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Optics Express Oct 2020This paper presents a detailed analysis examining the absorption performance of a metal-dielectric slab with subwavelength size periodic perforations exploiting...
This paper presents a detailed analysis examining the absorption performance of a metal-dielectric slab with subwavelength size periodic perforations exploiting quarter-wave impedance matching (QWIM) technique within long wave infrared (LWIR) regime (8-12µm). Integration of perforations to a simple stack with various period sizes and perforated area ratios are examined through theory, simulation, and measurements that are in great agreement. Advantages of perforated absorbers for thermal detectors are discussed in maximizing optical absorption and reducing thermal-mass point of view. Introducing perforation in umbrella type absorbers is mainly employed for reducing the thermal-mass while maintaining the high absorption performance. Within the scope, it is experimentally shown that a perforation ratio (width/period) of 50% with square holes for the umbrella layer is possible without degrading the maximum LWIR absorption performance of 96% when the sheet resistance of R=400Ω/□ is employed for the absorbing metal layer, which is close to free space impedance of 377Ω/□. Nevertheless, this ratio can be increased up to 77% by depositing a thicker absorber metal with smaller sheet resistance, such as R=100Ω/□ while still maintaining an average absorption performance of 93%, which are all predicted numerically by simulations and physically explained through effective medium approach (EMA).
PubMed: 33115029
DOI: 10.1364/OE.405100 -
Insights Into Imaging Feb 2020Gastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies:...
Gastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies: oesophageal perforations can present with acute chest pain, odynophagia and vomiting, gastroduodenal perforations with acute severe abdominal pain, while colonic perforations tend to follow a slower progression course with secondary bacterial peritonitis or localised abscesses. A subset of patients may present with delayed symptoms, abscess mimicking an abdominal mass, or with sepsis.Direct multidetector computed tomography (MDCT) findings support the diagnosis and localise the perforation site while ancillary findings may suggest underlying conditions that need further investigation following primary repair of ruptured bowel. MDCT findings include extraluminal gas, visible bowel wall discontinuity, extraluminal contrast, bowel wall thickening, abnormal mural enhancement, localised fat stranding and/or free fluid, as well as localised phlegmon or abscess in contained perforations.The purpose of this article is to review the spectrum of MDCT findings encountered in GIT perforation and emphasise the MDCT and clinical clues suggestive of the underlying aetiology and localisation of perforation site.
PubMed: 32086627
DOI: 10.1186/s13244-019-0823-6 -
JPRAS Open Dec 2022Digital artery perforator flaps provide a useful option for reconstruction of soft tissue defects of the digits, and many variations of these flaps have been described... (Review)
Review
BACKGROUND
Digital artery perforator flaps provide a useful option for reconstruction of soft tissue defects of the digits, and many variations of these flaps have been described for fingertip defects. This review aims to summarize various pedicled digital artery perforator flap anatomical configurations described in literature for fingertip reconstruction and their results.
METHODS
A literature review of PubMed, Medline and Embase databases was conducted. Studies reporting homodigital digital artery perforator flaps for fingertip reconstruction without sacrificing the proper digital artery were included in the review. Data collected included flap design, perforator location, pathology, defect location, flap dimensions, flap survival, sensory recovery, range of movement, outcome measures, and complications. The flaps were analysed and categorized based on flap location, flap design, transfer method, and flap innervation.
RESULTS
Pedicled digital artery perforators have been described in various configurations by different authors including propeller, bilobed, V-Y advancement, rotation and turnover flaps. Variations to make these flaps sensate have also been described. According to the available reports, these flaps have low complications and high patient satisfaction rates.
CONCLUSION
Pedicled digital artery perforator flaps provide a versatile option for the reconstruction of fingertip and thumb tip defects. Various flap options are available for use depending on the reconstructive need. They are quicker and easier to perform than free flaps and can provide excellent outcomes in suitable cases.
PubMed: 36407856
DOI: 10.1016/j.jpra.2022.09.004 -
Anatolian Journal of Cardiology Aug 2022Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in...
Multi-Center Experience of Coronary Artery Perforation During Percutaneous Coronary Intervention: Clinical and Angiographic Characteristics, Management, and Outcomes Between 2010 and 2020.
BACKGROUND
Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey.
METHODS
The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients.
RESULTS
The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%.
CONCLUSION
The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications.
Topics: Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Heart Injuries; Humans; Percutaneous Coronary Intervention; Retrospective Studies; Stents; Treatment Outcome; Vascular System Injuries
PubMed: 35924287
DOI: 10.5152/AnatolJCardiol.2022.1337 -
Tomography (Ann Arbor, Mich.) Mar 2022Gastrointestinal perforations are a frequent cause of acute abdominal symptomatology for patients in the emergency department. The aim of this study was to investigate...
Gastrointestinal perforations are a frequent cause of acute abdominal symptomatology for patients in the emergency department. The aim of this study was to investigate the findings of multidetector-row computed tomography of gastrointestinal perforations and analyze the impact of any imaging signs on the presurgical identification of the perforation site. We retrospectively reviewed emergency MDCT findings of 93 patients submitted to surgery for gastrointestinal perforation at two different institutions. Two radiologists separately reviewed the emergency MDCT examinations performed on each patient, before and after knowing the surgical diagnosis of the perforation site. A list of findings was considered. Positive predictive values were estimated for each finding with respect to each perforation site, and correspondence analysis (CA) was used to investigate the relationship between the findings and each of the perforation types. We did not find inframesocolic free air in sigmoid colorectal perforations, and in rare cases, only supramesocolic free fluid in gastroduodenal perforations was found. A high PPV of perivisceral fat stranding due to colonic perforation and general distension of upstream loops and collapse of downstream loops were evident in most patients. Our data could offer additional information on the perforation site in the case of doubtful findings to support surgeons, especially in planning a laparoscopic approach.
Topics: Humans; Intestinal Perforation; Multidetector Computed Tomography; Predictive Value of Tests; Retrospective Studies; Stomach Ulcer
PubMed: 35314633
DOI: 10.3390/tomography8020056 -
Pediatric Gastroenterology, Hepatology... May 2020Perforation of choledochal cyst (CC) is a relatively rare clinical presentation in pediatric populations and difficult to predict preoperatively. We assess the clinical...
PURPOSE
Perforation of choledochal cyst (CC) is a relatively rare clinical presentation in pediatric populations and difficult to predict preoperatively. We assess the clinical implications by comparing clinical parameters based on a single-center experience between perforated and nonperforated CC to facilitate the appropriate management for future interventions.
METHODS
A total of 92 cases of CC in pediatric patients (aged <18 years) who received surgical management between January 2003 and December 2018 at a Pusan National University Children's Hospital were reviewed. After screening the clinical features of perforated cases, we compared the demographic findings, clinical characteristics, and some laboratory results between the perforated and nonperforated groups.
RESULTS
Perforated CC was identified in 8 patients (8.7%), and nonperforated CC in 84 patients (91.3%). Perforation can be classified into three categories: free perforation of cyst (3 cases), pinpoint perforation of cyst (2 cases), and necrotic change of cyst (3 cases). CC perforation occurred significantly more commonly in patients aged <24 months. Clinically, the perforated group showed significantly higher frequency of fever and higher C-reactive protein (CRP) level during the initial visit.
CONCLUSION
Perforation is more likely to be suspected in patients aged <24 months presenting together with fever and high CRP level in the initial visit. It is also necessary to keep in mind that it indicates not only a possibility of complicated disease status regardless of its association with stones but also a difficulty of applying a minimal invasive procedure and relatively increased length of hospital stay.
PubMed: 32483547
DOI: 10.5223/pghn.2020.23.3.259 -
Stroke Oct 2021The anatomic distribution of the deep cerebral perforators is considered either a given or subject to enormous variability. Most published overviews on this topic only... (Review)
Review
The anatomic distribution of the deep cerebral perforators is considered either a given or subject to enormous variability. Most published overviews on this topic only report findings from a limited number of anatomic dissections, and no attempt has been made to date to provide a comprehensive overview of all published data. A comprehensive literature search was performed on MEDLINE, Embase, and Google Scholar with the help of an information specialist. Three types of studies were included: (1) articles that described the anatomy and distribution territories of perforator groups arising from the arteries of the circle of Willis; (2) studies that evaluated the anatomy of the deep cerebral perforators using imaging techniques; and (3) studies that evaluated either microsurgically or radiologically confirmed perforator occlusion and reported the (magnetic resonance imaging-confirmed) distribution territory of the infarction together with a description of the clinical symptoms associated as a result of the infarction. A total of 2715 articles were screened and 53 were included. Of these, 40 dealt with the anatomic and imaging anatomy of perforator groups (37 reported results of dissections and 3 results of imaging studies), with a total of 2421 hemispheres investigated. Another 13 articles with 680 patients were included that evaluated perforator infarction territories. The deep cerebral perforator distribution shows large variability with poor concordance rates among reported studies, with the exception of the posterior communicating and anterior choroidal artery perforators. Despite the assumption that cerebral perforator anatomy is a given, studies show large variability in the anatomic distribution of various perforator groups. Perforator anatomy and relationships between perforator groups, as well as potential collateral circulation in these territories should be prioritized as a research topic in cerebrovascular disease in the near future.
Topics: Animals; Arterial Occlusive Diseases; Carotid Artery, Internal; Cerebral Arteries; Cerebrovascular Circulation; Collateral Circulation; Humans; Magnetic Resonance Imaging
PubMed: 34311568
DOI: 10.1161/STROKEAHA.120.034096 -
Cureus Nov 2023Background Every diagnostic tool that may assist in the identification of appendicitis is of great importance to emergency general surgeons. While recent research has...
Background Every diagnostic tool that may assist in the identification of appendicitis is of great importance to emergency general surgeons. While recent research has indicated that hyperbilirubinemia can serve as a valuable predictor of appendiceal perforation, these studies have not specifically examined the role of bilirubin as an indicator for acute appendicitis. This study aimed to assess the role of hyperbilirubinemia as a diagnostic factor in detecting appendicitis and appendiceal perforation. Methodology This single-center retrospective study involved 333 patients with acute appendicitis who underwent an emergency appendectomy at a model three hospital between January 2021 and December 2022. Statistical analysis was performed using STATA/SE 18.0 for Windows (StataCorp., College Station, TX, USA) to compare bilirubin levels, white blood cell count (WCC), and C-reactive protein (CRP) among normal appendices, non-perforated appendicitis, and perforated appendicitis. Results Among 333 patients, 60.66% were male, and 39.34% were female, with a male-to-female ratio of 1.54:1. The average hospital stay was 3.27 ± 3.02 days. Hyperbilirubinemia was observed in 25.53% (85 individuals). Among the 51 cases of perforated appendicitis, 70.59% had elevated bilirubin levels of above 20 μmol/L. Significantly more patients with appendiceal perforation had hyperbilirubinemia than non-perforated appendicitis (70.59% vs. 19.03%, p < 0.001). Bilirubin had higher specificity (94.29%) for detecting non-perforated appendicitis than normal appendices (odds ratio = 3.88), while WCC and CRP showed higher sensitivities. WCC had a sensitivity of 73.28% and a specificity of 42.86%, and CRP had a sensitivity of 76.53% and a specificity of 60.00%. When comparing perforated appendicitis with non-perforated appendicitis, bilirubin showed a specificity of 80.97% and an odds ratio of 10.21. The likelihood of a patient with hyperbilirubinemia having perforated appendicitis was more than 10 times higher than those without appendiceal perforation, suggesting it to be a potential indicator for appendiceal perforation. WCC showed a specificity of 26.72% and an odds ratio of 4.28, while CRP had a specificity of 23.48% and an odds ratio of 4.91. Conclusions The significant association between bilirubin levels and appendicitis highlights its potential as a valuable marker for predicting appendicitis and appendiceal perforation. The simplicity, cost-effectiveness, and diagnostic value of bilirubin assessment support its routine use in suspected cases of acute appendicitis.
PubMed: 37929270
DOI: 10.7759/cureus.48203 -
Surgical Case Reports Jan 2023A muco-submucosal elongated polyp is a non-neoplastic growth composed of mucosa and submucosa. Although muco-submucosal elongated polyps are commonly reported in the...
BACKGROUND
A muco-submucosal elongated polyp is a non-neoplastic growth composed of mucosa and submucosa. Although muco-submucosal elongated polyps are commonly reported in the large intestine, they are rare in the small intestine, in which they are called enteric muco-submucosal elongated polyps. We herein present a case of jejunal intussusception and perforation due to an enteric muco-submucosal elongated polyp.
CASE PRESENTATION
A 46-year-old woman presented with abdominal pain and vomiting. Computed tomography revealed jejunal intussusception, which was reduced via a nasointestinal ileus tube. Oral double-balloon endoscopy showed an elongated polyp in the proximal jejunum. The patient refused surgical resection and thus, the polyp was monitored. Six months later, the patient was readmitted with the recurrence of jejunal intussusception and underwent emergency surgery. Intraoperative findings revealed an intussuscepted bowel with an elongated polyp and multiple perforations in the proximal jejunum. We resected approximately 90 cm of the bowel, including the intussuscepted segment and perforated sites. The pedunculated polyp, which was 60 mm in length, was located on the oral side of the resected specimen. Histopathologically, the polyp was covered by normal mucosa and the submucosa consisted of edematous loose connective tissue. The histopathological diagnosis confirmed an enteric muco-submucosal elongated polyp.
CONCLUSIONS
Symptomatic patients with enteric muco-submucosal elongated polyps may be at risk of complications, as observed in the present case, and need to undergo timely resection.
PubMed: 36627469
DOI: 10.1186/s40792-022-01584-6 -
Surgical Endoscopy Mar 2023Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options...
BACKGROUND
Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options exist, but the size and location of the perforation can limit their application. We present a retrospective study, demonstrating a successful application of endoscopic vacuum therapy (EVT) for duodenal leaks.
METHODS
We performed a retrospective study of all patients who underwent EVT for duodenal perforations between 2016 and 2021 at two tertiary centers. We analyzed demographic and clinical patient characteristics, surgical outcomes, leak characteristics, sponge-related complications, and success rate.
RESULTS
Indications for treatment with EVT in the duodenum consisted of leak after duodenal suture of a perforated ulcer (n = 4), iatrogenic perforation after endoscopic resection (n = 2), iatrogenic perforation during surgery (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 2). EVT was used as a first-line treatment in seven patients and as a second-line treatment in three patients. EVT was successfully applied in all interventions (n = 10, 100%). Overall, EVT lead to definitive closure of the defects in eight out of ten patients (80%). No severe EVT-related adverse events occurred.
CONCLUSION
EVT is safe and technically feasible, so it emerges as a promising endoscopic treatment option for duodenal leaks. However, multidisciplinary collaboration and management are important to reduce the occurrence of postoperative complications, and to improve recovery rates.
Topics: Humans; Retrospective Studies; Negative-Pressure Wound Therapy; Endoscopy; Anastomotic Leak; Peptic Ulcer Perforation; Duodenal Ulcer; Iatrogenic Disease; Treatment Outcome
PubMed: 36241747
DOI: 10.1007/s00464-022-09686-w