We report an uncommon gastrointestinal complication of multiple small intestinal perforations following organophosphorus poisoning. A 28-year old male presented after ingesting dichlorvos mixed with alcohol. Following the initial cholinergic symptoms, the patient developed severe shock with fever, attributed to aspiration pneumonia. Despite appropriate antibiotics, shock was persistent. Over the next 24-hours, he developed abdominal distension, loose stools and high nasogastric aspirates. Computed tomography showed pneumoperitonium. Exploratory laparotomy revealed six perforations in the jejunum and ileum. The involved portion of the bowel was resected and re-anastomosed, following which only 80-cm of small bowel was left. Postoperatively, shock resolved over 72-hours. However, over the next few days, patient developed features of anastomotic leak. Since only a small portion of the small bowel was preserved, a conservative approach was adopted. He deteriorated further and finally succumbed to the illness.

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

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

    1997-12-01

    We describe the microanatomy of the perforating arteries arising from the anterior communicating artery complex (5 mm distal of the anterior cerebral artery, the anterior communicating artery, and 5 mm proximal of the distal anterior cerebral artery). Thirteen unfixed human brains were used in this study. The origin and number of perforators are described, as is the site of brain penetration, and results are correlated with previous studies. The hemodynamics of blood flow in relation to the formation of an anterior communicating artery aneurysm and different surgical approaches are mentioned. The neuropsychological outcome after aneurysm clipping with regards to the pattern of blood supply from the anterior cerebral artery complex is also discussed. PMID:9427956

  10. Nasal septum perforation in patient with pyoderma gangrenosum

    Maia, Camilla Bezerra da Cruz

    2012-01-01

    Full Text Available Introduction: The cocaine is obtained from the leaves of the coca (Erythroxylon coca. It can be used in many ways, but the most common is the drug inhalation. The Cocaine also causes vasoconstriction at nasal mucous membrane and its chronic use can cause necrosis and nasal septum perforation. Pyoderma gangrenosum is an uncommon idiopathic disease characterized by ulcerations, usually observed on the legs. Its diagnosis is most common an exclusion of others diseases. So far, there is no specific treatment based on evidence by randomized controlled trials. Objective: Describe the rare association between Pyoderma gangrenosum and cocaine. Case Report: E. A., 27-year-old woman with destruction of nasal septum and palate who has been using a big amount of cocaine, been necessary note the difference from which disease cause de damage. Final Comments: Also there are only three cases of Pyoderma gangrenosum complicated with nasal septum perforation in cocaine users.

  11. Sigmoid perforation post laser ablation of fistula in ano

    Raj Gautam

    2015-06-01

    Full Text Available Laser ablation of fistula tract is a safe, effective, sphincter-preserving therapy that can be successfully performed by surgeons. Various studies and papers have been published advocating the use of lasers. However clinical experience and technical expertise is necessary for the use of lasers. Here we present a case of a 45 year old male presenting with acute abdomen following laser ablation of fistula in ano. The patients X-Ray abdomen showed free gas under the diaphragm and was explored. The exploration revealed a pyoperitoneum and a sigmoid perforation for which closure of perforation and a diverting colostomy was done. The patient was further operated for fistula excision and Seton suturing and is planned for colostomy closure. [Int J Res Med Sci 2015; 3(6.000: 1551-1553

  12. Reconstruction of hand contracture by reverse ulnar perforator flap

    Cengiz Eser

    2016-04-01

    Full Text Available Hand burn scar contractures affect patients in aesthetic and functional aspects. After releasing these scars, the defects should be repaired. The reconstruction methods include primary suturation, Z plasty, skin grafting, local or free flaps, etc. All methods have their own advantages and disadvantages. One of the most useful flaps is the reverse ulnar perforator flap. We performed a two-staged procedure for repairing a post-burn contracture release defect in a 40-year-old male. In the first stage we applied reverse ulnar perforator flap for the hand defect, and ulnar artery and vein repair in the second stage. In conclusion, this two-staged procedure is a non-primary but useful option for hand and finger defects and prevents major vascular structure damage of the forearm. [Hand Microsurg 2016; 5(1.000: 40-43

  13. Impalement injury by glass shard with delayed colonic perforation

    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

  14. Risk factors in patients surgically treated for peptic ulcer perforation

    Møller, Morten Hylander; Shah, Kamran; Bendix, Jørgen;

    2009-01-01

    Society of Anaesthesiologists) class, age, shock upon admission, preoperative metabolic acidosis, elevated concentration of creatinine upon admission, subnormal concentration of albumin upon admission and insufficient postoperative nutrition. CONCLUSIONS: Thus, preoperative metabolic acidosis, renal...... admission and preoperative metabolic acidosis are independently related to 30-day mortality could indicate that patients with peptic ulcer perforation are septic upon admission, and thus might benefit from a perioperative care protocol with early source control and early goal-directed therapy according to...

  15. Unusual perforated appendicitis within umbilical hernia: CT findings.

    Arnáiz, J; Ortiz, A; Marco de Lucas, E; Piedra, T; Jordá, J; Arnáiz, A M; Pagola, M A

    2006-01-01

    We present the first imaging report of perforated appendicitis in an umbilical hernia. Computed tomography demonstrated a gas-forming abscess within an umbilical hernia and the cecum was found inside the hernial sac, with an inner relation to the abscess. Computed tomographic findings suggested appendicitis as possible diagnosis, which was confirmed at surgery. Physicians must consider appendicitis within the differential diagnosis of an abdominal abscess located near to the cecum, even at an unexpected location. PMID:16465570

  16. Fire safety in perforated wooden slab, a numerical approach

    Fonseca, E.M.M.; Couto, D.; Piloto, P.A.G.

    2013-01-01

    The main goal of this work is to present a numerical model to assess the fire safety of wooden slabs with rectangular perforations at the ceiling. These typical constructions have good sound absorption, heat insulation and relevant architectonic characteristics. They are used in many civil applications: concert and conference halls, classrooms, nurseries, airports, hotels, shopping, universities, and many other public buildings. These panels are normally installed at lower level in building c...

  17. Vibroacoustics of thin micro-perforated sound absorbers

    Maury, Cédric; Bravo, Teresa; Pinhède, Cédric

    2012-01-01

    ISBN 978-2-919340-01-9 International audience Lightweight Micro-Perforated Panels (MPP) backed by an air cavity constitute compact sound absorbing resonators, mostly efficient in the mid-frequency range, and that may be constructed using transparent, fibreless and recyclable materials. These soundproof devices have been intensively studied due to their important applications in building acoustics and the aeronautic, astronautic and automotive industries. However, MPPs have been often co...

  18. PERITONITIS DUE TO TRANSVERSE COLON PERFORATION: A RARE PRESENTATION

    Vandana B.

    2015-08-01

    Full Text Available Abdominal tuberculosis is defined as infection of the peritoneum, hollow or solid abdominal organs with Mycobacterium tuberculi . TB can affect any part of the gastrointestinal (GI tract including anus, peritoneum and hepatobiliary system. The peritoneum and the ileocaecal region are the most likely sites of infection. The clinical manifestations of abdominal tuberculosis are nonspecific and mimic various GI disorders and cause delay in diagnosis and management. This pa thology has several complications, including free intestinal perforation.

  19. Postpartum spontaneous colonic perforation due to antiphospholipid syndrome

    Ahmed, Kamran; Darakhshan, Amir; Au, Eleanor; Khamashta, Munther A; Katsoulis, Iraklis E

    2009-01-01

    The antiphospholipid syndrome (APS) is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis, fetal loss, thrombocytopenia, leg ulcers, livedo reticularis, chorea, and migraine. We document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean section. At laparotomy the underlying ...

  20. Neovaginal perforation following sexual intercourse in a transsexual patient

    Deliktas, Hasan; Ozcan, Onder; Cullu, Nesat; Erdogan, Omer

    2014-01-01

    Background Neovaginal perforation can develop following sexual intercourse in patients that have undergone male to female gender reassignment surgery. In such cases urinary tract symptoms may mimic acute cystitis and acute pyelonephritis. Case presentation A 33-year old white transsexual patient presented to the emergency department with dysuria, hematuria, difficulty urinating, widespread groin pain, bilateral side pain, clear vaginal discharge, abdominal pain, and nausea 2-3 h after sexual ...

  1. Furcal perforation repair using calcium enriched mixture cement

    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...

  2. Nasal septum perforation in patient with pyoderma gangrenosum

    Maia, Camilla Bezerra da Cruz; Felix, Felippe; Paes, Vania; Azevedo, Julia Alves de; Grangeiro, Eliza Raquel Negrão; Riccio, Jonatah Lucas N.; Rito, Helen Cruz

    2012-01-01

    Summary Introduction: The cocaine is obtained from the leaves of the coca (Erythroxylon coca). It can be used in many ways, but the most common is the drug inhalation. The Cocaine also causes vasoconstriction at nasal mucous membrane and its chronic use can cause necrosis and nasal septum perforation. Pyoderma gangrenosum is an uncommon idiopathic disease characterized by ulcerations, usually observed on the legs. Its diagnosis is most common an exclusion of others diseases. So far, there is ...

  3. Laparoscopic Lavage for Perforated Diverticulitis With Purulent Peritonitis

    Thornell, Anders; Angenete, Eva; Bisgaard, Thue;

    2016-01-01

    BACKGROUND: Perforated diverticulitis with purulent peritonitis has traditionally been treated with open colon resection and stoma formation with risk for reoperations, morbidity, and mortality. Laparoscopic lavage alone has been suggested as definitive treatment. OBJECTIVE: To compare laparoscopic...... 11 in the Hartmann group had a stoma. LIMITATION: Not all patients presenting with suspected diverticulitis were enrolled. CONCLUSION: Laparoscopic lavage reduced the need for reoperations, had a similar safety profile to the Hartmann procedure, and may be an appropriate treatment of choice for acute...

  4. Chemical process for backsurging fluid through well casing perforations

    Berkshire, D.C.; Richardson, E.A.; Scheuerman, R.F.

    1980-08-26

    A backsurge of fluid through perforations in a well casing is chemically induced by injecting into the surrounding reservoir a solution which contains (A) nitrogen gas-generating reactants, (B) a reaction-retarding alkaline buffer, and (C) a ph-reducing reactant that is capable of subsequently overriding the buffer, so that a rapid production of gas and heat causes a backsurging of fluid into the wellbore.

  5. Chemical process for backsurging fluid through well casing perforations

    Berkshire, D.C.; Richardson, E.A.; Scheuerman, R.F.

    1981-09-15

    A backsurge of fluid through perforations in a well casing is chemically induced by injecting into the surrounding reservoir a solution which contains nitrogen gas-generating reactants, a reaction-retarding alkaline buffer, and a pH-reducing reactant that is capable of subsequently overriding the buffer, so that a rapid production of gas and heat causes a backsurging of fluid into the wellbore.

  6. Numerical investigation of wind effects on the perforated structures

    Král, Radomil; Pospíšil, Stanislav

    Vol. 821. Zürich: Trans Tech Publications, 2016 - (Fischer, C.), s. 591-598 ISBN 978-3-03835-700-1. [Engineering mechanics 2015 /21./. Svratka (CZ), 11.05.2015-14.05.2015] R&D Projects: GA ČR(CZ) GP14-34467P Institutional support: RVO:68378297 Keywords : CFD * perforated surface * resistance barrier * wind effect * screen boundary condition Subject RIV: JM - Building Engineering

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

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

    2013-01-01

    INTRODUCTION Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation. PRESENTATION OF CASE A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation...

  8. Perforated appendicitis: an underappreciated mimic of intussusception on ultrasound

    Newman, Beverley; Schmitz, Matthew; Gawande, Rakhee; Vasanawala, Shreyas; Barth, Richard [Lucile Packard Children' s Hospital, Department of Radiology, Stanford University, Stanford, CA (United States)

    2014-05-15

    We encountered multiple cases in which the US appearance of ruptured appendicitis mimicked intussusception, resulting in diagnostic and therapeutic delay and multiple additional imaging studies. To explore the clinical and imaging discriminatory features between the conditions. Initial US images in six children (age 16 months to 8 years; 4 boys, 2 girls) were reviewed independently and by consensus by three pediatric radiologists. These findings were compared and correlated with the original reports and subsequent US, fluoroscopic, and CT images and reports. All initial US studies demonstrated a multiple-ring-like appearance (target sign, most apparent on transverse views) with diagnostic consensus supportive of intussusception. In three cases, US findings were somewhat discrepant with clinical concerns. Subsequently, four of the six children had contrast enemas; two were thought to have partial or complete intussusception reduction. Three had a repeat US examination, with recognition of the correct diagnosis. None of the US examinations demonstrated definite intralesional lymph nodes or mesenteric fat, but central echogenicity caused by debris/appendicolith was misinterpreted as fat. All showed perilesional hyperechogenicity that, in retrospect, represented inflamed fat ''walling off'' of the perforated appendix. There were four CTs, all of which demonstrated a double-ring appearance that correlated with the US target appearance, with inner and outer rings representing the dilated appendix and walled-off appendiceal rupture, respectively. All six children had surgical confirmation of perforated appendicitis. Contained perforated appendicitis can produce US findings closely mimicking intussusception. Clinical correlation and careful multiplanar evaluation should allow for sonographic suspicion of perforated appendicitis, which can be confirmed on CT if necessary. (orig.)

  9. Pyometra Perforation Caused by Actinomyces without Intrauterine Device Involvement

    Hideharu Hagiya

    2013-01-01

    An 86-year-old woman with diabetes mellitus and severe decubitus at the sacral and calcaneal regions stemming from poor daily activity was diagnosed with pyometra perforation caused by Actinomyces. No foreign materials, including an IUD, were found inside the uterus. Pyometra is usually caused by Enterobacteriaceae or anaerobes derived from the gastrointestinal tract. The virulence of Actinomyces is rather low, and, in almost all the reported cases of Actinomyces-related pyometra, an intraut...

  10. Internal granuloma with perforation – 2 case report

    Ioana Suciu

    2015-11-01

    Full Text Available Internal resorption was associated with long-term chronic inflammation of the pulp (chronic granulomatous pulpitis. When internal resorption is radiographically confirmed, endodontic treatment becomes a necessity. Vital teeth internal resorption appears radiographically as an oval enlargement of the pulp chamber and root canal with smooth, symmetrical outline. Internal granuloma is assumed to be an effect of the trauma, or pulp inflammation, the ailment is rare, asymptomatic and might progress rapidly, causing perforation.

  11. Energy-momentum balance in particle - domain wall perforating collision

    Gal'tsov, D. V.; Melkumova, E. Yu.; Spirin, P. A.

    2014-01-01

    We investigate the energy-momentum balance in the perforating collision of a point particle with an infinitely thin planar domain wall within the linearized gravity in arbitrary dimensions. Since the metric of the wall increases with distance, the wall and the particle are never free, and their energy-momentum balance involves not only the instantaneous kinetic momenta, but also the non-local contribution of gravitational stresses. However, careful analysis shows that the stresses can be unam...

  12. Retinal detachment secondary to ocular perforation during retrobulbar Anaesthesia

    Gopal Lingam; Badrinath S; Parikh Sunil; Chawla Gajendra

    1995-01-01

    The clinical characteristics and the retinal breaks associated with rhegmatogenous retinal detachments secondary to accidental globe perforation during local infiltration anaesthesia in five highly myopic eyes are presented. Retinal detachment was total with variable proliferative vitreoretinopathy. The pattern of retinal breaks was rather typical and predictable. Management involved vitreous surgery with internal tamponade by silicone oil in four eyes and perfluoropropane gas in one eye. At ...

  13. T2* weighted MR imaging for the diagnosis of the perforation of triangular fibrocartilage

    Perforation of the triangular fibrocartilage (TFC) has been considered an important factor in the etiology of pain in the ulnar wrist joint, and arthrography has been used conventionally to diagnose the perforation. Recently, magnetic resonance imaging (MRI) has been used to diagnose TFC perforation. Gundy et al. examined cadaver wrists with Tl weighted imaging and arthrography, and obtained findings suggesting that arthrography provides a more accurate diagnosis of the TFC perforation. To our knowledge, no comparison has yet been made between T2* weighted imaging and arthrography in the diagnosis of TFC perforation. The present study compared the usefulness of T2*-weighted imaging and arthrography in the diagnosis of TFC perforation in 22 wrist joints of 11 cadavers (5 males and 6 females with ages ranging from 61 to 92 years and an average age of 78.8 years) fixed in 60% formalin. The specimens were firstly analyzed by a T2*-weighted 0.5T MRI scan and subsequently by arthrography. After diagnosing the image obtained by the two methods, the accuracy of the diagnosis was determined by comparison with the macroscopic findings of autopsy, including the presence and degree of TFC perforation. A T2*-weighted MRI scan of the TFC perforation showed high-intensity areas over the distal radio-ulnar joint, and demonstrated the same diagnostic accuracy as arthrography, providing correct diagnoses in all cases other than linear perforation. However, neither of the image diagnostic methods allowed definition of the type of perforation. (author)

  14. Tuberculosis and the acquired immune deficiency syndrome in South Brazil

    Tuberculosis and the acquired immune deficiency syndrome in South Brazil. The authors studied the incidence of tuberculosis in South Brazilian patients with acquired immune deficiency syndrome from January 1985 to June 1988. During this period, tuberculosis occurred in 10.3% of acquired immune deficiency syndrome patients. The socioeconomic conditions and the incidence of disease in the population were not confirmed as a potential risk for tuberculosis infection. Chest radiographs revealed pulmonary infiltrates in six patients, hilar and/or mediastinal adenopathy in three, and pleural effusion in two. The two remaining patients had pulmonary consolidation associated with other features. None of these patients presented pulmonary cavitation or radiographic findings of typical reactivation of pulmonary tuberculosis. (author)

  15. Evaluation of prognostic factors and scoring system in colonic perforation

    Atsushi Horiuchi; Yuji Watanabe; Takashi Doi; Kouichi Sato; Syungo Yukumi; Motohira Yoshida; Yuji Yamamoto; Hiroki Sugishita; Kanji Kawachi

    2007-01-01

    AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation.METHODS: A total of 26 patients (9 men, 17 women;mean age 72.7±11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluationⅡ (APACHE Ⅱ),Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively.RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, nonsurvivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH,low PaO2/FiO2, and high serum creatinine postoperatively.APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4±3.84 vs19.3±2.87, P= 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no significant difference was identified.CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with significantly increased mortality rate.

  16. Application of high powered lasers to perforated completions.

    Xu, Z.; Reed, C.; Leong, K.; Parker, R.; Graves, R.; Nuclear Engineering Division; Parker Geoscience; Colorado School of Mines

    2003-01-01

    As part of the process of drilling an oil or gas well, a steel production casing is often inserted to the bottom of the well and sealed with cement against the productive formation. Openings must be made through the steel casing wall and cement and into the rock formation to allow formation fluid to enter the well. Conventionally, a perforator is lowered through the casing on a wire line. When it is in the correct position, bullets are fired or explosive charges are set off to create an open path between the formation and the production string. As effective as those processes are in creating a hole or tunnel, they alter the surrounding rock and cause formation damage around the created tunnel. The permeability of the altered zone is significantly less than virgin formation by as much as 80%. The petroleum industry welcomes new perforation technologies that not only create holes effectively but also minimize the formation damage. This paper will present the feasibility study results of application of high power lasers to perforation completions and focus on methods for creating deep holes in rocks by high power lasers.

  17. A case of delayed cardiac perforation of active ventricular lead

    Hangyuan Guo

    2011-12-01

    Full Text Available A 65-year-old man was admitted as for one month of repetitive dizziness and one episode of syncope. Electrocardiogram showed sinus bradycardia and his Holter monitoring also showed sinus bradycardia with sinus arrest, sino-atrial block and a longest pause of 4.3 s. Then sick sinus syndrome and Adam-Stokes syndrome were diagnosed. Then a dual chamber pacemaker (Medtronic SDR303 was implanted and the parameters were normal by detection. The patient was discharged 1 week later with suture removed. Then 1.5 month late the patient was presented to hospital once again for sudden onset of chest pain with exacerbation after taking deep breath. Pacemaker programming showed both pacing and sensing abnormality with threshold of?5.0V and resistance of 1200?. Lead perforation was revealed by chest X-ray and confirmed by echocardiogram. Considering the fact that there was high risk to remove ventricular lead, spiral tip of previous ventricular lead was withdrew followed by implantation of a new ventricular active lead to the septum. Previous ventricular lead was maintained. As we know that the complications of lead perforation in the clinic was rare. Here we discuss the clinical management and the possible reasons for cardiac perforation of active ventricular lead.

  18. What are the risk factors of colonoscopic perforation?

    Lohsiriwat Darin

    2009-09-01

    Full Text Available Abstract Background Knowledge of the factors influencing colonoscopic perforation (CP is of decisive importance, especially with regard to the avoidance or minimization of the perforations. The aim of this study was to determine the incidence and risk factors of CP in one of the endoscopic training centers accredited by the World Gastroenterology Organization. Methods The prospectively collected data were reviewed of all patients undergoing either colonoscopy or flexible sigmoidoscopy at the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand between January 2005 and July 2008. The incidence of CP was evaluated. Eight independent patient-, endoscopist- and endoscopy-related variables were analyzed by a multivariate model to determine their association with CP. Results Over a 3.5-year period, 10,124 endoscopic procedures of the colon (8,987 colonoscopies and 1,137 flexible sigmoidoscopies were performed. There were 15 colonic perforations (0.15%. Colonoscopy had a slightly higher risk of CP than flexible sigmoidoscopy (OR 1.77, 95%CI 0.23-13.51; p = 1.0. Patient gender, emergency endoscopy, anesthetic method, and the specialty or experience of the endoscopist were not significantly predictive of CP rate. In multivariate analysis, patient age of over 75 years (OR = 6.24, 95%CI 2.26-17.26; p Conclusion The incidence of CP in this study was 0.15%. Patient age of over 75 years and therapeutic colonoscopy were two important risk factors for CP.

  19. Perforated plates for cryogenic regenerators and method of fabrication

    Perforated plates having very small holes with a uniform diameter throughout the plate thickness are prepared by a open-quotes wire drawingclose quotes process in which a billet of sacrificial metal is disposed in an extrusion can of the plate metal, and the can is extruded and restacked repeatedly, converting the billet to a wire of the desired hole diameter. At final size, the rod is then sliced into wafers, and the wires are removed by selective etching. This process is useful for plate metals of interest for high performance regenerator applications, in particular, copper, niobium, molybdenum, erbium, and other rare earth metals. Er3Ni, which has uniquely favorable thermophysical properties for such applications, may be incorporated in regions of the plates by providing extrusion cans containing erbium and nickel metals in a stacked array with extrusion cans of the plate metal, which may be copper. The array is heated to convert the erbium and nickel metals to Er3Ni. Perforated plates having two sizes of perforations, one of which is small enough for storage of helium, are also disclosed. 10 figures

  20. Cervical cellulitis and mediastinitis following esophageal perforation: A case report

    Christian A Righini; Basilide Z Tea; Emile Reyt; Karim A Chahine

    2008-01-01

    Chicken bone is one of the most frequent foreign bodies (FB) associated with upper esophageal perforation.Upper digestive tract penetrating FB may lead to life threatening complications and requires prompt management.We present the case of a 52-year-old man who sustained an upper esophageal perforation associated with cervical cellulitis and mediastinitis.Following CT-scan evidence of FB penetrating the esophagus,the impacted FB was successfully extracted under rigid esophagoscopy.Direct suture was required to close the esophageal perforation.Cervical and mediastinal drainage were made immediately.Nasogastric tube decompression,broad-spectrum intravenous antibiotics,and parenteral hyperalimentation were administered for 10 d postoperatively.An esophagogram at d 10 revealed no leak at the repair site,and oral alimentation was successfully reinstituted.Conclusion:Rigid endoscope management of FB esophageal penetration is a simple,safe and effective procedure.Primary esophageal repair with drainage of all affected compartments are necessary to avoid life-threatening complications.

  1. Implantation epithelial iris cyst following the perforating corneal injury

    Jovanović Miloš

    2006-01-01

    Full Text Available The objective of this case report was to present the development of implantation cyst following the perforating corneal injury, the problems related to the treatment, including total surgical excision of the cyst, the secondary cataract extraction, iridoplasty and the artificial intraocular lens reposition. A patient first presented with perforating corneal injury inflicted by a piece of wood, with the iris prolapse. Primary wound management, reposition of prolapsed iris and corneal sutures were performed four days after the injury. Eight months later, the patient was rehospitalized due to an implantation iris cyst and traumatic cataract. The cyst was excised, the extracapsular cataract extraction was done and the anterior chamber lens was implanted. Postoperative visual acuity was normal. Three years later, the patient presented for a follow-up examination, with the cyst filled up again, occupying two thirds of the anterior chamber. This time, the cyst was completely excised, all fibrous remnants of the secondary cataract were removed, and the iridoplasty was necessary due to large iris coloboma. Reposition of the anterior chamber lens was carried out. Histological examination revealed an implantation iris cyst covered by multilayered squamous epithelium. Normal visual acuity was achieved. The patient has been followed-up for six months uneventfully. Management of perforating corneal wound with iris prolapse may lead to development of an implantation iris cyst. Puncture of the cyst as well as incomplete excision will not solve the problem. Complete surgical removal of the iris cyst is the treatment of choice.

  2. Spontaneous corneal perforation in an eye with Peters' anomaly

    Kim M

    2013-07-01

    Full Text Available Moosang Kim, Seung-Chan Lee, Seung-Jun Lee Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, South Korea Abstract: A premature female infant underwent her first ophthalmologic examination at the age of 4 weeks. The initial examination of the baby was requested for evaluation of a ‘white spot’ on the surface of her right eye. She had been hospitalized in the neonatal intensive care unit because of systemic abnormalities, such as a right clavicle fracture and microcephaly. Slit-lamp examination of the right eye showed a central corneal opacity, corneal thinning, and an iridocorneal adhesion. The lens and fundus of the right eye could not be observed. We observed no pathologic findings in the left eye. The baby's parents were informed of the high risk for spontaneous corneal perforation without external pressure. At 42 days of age, an ophthalmologic examination of the infant was again requested for evaluation of ‘tears’ from her right eye 3 hours previously. Examination revealed corneal perforation, iris protrusion, and a flat anterior chamber. We performed emergent conjunctival flap surgery. Three months following surgery, the patient's right eye was successfully preserved with no sign of inflammation or leakage. Keywords: conjunctival flap, corneal perforation, Peters' anomaly

  3. What Is Reactive Arthritis?

    ... Arthritis PDF Version Size: 69 KB November 2014 What is Reactive Arthritis? Fast Facts: An Easy-to- ... Information About Reactive Arthritis and Other Related Conditions What Causes Reactive Arthritis? Sometimes, reactive arthritis is set ...

  4. Acquired Aplastic Anemia in Children

    Hartung, Helge D.; Olson, Timothy S.; Bessler, Monica

    2013-01-01

    This article provides a practice-based and concise review of the etiology, diagnosis, and management of acquired aplastic anemia in children. Bone marrow transplantation, immunosuppressive therapy, and supportive care are discussed in detail. The aim is to provide the clinician with a better understanding of the disease and to offer guidelines for the management of children with this uncommon yet serious disorder.

  5. Acquired anhidrosis a case report

    Nair Laxmi

    1992-01-01

    Full Text Available A 30-year -old man was seen for acquired anhidrosis. There was no systemic disease. Vasomotor functions were normal. Biopsy showed normal sweat glands and ducts. Intravenous injection of neostigmine could produce profuse sweating on the face, trunk and arms. The disorder is likely to be due to a peripheral dysautonomia selectively affecting the sudomotor function.

  6. Acquired anhidrosis a case report

    Nair Laxmi; Beena D; Manohar S

    1992-01-01

    A 30-year -old man was seen for acquired anhidrosis. There was no systemic disease. Vasomotor functions were normal. Biopsy showed normal sweat glands and ducts. Intravenous injection of neostigmine could produce profuse sweating on the face, trunk and arms. The disorder is likely to be due to a peripheral dysautonomia selectively affecting the sudomotor function.

  7. The reactivity meter and core reactivity

    The point kinetic equations and the characteristics of the point kinetic reactivity meter are discussed, particularly for large negative reactivities. From a given input signal representing the neutron flux seen by a detector, the meter computes a value of reactivity in dollars (ρ/β), based on inverse point kinetics. The prompt jump point of view is emphasised. A simple point model of the reactor and a local flux distortion factor are used to generate input signals into a simulated reactivity meter. The obtained results show how the reading of the reactivity meter will approach the reactivity of the core model, if the reactivity is lower than -1 dollars. However, for reactivity values higher than -1 dollars, the influence of the flux distortion on the reading of the reactivity meter persists. Reactivity meter measurements taken during typical rod drop experiments in VVER-440 reactors do not produce accurate indications of the (static) core reactivity. (author)

  8. Investigations on the acoustic transmission characteristics of underwater perforated panel structures

    WANG Zefeng; HU Yongming

    2009-01-01

    Perforated panel structures have a wide potential in underwater applications. However, up to now there has been little related research. The acoustic impedance of an underwater perforated panel is obtained based on the theories for air perforated panel sound absorption.In this paper sound transmission characteristics of underwater perforated panel structures are theoretically analyzed by the transfer matrix method. A formula for normal incidence sound transmission coefficients is given. The main factors that have effects on the acoustic transmission coefficient are analyzed by numerical simulations. The perforated panel structures made by ourselves are tested in a standing-wave tube by the four-sensor transfer-function method.The experimental results are well in accord with the results obtained by the numerical method,which proves that the theoretical analysis is correct. This paper has provided theoretical and experimental bases for the design of underwater perforated panel structures.

  9. Intrahepatic type II gall bladder perforation by a gall stone in a CAPD patient

    Göbel T

    2011-05-01

    Full Text Available Abstract Introduction Perforation of the gall bladder represents a rare, but life-threatening complication of cholecystitis. Clinical presentation may vary between severe peritonism in acute perforation and absence of symptoms in subacute or chronic progression of perforation. Abdominal imaging like ultrasound or CT-scan are important tools for immediate diagnose of gall bladder perforation. Case presentation We report a case of a 30-year old female patient with end-stage kidney disease treated by continuous ambulatory peritoneal dialysis (CAPD who was admitted to the emergency room with fever and mild abdominal pain. A type II gall bladder perforation by a solitary gall stone with development of a liver abscess was detected by abdominal ultrasound. Conclusion Gall bladder perforations are rare but have to be considered in patients with abdominal pain and fever. Abdominal ultrasound is a reliable tool to establish diagnosis.

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

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

    2016-12-01

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

  11. Occupationally Acquired American Cutaneous Leishmaniasis

    Maria Edileuza Felinto de Brito

    2012-01-01

    Full Text Available We report two occupationally acquired cases of American cutaneous leishmaniasis (ACL: one accidental laboratory autoinoculation by contaminated needlestick while handling an ACL lesion sample, and one acquired during field studies on bird biology. Polymerase chain reaction (PCR assays of patient lesions were positive for Leishmania, subgenus Viannia. One isolate was obtained by culture (from patient 2 biopsy samples and characterized as Leishmania (Viannia naiffi through an indirect immunofluorescence assay (IFA with species-specific monoclonal antibodies (mAbs and by multilocus enzyme electrophoresis (MLEE. Patients were successfully treated with N-methyl-glucamine. These two cases highlight the potential risks of laboratory and field work and the need to comply with strict biosafety procedures in daily routines. The swab collection method, coupled with PCR detection, has greatly improved ACL laboratory diagnosis.

  12. CNOOC Acquires Oversea Assets Successfully

    Hu Senlin

    2006-01-01

    @@ After last year CNOOC's bidding for buy the US energy company Unocal Corp lost out to the Chevron Corporation, it conducted the crossing-border asset-acquirement again in the beginning of this year. On Jan. 9, 2006,CNOOC Ltd signed a definitive agreement with Nigeria South Atlantic Petroleum Limited (SAPETRO) to acquire a 45 % working interest in an offshore oil developing license OML 130 in Nigeria for US$2.268 billion cash. The purchase will be funded by the internal capital resources of CNOOC Ltd. In which, US$1.75 billion will pay for buying SAPETRO, and the remaining cash will be used to pay for the early operation cost.

  13. Cogema acquires TOTAL's uranium assets

    On April 28, France's nuclear fuel cycle conglomerate Cogema and petroleum group TOTAL announced a plan in which Cogema will assume ownership of TOTAL's uranium assets worldwide, and as part of the deal, each firm will acquire shares of the other. On June 2, the agreement will be submitted to shareholders and, assuming it is approved, will go into effect this year. The agreement calls for TOTAL to acquire a 10.8-percent share in Cogema, thus becoming its first private sector shareholder, by underwriting a reserve capital increase of FF1.5 billion (approximately US$283 million). In return, Cogema will pay FF2.52 billion for approximately 4.3 percent of TOTAL, as part of a reserve capital increase totalling FF4.07 billion

  14. Transstomal Small Bowel Evisceration after Colonic Perforation Secondary to Ischemic Colitis

    Ali Guner

    2012-01-01

    Full Text Available Intestinal stomas are commonly used in a temporary or permanent fashion in gastrointestinal surgeries. The complication rate of stomas has been reported to vary between 23 and 50%. There is only one case in the literature involving transstomal small bowel evisceration following colonic perforation. In this paper, we aimed to present a patient with a perforated colon secondary to ischemic colitis, which resulted in small bowel evisceration through this perforation site.

  15. Transstomal Small Bowel Evisceration after Colonic Perforation Secondary to Ischemic Colitis

    Ali Guner; Izzettin Kahraman; Omer Faruk Ozkan; Adem Aktas; Can Kece

    2012-01-01

    Intestinal stomas are commonly used in a temporary or permanent fashion in gastrointestinal surgeries. The complication rate of stomas has been reported to vary between 23 and 50%. There is only one case in the literature involving transstomal small bowel evisceration following colonic perforation. In this paper, we aimed to present a patient with a perforated colon secondary to ischemic colitis, which resulted in small bowel evisceration through this perforation site.

  16. Surgical Outcome and Complications of Nasal Septal Perforation Repair with Temporal Fascia and Periosteal Grafts

    Paula Virkkula; Mäkitie, Antti A.; Seija I. Vento

    2015-01-01

    AIMS Surgical treatment of nasal septal perforation remains a challenging field of rhinology. A large variety of techniques and grafts with promising results have been introduced for perforation repair. However, the use of fascia or fascia with periosteum has not been previously evaluated for a large sample of patients. METHODS During the years 2007–2014, 105 operations were performed and 98 patients were treated for nasal septal perforation at the Department of Otorhinolaryngology—Head and N...

  17. Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

    Tae Hoon Lee; Do Hyun Park; Ji-Young Park; Suck-Ho Lee; Il-Kwun Chung; Hong Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2008-01-01

    Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

  18. The Houdini effect--an unusual case of blunt abdominal trauma resulting in perforative appendicitis.

    O'Kelly, F

    2012-03-01

    We present a unique case of perforative appendicitis that occurred in an adult following blunt abdominal trauma. This case represents the first such reported case from Ireland. It also represents a modern practical example of Laplace\\'s theory of the effect of increased pressure on colonic wall tension leading to localized perforation, and serves to highlight not only the importance in preoperative imaging for blunt abdominal trauma, but also the importance of considering appendiceal perforation.

  19. Perforation of the colon and rectum--a newly recognized complication of CT colonography.

    Sosna, Jacob; Sella, Tamar; Bar-Ziv, Jacob; Libson, Eugene

    2006-04-01

    CT colonography (CTC) and conventional colonoscopy may have similar efficacy for detection of polyps > 6 mm. Perforation of the colon and rectum is a relatively rare, but potentially morbid complication of CTC, especially in symptomatic patients. Older age and underlying concomitant colon pathology increase the risk of perforation. This review describes the incidence, clinical features, and management of colon perforations at CTC, a study that was considered risk-free until recently. PMID:16623370

  20. Efficacy of the Ovesco Clip for Closure of Endoscope Related Perforations

    Phonthep Angsuwatcharakon; Piyapan Prueksapanich; Pradermchai Kongkam; Thawee Rattanachu-ek; Jaksin Sottisuporn; Rungsun Rerknimitr

    2016-01-01

    Aim. To study the efficacy and other treatment outcomes of Ovesco clip closure of iatrogenic perforation. Methods. Retrospective study from 3 tertiary-care hospitals in Thailand. Patients with iatrogenic perforation who underwent immediate endoscopic closure by Ovesco clip were included. Patients’ demographic data, perforation size, number of Ovesco clips used, fasting day, length of hospital stay, success rates, and complication rate were recorded. Technical success was defined as closure ac...

  1. Role of topical heparine in healing of traumatic tympanic membrane perforations

    Zafarullah Beigh; Manzoor Ahmad Malik; Aamir Yousuf; Rafiq Ahmad Pampori

    2012-01-01

    Background: Traumatic tympanic membrane (TM) perforations may arise from instruments such as cotton swabs, bobby pins, and sticks, skull fractures, acid burns and welding or metal working slag burns. Pressure induced perforations can occur after loud noise and explosions, open palm trauma (slapping), or changes in ambient pressure that occurs during flying and underwater diving. In case of traumatic perforation, some observation time is recommended before surgical intervention. In the recent ...

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

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

    2014-01-01

    Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal...

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

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

    2013-01-01

    Iatrogenic perforation of the furcation area in multi-rooted molars during preparation of the access cavity can potentially lead to tooth extraction. The present case report describes the nonsurgical endodontic management of an extensive pulp chamber floor perforation in a first mandibular molar with calcium enriched mixture (CEM) cement. The perforation was chemically cleaned and then physically sealed with CEM cement. Root canal therapy was completed and the tooth was then restored with ama...

  4. Perforated small intestine in a patient with T-cell lymphoma; a rare cause of peritonitis

    Petrişor Banu; Vlad D. Constantin; Florian Popa; Mihaela F. Nistor

    2016-01-01

    The nontraumatic perforations of the small intestine are pathological entities with particular aspects in respect to diagnosis and treatment. These peculiarities derive from the nonspecific clinical expression of the peritonitis syndrome, and from the multitude of causes that might be the primary sources of the perforation: foreign bodies, inflammatory diseases, tumors, infectious diseases, etc. Accordingly, in most cases intestinal perforation is discovered only by laparotomy and the definit...

  5. An unusual cause of ileal perforation: Report of a case and literature review

    Sami Akbulut; Bahri Cakabay; Cihan Akgul Ozmen; Arsenal Sezgin; Mahsuni Mert Sevinc

    2009-01-01

    An ileal perforation resulting from a migrated biliary stent is a rare complication of endoscopic stent placement for benign or malignant biliary tract disease.We describe the case of a 59-year-old woman with a history of abdominal surgery in which a migrated biliary stent resulted in an ileal perforation. Patients with comorbid abdominal pathologies, including colonic diverticuli, parastomal hernia, or abdominal hernia, may be at increased risk of perforation from migrated stents.

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

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

    2014-01-01

    Acute abdomen during pregnancy is a medico-surgical emergency demanding concerted, synchronized specialties approach of obstetrician, surgeon and gastroenterologist. Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy. Here, we report a case of duodenal perforation with peritonitis in third trimester of pregnancy requiring surgical management. Our aim of reporting this case is to stress the physicians to keep the differential of duodenal perforation also in mind whil...

  7. Non surgical perforation repair by mineral trioxide aggregate under dental operating microscope

    Mousumi Biswas; Dibyendu Mazumdar; Abhijit Neyogi

    2011-01-01

    Root perforation repair has historically been an unpredictable treatment modality, with an unacceptably high rate of clinical failure. Recent developments in the techniques and materials utilized in root perforation repair have dramatically enhanced the prognosis of both surgical and nonsurgical procedures. Mineral Trioxide Aggregate is a relatively new material that is being successfully used to repair perforations. Technological advancements such as the use of a Dental Operating Microscope ...

  8. Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum

    Shapey, IM; Nasser, T; Dickens, P; Haldar, M; Solkar, MH

    2012-01-01

    Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which ar...

  9. Successful Late Management of Esophageal Perforation with T-Tube Drainage

    Nakabayashi, Toshihiro; Kudo, Michiaki; Hirasawa, Toshiaki; Kuwano, Hiroyuki

    2008-01-01

    The late management of spontaneous esophageal perforation is the most challenging problem for the surgeon. In this paper, we present a case in whom a spontaneous esophageal perforation was successfully treated by T-tube drainage after unsuccessful conservative treatment. The patient, a 68-year-old male, was admitted to the hospital with sudden upper abdominal pain. After 2 days, esophageal perforation was diagnosed, and conservative management was begun. Thereafter, the subcutaneous emphysema...

  10. Acquired causes of intestinal malabsorption.

    van der Heide, F

    2016-04-01

    This review focuses on the acquired causes, diagnosis, and treatment of intestinal malabsorption. Intestinal absorption is a complex process that depends on many variables, including the digestion of nutrients within the intestinal lumen, the absorptive surface of the small intestine, the membrane transport systems, and the epithelial absorptive enzymes. Acquired causes of malabsorption are classified by focussing on the three phases of digestion and absorption: 1) luminal/digestive phase, 2) mucosal/absorptive phase, and 3) transport phase. Most acquired diseases affect the luminal/digestive phase. These include short bowel syndrome, extensive small bowel inflammation, motility disorders, and deficiencies of digestive enzymes or bile salts. Diagnosis depends on symptoms, physical examination, and blood and stool tests. There is no gold standard for the diagnosis of malabsorption. Further testing should be based on the specific clinical context and the suspected underlying disease. Therapy is directed at nutritional support by enteral or parenteral feeding and screening for and supplementation of deficiencies in vitamins and minerals. Early enteral feeding is important for intestinal adaptation in short bowel syndrome. Medicinal treatment options for diarrhoea in malabsorption include loperamide, codeine, cholestyramine, or antibiotics. PMID:27086886

  11. Six-year retrospective analysis of colonic perforation in neonates and infants: Single centre experience

    Sunita Singh

    2012-01-01

    Full Text Available Background: Developing countries at tertiary referral centre. This study analysed the aetiology of colonic perforation (CP in neonates and infants. Materials and Methods: Retrospective analyses of 60 CP cases (presented from May 2005 to May 2011 were done. Results: The mean age at presentation was 8.33 ± 0.11 days (range, 2-110 days. The aetiology were Hirschsprung′s disease (HD, necrotising enterocolitis (NEC and idiopathic perforation in 78.33% (47/60, 6.67% (4/60 and 15% (9/60, respectively. There were 210 patients with histopathologically proven HD; 22.38% (47/210 cases of HD had CP. Most common site of perforation was mid-transverse colon (74%, 35/47 in HD patients. All HD-associated mid-transverse colonic, caecal, appendicular and ascending colon perforations (except one caecal perforation had aganglionic recto-sigmoid region and ganglionic perforation site. Features of enterocolitis were not found in any HD patients. Two patients (3.33% died due to sepsis. Conclusions: There was a high rate of primary HD-associated colonic perforation in this study. Colonic perforation may the initial presenting condition in HD disease. We advocate colonic biopsy to rule out HD in any neonate presenting with primary colonic perforation.

  12. Repair of chronic tympanic membrane perforations using applications of hyaluronan or rice paper prostheses.

    Laurent, C; Söderberg, O; Anniko, M; Hartwig, S

    1991-01-01

    A controlled randomized study was performed in 60 patients with 64 chronic, dry tympanic membrane (TM) perforations. The perforations were randomly allocated to either resection of the perforation rim and instillation of 1% hyaluronan (Healon; HYA) in the perforation gap once daily for 7 days (33 ears) or resection of the perforation margin and application of a sterile rice paper prosthesis (31 ears). The treatment effect was documented by TM photography and morphometric measurements of the perforation area. The hearing was assessed with puretone and high-frequency audiometry. After 2 months, 5 of the HYA-treated perforations (15%) and 4 of the rice-paper-treated TMs (13%) were healed. After 1 year, 18 perforations (9 in each treatment group) were healed. In neither group were there any persistent adverse effects on hearing. It is noteworthy that 28% (18/64) of the chronic, long-standing TM perforations could be repaired by these technically simple and time-saving methods. Both procedures should be considered as easy first-choice alternatives to myringoplasty in selected cases. PMID:2008293

  13. Effect of electrochemical etching current on prepared perforated silicon structures for neutron detectors

    Xiao-Qiang FAN; Yong JIANG; Chang-Yong ZHAN; Yu ZOU; Jian-Chun WU; Ning-Kang HUANG

    2013-01-01

    Neutron detector based on perforated silicon structures backfilled with neutron converting materials could be operated at a low voltage and improves the detection efficiency of thermal neutron. It is found that the intrinsic detection efficiency of thermal neutron is affected by a lot of factors such as the geometry, size, and depth of the perforation and so on. In this study, the perforated silicon was prepared by electrochemical etching. Effect of etching current on geometry, size, and depth of the perforated silicon structures for neutron detectors was also reported.

  14. Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips

    Panagiotis Katsinelos; George Paroutoglou; Basilios Papaziogas; Athanasios Beltsis; Stavros Dimiropoulos; Konstantinos Atmatzidis

    2005-01-01

    Perforation is one of the most serious complications of endoscopic sphincterotomy (ES) necessitating immediate surgical intervention. We present a case of successful management of such a complication with endoclipping. A85-year-old woman developed duodenal perforation after ES. The perforation was identified early and its closure was achieved using three metallic clips in a single session.There was no procedure-related morbidity or complications and our patient was discharged from hospital 10 d later.Endoclipping of duodenal perforation induced by ES is a safe, effective and alternative to surgery treatment.

  15. Furcal-perforation repair with mineral trioxide aggregate: Two years follow-up

    Emmanuel João Nogueira Leal da Silva

    2012-01-01

    Full Text Available Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure. Mineral trioxide aggregate (MTA has been regarded as an ideal material for perforation repair, retrograde filling, pulp capping, and apexification. This case report describes a furcal perforation in a maxillary first molar, which was repaired using MTA. The tooth was endodontically treated and coronally restored with resin composite. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing the perforation using MTA.

  16. Calculation of the thermal field of polyfunctional electromechanical transducer with a hollow perforated rotor

    N.N. Zablodskiy; Pliugin, V. E.; V.Yu. Gritsyuk; Grin', G. M.

    2013-01-01

    Proposed the method of calculating the temperature field polyfunctional electromechanical transducer with hollow perforated rotor on the based finite element model of interconnected electromagnetic and thermal processes.

  17. Inhibitors against the coagulation factors spontaneously acquired: Acquired B Hemophilia

    Claudia Lucía Sossa Melo; Sara Inés Jiménez Sanguino; Pilar Rodríguez

    2003-01-01

    Spontaneously acquired inhibitors to factor IX, are extremely rare. A 70-year-old male, presented with major continuous post-orthopedic surgery bleeding. His initial APTT was 77.4 s (normal range, 25-36) and normal PT. Expanded APTT corrects, results in favor of deficit of factor IX, confirming the level of dose of IX factor: 52% (NR 70–125%) with normal factor VIII. It was realized with fresh frozen plasma, and by the fifth day of treatment, he presents a bruise in the surgery bed with radic...

  18. Study of water/air countercurrent flow through perforated plates

    Understanding countercurrent flow limitation or flooding phenomenon is of great concern in nuclear safety analysis. A program is underway at CDTN/CNEN on emergency cooling of PWRs. Currently experimental research is oriented to a better understanding of the fluid dynamic process in the fuel element top nozzle area during a Loss of Coolant Accident (LOCA). This paper reports flooding experiments carried out with air and water flowing along a vertical square channel internals consisting of a 5 X 5 rod bundle and eleven interchangeable perforated plates. Some empirical flooding models available in the literature are used to verify the data consistency. (author)

  19. Perforated peptic ulcer: main factors of morbidity and mortality.

    NOGUIERA, C.; A.S. Silva; SANTOS, J.N.; A. G. SILVA; Ferreira, J; E. Matos; VILACA, H.

    2003-01-01

    World J Surg. 2003 Jul;27(7):782-7. Perforated peptic ulcer: main factors of morbidity and mortality. Noguiera C, Silva AS, Santos JN, Silva AG, Ferreira J, Matos E, Vilaça H. Surgery Department, Surgery 1, Hospital Geral de Santo António, Instituto de Ciencias Biomédicas Abel Salazar, Largo do Prof. Abel Salazar, 4099-001 Oporto, Portugal. Abstract It is well stated in the literature that medical treatment for peptic ulcer is based on a combination of proton pump inhibitors...

  20. Numerical investigation of wind effects on the perforated structures

    Král, Radomil; Pospíšil, Stanislav

    Prague : Institute of theoretical and applied mechanics, Academy of Sciences of the Czech Republic, v. v. i., 2015 - (Náprstek, J.; Fischer, C.). s. 156-157 ISBN 978-80-86246-42-0. ISSN 1805-8248. [Engineering mechanics 2015 /21./. 11.05.2015-14.05.2015, Svratka] R&D Projects: GA ČR(CZ) GP14-34467P Institutional support: RVO:68378297 Keywords : CFD * perforated surface * resistance barrier * wind effect * screen boundary condition Subject RIV: JM - Building Engineering

  1. HOMOGENIZATION OF SEMILINEAR PARABOLIC EQUATIONS IN PERFORATED DOMAINS

    P.DONATO; A. NABIL

    2004-01-01

    This paper is devoted to the homogenization of a semilinear parabolic equation with rapidly oscillating coefficients in a domain periodically perforated by e-periodic holes of size ε. A Neumann condition is prescribed on the boundary of the holes.The presence of the holes does not allow to prove a compactness of the solutions in L2. To overcome this difficulty, the authors introduce a suitable auxiliary linear problem to which a corrector result is applied. Then, the asymptotic behaviour of the semilinear problem as e → 0 is described, and the limit equation is given.

  2. Retinal detachment secondary to ocular perforation during retrobulbar Anaesthesia

    Gopal Lingam

    1995-01-01

    Full Text Available The clinical characteristics and the retinal breaks associated with rhegmatogenous retinal detachments secondary to accidental globe perforation during local infiltration anaesthesia in five highly myopic eyes are presented. Retinal detachment was total with variable proliferative vitreoretinopathy. The pattern of retinal breaks was rather typical and predictable. Management involved vitreous surgery with internal tamponade by silicone oil in four eyes and perfluoropropane gas in one eye. At the last follow-up, all eyes had attached retina. One eye did not recover useful vision due to possible concurrent optic nerve damage.

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

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

    2014-12-15

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

  4. Pyometra Perforation Caused by Actinomyces without Intrauterine Device Involvement

    Hideharu Hagiya

    2013-01-01

    Full Text Available An 86-year-old woman with diabetes mellitus and severe decubitus at the sacral and calcaneal regions stemming from poor daily activity was diagnosed with pyometra perforation caused by Actinomyces. No foreign materials, including an IUD, were found inside the uterus. Pyometra is usually caused by Enterobacteriaceae or anaerobes derived from the gastrointestinal tract. The virulence of Actinomyces is rather low, and, in almost all the reported cases of Actinomyces-related pyometra, an intrauterine device (IUD was involved. Although rare, Actinomyces may be ascribed as a virulent pathogen that causes pyometra in the absence of foreign materials.

  5. Dimensional Analysis on the Perforation of Stiffened Plates by Projectiles

    SONG Wei-dong; NING Jian-guo

    2007-01-01

    The phenomena attendant to the perforation of truncated oval shape projectile in to multi-layered stiffened plates were investigated. Dimensional analysis was employed to give an empirical formula. Then a membership function was introduced to modify the empirical formula. The effects of initial velocities, base plate thicknesses, height and width of stiffener on residual velocities were explored. The predictions of the empirical formula are in reasonably good agreement with those of experiment and numerical results. All these results indicate that the empirical formula is capable of predicting the residual velocity of the projectile penetrating the multi-layered stiffened plates.

  6. Reactivation-Dependent Amnesia in Pavlovian Approach and Instrumental Transfer

    Lee, Jonathan L. C.; Everitt, Barry J.

    2008-01-01

    The theory of memory reconsolidation relates to the hypothesized restabilisation process that occurs following the reactivation of a memory through retrieval. Thus, the demonstration of reactivation-dependent amnesia for a previously acquired memory is a prerequisite for showing that such a memory undergoes reconsolidation. Here, we show that the…

  7. Knowledge transfer - Acquiring implicit knowledge

    Many organisations have recognised the problem of experts taking home a huge amount of specific knowledge, which they have gathered in their department, when they leave. The successor is capable only of acquiring explicit expertise because implicit experiences are not documented and therefore no more available. That is why we have started this pilot study in order to try to conserve the above mentioned tacit and implicit knowledge and to make it available to other colleagues. Using a semi-standardised interview we elicit tacit knowledge from the expert and summarise it in a report. This interview-guideline forms the basis of in-depth investigation for implicit knowledge. (author)

  8. Melioidosis: reactivation during radiation therapy

    Melioidosis is caused by Pseudomonas pseudomallei, a gram-negative, motile bacillus which is a naturally occurring soil saprophyte. The organism is endemic in Southeast Asia, the Philippines, Australia, and parts of Central and South America. Most human disease occurs from infection acquired in these countries. Infection with P pseudomallei may produce no apparent clinical disease. Acute pneumonitis or septicemia may result from inhalation of the organism, and inoculation into sites of trauma may cause localized skin abscesses, or the disease may remain latent and be reactivated months or years later by trauma, burns, or pneumococcal pneumonia, diabetic ketoacidosis, influenza, or bronchogenic carcinoma. The last is probably the commonest form of melioidosis seen in the United States. We present the first case of reactivation of melioidosis after radiation therapy for carcinoma of the lung, again emphasizing the need to consider melioidosis in a septic patient with a history of travel, especially to Southeast Asia

  9. Melioidosis: reactivation during radiation therapy

    Jegasothy, B.V.; Goslen, J.B.; Salvatore, M.A.

    1980-05-01

    Melioidosis is caused by Pseudomonas pseudomallei, a gram-negative, motile bacillus which is a naturally occurring soil saprophyte. The organism is endemic in Southeast Asia, the Philippines, Australia, and parts of Central and South America. Most human disease occurs from infection acquired in these countries. Infection with P pseudomallei may produce no apparent clinical disease. Acute pneumonitis or septicemia may result from inhalation of the organism, and inoculation into sites of trauma may cause localized skin abscesses, or the disease may remain latent and be reactivated months or years later by trauma, burns, or pneumococcal pneumonia, diabetic ketoacidosis, influenza, or bronchogenic carcinoma. The last is probably the commonest form of melioidosis seen in the United States. We present the first case of reactivation of melioidosis after radiation therapy for carcinoma of the lung, again emphasizing the need to consider melioidosis in a septic patient with a history of travel, especially to Southeast Asia.

  10. Simulation of air velocity in a vertical perforated air distributor

    Ngu, T. N. W.; Chu, C. M.; Janaun, J. A.

    2016-06-01

    Perforated pipes are utilized to divide a fluid flow into several smaller streams. Uniform flow distribution requirement is of great concern in engineering applications because it has significant influence on the performance of fluidic devices. For industrial applications, it is crucial to provide a uniform velocity distribution through orifices. In this research, flow distribution patterns of a closed-end multiple outlet pipe standing vertically for air delivery in the horizontal direction was simulated. Computational Fluid Dynamics (CFD), a tool of research for enhancing and understanding design was used as the simulator and the drawing software SolidWorks was used for geometry setup. The main purpose of this work is to establish the influence of size of orifices, intervals between outlets, and the length of tube in order to attain uniformity of exit flows through a multi outlet perforated tube. However, due to the gravitational effect, the compactness of paddy increases gradually from top to bottom of dryer, uniform flow pattern was aimed for top orifices and larger flow for bottom orifices.

  11. Extended thoracodorsal artery perforator flap for breast reconstruction.

    Angrigiani, Claudio; Rancati, Alberto; Escudero, Ezequiel; Artero, Guillermo

    2015-12-01

    A total of 45 patients underwent partial or total autologous breast reconstruction after skin-sparing mastectomy, skin-reducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator (TDAP) flap. The detailed surgical technique with its variations is explained in this report. The propeller, flip-over, conventional perforator, and muscle-sparing flaps have been described and evaluated. The flaps were partially or completely de-epithelialized. The conventional TDAP can be enlarged or "extended" as the traditional latissimus dorsi musculocutaneous (LD-MC) flap by incorporating the superior and inferior fat compartments. It can be referred to as the "extended TDAP flap". This technique augments the flap volume. In addition, this flap can serve as a scaffold for lipofilling to obtain autologous breast reconstruction in medium to large cases. There were two complete failures due to technical errors during flap elevation. Distal partial tissue suffering was observed in four flaps. These flaps were longer than usual; they reached the midline of the back. It is advisable to discard the distal medial quarter of the flap when it is designed up to the midline to avoid steatonecrosis or fibrosis. A retrospective analysis of the 39 flaps that survived completely revealed a satisfactory result in 82% of the cases. The main disadvantage of this procedure is the final scar. The TDAP flap is a reliable and safe method for partial or total breast autologous reconstruction. PMID:26645006

  12. Early intestinal perforation secondary to congenital mesenteric defects

    Ingrid Anne Mandy Schierz

    2016-05-01

    Full Text Available Gastrointestinal perforation (GIP in preterm neonates may be idiopathic, due to necrotizing enterocolitis (NEC, or mechanical obstruction. The predominant cause of GIP in the neonatal period is NEC. Differential diagnosis with congenital malformations, including mesenteric defects leading to internal hernias, is mandatory if the onset is early. We describe two newborns with trans-mesenteric herniation resulting in GIP, and we discuss the presence of possible additional risk factors such as prematurity and predisposing vascular disruption in connective tissue disorders (Ehlers-Danlos syndrome, twinning, and use of assisted reproductive technologies. These cases prompted us to review our exploratory laparotomies performed for intestinal obstruction, complicated/or not with perforation, to identify the frequency of neonatal trans-mesenteric hernias in a referral hospital. The prevalence of GIP and of internal hernia was 25% and 3.3%, respectively. In conclusion, time-onset and particular conditions associated with GIP should lead to a high index of suspicion for internal hernias in order to achieve appropriate diagnosis and therapy.

  13. Postpartum spontaneous colonic perforation due to antiphospholipid syndrome

    Kamran Ahmed; Amir Darakhshan; Eleanor Au; Munther A Khamashta; Iraklis E Katsoulis

    2009-01-01

    The antiphospholipid syndrome (APS) is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis, fetal loss, thrombocytopenia, leg ulcers, livedo reticularis, chorea,and migraine. We document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean section. At laparotomy the underlying cause of colonic perforation was not clear and after resection of the affected bowel an ileo-colostomy was performed. The diagnosis of APS was established during post-operative hospital stay and the patient was commenced on warfarin.Eventually, she made a full recovery and had her stoma reversed after 4 mo. Pregnancy poses an increased risk of complications in women with APS and requires a more aggressive approach to the obstetric care. This should include full anticoagulation in the puerperium and frequent doppler ultrasound monitoring of uterine and umbilical arteries to detect complications such as preeclampsia and placental insufficiency.

  14. Avoiding or reversing Hartmann's procedure provides improved quality of life after perforated diverticulitis

    J. Vermeulen (Jefrey); M.P. Gosselink (Martijn Pieter); J.J. van Busschbach (Jan); J.F. Lange (Johan)

    2010-01-01

    textabstractINTRODUCTION: The existing literature regarding acute perforated diverticulitis only reports about short-term outcome; long-term following outcomes have not been assessed before. The aim of this study was to assess long-term quality of life (QOL) after emergency surgery for perforated di

  15. Neonatal appendicitis with perforation: A case report and review of literature

    Gupta Vipul

    2005-01-01

    Full Text Available Acute perforated appendicitis is described as a rare clinical entity in 20 days old male neonate presented clinically with features suggestive of peritonitis. Surgical exploration revealed perforated appendix with free fluid in peritoneal cavity. Appendectomy with general supportive measures resulted in a satisfactory recovery. Authors review their experience with this rare entity along with pertinent literature.

  16. A RARE CASE OF GALLBLADDER PERFORATION WITH CONCOMITANT SUPERIOR MESENTERIC ARTERY THROMBOSIS CAUSING BOWEL ISCHEMIA

    Minakshi

    2014-01-01

    Full Text Available We are presenting a rare case of Gall Bladder Perforation with Superior Mesenteric Artery thrombosis causing mid gut gangrene. Gall bladder Perforation due to gallstones and Acute Mesenteric Ischemia are two different pathologies not associated with each other , occurring together in the same patient causing acute abdomen has not been reported in the literature till date.

  17. Impact of hydraulic perforation on fracture initiation and propagation in shale rocks

    ZHAO Xi; JU Yang; YANG Yong; SU Sun; GONG WenBo

    2016-01-01

    To enhance the oil and gas recovery rate,hydraulic fracturing techniques have been widely adopted for stimulation of low-permeability reservoirs.Pioneering work indicates that hydraulic perforation and layout could significantly affect fracture initiation and propagation in low-permeability reservoir rocks subjected to complex in-situ stresses.This paper reports on a novel numerical method that incorporates fracture mechanics principles and the numerical tools FRANC3D and ANSYS to investigate the three-dimensional initiation and propagation behavior of hydro-fracturing cracks in shale rock.Considering the transverse isotropic property of shale rocks,the mechanical parameters of reservoir rocks attained from laboratory tests were adopted in the simulation.The influence of perforation layouts on the 3D initiation of hydro-fracturing fractures in reservoir rocks under geo-stresses was quantitatively illuminated.The propagation and growth of fractures in three dimensions in different perforating azimuth values were illustrated.The results indicate that:1) the optimal perforation direction should be parallel to the maximum horizontal principal stress,2) the crack plane gradually turns toward the direction of the maximum horizontal principal stress when they are not in parallel,3) compared with the linear and symmetric pattern,the staggered perforation is the optimal one,4) the proper perforation density is four to six holes per meter,5) the optimal perforation diameter in this model is 30 mm,and 6) the influence of the perforation depth on the fracture initiation pressure is low.

  18. Perforation of the Papilla of Vater in Wire-Guided Cannulation

    Yuichi Takano

    2016-01-01

    Full Text Available Background. WGC in ERCP is considered a safe technique, although rare complications can occur. One unique complication of WGC is the perforation of the papilla of Vater by the guidewire. Subjects and Methods. Of 2032 patients who underwent ERCP at our department between January 2010 and December 2014, we selected 208 patients who underwent WGC for naïve papilla as subjects. A detailed examination of patients in whom a perforation occurred was conducted, and risk factors for perforations were investigated. Results. The perforation was observed in 7 of 208 patients (3.4%. All patients recovered with conservative treatment without the need for surgery. The perforation rate was significantly higher in the patients with juxtapapillary duodenal diverticula than those without diverticula (12.5% versus 0.6%, p<0.001. Cannulation of the bile duct was ultimately achieved in 5 of 7 patients; PSP was performed for 4 of these patients. Conclusion. Caution must be exercised when dealing with patients who have a juxtapapillary duodenal diverticula because they are at higher risk of perforations. Because these are small perforations made by a wire, most of them heal with conservative treatment. However, perforations can make cannulation difficult, and PSP may be useful for deep cannulation.

  19. Hydrodynamic loading and viscous damping of patterned perforations on microfabricated resonant structures

    Park, Kidong; Shim, Jeong; Solovyeva, Vita; Corbin, E.; Banerjee, Sutanuka; Bashir, R.

    2012-01-01

    geometries was characterized from resonant frequency and quality factor. In water, the damping increased linearly with the perimeter at 45.4 × 10 Ns/m , until the perforation's radius was 123% ± 13% of the depth of penetration of fluid's oscillation. The added mass effect decreased with perforations and...

  20. Persistent perforation in non-faeculant diverticular peritonitis--incidence and clinical significance.

    O'Leary, D P

    2013-02-01

    Non-resectional strategies (NRS) have improved outcomes for a sub-group of patients with perforated diverticulitis. NRS are applicable to patients with non-faeculant peritonitis (Hinchey II and III). Success is dependent on the initial perforation sealing, which Hinchey estimated occurred \\'most of the time\\'. An exact percentage remains ill-defined.

  1. Tulip bundle technique and fibrin glue injection:Unusual treatment of colonic perforation

    Filippo Mocciaro; Gabriele Curcio; Ilaria Tarantino; Luca Barresi; Marco Spada; Sergio Li Petri; Mario Traina

    2011-01-01

    We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques.The lesion was large and irregular with three discrete perforations, therefore,we decided to close it by placing one clip per perforation,and then connecting all the clips with two endoloops.Finally we chose to use a fibrin glue injection to obtain a complete sealing.Four days after the colonoscopy the patient underwent a laparoscopic right hemicolectomy due to evidence of a large polyp of the caecum with high grade dysplasia and focal carcinoma in situ .Inspection of the sigma showed complete repair of the perforation.This report underlines how a conservative approach,together with a combination of various endoscopic techniques,can resolve complicated iatrogenic perforations of the colon.

  2. Shape-based 3D vascular tree extraction for perforator flaps

    Wen, Quan; Gao, Jean

    2005-04-01

    Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned perforated flaps, greater survivability and decrease in donor site morbidity have been reported. Knowledge of the 3D vascular tree will provide insight information about the dissection region, vascular territory, and fascia levels. This paper presents a scheme of shape-based 3D vascular tree reconstruction of perforator flaps for plastic surgery planning, which overcomes the deficiencies of current existing shape-based interpolation methods by applying rotation and 3D repairing. The scheme has the ability to restore the broken parts of the perforator vascular tree by using a probability-based adaptive connection point search (PACPS) algorithm with minimum human intervention. The experimental results evaluated by both synthetic and 39 harvested cadaver perforator flaps show the promise and potential of proposed scheme for plastic surgery planning.

  3. Freestyle facial perforator flaps-a safe reconstructive option for moderate-sized facial defects

    Gunnarsson, Gudjon Leifur; Jackson, Ian Thomas; Thomsen, Jorn Bo

    2014-01-01

    BACKGROUND: Perforators are a constant anatomical finding in the facial area and any known flap can in theory be based on the first perforator located at the flap rotation axis. METHODS: A case series of single stage reconstruction of moderate sized facial defects using 21 perforator based local...... flaps in 19 patients from 2008-2013. RESULTS: A sufficient perforator was located in every case and the flap rotated along its axis (76 %) or advanced (24 %). Reconstruction was successfully achieved with a high self reported patient satisfaction. Two minor complications occurred early on in the series...... and corrective procedures were performed in four patients. CONCLUSIONS: The random facial perforator flap seems to be a good and reliable option for the reconstruction of facial subunits, especially the periorbital, nasal and periocular area with a minimal morbidity and a pleasing result in a one...

  4. An unusual cause of duodenal perforation due to a lollipop stick

    Mi Jin Kim

    2013-04-01

    Full Text Available Children have a natural tendency to explore objects with their mouths; this can result in the swallowing of foreign objects. Most ingested foreign bodies pass uneventfully through the gastrointestinal tract.However, some foreign bodies cause obstruction or perforation of the gastrointestinal tract, requiring surgical intervention. Perforation of the gastrointestinal tract may be associated with considerable morbidity and mortality. The most common sites of intestinal foreign body perforation are the ileocecal and rectosigmoid regions. Foreign body perforation of the duodenum is relatively uncommon. We report the first Korean case of duodenal perforation by an ingested 8-cm lollipop stick. Lollipops are popular with the children and fairly accessible to them, as most parents are not aware of their potential harm. Pediatric clinicians should be aware of the risks associated with lollipop stick ingestion. Our report also describes the feasibility and safety of laparoscopic diagnosis and management of pediatric patients with peritonitis induced by the ingestion of foreign bodies.

  5. Sealing Ability of MTA Used in Perforation Repair of Permanent Teeth; Literature Review

    Baroudi, Kusai; Samir, Samah

    2016-01-01

    There were several materials used to seal different types of perforation defects. MTA is one of these restorative materials that is considered the most effective, biocompatible, non-toxic, and non-irritant; promote bone healing and cementum regeneration. The objective of this article was to review and summarize the sealing ability of MTA compared with the other materials used for sealing different types of root perforations of permanent teeth. A literature search was conducted using Medline, accessed via the National Library of Medicine Pub Med from 2005 to 2015 searching for articles related to sealing ability of MTA. This study found that factors affecting prognosis are the size, site of the perforation and time elapsed as well as the repair material. MTA is an important filling material to be used for sealing different types of perforations when perforated sites sealed immediately with MTA. PMID:27347231

  6. Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report

    Sugizaki Katsuyoshi

    2010-05-01

    Full Text Available Abstract Background Gallbladder perforation is a rare clinical condition, which mostly occurs following acute cholecystitis associated with cholelithiasis. A tumor of the ampulla of Vater causes gradually progressive symptoms, and is rarely associated with perforation of the gallbladder. Case Presentation A 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis. He complained of right upper abdominal pain, and laparotomy revealed perforation of the gallbladder with no gallstones. Postoperative upper gastrointestinal endoscopy demonstrated a slightly enlarged duodenal papilla, and biopsy revealed adenocarcinoma of the ampulla. Pylorus-preserving pancreaticoduodenectomy was performed subsequently. Conclusion Ampullary carcinoma can be associated with gallbladder perforation and present with acute manifestations. Immediate surgical treatment is required for this condition.

  7. Giant trochanteric pressure sore: Use of a pedicled chimeric perforator flap for cover

    Mehrotra Sandeep

    2009-01-01

    Full Text Available Pressure sores are increasing in frequency commensurate with an ageing population with multi-system disorders and trauma. Numerous classic options are described for providing stable wound cover. With the burgeoning knowledge on perforator anatomy, recent approaches focus on the use of perforator-based flaps in bedsore surgery. A giant neglected trochanteric pressure sore in a paraplegic is presented. Since conventional options of reconstruction appeared remote, the massive ulcer was successfully managed by a chimeric perforator-based flap. The combined muscle and fasciocutaneous flaps were raised as separate paddles based on the anterolateral thigh perforator branches and provided stable cover without complications. Perforators allow versatility in managing complex wounds without compromising on established principles.

  8. One Dimensional Finite Element Analysis of Heat Dissipation from Rectangular Fin with Longitudinal Hexagonal Perforations

    Isam H. E. Qasem

    2015-06-01

    Full Text Available In this study the finite element method (FEM is used in solving the heat dissipation from a perforated fin. This fin is horizontal rectangular fin subjected to natural convection and provided with longitudinal hexagonal perforations. The orientation of these perforations is described as they have two sides parallel to the fin sides. The body of the fin is discretized into the sufficient finite elements. The number of these elements can be altered as required according to the automatic mesh generation. The heat dissipation of the perforated fin is computed and compared with that of the solid one of the same dimensions and same thermal properties. The comparison refers to acceptable results and heat dissipation enhancement due to certain perforation.

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

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

    2016-01-01

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

  10. Viscosity method for Homogenization of Parabolic Nonlinear Equations in Perforated Domains

    Kim, Sunghoon

    2011-01-01

    In this paper, we develop a viscosity method for Homogenization of Nonlinear Parabolic Equations constrained by highly oscillating obstacles or Dirichlet data in perforated domains. The Dirichlet data on the perforated domain can be considered as a constraint or an obstacle. Homogenization of nonlinear eigen value problems has been also considered to control the degeneracy of the Porous medium equation in perforated domains. For the simplicity, we consider obstacles that consist of cylindrical columns distributed periodically and perforated domains with punctured balls. If the decay rate of the capac- ity of columns or the capacity of punctured ball is too high or too small, the limit of u\\k{o} will converge to trivial solutions. The critical decay rates of having nontrivial solution are obtained with the construction of barriers. We also show the limit of u\\k{o} satisfies a homogenized equation with a term showing the effect of the highly oscillating obstacles or perforated domain in viscosity sense.

  11. Spontaneous gallbladder perforation in a child secondary to a gallbladder cyst: a rare presentation and review of literature.

    Badru, F; Litton, T; Puckett, Y; Bansal, S; Guzman, M; Vane, D; Villalona, G A

    2016-06-01

    Spontaneous gallbladder perforation is rare in children. The etiology of gallbladder perforation varies greatly and is often unknown. Identified causes include infection, congenital, stones or choledochal cysts. Presently there are only five reported cases of spontaneous gallbladder perforation in children in the English literature. As such, the optimal method of diagnosis and management remains controversial. We report the case of a 2-year-old girl who presented with peritonitis secondary to spontaneous gallbladder perforation. PMID:27062138

  12. Comparison of the Multidetector-row Computed Tomographic Angiography Axial and Coronal Planes' Usefulness for Detecting Thoracodorsal Artery Perforators

    Jong Gyu Kim; Soo Hyang Lee

    2012-01-01

    Background During the planning of a thoracodorsal artery perforator (TDAP) free flap, preoperative multidetector-row computed tomographic (MDCT) angiography is valuable for predicting the locations of perforators. However, CT-based perforator mapping of the thoracodorsal artery is not easy because of its small diameter. Thus, we evaluated 1-mm-thick MDCT images in multiple planes to search for reliable perforators accurately. Methods Between July 2010 and October 2011, 19 consecutive patients...

  13. Bladder perforation during laparoscopy detected by gaseous distention of the urinary bag -A report of two cases-

    Woo, Jae Hee; Lee, Guie Yong; Baik, Hee Jung

    2011-01-01

    Bladder perforation during laparoscopy is a recognized, uncommon complication. We present two cases of bladder perforation during laparoscopic gynecologic operations that were detected by gaseous distention of the urinary bag. Bladder perforation occurred through laparoscopic division of adhesion. One bladder perforation was repaired laparoscopically, and the other case was repaired by laparotomy during the same general anesthesia. In this report, we present evidence that monitoring a gas-dis...

  14. Pseudomona pseudomallei community acquired pneumonia

    This is the first published case report en Colombia about pseudomona pseudomallei community acquired pneumonia. This uncommon pathogen is from the epidemiological standpoint a very important one and medical community should be aware to look after it in those patients where no other etiological pathogen is recovered. A brief summary about epidemiology is showed, emphasizing those regions where it can be found. Likewise, comments about the differential diagnosis are important since it should be considered in those patients where tuberculosis is suspected. This is particularly representative for countries with high tuberculosis rates. Furthermore, a microbiological review is shown, emphasizing on isolation techniques, descriptions about therapeutics and other regarding treatment issues according international standards. Finally; a description about the clinical picture, laboratory findings, treatment and evolution of the case reported are shown for discussion

  15. Complement's participation in acquired immunity

    Nielsen, Claus Henrik; Leslie, Robert Graham Quinton

    2002-01-01

    B cell receptor for antigen (BCR), a complex composed of the iC3b/C3d fragment-binding complement type 2 receptor (CR2, CD21) and its signaling element CD19 and the IgG-binding receptor FcgammaRIIb (CD32). The positive or negative outcome of signaling through this triad is determined by the context...... in which antigen is seen, be it alone or in association with natural or induced antibodies and/or C3-complement fragments. The aim of this review is to describe the present status of our understanding of complement's participation in acquired immunity and the regulation of autoimmune responses.......The preliminary evidence for the involvement of complement in promoting primary humoral responses dates back over a quarter of a century. However, it is only in the course of the past decade or so that the detailed mechanisms underlying complement's influence have been characterized in depth. It is...

  16. Acquired vulval lymphangiectases mimicking genital warts

    Sharma Rajeev; Tomar Sudarshan; Chandra Mithilesh

    2002-01-01

    Acquired lymphangiectasia can sometimes occur on the vulva and cause diagnostic difficulties especially if they have a warty appearance. We report a case of acquired vulva I lymphangiectasia which mimicked genital warts.

  17. Acquired vulval lymphangiectases mimicking genital warts

    Sharma Rajeev

    2002-01-01

    Full Text Available Acquired lymphangiectasia can sometimes occur on the vulva and cause diagnostic difficulties especially if they have a warty appearance. We report a case of acquired vulva I lymphangiectasia which mimicked genital warts.

  18. Critical impact energies for scabbing and perforation of concrete target

    In this paper, the influences of the relative target thickness (H/d) on those critical impact energies, at which local damage of various forms in concrete targets are initiated, are explored. The empirical formulae developed in the R3 Impact Assessment Procedure [BNFL, 2003. Reinforced Concrete Slab Local Damage Assessment, R3 Impact Assessment Procedure, vol. 3, Appendix H. Magnox Electric plc and Nuclear Electric Limited] are rationalized by different methods. A dimensional analysis was conducted to identify influential non-dimensional numbers, which were subsequently employed in the analyses of the experimental results relevant to scabbing and perforation by flat nosed missiles. The relationships between the non-dimensional impact energy 12MV02/(d3f) at failure and the non-dimensional target thickness H/d are presented for all of the relevant experimental data in the ''World Impact Data'' collection [Bainbridge, P., 1988. World Impact Data-S.R.D. Impact Database Version Pre 3i, CCSD/CIWP(88)107(P)]. This collated hundreds of experimental data on local damage in concrete targets due to missile impact from various sources of nuclear industries, as well as experimental data from the UK electrical power industry used to develop empirical formulae in the R3 Impact Assessment Procedure [BNFL, 2003. Reinforced concrete slab local damage assessment, R3 Impact Assessment Procedure, vol. 3, Appendix H. Magnox Electric plc and Nuclear Electric Limited]. The experimental data in Bainbridge [Bainbridge, P., 1988. World Impact Data-S.R.D. Impact Database Version Pre 3i, CCSD/CIWP(88)107(P)] are compared with empirical and semi-empirical formulae for scabbing and perforation in order to examine the effects of H/d on the critical non-dimensional impact energy for these two local failures. An analytical formula based on a penetration-plugging model is employed to give the relationship between the critical impact energy and target thickness for perforation by a flat

  19. Multicomponent reactive transport modeling at the Ratones uranium mine, Cáceres (Spain)

    Marcuello, A.; Gómez, P.; Carrera, Jesús; Ayora, Carlos

    2006-01-01

    [EN] Flooding of abandoned mines may have a major impact in groundwater quality. Predicting the long-term evolution of the water quality is, therefore, a relevant matter for environmental management. The Ratones uranium mine was abandoned and flooded in 1974. Due to its reducing underground environment uranium concentration is very low, although some points show high concentration in Fe and As. Within the works prior to a remediation strategy, reactive transport modelling were perfor...

  20. Infections Acquired in the Garden.

    Cunha, Cheston B; Cunha, Burke A

    2015-10-01

    Gardening is a wonderful pastime, and the garden is a very peaceful place to enjoy one's vacation. However, the garden may be a treacherous place for very young or compromised hosts when one takes into account the infectious potential residing in the soil, as well as the insect vectors on plants and animals. Even normal hosts may acquire a variety of infections from the soil, animals, or animal-related insect bites. The location of the garden, its natural animal and insect inhabitants, and the characteristics of the soil play a part in determining its infectious potential. The most important factor making the garden an infectious and dangerous place is the number and interaction of animals, whether they are pets or wild, that temporarily use the garden for part of their daily activities. The clinician should always ask about garden exposure, which will help in eliminating the diagnostic possibilities for the patient. The diagnostic approach is to use epidemiological principles in concert with clinical clues, which together should suggest a reasonable list of diagnostic possibilities. Organ involvement and specific laboratory tests help further narrow the differential diagnosis and determine the specific tests necessary to make a definitive diagnosis. PMID:26542044

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

    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.

  2. Small-bowel perforation caused by fish bone

    Sheng-Der Hsu; De-Chuan Chan; Yao-Chi Liu

    2005-01-01

    A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. We report the case of a 62-year-old woman who experienced severe pain in the right iliac fossa and fever for about five days before arrival at our hospital. The presumptive diagnosis was acute purulent appendicitis and an emergency appendectomy was planned. Swelling and erythema were noted in a segment of the small bowel in the lower right abdomen. A tiny pointed object was found penetrating the inflamed portion of the bowel, which proved to be a sharp fish bone (gray snapper). The bone was removed, followed by segmental resection of the terminal ileum and ascending colon. The postoperative course was uneventful.

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

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

    2013-01-01

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

  4. Perforated monolayers. Progress report, July 1, 1990--December 31, 1992

    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.

  5. Radiant heat test of Perforated Metal Air Transportable Package (PMATP).

    Gronewald, Patrick James; Oneto, Robert (Weidlinger Associates, Inc., Los Altos, CA); Mould, John (Weidlinger Associates, Inc., Los Altos, CA); Pierce, Jim Dwight

    2003-08-01

    A conceptual design for a plutonium air transport package capable of surviving a 'worst case' airplane crash has been developed by Sandia National Laboratories (SNL) for the Japan Nuclear Cycle Development Institute (JNC). A full-scale prototype, designated as the Perforated Metal Air Transport Package (PMATP) was thermally tested in the SNL Radiant Heat Test Facility. This testing, conducted on an undamaged package, simulated a regulation one-hour aviation fuel pool fire test. Finite element thermal predictions compared well with the test results. The package performed as designed, with peak containment package temperatures less than 80 C after exposure to a one-hour test in a 1000 C environment.

  6. A newborn with duodenal atresia and a gastric perforation

    Akcora Bulent

    2010-01-01

    Full Text Available Congenital duodenal atresia complicated by gastric perforation (GP is a very rare and a very mortal condition. Only three newborns could be cured in the reported 13 cases. We report a successfully treated newborn with this complicated disease. A 2-day-old male was hospitalized with prediagnosis of duodenal obstruction. Twelve hours later, significant abdominal distention occurred promptly. At laparotomy, GP and preampullary duodenal atresia were detected. Gastrorrhaphy and duodenoduodenostomy were performed in the same operation. The patient was discharged on the 15th postoperative day. This complicated disease can be treated by early diagnosis and surgical intervention. We choose one-stage operation because of the clean peritoneal cavity. However, generalized peritonitis may require two-stage operation in delayed cases.

  7. Mechanical seal having a single-piece, perforated mating ring

    Khonsari, Michael M.; Somanchi, Anoop K.

    2007-08-07

    A mechanical seal (e.g., single mechanical seals, double mechanical seals, tandem mechanical seals, bellows, pusher mechanical seals, and all types of rotating and reciprocating machines) with reduced contact surface temperature, reduced contact surface wear, or increased life span. The mechanical seal comprises a rotating ring and a single-piece, perforated mating ring, which improves heat transfer by controllably channeling coolant flow through the single-piece mating ring such that the coolant is in substantially uniform thermal contact with a substantial portion of the interior surface area of the seal face, while maintaining the structural integrity of the mechanical seal and minimizing the potential for coolant flow interruptions to the seal face caused by debris or contaminants (e.g., small solids and trash) in the coolant.

  8. Abdominal perforator vs. muscle sparing flaps for breast reconstruction.

    Butler, Paris D; Wu, Liza C

    2015-06-01

    Abdominally based free flaps have become the mainstay for women that desire to use their own tissue as a means of breast reconstruction after mastectomy. As the techniques have evolved, significant effort has been invested in finding the best means of minimizing morbidity to the abdominal donor site while ensuring a viable reconstructed breast that is aesthetically pleasing. This manuscript reviews and compares the muscle sparing free transverse rectus abdominis myocutaneous (MsfTRAM), the deep inferior epigastric artery perforator (DIEP), and the superficial inferior epigastric artery (SIEA) flaps, regarding flap success rate, operative times, abdominal donor site morbidity and residual functionality, hospital lengths of stay and associated costs, impact of co-morbid conditions, and resilience after adjuvant radiation treatment. PMID:26161306

  9. Generalized multiscale finite element methods for problems in perforated heterogeneous domains

    Chung, Eric T.

    2015-06-08

    Complex processes in perforated domains occur in many real-world applications. These problems are typically characterized by physical processes in domains with multiple scales. Moreover, these problems are intrinsically multiscale and their discretizations can yield very large linear or nonlinear systems. In this paper, we investigate multiscale approaches that attempt to solve such problems on a coarse grid by constructing multiscale basis functions in each coarse grid, where the coarse grid can contain many perforations. In particular, we are interested in cases when there is no scale separation and the perforations can have different sizes. In this regard, we mention some earlier pioneering works, where the authors develop multiscale finite element methods. In our paper, we follow Generalized Multiscale Finite Element Method (GMsFEM) and develop a multiscale procedure where we identify multiscale basis functions in each coarse block using snapshot space and local spectral problems. We show that with a few basis functions in each coarse block, one can approximate the solution, where each coarse block can contain many small inclusions. We apply our general concept to (1) Laplace equation in perforated domains; (2) elasticity equation in perforated domains; and (3) Stokes equations in perforated domains. Numerical results are presented for these problems using two types of heterogeneous perforated domains. The analysis of the proposed methods will be presented elsewhere. © 2015 Taylor & Francis

  10. Ballistic behavior of high hardness perforated armor plates against 7.62 mm armor piercing projectile

    Highlights: • High hardness perforated plates can be used effectively in ballistic protection. • Perforated plate has potential of decreasing areal mass efficiency dramatically. • The defeating mechanism of multilayer perforated plates includes three principles. • Deviation from trajectory, core fracture and nose erosion are defeating mechanisms. • With the simulations and tests, the bullet defeating mechanism has been explained. - Abstract: In this paper, some of the important defeating mechanisms of the high hardness perforated plates against 7.62 × 54 armor piercing ammunition were investigated. The experimental and numerical results identified three defeating mechanisms effective on perforated armor plates which are the asymmetric forces deviates the bullet from its incident trajectory, the bullet core fracture and the bullet core nose erosion. The initial tests were performed on the monolithic armor plates of 9 and 20 mm thickness to verify the fidelity of the simulation and material model parameters. The stochastic nature of the ballistic tests on perforated armor plates was analyzed based on the bullet impact zone with respect to holes. Various scenarios including without and with bullet failure models were further investigated to determine the mechanisms of the bullet failure. The agreement between numerical and experimental results had significantly increased with including the bullet failure criterion and the bullet nose erosion threshold into the simulation. As shown in results, good agreement between Ls-Dyna simulations and experimental data was achieved and the defeating mechanism of perforated plates was clearly demonstrated

  11. Management of a Small Paracentral Corneal Perforation Using Iatrogenic Iris Incarceration and Tissue Adhesive

    Akira Kobayashi

    2012-07-01

    Full Text Available Background: Surgical intervention for corneal perforation is indicated when the anterior chamber does not reform within a short period of time. Herein, we report the successful management of a small paracentral corneal perforation using autologous iris incarceration and tissue adhesive. Case: A 41-year-old man developed a small paracentral corneal perforation (0.5 mm in size in the right eye, while the treating physician attempted to remove the residual rust ring after removal of a piece of metallic foreign body. Observations: The eye was initially managed with a bandage soft contact lens to ameliorate the aqueous leakage; however, without success. Iatrogenic iris incarceration of the wound was first induced, followed by application of cyanoacrylate tissue adhesive to the perforated site. As a result, the anterior chamber was immediately reformed and maintained. Complete corneal epithelialization of the perforation was achieved in 2 months without visual compromises. Conclusions: Cyanoacrylate tissue adhesive with iatrogenic incarceration of the autologous iris was effective in treating this type of small corneal perforation. This technique is simple and potentially useful for small paracentral corneal perforations outside the visual axis and without good apposition.

  12. Descriptive anatomy of the dominant septal perforators using Dual Source Coronary CT Angiography.

    Brinjikji, Waleed; Harris, Scott R; Froemming, Adam T; Christensen, Kevin N; Lachman, Nirusha; Araoz, Philip A

    2010-01-01

    Although clinical outcomes for septal ablation in treating left ventricular outflow tract obstructions are generally favorable, a variety of complications have been reported including a high incidence of right bundle branch block. These complications may be attributed to anatomic variability of the dominant septal perforator. We used Dual Source CT Coronary Angiography (DS-CTA) to determine the location of the termination point of the dominant septal perforator as well as the distance of the termination point from the mitral annulus in patients undergoing DS-CTA. One-hundred-fourteen DS-CTA scans were retrospectively reviewed by two observers by consensus. The left ventricle was divided into anterior wall, anterioseptum, and inferioseptum. For each segment, the myocardium was divided into three layers (1) right ventricular side, (2) mid portion, and (3) left ventricular side. The zone of termination of the dominant septal perforator was identified as well as the distance of the termination point from the mitral annulus. The dominant septal perforator terminated in the right ventricular side of the anterioseptum in 86 of the 118 visualized terminations (73%) and in the left ventricular anterior wall in 6 visualized terminations (5%). On average, the dominant septal perforator terminated 26.3 +/- 8.6 mm from the mitral annulus. In the majority of cases, the dominant septal perforator terminates in the right ventricular side of anterioseptum. In addition, there is great variability in the distribution of the termination point of the dominant septal perforator from the mitral annulus. PMID:19918876

  13. Bowel Perforation in Premature Infants with Necrotizing Enterocolitis: Risk Factors and Outcomes

    Lingling Yu

    2016-01-01

    Full Text Available We aim to determine risk factors and clinical outcomes for bowel perforation in premature infants with NEC. We analyzed clinical data of 57 cases of premature infants with NEC at our NICU between January 2010 and December 2012. Based on the presence of bowel perforation, we divided these infants into two groups: perforated NEC group (n=10 and nonperforated NEC group (n=47. We compared general information, clinical characteristics, and laboratory findings between groups. The perforated NEC group, compared to the nonperforated NEC group, had significantly lesser gestational age, lower birth weight, higher prevalence of apnea, mechanical ventilation, sepsis and shock, lower blood pH, higher levels of blood glucose, abnormal WBC count and thrombocytopenia, and elevated CRP (all P<0.05. Moreover, the perforated NEC group had significantly longer durations of fasting and TPN usage, higher incidences of EUGR and cholestasis, longer duration of antibiotics, higher frequency of advanced antibiotics use, and poorer prognosis than the nonperforated NEC group (all P<0.05. Bowel perforation in premature infants with NEC was associated with multiple risk factors. Early identification of some of these risk factors in premature infants with NEC may help implement early intervention to reduce the incidence of bowel perforation and thereby improve the prognosis.

  14. The US findings of acute nonperforated and perforated appendicitis in children

    To analyse and interpret different sonographic findings in acute nonperforated and appendicitis. In 46 cases of acute appendicitis in children(26 girls, 20 boys) proven by surgery, sonographic findings were reviewed retrospectively. The findings of nonperforated and perforated appendicitis were analysed, focusing on the size, shape and echogenicity of the appendix, echo patterns of periappendiceal abscesses, mesenteric lymphadenopathy, and the prevalence of appendicolith. A noncompressible distended appendix was present in 18 of 21 patients with nonperforated appendicitis and in 13 of 25 patients with perforation. In 18 patients with nonperforated appendicitis, the average diameter of distended appendix was 8.6 mm ; target appearance was noted in 16 patients and loss of echogenic submucosa in two. In 13 patients with perforated appendicitis, the average diameter of appendix was 9.1 mm ; target appearance was noted in four patients and loss of echogenic submucosa in nine. Periappendiceal abscesses were present in 21 of 25 cases of perforated appendicitis, and the echogenicity of abscesses was mixed in 12 patients, hypoechogenic in eight, and hyperechogenic in one. Mesenteric lymphadenopathy was present in two of 21 patients with nonperforated appendicitis and in four of 25 with perforation. Appendicolith was detected on sonography in three of 25 patients with perforated appendicitis, but was found in seven patients during surgery. One patients with perforated appendicitis also had right side hydronephrosis. Sonographically false-negative results were obtained in six cases. A sonographic examination was useful to differenciate perforated and nonperforated appendicitis in children. Loss of echogenic submucosa in the distended appendix and periappendiceal abscess formation were important findings in diagnosis of perforated appendicitis

  15. Preliminary evaluation of the deep inferior epigastric artery perforator with CT angiography

    Objective: To evaluate the clinical value of multislice-CT angiography (MSCTA) in planning for the patients undergoing deep inferior epigastric artery perforator (DIEAP) flap operations. Methods: Eighteen patients were performed with a 16-slice CT scanner to evaluate the deep inferior epigastric artery perforator prior to DIEAP flap operations. Axial, multiplanar reconstruction (MPR), maximum intensity projection (MIP) and volume rendered( VR) images were analysed and the origins, calibers, courses and anatomic relationships of the deep inferior epigastric artery perforator were evaluated. The anastomosis between the superficial inferior epigastric artery and the main perforator was observed as well. The images were classified into three grades based on the vessels' appearance. A + indicated the vessel appeared clear, continuous and thick. A - indicated the vessel appeared foggy, discontinuous and thin or the vessel partly showed. B indicated no related vessel can be seen. Other 18 patients undergoing conventional abdomen-pelvis CT scans for other reasons were used for control group t o compare their CT findings of the deep inferior epigastric artery perforator. Results: MSCTA well showed the course of the deep inferior epigastric artery (DIEA). Of the 18 cases, 17 cases appeared as A +, another one A -. It precisely displayed the origins, subcutaneous and intramuscular courses, relations of the main perforators on all cases of showing A +. The exact points where the chosen perforator vessels emerged from the rectus abdominis muscle fascia were located precisely. The superficial inferior epigastric arteries were mostly displayed and the connection between the arteries and the largest-caliber perforator from the deep system could also be shown clearly. Strict concordance with operative findings was found in CTA. Conclusion: MSCTA can precisely locate the chosen perforator vessels emerging from the rectus abdominis muscle fascia and it may be a feasible, fast, safe

  16. Surface Sampler Arm Acquiring Sample

    1976-01-01

    Operation of the surface sampler in obtaining Martian soil for Viking 2's molecular analysis experiment last Saturday (September 25) was closely monitored by one of the Lander cameras because of the precision required in trenching the small area--8 by 9 inches-surrounded by rocks. Dubbed 'Bonneville Salt Flats,' the exposure of thin crust appeared unique in contrast with surrounding materials and became a prime target for organic analysis in spite of potential hazards. Large rock in foreground is 8 inches high. At left, the sampler scoop has touched the surface, missing the rock at upper left by a comfortable 6 inches, and the backhoe has penetrated the surface about one-half inch. The scoop was then pulled back to sample the desired point and (second photo) the backhoe furrowed the surface pulling a piece of thin crust toward the spacecraft. The initial touchdown and retraction sequence was used to avoid a collision between a rock in the shadow of the arm and a plate joining the arm and scoop. The rock was cleared by 2 to 3 inches. The third picture was taken 8 minutes after the scoop touched the surface and shows that the collector head has acquired a quantity of soil. With surface sampler withdrawn (right), the foot-long trench is seen between the rocks. The trench is three inches wide and about 1 1/2 to 2 inches deep. The scoop reached to within 3 inches of the rock at far end of trench. Penetration appears to have left a cavernous opening roofed by the crust and only about one inch of undisturbed crust separates the deformed surface and the rock.

  17. Method for improving the electrostatics perforation pattern using power controlled discharges

    Garzon, C; Miranda, E; GarcIa-Garcia, J [Departament d' Enginyeria Electronica, Universitat Autonoma de Barcelona, 08193 Bellaterra, Barcelona (Spain); Martinez-Cisneros, C; Alonso, J, E-mail: carolina.garzon@uab.cat [Departament de Quimica Analitica, Universitat Autonoma de Barcelona, 08193 Bellaterra, Barcelona (Spain)

    2011-06-23

    The aims of this work are to show the influence of adding a series resistance at the output of a discharge generator circuit and to point out that this component can be used to control the spark energy in electrostatic perforation systems. Analysis of the experimental results reveals that there exists a close connection between the resistor value and the obtained perforation pattern both in hole density and size. The use of a series resistor has a strong influence on the material porosity, which is an important industrial parameter for assessing the pattern perforation quality.

  18. Severe Hypokalaemia, Hypertension, and Intestinal Perforation in Ectopic Adrenocorticotropic Hormone Syndrome

    Karacaer, Cengiz; Açikgöz, Seyyid Bilal; Aydemir, Yusuf; Tamer, Ali

    2016-01-01

    Ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare cause of the Cushing’s syndrome. The occurrence of the ectopic ACTH syndrome presenting with severe hypokalaemia, metabolic alkalosis, and hypertension has been highlighted in case reports. However, presentation with lower gastrointestinal perforation is not known. We report the case of a 70-year-old male patient with severe hypokalaemia, metabolic alkalosis, hypertension, and colonic perforation as manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic ACTH syndrome should be kept in mind as a cause of hypokalaemia, hypertension, and intestinal perforation in patients with lung carcinoma. PMID:26894113

  19. A rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome

    Rokicki, Wojciech; Rokicki, Marek

    2015-01-01

    Esophageal perforation is the fastest progressing and the most life-threatening disruption of gastrointestinal tract continuity. It must be regarded as an emergency condition that requires early diagnosis as well as very aggressive and rapid implementation of treatment in order to avoid serious complications and death. Methods of treatment for spontaneous esophageal perforation continue to be a matter of controversy. However, all authors emphasize that ultimate success depends largely on the time taken to establish the diagnosis. The authors of this study describe a rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome. PMID:26702287

  20. Case report of idiopathic cecal perforation presenting as acute appendicitis on ultrasound

    Calista Harbaugh

    2016-08-01

    Full Text Available Cecal perforation is an uncommon phenomenon in a pediatric population. It has been linked to a number of underlying medical conditions, which may result in focal inflammation or relative ischemia including hematologic malignancy, infection, and inflammatory bowel disease. We present an otherwise healthy 16-year-old male diagnosed with acute uncomplicated appendicitis on ultrasound, who was found to have cecal perforation with normal appendix intraoperatively, ultimately requiring ileocectomy. With this report, we aim to present the numerous pathophysiologic etiologies of cecal perforation, and to promote a comprehensive differential diagnosis despite the clinical and radiologic findings consistent with uncomplicated appendicitis.

  1. Localized intestinal perforations as a potential complication of brain hypothermic therapy for perinatal asphyxia.

    Nishizaki, Naoto; Maiguma, Atsuko; Obinata, Kaoru; Okazaki, Tadaharu; Shimizu, Toshiaki

    2016-08-01

    Brain hypothermic therapy (BHT) is becoming a frequently used standard of care for perinatal asphyxia. Although cardiovascular side effects, coagulation disorders, renal impairment, electrolyte abnormalities, impaired liver function, opportunistic infections, and skin lesions are well-known adverse effects of BHT in newborns, little information is available on the clinical features of intestinal perforation-related BHT. We herein report a case of therapeutic brain cooling for perinatal asphyxia complicated by localized intestinal perforation. In practice, the neonatologist should be aware that intestinal perforation in an infant with perinatal asphyxia is possible, particularly following BHT. PMID:26445344

  2. Inferior epigastric artery angiography applied in the transplantation with the deep inferior epigastric perforator free flap

    Objective: To observe the effect of inferior epigastric artery angiography applied in the transplantation with the deep inferior epigastric perforator free flap. Methods: Seven patients who had undergone the deep inferior epigastric perforator free flap transplantation, received angiography of the inferior epigastric artery. The value of the angiography was discussed. Results: All patients were successful in angiography without any adverse reaction. All patients were successful in transplantation except one because of personal reason. Conclusion: Inferior epigastric artery angiography facilitates the transplantation with the deep inferior epigastric perforator free flap. (authors)

  3. Surgical management for large chest keloids with internal mammary artery perforator flap.

    Xue, Dan; Qian, Huan

    2016-01-01

    Therapy for large symptomatic keloids is often plagued with complicated reconstruction manner and recurrence. This article reports a rare treatment combination for a chest keloid with internal mammary artery perforator flap reconstruction and radiation therapy. We excised the keloid and covered the defect with an internal mammary artery perforator flap. Immediate electron-beam irradiation therapy was applied on the second postoperative day. There was no sign of recurrence over the follow-up period of 18 months. The combination of internal mammary artery perforator flap and immediate radiation therapy is useful when faced with chest keloids of similar magnitude and intractability. PMID:26982790

  4. PIV Measurements of Turbulent Flow in a Channel with Solid or Perforated Ribs

    Wang, Lei; Salewski, Mirko; Sundén, Bengt

    2011-01-01

    Particle image velocimetry measurements are performed in a channel with periodic ribs on one wall. We investigate the flow around two different rib configurations: solid and perforated ribs with a slit. The ribs obstruct the channel by 20% of its height and are arranged 10 rib heights apart. For...... the perforated ribs, the slit height is 20% of the rib height, and the open-area ratio is 16%. We discuss the flow in terms of mean velocity, streamlines, vorticity, turbulence intensity, and Reynolds shear stress. We find that the recirculation bubbles after the perforated ribs are significantly...

  5. EVALUAT I ON OF VARIOUS PROGNOSTIC FACTORS IN PERFORATIVE PERITONITIS MANAGEMENT

    Sarada

    2015-09-01

    Full Text Available Peritonitis is one of the major problems confronting the surgeons in day to day practice. Despite many advances in understanding pathophysiology, mortality rate of diffuse suppurative peritonitis remains high. A prospective study, with prior institutional ethics committee approval, involving 100 patients of perforative peritonitis is done to assess the vari ous prognostic factors in management of generalized peritonitis. Role of age, gender, duration, type of perforation, associated systemic factors are studied in relation to morbidity and mortality in the outcome of management of peritonitis. Elderly age, il eal perforations, delay in presentation of more than 24 hours and associated shock on day one are found to have bad prognosis

  6. Experimental study of reflection coefficient and wave forces acting on perforated caisson

    陈雪峰; 李玉成; 孙大鹏; 陈仁友

    2002-01-01

    -- The reflection coefficient and the total horizontal forces of regular waves acting on the perforated caisson are experimentally investigated. The empirical relationship between reflection coefficient and the ratio of the total horizontal forces acting on the perforated caisson to those on solid vertical walls with the relative chamber width, relative water depth and porosity of perforated wall, etc. are given. Moreover, the results of the ratio of the total horizontal forces are also compared with formulas given by Chinese Harbour Design Criteria and Takahashi, which may be useful for the practical engineering application.

  7. Gastroduodenal Perforation and Ulcer Associated With Rotavirus and Norovirus Infections in Japanese Children: A Case Report and Comprehensive Literature Review.

    Ueda, Norishi

    2016-01-01

    Background.  There is no literature review on gastroduodenal perforation or ulcer (GDPU) with rotavirus (RV) and norovirus (NoV) gastroenteritis. Methods.  Pediatric cases of GDPU or upper gastrointestinal bleeding with RV and NoV gastroenteritis were searched from September 1974 until October 2015 using PubMed, Google for English, other-language-publications, and Ichushi (http://www.jamas.or.jp) for Japanese-language publications. All reports confirming GDPU or upper gastrointestinal bleeding with RV and NoV gastroenteritis were eligible for inclusion in the study. In addition, clinical characteristics were reviewed. Results.  A boy with duodenal ulcer (DU) and NoV gastroenteritis was described. There were 32 GDPU cases (23 RVs and 9 NoVs cases), including our case; with the exception of 1 case, all were Japanese. Mean age, male/female ratio, and symptoms' duration before admission were 21.6 months, 2.2, and 4.0 days, respectively. Vomiting was the most common symptom, followed by diarrhea, lethargy, fever, abdominal distension, and convulsion. Dehydration, hematemesis, melena, drowsiness or unconsciousness, shock, metabolic acidosis, leukocytosis, anemia, positive C-reactive protein, high blood urea nitrogen, and hyponatremia commonly occurred. Helicobacter pylori was a minor cause of GDPU. Duodenal (DP) or gastric perforation (GP) developed in 14 cases (10 DP/RVs, 1 GP/RV, and 3 DP/NoVs). Duodenal ulcer or gastric ulcer (GU) developed in 18 cases (10 DU/RVs, 4 DU/NoVs, 1 GU/RV, 1 GU + DU/NoV, and 2 upper gastrointestinal bleeding/RVs). The predominant perforation or ulcer site was in the duodenum. With the exception of 2 deaths from DU, all cases recovered. Conclusions.  Race, young age, male, severe dehydration, metabolic acidosis, drowsiness and unconsciousness, and shock may be potential risk factors of GDPU associated with RV and NoV gastroenteritis. Limitation of this descriptive study warrants further investigations to determine the risk factors in

  8. 17 CFR 210.8-06 - Real estate operations acquired or to be acquired.

    2010-04-01

    ... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Real estate operations acquired or to be acquired. 210.8-06 Section 210.8-06 Commodity and Securities Exchanges SECURITIES AND... Statements of Smaller Reporting Companies § 210.8-06 Real estate operations acquired or to be acquired....

  9. Evaluation of a filament perforation model for mouse subarachnoid hemorrhage using 7.0 Tesla MRI.

    Muroi, Carl; Kashiwagi, Yuto; Rokugawa, Takemi; Tonomura, Misato; Obata, Atsushi; Nevzati, Edin; Tsuboi, Akio; Okuchi, Kazuo; Mishima, Kenichi; Abe, Kohji; Fujioka, Masayuki

    2016-06-01

    The filament perforation model (FPM) in mice is becoming increasingly popular to elucidate the molecular pathogenesis of neuronal injury after subarachnoid hemorrhage (SAH). We evaluated brain MRI in a mouse FPM. A total of 28 male C57Bl/6J mice were used. Seventeen animals underwent SAH induction by FPM. In two animals, transient middle cerebral artery occlusion (MCAo) was induced. Nine mice served as controls. T1-weighted images (T1WI), T2-weighted images (T2WI), T2(∗)-weighted images (T2*WI) and apparent diffusion coefficient maps were acquired at day 0 and at various time points following SAH (range: day 1-6 after SAH). Cerebral blood flow (CBF) analysis by (14)C-iodoamphetamine ((14)C-IMP) autoradiography was conducted in nine animals. Hemorrhage could be best confirmed using T2*WI. The degree of hemorrhage varied. All animals evaluated for ⩾2days were hydrocephalic, which was best seen on T2WI. T2-hyperintensity of the corpus callosum and external capsule, indicating white matter (WM) injury, was present after SAH. Ventricle and WM injury volumes were statistically significantly higher at day 3 compared to day 0. Territorial ischemia was detectable in MCAo but not in SAH. Markedly hypointense cortical veins were visible in the hyperacute and delayed phase after SAH on T2*WI. The (14)C-IMP analysis indicated decreased CBF after SAH. MRI is feasible and useful in evaluating pathophysiological changes over time. T2*WI seems best for SAH detection and grading. The chronological change of hydrocephalus and WM injury could be analyzed. T2*WI illustrated specific signal changes of cortical veins, possibly caused by increased oxygen extraction fraction due to decreased CBF. PMID:27021225

  10. Reactive Kripke semantics

    Gabbay, Dov M

    2013-01-01

    This text offers an extension to the traditional Kripke semantics for non-classical logics by adding the notion of reactivity. Reactive Kripke models change their accessibility relation as we progress in the evaluation process of formulas in the model. This feature makes the reactive Kripke semantics strictly stronger and more applicable than the traditional one. Here we investigate the properties and axiomatisations of this new and most effective semantics, and we offer a wide landscape of applications of the idea of reactivity. Applied topics include reactive automata, reactive grammars, rea

  11. Perforating Granuloma Annulare — An Unusual Subtype of a Common Disease

    João Alves

    2014-09-01

    Full Text Available Perforating granuloma annulare (GA is a rare subset of GA with an unknown etiology and chronic course. Herein, we report the case of 72 year-old women with a 3-month history of a post-traumatic, persistent, erythematous and exudative plaque located on her left leg. Differential diagnosis included mycobacterial infection, subcutaneous mycosis, perforating dermatoses, pyoderma and squamous cell carcinoma. The histopathology was highly suggestive of a perforating GA. The patient was treated with betamethasone dipropionate cream applied once daily and a complete resolution of the lesion was observed in three weeks. Despite being a very rare subtype of a common disease, perforating granuloma annulare has clinical and histopathological characteristic features that facilitate the differential diagnosis, avoiding unnecessary procedures and inadequate and potentially more invasive treatments.

  12. Perforation of metastatic melanoma to the small bowel with simultaneous gastrointestinal stromal tumor

    Nathan Brummel; Ziad Awad; Shellaine Frazier; Jiafan Liu; Nitin Rangnekar

    2005-01-01

    The gastrointestinal tract (GIT) is a common site of metastases for malignant melanoma. These metastatic tumors are often asymptomatic. We describe a case of a 58-year-old male who presented with a sudden onset of generalized abdominal pain. The patient's past medical history was significant for lentigo melanoma of the right cheek. Laparotomy was performed and two segments ofsmall bowel, one with a perforated tumor, the other with a non-perforated tumor, were removed. Histology and immunohistochemical staining revealed the perforated tumor to be a metastatic malignant melanoma and the non-perforated tumor was found to be a gastrointestinal stromal tumor (GIST). The patient was discharged 7 d postoperatively. To the best of our knowledge, this is the first reported case in the literature of a simultaneous metastatic malignant melanoma and a GIST. Surgical intervention is warranted in patients with symptomatic GIT metastases to improve the quality of life or in those patients with surgical emergencies.

  13. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  14. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    Vyas, Rajashree C.; Sides, Corey; Klein, Deborah J. [University of Rochester Medical Center, Rochester, NY (United States); Reddy, Sireesha Y. [University of Rochester, Obstetrics and Gynecology, Rochester, NY (United States); Santos, Mary C. [University of Rochester, Pediatric Surgery, Rochester, NY (United States)

    2008-09-15

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  15. Homogenization of a Parabolic Equation in Perforated Domain with Neumann Boundary Condition

    A K Nandakumaran; M Rajesh

    2002-02-01

    In this article, we study the homogenization of the family of parabolic equations over periodically perforated domains \\begin{align*}_tb\\left(\\frac{x}{}, u_{}\\right)-\\mathrm{div} a\\left(\\frac{x}{}, u_{},\

  16. Perforated nanocap array: Facile fabrication process and efficient surface enhanced Raman scattering with fluorescence suppression

    Wang Jun; Huang Li-Qing; Tong Hui-Min; Zhai Li-Peng; Yuan Lin; Zhao Li-Hua; Zhang Wei-Wei

    2013-01-01

    Recently,individual reduced-symmetry metal nanostructures and their plasmonic properties have been studied extensively.However,little attention has been paid to the approach to fabricating ordered reduced-symmetry metal nanostructure arrays.In this paper,a novel perforated silver nanocap array with high surface-enhanced Raman scattering (SERS) activity and fluorescence suppression is reported.The array is fabricated by electron beam evaporating Ag onto the perforated barrier layer side of a hard anodization (HA) anodic aluminum oxide (AAO) template.The morphology and optical property of the perforated silver nanocap array are characterized by an atomic force microscope (AFM),a scanning electron microscope (SEM),and absorption spectra.The results of SERS measurements reveal that the perforated silver nanocap array offers high SERS activity and fluorescence suppression compared with an imperforated silver nanocap array.

  17. Large Gastric Perforation in Carmi Syndrome: A Morbid Complication in a Rare Association

    M Joshi

    2012-09-01

    Full Text Available The association between epidermolysis bullosa (EB and congenital pyloric atresia (CPA named Carmi Syndrome is rare. We report unusual and morbid complication of gastric perforation resulting in peritonitis in a preterm neonate born with Carmi Syndrome.

  18. Experimental investigation of sound absorption properties of perforated date palm fibers panel

    This paper presents the sound absorption properties of a natural waste of date palm fiber perforated panel. A single layer of the date palm fibers was tested in this study for its sound absorption properties. The experimental measurements were carried out using impedance tube at the acoustic lab, Faculty of Engineering, Universiti Kebangsaan Malaysia. The experiment was conducted for the panel without air gap, with air gap and with perforated plate facing. Three air gap thicknesses of 10 mm, 20 mm and 30 mm were used between the date palm fiber sample and the rigid backing of the impedance tube. The results showed that when facing the palm date fiber sample with perforated plate the sound absorption coefficient improved at the higher and lower frequency ranges. This increase in sound absorption coincided with reduction in medium frequency absorption. However, this could be improved by using different densities or perforated plate with the date palm fiber panel.

  19. Cyanoacrylate repair of laser in situ keratomileusis corneal flap perforation by a snake bite.

    Korn, Bobby S; Korn, Tommy S

    2005-11-01

    A 30-year-old man who had laser in situ keratomileusis (LASIK) for myopia 1 year earlier developed a corneal perforation in the left eye from a boa constrictor. The patient presented to the emergency room, and a small corneal perforation just outside the visual axis was diagnosed within the LASIK flap. Cyanoacrylate adhesive was used to close the corneal perforation. The patient went on to full visual recovery with an uncorrected visual acuity of 20/20. This is the first reported case of a penetrating corneal injury from a serpent in an eye that had LASIK. Cyanoacrylate may be used to repair small traumatic corneal perforations with a favorable visual outcome in eyes that have had LASIK. PMID:16412943

  20. The sensitivity of plain films for detecting perforation in children with appendicitis

    The plain films of 37 patients under age 18 with surgically and pathologically proven non perforated (16/37) and ruptured (21/37) appendicitis were reviewed in order to determine the ability of the plain film to specify perforation. Perforation was suggested when one or more of the following six findings were clearly defined: 1. Acute small bowel construction. 2. Extraluminal gas. 3. Mass in the right lower quadrant. 4. Colon cut-off sign at the hepatic flexure. 5. Fecalith. 6. Obliteration of the pelvic fat planes. This approach resulted in a sensitivity of 80% and a specificity of 94%, with the only false positive for perforation occurring in a patient with a fecalith. In five patients, extraluminal gas produced a triangular accumulation in the right flank which could be distinguished from intraluminal bowel gas on the supine or prone film. (orig.)

  1. A case of perforating injury of eyeball and traumatic cataract caused by acupuncture.

    Shuang, Han; Yichun, Kong

    2016-04-01

    Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon. PMID:27221689

  2. Association of mortality with out-of-hours admission in patients with perforated peptic ulcer

    Knudsen, N V; Møller, M H

    2015-01-01

    BACKGROUND: Perforated peptic ulcer is a serious emergency surgical condition. The aim of the present nationwide cohort study was to evaluate the association between mortality and out-of-hours admission in patients surgically treated for perforated peptic ulcer. METHODS: All Danish patients...... surgically treated for benign gastric or duodenal perforated peptic ulcer in Denmark between September 1, 2011 and August 31, 2013 were included. Patients were identified through The Danish Clinical Register of Emergency Surgery. The association between 90-day mortality and time and day of admission and...... the primary analysis. The overall 90-day mortality rate was 25.6% (186/726). CONCLUSION: No statistically significant adjusted association between 90-day mortality and out-of-hours admission was found in patients surgically treated for perforated peptic ulcer....

  3. A case of perforating injury of eyeball and traumatic cataract caused by acupuncture

    Shuang, Han; Yichun, Kong

    2016-01-01

    Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon. PMID:27221689

  4. A case of perforating injury of eyeball and traumatic cataract caused by acupuncture

    Han Shuang

    2016-01-01

    Full Text Available Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon.

  5. Giant transmission and dissipation in perforated films mediated by surface phonon polaritons

    Korobkin, D.; Urzhumov, Y. A.; Neuner III, B.; Shvets, G.; Zhang, Z.; Mayergoyz, I. D.

    2006-01-01

    We experimentally and theoretically study electromagnetic properties of optically thin silicon carbide (SiC) membranes perforated by an array of sub-wavelength holes. Giant absorption and transmission is found using Fourier Transformed Infrared (FTIR) microscopy and explained by introducing a frequency-dependent effective permittivity $\\epsilon_{\\rm eff}(\\omega)$ of the perforated film. The value of $\\epsilon_{\\rm eff}(\\omega)$ is determined by the excitation of two distinct types of hole res...

  6. Perforated appendicitis: accuracy of CT diagnosis and correlation of CT findings with the length of hospital

    To determine the sensitivity and specificity of CT findings in the differentiation of perforated from nonperforated appendicitis and correlate CT diagnosis with the length of hospital stay. The study included 70 patients who presented with right lower quadrant abdominal pain and underwent preoperative CT scan followed by appendectomy. Patients were divided into two groups of having perforated and nonperforated appendicitis on the basis of CT scan findings. The surgical and pathological reports combined were considered the reference standard for the diagnosis of perforated appendicitis. Various CT scan findings and average duration of hospital stay in days was compared by t-test. Twenty-six (37%) of 70 patients had perforated appendicitis. It was correctly identified on pre-operative CT scan in 18 patients. There were 18 true positive diagnoses, 43 true negative diagnoses, 1 false positive diagnosis and 8 false negative diagnoses which yielded a sensitivity of 69%, specificity of 97%, positive predictive value of 94% and negative predictive value of 84%. Mean length of hospital stay in perforated group was 6.3 days and 2.9 days in nonperforated group. Severe periappendiceal inflammation, periappendiceal and or abdominopelvic fluid and abscess were significantly associated with perforated appendicitis and with a significant longer hospital stay (p <.001). CT scan is 69% sensitive and 97% specific for the diagnosis of perforated appendicitis and constellation of CT findings can be used to select patients with perforated appendicitis for initial non-operative management. Presence of CT signs of significant appendiceal inflammation is independent predictor of longer hospital stay. (author)

  7. Multiple intestinal perforations as a primary manifestation of abdominal tuberculosis in a HIV-infected patient

    Amir Hossein Sarrami

    2010-12-01

    Full Text Available Abdominal tuberculosis (TB is the sixth commonest extra-pulmonary TB form after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis. Perforation is a serious and uncommon complication of abdominal tuberculosis which can occur even during the treatment. A 30-year-old man was admitted with a three-day history of abdominal pain who had emergency surgery for multiple perforations of the distal ileum.

  8. Colonic necrosis and perforation due to calcium polystyrene sulfonate in a uraemic patient: a case report

    Akagun, Tulin; Yazici, Halil; Gulluoglu, Mine G.; Yegen, Gulcin; Turkmen, Aydin

    2011-01-01

    Sodium or calcium polystyrene sulfonate (Kayexalate or analog) is an ion-exchange resin commonly used to treat hyperkalaemia in patients with chronic kidney disease. It is known to cause digestive complications, such as nausea, vomiting and constipation. Although rare, colonic necrosis and perforation are very severe complications associated with the medication. In this case report, we present a case of calcium polystyrene sulfonate-induced colonic necrosis and perforation to remind clinician...

  9. Diagnosis and treatment of spontaneous colonic perforation: Analysis of 10 cases

    Bo Yang; Huai-Kun Ni

    2008-01-01

    AIM: To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon.METHODS: The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from January 2004 to December 2007,were analyzed retrospectively.RESULTS: The mean age at onset was 65 years (range from 45 to 73). Seven patients had a history of chronic constipation. All patients complained of sudden lower abdominal pain. The perforation occurred after coloclysis and administration of senna leaves in two patients. Nine patients had signs of peritoneal irritation. Seven cases underwent abdominal paracentesis, which was diagnostic in six. Only one case was definitely diagnosed prior to surgery. Onepatient underwent neoplasty of the colon, another a partial resection of colon, six a neoplasty of the colon plus sigmoid colostomy, and two underwent Hartmann surgery. All perforation sites were opposite to the mesenteric edge. The perforation sites were located on descending colon in one case, sigmoid colon in three cases, and rectosigmoid colon in six cases. In five patients, surgical pathological examination was consistent with the microscopical changes of colonic perforation caused by feces. Three patients died after surgery.CONCLUSION: Spontaneous perforation of the colon most commonly occurs among the elderly with chronic constipation. Abdominal paracentesis is helpful for the diagnosis. The perforation site is located opposite to the mesenteric edge. Sigmoid colon and rectosigmoid colon are the most frequent locations. Neoplasty of the colon and sigmoid colostomy are the most frequent treatment. The prognosis is bad and the mortality rate after surgery is high.

  10. Presentation and Management Outcomes of Corneal and Scleral Perforations in Geriatric Nursing Home Residents

    Ying Fong, Yoly Yeuk; Yu, Marco; Young, Alvin Lerrmann; Jhanji, Vishal

    2015-01-01

    Abstract We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nurs...

  11. NSAID-Associated Perforation of a Meckel’s Diverticulum: A Case Report

    Brar, Avneet S.; Gill, Richdeep S; Gill, Sumeet S.; Wang, Haili

    2011-01-01

    Meckel’s diverticulum is the most frequent congenital malformation of the gastrointestinal tract. The most common ectopic tissue within a Meckel’s is heterotopic gastric mucosa, with bleeding being the most common presentation. However, perforation of a Meckel’s diverticulum is a rare presentation. NSAID-associated Meckel’s perforation has been suggested, however has not been documented in the literature. We present a case of a 17-year-old female with acute abdominal pain and tenderness follo...

  12. Is there a role of abdominal drainage in primarily repaired perforated peptic ulcers?

    Musharraf Husain; Shahla Haleem; Arif Akhtar; Maulana M Ansari; Ajay Kumar

    2012-01-01

    Objective: To compare the survival and post-op complications following primary closure of perforated peptic ulcer by omental patch technique in 4 groups of patients as follows: two-drain group, one-drain subhepatic group, one-drain pelvic group and no-drain group. Methods: This is a prospective case-controlled clinical study performed in the Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India. A total of 114 patients with perforated peptic ulcer who underwent ...

  13. Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation

    Arya Satyavrat; Singh Tanveer; Mohil Ravindra; Bhatnagar Dinesh

    2008-01-01

    Abstract Background Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operative Severity Scoring for the enUmeration of Mortality and morbidity (POSSUM) score in cases of ileal perforations. Methods Prospective study on 125 patients of ileal perforations. Resection anastamosis (Group I) was done in 38 patients, primary ...

  14. Anatomical study of terminal peroneal artery perforators and their clinical applications

    Rajendran Purushothaman; Balakrishnan, T. M.; Alalasundaram, K. V.

    2013-01-01

    Introduction: Peroneal artery gives off plenty of perforators that pass through fascial septum to supply skin and tenosynovium of peroneal muscles. Aim: The aim of this study was to study the anatomical basis of perforators from terminal part of peroneal artery axiality and to make use of this knowledge in reconstructing defects of posterior heel with the advantage of reducing the morbidity of conventional flaps. Materials and Methods: Our study was conducted at Department of Plastic surgery,...

  15. Intestinal perforation in a two-year-old child with eosinophilic gastroenteritis

    Agertoft, A; Husby, S; Høst, A

    1991-01-01

    A two-year-old boy underwent a laparatomy for an intestinal perforation due to eosinophilic gastroenteritis. He had marked peripheral blood eosinophilia and a small duodenal biopsy showed heavy eosinophilic infiltration in the mucosa. After 1 1/2 year on a restricted diet, a control duodenal biopsy...... showed only slight eosinophilia. Perforation of the small intestine is a rare but serious complication in eosinophilic gastroenteritis....

  16. Neonatal colon perforation due to anorectal malformations: Can it be avoided?

    Tong, Wei-Dong; Ludwig, Kirk A

    2013-01-01

    Anorectal malformations (ARM) are common anomalies in neonates. Diagnostic and therapeutic delays in the management of ARM may lead to colonic perforation, and even death. Physical examination of the perineum is often sufficient to diagnose ARM in neonates. Notwithstanding, delayed diagnosis of ARM has become increasingly familiar to surgeons, as evidenced by the number of recent publications on this topic in the literature. In this commentary, we discuss spontaneous colonic perforation due t...

  17. Structural performance of perforated steel beams with novel web openings and with partial concrete encasement

    Tsavdaridis, K. D.

    2010-01-01

    The research covered in this thesis is concerned with the effects of the behaviour and load carrying capacities of classes of steel beam structures with various shapes of web openings. A comprehensive investigation on non-composite and partially concrete encased perforated steel Isections with large web openings positioned along the centre-line of the beams was undertaken. This thesis enhances the current knowledge on these classes of perforated beams, as previous research has shown that thes...

  18. Mauling by monkey: A rare cause of intestinal perforation in a neonate

    Singh Narinder

    2005-01-01

    Full Text Available A rare case of traumatic perforation of the ileum in a neonate due to mauling by wild monkey from a hilly area is reported. The patient presented with features of septicemia, bilious vomiting, abdominal distention and signs of peritonitis. Exploratory laparotomy with closure of the perforation was performed and the baby survived. After thorough and careful review of available English literature, we found no similar case and this forms the basis of present publication.

  19. Intestinal perforation by multiple ectopic pancreatic tissues in a neonate with multiple congenital anomalies

    Ectopic pancreatic tissues of the gut are usually found incidentally during laparotomy or are reported in the autopsy findings. Rarely these ectopic pancreatic tissues may cause symptoms such as hemorrhage, pancreatitis, intussusception or perforation. We present a case report of presence of multiple ectopic pancreatic tissues in the gut causing hemorrhage and perforation in a preterm, extremely low birth weight neonate with multiple congenital anomalies. (author)

  20. Nonsurgical Management of an Extensive Perforative Internal Root Resorption with Calcium-Enriched Mixture Cement

    Esnaashari, Ehsan; Pezeshkfar, Arezou; Fazlyab, Mahta

    2014-01-01

    Internal inflammatory root resorption (IIRR) is a rare condition of the root canal and if it is left untreated it may lead to destruction of the surrounding dental hard tissues. Odontoclasts are responsible for this situation which can potentially perforate the root. Many initiating factors have been mentioned for IIRR, almost all causing chronic inflammation in the vital pulp. IIRR is usually symptom free, but in cases of root perforation, a sinus tract usually forms. The prognosis of treatm...

  1. Sealing of root perforation with glass ionomer cement: a case report

    Ronise Ferreira Dotto; Alcebiades Nunes Barbosa; Sidney Ricardo Dotto; Chirley Roberta Hermes

    2014-01-01

    Despite the development of endodontic therapy, adverse complications can arise during treatment, resulting in a questionable prognosis; root perforation is one such complication. Root perforations located along different thirds of the root canal are associated with practitioner error during the operative stages of endodontic treatment, particularly with failure to observe the anatomic singularities of different tooth types. Various materials have been suggested and used to repair root canal p...

  2. Perforated sigmoid diverticulitis in a lumbar hernia after iliac crest bone graft - a case report

    Frueh, Florian S; Vuille-Dit-Bille, Raphael N; Raptis, Dimitri A; Notter, Hanspeter; Muff, Brigitte S

    2014-01-01

    Background The combination of perforated diverticulitis in a lumbar hernia constitutes an extremely rare condition. Case presentation We report a case of a 66 year old Caucasian woman presenting with perforated sigmoid diverticulitis localized in a lumbar hernia following iliac crest bone graft performed 18 years ago. Emergency treatment consisted of laparoscopic peritoneal lavage. Elective sigmoid resection was scheduled four months later. At the same time a laparoscopic hernia repair with a...

  3. Perforated sigmoid diverticulitis in a lumbar hernia after iliac crest bone graft - a case report

    Frueh, Florian S; Vuille-Dit-Bille, Raphael N; Raptis, Dimitri A; Notter, Hanspeter; Muff, Brigitte S

    2014-01-01

    BACKGROUND The combination of perforated diverticulitis in a lumbar hernia constitutes an extremely rare condition. CASE PRESENTATION We report a case of a 66 year old Caucasian woman presenting with perforated sigmoid diverticulitis localized in a lumbar hernia following iliac crest bone graft performed 18 years ago. Emergency treatment consisted of laparoscopic peritoneal lavage. Elective sigmoid resection was scheduled four months later. At the same time a laparoscopic hernia rep...

  4. Coronary artery perforation during percutaneous coronary intervention (PCI), successful management with covered stent

    Coronary artery perforation, (CP) is a rare and potentially life-threatening complication of percutaneous coronary intervention (PCI). CP has historically been reported to occur in 0.1-3.0% of PCI procedures. Although CP can be caused by coronary wires and balloon angioplasty, they are more frequently reported in PCI using atheroablative devices, stenting and excimer laser coronary angioplasty. We report a case of coronary perforation took place and was managed successfully. (author)

  5. Perforation of the neovagina in a male-to-female transsexual: a case report

    Shimamura, Yuto; Fujikawa, Aoi; Kubota, Keisuke; Ishii, Naoki; Fujita, Yoshiyuki; Ohta, Keiichiro

    2015-01-01

    Introduction There are several techniques for creation of a neovagina in male-to-female reassignment surgery. Although vaginoplasty with the sigmoid colon is not a common procedure, it is becoming more common. Perforation of the recto-sigmoid neovagina after sex reassignment surgery is very rare. We hereby report a case of perforation of the neovagina that presented as acute peritonitis, with a massive abscess in the intra-abdominal cavity. Case presentation This case report describes a 33-ye...

  6. Acute mesenteric ischemia and duodenal ulcer perforation: a unique double pathology

    Haruna Lois; Aber Ahmed; Rashid Farhan; Barreca Marco

    2012-01-01

    Abstract Background Acute mesenteric ischaemia and duodenal perforation are surgical emergencies with serious consequences. Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60% whereas those presenting with peptic ulcer perforation the mortality rates range from 6-14%. There are very few reported cases of patients presenting with this dual pathology. Case presentation We report a unique case of a 53 year old Italian lady who presented with acute ...

  7. Study on productivity of horizontal wells with segmental perforation based on pseudo steady-state flow

    Liu Hui; He Shunli

    2008-01-01

    Segmental perforation is widely used for horizontal wells.However,the flow of fluid in porous media is a com-plex problem.Using the Fourier transform,principle of potential superposition,trigonometric function transform,as-ymptotic analyses,a pressure solution of a pseudo steady-state flow model in 3D circular-boxed media has been estab-lished.Comparing with the productivity of vertical wells,an equivalence radius model can be obtained.Based on the model,a method of evaluating the productivity of segmental perforation horizontal well is presented by means of principle of superposition.It shows that the equivalence radius is different for various positions of horizontal wells;the output of both ends of horizontal wells is greater than the others under the same length of perforation interval;it is more important to obtain high productivity by increasing the length of perforation interval than enlarging the spacing between perforation intervals.The result of this research can be used to ascertain the yield of each perforated interval.

  8. Semi-theoretical analyses of the concrete plate perforated by a rigid projectile

    Wu, Hao; Fang, Qin; Zhang, Ya-Dong; Gong, Zi-Ming

    2012-12-01

    Based on the three-stage perforation model, a semi-theoretical analysis is conducted for the ballistic performances of a rigid kinetic projectile impacting on concrete plates. By introducing the projectile resistance coefficients, dimensionless formulae are proposed for depth of penetration (DOP), perforation limit thickness, ballistic limit velocity, residual velocity and perforation ratio, with the projectile nosed geometries and projectile-target interfacial friction taken into account. Based on the proposed formula for DOP and lots of penetration tests data of normal and high strength concrete targets, a new expression is obtained for target strength parameter. By comparisons between the results of the proposed formulae and existing empirical formulae and large amount of projectile penetration or perforation tests data for monolithic and segmented concrete targets, the validations of the proposed formulae are verified. It is found that the projectile-target interfacial friction can be neglected in the predictions of characteristic ballistic parameters. The dimensionless DOP for low-to-mid speed impacts of non-flat nosed projectiles increases almost linearly with the impact factor by a coefficient of 2/(π S). The anti-perforation ability of the multilayered concrete plates is dependent on both the target plate thickness and the projectile impact velocity. The variation range of the perforation ratio is 1-3.5 for concrete targets.

  9. Combined esophageal injury complicated by progression to a second perforation: a case report

    Krieg Andreas

    2009-09-01

    Full Text Available Abstract Introduction Intramural dissection of the esophagus is a rare disorder characterized by a lesion between the submucosa and mucosa dividing the esophagus into a false and true lumen. The etiology of esophageal dissection remains uncertain but it affects predominantly women in their seventies and eighties. Symptoms may include uncharacteristic ones such as retrosternal pain, odynophagia or dysphagia. Conservative management is thought to be adequate and surgery should only be performed if complications such as abscess formation or perforation appear. Here we report the case and surgical management of a combined esophageal perforation and dissection. Case presentation We report the case of a combined esophageal perforation and dissection in a 45-year-old Caucasian woman with a history of relapsing periods of dysphagia since her childhood. The clinical course in this patient was complicated by progression to a second perforation, which made a definitive surgical management by esophagectomy necessary. Conclusion To the best of our knowledge, this is the first reported case of a combined esophageal perforation and dissection complicated by progression to a second perforation. This emphasizes that cautious and intensive observation is necessary in patients with esophageal dissection.

  10. Three-dimensional numerical simulation of wave interaction with perforated quasi-ellipse caisson

    Yong-xue WANG

    2011-03-01

    Full Text Available The finite difference method and the VOF method have been used to develop a three dimensional numerical model to study wave interaction with a perforated caisson. And the partial cell method is also adopted to this type of problems for the first time. The validity of the present model, with and without the presence of structures, is examined by comparing the model results with experimental data. Then, the numerical model is used to investigate the effects of various wave and structure parameters on the wave forces and the wave runup of the perforated quasi-ellipse caisson. Compared with the solid quasi-ellipse caisson, the wave force of the perforated quasi-ellipse caisson is significantly reduced with the increasing of porosity on the perforated quasi-ellipse caisson. Furthermore, the perforated quasi-ellipse caisson can reduce the wave runup compared with the solid quasi-ellipse caisson. This reduction tends to increase as the porosity of the perforated quasi-ellipse caisson and relative wave height increase.

  11. Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

    Haridimos Markogiannakis; Manousos Konstadoulakis; Dimitrios Tzertzemelis; Pantelis Antonakis; Ilias Gomatos; Constantinos Bramis; Andreas Manouras

    2008-01-01

    Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigation of even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.

  12. Experimental study of dissolved oxygen transport by regular waves through a perforated breakwater

    Yin, Zegao; Yu, Ning; Liang, Bingchen; Zeng, Jixiong; Xie, Shaohua

    2016-02-01

    The perforated breakwater is an environmentally friendly coastal structure, and dissolved oxygen concentration levels are an important index to denote water quality. In this paper, oxygen transport experiments with regular waves through a vertical perforated breakwater were conducted. The oxygen scavenger method was used to reduce the dissolved oxygen concentration of inner water body with the chemicals Na2SO3 and CoCl2. The dissolved oxygen concentration and wave parameters of 36 experimental scenarios were measured with different perforated arrangements and wave conditions. It was found that the oxygen transfer coefficient through wave surface, K1 a 1, is much lower than the oxygen transport coefficient through the perforated breakwater, K2 a 2. If the effect of K1 a 1 is not considered, the dissolved oxygen concentration computation for inner water body will not be greatly affected. Considering the effect of a permeable area ratio a, relative location parameter of perforations δ and wave period T, the aforementioned data of 30 experimental scenarios, the dimensional analysis and the least squares method were used to derive an equation of K2 a 2 (K2 a 2=0.0042 a 0.5 δ 0.2 T -1). It was validated with 6 other experimental scenarios data, which indicates an approximate agreement. Therefore, this equation can be used to compute the DO concentration caused by the water transport through perforated breakwater.

  13. Experimental investigation of perforations interactions effects under high sound pressure levels

    Tayong, Rostand

    2009-01-01

    Most models for predicting the acoustic response of perforated panels are based on the assumption that there is no interactions between the holes. The common way of taking into account the perforates effects is the use of Fok's functions. The few papers that deal with these effects study the case of low sound pressure levels. This paper investigates the Holes Interaction Effects (HIE) of perforated and micro-perforated panels when submitted to high sound pressure levels. Analysis of the data yields to the fact that even with HIE, the nonlinear reactance dependency with velocity is very slight. The HIE can provide good absorption of the perforated panel backed by an air cavity at low and high sound pressure levels if the holes positions are well configured. Perforated panels of holes diameters less than 2 millimeters were built out of steel with different interstices (distance between two adjacent holes) and tested. Experimental results (performed with an impedance tube) in the cases of interaction are done an...

  14. Sealing of root perforation with glass ionomer cement: a case report

    Ronise Ferreira Dotto

    2014-01-01

    Full Text Available Despite the development of endodontic therapy, adverse complications can arise during treatment, resulting in a questionable prognosis; root perforation is one such complication. Root perforations located along different thirds of the root canal are associated with practitioner error during the operative stages of endodontic treatment, particularly with failure to observe the anatomic singularities of different tooth types. Various materials have been suggested and used to repair root canal perforations, including calcium hydroxide, silver amalgam, mineral trioxide aggregate (MTA, hydroxyapatite, and glass ionomer cement. This report describes the clinical management of a maxillary second premolar in which periapical radiography showed satisfactory canal obturation, but with a lateral root perforation present at the cervical level. Initial treatment involved curettage and sealing of the perforated area with resin-modified glass ionomer cement, followed by composite-resin reconstruction of the crown. There was favorable clinical and radiographic progression at 1- and 2-year follow-up. We thus conclude that tooth longevity can be prolonged even in the presence of a root perforation.

  15. Perforated small intestine in a patient with T-cell lymphoma; a rare cause of peritonitis

    Petrişor Banu

    2016-04-01

    Full Text Available The nontraumatic perforations of the small intestine are pathological entities with particular aspects in respect to diagnosis and treatment. These peculiarities derive from the nonspecific clinical expression of the peritonitis syndrome, and from the multitude of causes that might be the primary sources of the perforation: foreign bodies, inflammatory diseases, tumors, infectious diseases, etc. Accordingly, in most cases intestinal perforation is discovered only by laparotomy and the definitive diagnosis is available only after histopathologic examination. Small bowel malignancies are rare; among them, lymphomas rank third in frequency, being mostly B-cell non Hodgkin lymphomas. Only 10% of non-Hodgkin lymphomas are with T-cell. We report the case of a 57 years’ old woman with intestinal T-cell lymphoma, whose first clinical symptomatology was related to a complication represented by perforation of the small intestine. Laparotomy performed in emergency identified an ulcerative lesion with perforation in the jejunum, which required segmental enterectomy with anastomosis. The nonspecific clinical manifestations of intestinal lymphomas make from diagnosis a difficult procedure. Due to the fact that surgery does not have a definite place in the treatment of the small intestinal lymphomas (for cases complicated with perforation, and beyond the morbidity associated with the surgery performed in emergency conditions, prognosis of these patients is finally given by the possibility to control the systemic disease through adjuvant therapy.

  16. Esophageal perforation in South of Sweden: Results of surgical treatment in 125 consecutive patients

    Lillo-Gil Ramon

    2010-10-01

    Full Text Available Abstract Background For many years there has been a debate as to which is the method of choice in treating patients with esophageal perforation. The literature consists mainly of small case series. Strategies for aiding patients struck with this disease is changing as new and less traumatic treatment options are developing. We studied a relatively large consecutive material of esophageal perforations in an effort to evaluate prognostic factors, diagnostic efforts and treatment strategy in these patients. Methods 125 consecutive patients treated at the University Hospital of Lund from 1970 to 2006 were studied retrospectively. Prognostic factors were evaluated using the Cox proportional hazards model. Results Pre-operative ASA score was the only factor that significantly influenced outcome. Neck incision for cervical perforation (n = 8 and treatment with a covered stent with or without open drainage for a thoracic perforation (n = 6 had the lowest mortality. Esophageal resection (n = 8 had the highest mortality. A CAT scan or an oesophageal X-ray with oral contrast were the most efficient diagnostic tools. The preferred treatment strategy changed over the course of the study period, from a more aggressive surgical approach towards using covered stents to seal the perforation. Conclusion Pre-operative ASA score was the only factor that significantly influenced outcome in this study. Treatment strategies are changing as less traumatic options have become available. Sealing an esophageal perforation with a covered stent, in combination with open or closed drainage when necessary, is a promising treatment strategy.

  17. Phleboscintigraphic detection of incompetent perforating veins to guide the surgical treatment of venous stasis ulceration

    Most venous leg ulcers are due to the incompetence of perforating veins. The principal aim of surgery in the treatment of chronic ulcers which are not responsive to conservative therapy, is the identification, division and ligation of those incompetent perforating veins which transmit the hig venous pressure to the ulcerated area. Both radionuclide scanning and contrast venography may be accurate methods of evaluating the deep venous system and incompetent perforating veins; however, the role of radionuclide scanning in this setting is not fully exploited. The authors present one case of chronic, refractory postphlebitic ulcer in which radionuclide venography was employed to detect the incompetent perforating vein responsible for the development of the ulcer. Radionuclide venography (with Tc-99m red blood cells) allowed the main perforating vein to be clearly detected among others already identified by contrast venography. After surgical treatment the ulcer healed, and the perforating vein had disappeared when venoscintigraphy was repeated. In the author's opinion radionuclide venography is a useful support to contrast venography in planning the surgical treatment of venous stasis ulcers. (orig.)

  18. Perforation rate in CT colonography: a systematic review of the literature and meta-analysis

    The primary aim was to assess the perforation rate of CTC; the secondary aim was to identify potential clinical/technical predictors of this complication. Methods for analysis were based on PRISMA (preferred reporting items for systematic reviews and meta-analyses). From the selected studies, the rate of CTC perforation and patient/technical characteristics potentially associated with this event were extracted. Forest plots showing individual and pooled estimates of the perforation rate were obtained for all analyses. I2 was used to evaluate heterogeneity between studies. Eleven articles out of the 187 initially identified were selected for the analysis (103,399 patients). There were 29,048 (28 %) asymptomatic individuals and 30,773 (30 %) symptomatic patients; this characteristic was not reported in the remaining subjects (42 %). Colon distension was obtained manually in 69,222 (67 %) and using an automated carbon dioxide insufflator in 26,479 (26 %) patients; in the remaining 7 % of patients, this information was missing. Twenty-eight colonic perforations were reported, with the CTC perforation rate estimated to be 0.04 % (95 % CI. 0.00-0.10), 19-fold higher in symptomatic than in screening subjects (OR: 19.2, CI 3.3-108 and P = 0.001). The surgical rate was 0.008 %. No CTC-related deaths were reported. The perforation rate in CTC is very low, particularly considering asymptomatic individuals. circle This is the first meta-analysis on this topic, based on 100,000 patients. (orig.)

  19. COMPARATIVE STUDY BETWEEN TWO DIFFERENT TECHNIQUES OF PEPTIC ULCER PERFORATION CLOSURE

    Rajendra

    2015-05-01

    Full Text Available INTRODUCTION: Peptic ulcer perforation is one of most serious and overwhelming catastrophic event that is affecting the human being. Inspite of better understanding of the disease, effective resuscitation and prompt surgery under modern anaesthetic techniques there is high morbidity and mortality. Hence attempt has been made to analyse the outcomes of various surgical techniques of closure of peptic perforation. MATERIALS AND METHODS: At Referral centre 121 patients with prepyloric perforation were studied in between th e duration of April 2012 to March 2015. Two different techniques, Grahams patch omentopexy and figure of “ 8 ” stitches were performed on these patients. Demography, symptomatology, general conditions of patients, site, size, type of operations, post - operati ve complications and outcome of patients after the surgery were studied. OBSERVATIONS: Grahams patch was used in majority of patients (85 with oral feeding started on post - operative 5 th day and discharged on 9 th day while figure of 8 stitch was used in 36 Case of perforations sized <.5cm and oral feeding started on 4 th day and discharged on 8 th day . SUMMARY: Through the study we can conclude that figure of 8 stitch is a better technique than grahams patch for closure of prepyloric perforation when used for small sized perforation with earlier post op feeding and discharge rates.

  20. Effect Of Pentoxifylline On The Healing Of Guinea Pig Perforated Tympanic Membrane

    Sazegar A A

    2004-06-01

    Full Text Available Background: Tympanic membrane perforation as a sign of different otologic disorders have multiple causes, for example trauma .Traumatic perforations heal spontaneously in most cases but in large and stable perforation otolarngologist intervention is necessary . In the stable perforation of tympanic membrane , if there isn’t infection in the tympanic cavity , the paper patch or myringoplasty may be used. These procedures need remedy charge and time and may be with morbidity and other complications. Recently materials like hyaluronic acid and epidermal growth factors has been used to speed healing of tympanic membrane perforation, and their effect has been proved. Pentoxifylline an anti-thrombotic drug has positive effect on increasing perfusion and wound healing in pathological conditions. Alike we have used pentoxifylline to show it’s effect on the healing of guinea pig perforated tympanic membrane. Materials and Methods: This study has been done prospectively, on 32 guinea pig ears. Results & Conclusion: Final otomicroscopic study after three weeks showing no significant difference in the healing rate of tympanic membrane in pentoxifylline group versus control group.