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Cureus Feb 2022In the emergency room, acute pain in the abdomen is one of the most common symptoms that patients present with, and it is a result of a myriad of causes, leading to an...
INTRODUCTION
In the emergency room, acute pain in the abdomen is one of the most common symptoms that patients present with, and it is a result of a myriad of causes, leading to an exhaustive differential diagnosis. A perforated peptic ulcer is a rare cause of acute right iliac fossa or lower quadrant abdominal pain. It causes leakage of gastrointestinal contents in the area, resulting in localized inflammation and pain that is clinically similar to acute appendicitis. This condition is known as Valentino's syndrome.
AIM
This study aims to highlight clinical and radiological features for patients with Valentino's syndrome, improving diagnostic accuracy.
METHODS
The authors conducted a retrospective analysis of all diagnosed cases of Valentino's syndrome from multiple facilities within the same organization for the research study. A total of 14 nonsequential cases were gathered. The term "Valentino's syndrome" was used to search in the PubMed and Google Scholar databases for the review of literature, and only 17 cases were found and reviewed.
RESULTS
Of the 31 patients, 83.9% were male, with a mean age of 39 years. Of all patients who presented with abdominal pain, 25.8% had it in the lower right abdomen. Vomiting (38.7%), nausea (35.4%), fever (16.1%), and constipation were all associated symptoms (12.9%). All cases were clinically diagnosed as acute appendicitis. Many patients had elevated levels of white blood cells, neutrophils, and CRP. Computed tomography (CT) scan was used in 70.9% of the cases, followed by ultrasound (58%) and x-ray (45.1%), where pneumoperitoneum and duodenal perforations were common. Graham's patch was used in 48.3% of the cases, appendectomy was used in 16.1% of the cases, and conservative care was used in 19.3% of the cases. Most patients were given proton pump inhibitors and antibiotics for Helicobacter pylori.
CONCLUSION
Timely diagnosis of Valentino's syndrome via CT imaging is critical because it leads to immediate perforation repair. Patients' mortality and morbidity may be reduced if they are aware of the condition and receive an accurate, rapid preoperative diagnosis.
PubMed: 35371708
DOI: 10.7759/cureus.22667 -
Plastic and Reconstructive Surgery.... Jul 2021From early on in the development of plastic surgery, it was quickly realized that utilizing locally adjacent tissue, or "matching like with like," yielded superior... (Review)
Review
From early on in the development of plastic surgery, it was quickly realized that utilizing locally adjacent tissue, or "matching like with like," yielded superior aesthetic reconstructions to those in which the tissue was derived from a distant location. In many cases, the use of a local perforator flap is a simpler procedure with less patient morbidity and a quicker recovery from surgery. The difficulty with local perforator flaps has been locating the supplying perforators, ensuring that the flap has a robust and reliable blood supply, and that sufficient tissue is able to be transferred. The recent reappraisal of our understanding of the blood supply of the integument has allowed, for the first time, the capacity to accurately and inexpensively, without the need for "high tech equipment," locate perforators, as they emerge from the deep fascia into the overlying integument, and through a better understanding of the interconnecting anastomotic vessels between perforators reliably predict how much tissue can be safely raised on a single perforator, before surgery. Further, through the use of strategic "delay," it is possible to manipulate the interconnecting vessels between the selected perforator and its surrounding neighbors to design a flap of tissue of any dimension, composed of whatever tissue we require, and safely transfer that tissue locally, or if required, distantly, as a free flap. This article will highlight these advances, explain their relevance in raising reliable local perforator flaps, and will, where possible, call attention to any pearls and pitfalls, and how to avoid complications.
PubMed: 34422514
DOI: 10.1097/GOX.0000000000003673 -
Journal of Clinical Medicine Sep 2022Precision medicine for inner ear disorders has seen significant advances in recent years. However, unreliable access to the inner ear has impeded diagnostics and... (Review)
Review
OBJECTIVES
Precision medicine for inner ear disorders has seen significant advances in recent years. However, unreliable access to the inner ear has impeded diagnostics and therapeutic delivery. The purpose of this review is to describe the development, production, and utility of novel microneedles for intracochlear access.
METHODS
We summarize the current work on microneedles developed using two-photon polymerization (2PP) lithography for perforation of the round window membrane (RWM). We contextualize our findings with the existing literature in intracochlear diagnostics and delivery.
RESULTS
Two-photon polymerization lithography produces microneedles capable of perforating human and guinea pig RWMs without structural or functional damage. Solid microneedles may be used to perforate guinea pig RWMs in vivo with full reconstitution of the membrane in 48-72 h, and hollow microneedles may be used to aspirate perilymph or inject therapeutics into the inner ear. Microneedles produced with two-photon templated electrodeposition (2PTE) have greater strength and biocompatibility and may be used to perforate human RWMs.
CONCLUSIONS
Microneedles produced with 2PP lithography and 2PTE can safely and reliably perforate the RWM for intracochlear access. This technology is groundbreaking and enabling in the field of inner ear precision medicine.
PubMed: 36143121
DOI: 10.3390/jcm11185474 -
The Journal of Invasive Cardiology Jul 2022To examine the incidence, treatment and outcomes of perforation during percutaneous coronary intervention (PCI).
OBJECTIVES
To examine the incidence, treatment and outcomes of perforation during percutaneous coronary intervention (PCI).
BACKGROUND
Coronary perforation is a potentially life-threatening PCI complication.
METHODS
We examined the clinical, angiographic, and procedural characteristics, management, and outcomes of coronary perforation at a tertiary care institution.
RESULTS
Between 2014 and 2019, perforation occurred in 70 of 10,278 PCIs (0.7%). Patient age was 71 ± 12 years, 66% were men, and 30% had prior coronary artery bypass graft surgery. Among perforation cases, the prevalence of chronic total occlusions was 33%, moderate/severe calcification was 66% and moderate/severe tortuosity was 41%. The frequency of Ellis class 1, 2, and 3 perforations was 14%, 50%, and 36%, respectively. Most (n = 51; 73%) were large vessel perforations, 16 (23%) were distal vessel perforations and 3 (4%) were collateral vessel perforations (1 septal and 2 epicardial). Hypotension occurred in 26%, pericardial effusion in 36% and tamponade in 13%; 47% of perforations did not have clinical consequences. Perforations were most often treated with prolonged balloon inflation (63%), reversal of anticoagulation (39%), and covered stent implantation (33%). Technical and procedural success were 73% and 60%, respectively, and major periprocedural adverse cardiac events occurred in 21% of the patients. Three patients (4%) required emergent CABG surgery and four (6%) died.
CONCLUSIONS
Coronary perforation is an infrequent complication of PCI. Most perforations are large vessel perforations and often require further intervention. The incidence of death or emergent cardiac surgery is low.
Topics: Aged; Aged, 80 and over; Coronary Angiography; Coronary Vessels; Female; Heart Injuries; Humans; Incidence; Male; Middle Aged; Percutaneous Coronary Intervention; Treatment Outcome; Vascular System Injuries
PubMed: 35714223
DOI: No ID Found -
Archives of Plastic Surgery Nov 2022The anterolateral thigh (ALT) flap has been extensively discussed in the literature as it allows for a wide variety and depth of tissues for complex wound coverage....
The anterolateral thigh (ALT) flap has been extensively discussed in the literature as it allows for a wide variety and depth of tissues for complex wound coverage. Thanks to many cadaveric and angiographic studies of the subdermal plexus, it is to date ascertained that tailoring ALT thickness can be safely performed without compromising flap outcomes or causing additional morbidity. Recently, the authors applied and described a simpler, safer, and less time-consuming superthin ALT perforator (ALTP) free flap harvesting technique. The aim of this article is to show the versatility of the adipofascial flap harvested around the chosen perforators, which allowed us to safely expand the usage of ALTP superthin flaps.
PubMed: 36523912
DOI: 10.1055/s-0042-1758634 -
Folia Morphologica 2023The perforating cutaneous nerve/perforating nerve of the sacrotuberous ligament is rarely observed. It usually arises from the posterior division of the sacral plexus or...
BACKGROUND
The perforating cutaneous nerve/perforating nerve of the sacrotuberous ligament is rarely observed. It usually arises from the posterior division of the sacral plexus or the pudendal nerve and perforates the sacrotuberous ligament. The anatomy of this nerve and its variants is poorly described in the literature, but there are data indicating its role in pudendal neuralgia.
MATERIALS AND METHODS
Herein, we present an anatomical study of six formalin-fixed cadavers with descriptions of the topography of spinal nerves S2-S4, the pudendal bundle, the perforating cutaneous nerve and the sacrotuberous ligament.
RESULTS
We found three perforating cutaneous nerves and described each of them in detail, with measurements of length and width, and point of perforation of the sacrotuberous ligament.
CONCLUSIONS
We distinguished three types of perforating cutaneous nerve on the basis of our findings and previous publications; two of the three types were observed in our study.
Topics: Humans; Pudendal Nerve; Lumbosacral Plexus; Pelvis; Ligaments, Articular; Cadaver
PubMed: 35099048
DOI: 10.5603/FM.a2022.0001 -
Journal of Surgical Case Reports Sep 2023Bowel perforation is an emergency condition that requires critical thinking and readily intervention; nevertheless, on occasions, its presentation can be challenging to...
Bowel perforation is an emergency condition that requires critical thinking and readily intervention; nevertheless, on occasions, its presentation can be challenging to diagnose. Several etiologies could cause bowel perforation, including obstruction, mass, inflammation, ischemia, etc. On rare occasions, a foreign body could be the cause of perforation, which mandates a detailed history and focused review of the images when the patient's condition allows. We report a case of ileal perforation caused by an ingested wooden toothpick that was suspected on the CT images, which the patient has no memory of ingesting.
PubMed: 37727225
DOI: 10.1093/jscr/rjad511 -
Journal of Cardiovascular... Feb 2022Cardiac perforation during leadless pacemaker implantation is more likely to require intervention than perforation by a transvenous lead. This study reports the...
BACKGROUND
Cardiac perforation during leadless pacemaker implantation is more likely to require intervention than perforation by a transvenous lead. This study reports the consequences of Micra pacemaker perforations and related device and operator use problems based on information the manufacturer has submitted to the Food and Drug Administration (FDA).
METHODS
FDA's Manufacturer and User Facility Device Experience (MAUDE) database was searched for Micra perforations. Data extracted included deaths, major adverse clinical events (MACEs), and device and/or operator use problems.
RESULTS
Between 2016 and July 2021, 563 perforations were reported within 30 days of implant and resulted in 150 deaths (27%), 499 cardiac tamponades (89%), 64 pericardial effusions (11%), and 146 patients (26%) required emergency surgery. Half of perforations were associated with 139 (25%) device problems, 78 (14%) operator use problems, and 62 (11%) combined device and operator use problems. Inadequate electrical measurements or difficult positioning were the most frequent device problems (n = 129); non-septal implants and perforation of other structures were the most frequent operator use problems (n = 69); a combined operator use and device problem resulted in 62 delivery system perforations. No device or operator use problem was identified for 282 perforations (50%), but they were associated with 78 deaths, 245 tamponades, and 57 emergency surgeries.
CONCLUSION
The Micra perforations reported in MAUDE are often associated with death and major complications requiring emergency intervention. Device and use problems account for at least half of perforations. Studies are needed to identify who is at risk for a perforation and how MACE can be avoided or mitigated.
Topics: Cardiac Tamponade; Heart Injuries; Humans; Pacemaker, Artificial; Treatment Outcome; United States; United States Food and Drug Administration
PubMed: 34953099
DOI: 10.1111/jce.15343 -
Surgical Endoscopy May 2022It has been reported that in conventional open surgery, approximately 10% of surgical gloves are perforated during surgery without being noticed. To protect both the...
BACKGROUND
It has been reported that in conventional open surgery, approximately 10% of surgical gloves are perforated during surgery without being noticed. To protect both the patient and medical staff from harm, double gloving or changing gloves routinely at certain intervals during surgery is recommended. However, whether these protective measures are also necessary for laparoscopic colorectal surgery is unknown because the actual perforation rate during laparoscopic procedures is unclear.
METHODS
Seventy-seven laparoscopic colorectal surgeries were evaluated, and a total of 616 surgical gloves used in the surgeries were collected for analysis. The presence of glove perforation was tested by the standard water-leak test method (EN455-1).
RESULTS
Seven perforations were detected (1.1%). The duration of the laparoscopic procedure was not a statistically significant risk factor for glove perforation (p = 0.41). Postoperative surgical site infections (SSIs) were observed in 12 cases (15.6%), but there was no significant correlation between the presence of glove perforation and SSI (p = 0.92). According to the bacterial cultivation results, the majority of causative agents of SSI were enterobacteria, which belong to the major gut flora.
CONCLUSION
Although the perforation rate was considerably lower than that in open surgery, surgical glove perforation occurred during laparoscopic procedures. Double gloving in laparoscopic colorectal surgery is recommended not to prevent SSI but to protect medical workers from harmful infections after direct contact with the patient.
Topics: Colorectal Neoplasms; Gloves, Surgical; Health Personnel; Humans; Laparoscopy; Risk Factors
PubMed: 34382122
DOI: 10.1007/s00464-021-08670-0 -
Brazilian Journal of Otorhinolaryngology 2022Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. (Review)
Review
INTRODUCTION
Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used.
OBJECTIVE
The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results.
METHODS
We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2 cm, Group B: ≥ 2 cm).
RESULTS
We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659).
CONCLUSION
This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.
Topics: Humans; Nasal Septal Perforation; Retrospective Studies; Surgical Flaps; Reoperation; Iatrogenic Disease; Nasal Septum; Treatment Outcome
PubMed: 33642213
DOI: 10.1016/j.bjorl.2020.12.018