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Cureus May 2020Unintentional ingestion of fish bones is a common but frequently unrecognized occurrence at the emergency room. Most ingested fish bones pass through the...
Unintentional ingestion of fish bones is a common but frequently unrecognized occurrence at the emergency room. Most ingested fish bones pass through the gastrointestinal tract without complications, but approximately 1% may perforate and cause acute abdomen, peritonitis and/or abscesses, requiring emergent surgery. Clinical presentation is non-specific and computed tomography is essential to confirm the diagnosis and guide the surgery. We present a case of gastric perforation by fish bone and discuss the clinical and radiological challenges in the diagnosis of this condition.
PubMed: 32523830
DOI: 10.7759/cureus.7973 -
Clinical Case Reports Apr 2022Intrauterine devices rarely fail, which results in pregnancy. Meanwhile, these devices can perforate uterine and migrate through abdomen. Our case experienced IUD...
Intrauterine devices rarely fail, which results in pregnancy. Meanwhile, these devices can perforate uterine and migrate through abdomen. Our case experienced IUD failure and perforation simultaneously, and the device was embedded in omentum and shifted rapidly, which made it hard to localize and could only be removed using ultrasonography guidance.
PubMed: 35441023
DOI: 10.1002/ccr3.5732 -
BMC Musculoskeletal Disorders Dec 2022In soft tissue reconstructive surgery, perforator localization and flap harvesting have always been critical challenges, but augmented reality (AR) has become a dominant...
PURPOSE
In soft tissue reconstructive surgery, perforator localization and flap harvesting have always been critical challenges, but augmented reality (AR) has become a dominant technology to help map perforators.
METHODS
The lateral circumflex femoral artery (LCFA) and its perforators were reconstructed by CTA in consecutive patients (N = 14). Then, the anterolateral thigh perforators and the points from which the perforators emerged from the deep fascia were marked and projected onto the skin surface. As the virtual images were projected onto patients according to bony markers, the courses of the LCFA and its perforators were depicted on the skin surface for intraoperative guidance. Finally, the locations of the emergence points were verified by intraoperative findings and compared to those determined by handheld Doppler ultrasound.
RESULTS
The sources, locations, and numbers of perforators were determined by CTA. The perforators and their emergence points were accurately mapped on the skin surface by a portable projector to harvest the anterolateral thigh perforator flap. During the operation, the accuracy of the CTA & AR method was 90.2% (37/41), and the sensitivity reached 97.4% (37/38), which were much higher than the corresponding values of Doppler ultrasound. Additionally, the differences between the AR-marked points and the intraoperative findings were much smaller than those seen with Doppler ultrasound (P < 0.001). Consequently, all of the flaps were well designed and survived, and only one complication occurred.
CONCLUSION
Augmented reality, namely, CTA combined with projection in this study, plays a vital and reliable role in locating the perforator emergence points and guiding the procedure to harvest flaps and has fewer potential risks.
Topics: Humans; Augmented Reality; Thigh; Veins; Surgical Flaps; Angiography
PubMed: 36457082
DOI: 10.1186/s12891-022-06013-1 -
Surgical Case Reports Jun 2022Heterotopic pancreas (HP) refers to the presence of abnormally located pancreatic tissue without any anatomic or vascular continuity with the main body of the pancreas....
BACKGROUND
Heterotopic pancreas (HP) refers to the presence of abnormally located pancreatic tissue without any anatomic or vascular continuity with the main body of the pancreas. HP can occur in the gastrointestinal tract and be complicated by gastrointestinal bleeding, pancreatitis, obstruction, or malignant generation. Specifically, perforation of the gastrointestinal tract because of HP is extremely rare.
CASE PRESENTATION
A 91-year-old woman was diagnosed with duodenal perforation, and an emergency laparoscopic operation was performed. The operative findings indicated a tumor and duodenal wall perforation. The tumor and the perforated site were resected with a linear stapler. Histopathological examination revealed the presence of HP tissue in the submucosal layer around the diverticulum without any signs of inflammation. The perforated site was not covered by HP tissues, and the duodenal wall might have been weaker than the other areas, which could have caused the internal pressure to increase and led to the perforation.
CONCLUSIONS
Preoperative HP diagnosis is difficult, and it is crucial to consider HP as the differential diagnosis in gastrointestinal perforations. The duodenal diverticula can be perforated due to increased internal pressure of the duodenum caused by the imbalanced localization of HP.
PubMed: 35648320
DOI: 10.1186/s40792-022-01460-3 -
Membranes Feb 2023This study uses computational design to explore the performance of a novel electro-membrane microfluidic diode consisting of physically conjugated nanoporous and...
This study uses computational design to explore the performance of a novel electro-membrane microfluidic diode consisting of physically conjugated nanoporous and micro-perforated ion-exchange layers. Previously, such structures have been demonstrated to exhibit asymmetric electroosmosis, but the model was unrealistic in several important respects. This numerical study investigates two quantitative measures of performance (linear velocity of net flow and efficiency) as functions of such principal system parameters as perforation size and spacing, the thickness of the nanoporous layer and the zeta potential of the pore surface. All of these dependencies exhibit pronounced maxima, which is of interest for future practical applications. The calculated linear velocities of net flows are in the range of several tens of liters per square meter per hour at realistically applied voltages. The system performance somewhat declines when the perforation size is increased from 2 µm to 128 µm (with a parallel increase of the inter-perforation spacing) but remains quite decent even for the largest perforation size. Such perforations should be relatively easy to generate using inexpensive equipment.
PubMed: 36837746
DOI: 10.3390/membranes13020243 -
Frontiers in Pediatrics 2022We evaluated the clinical features of neonatal Hirschsprung's disease (HD)-associated bowel perforation (perforated HD) and investigated risk factors related to it.
BACKGROUND AND AIM
We evaluated the clinical features of neonatal Hirschsprung's disease (HD)-associated bowel perforation (perforated HD) and investigated risk factors related to it.
METHODS
We retrospectively collected clinical data of neonates (<1 month of age) with perforated HD from multicenters in China from January 2006 to December 2019. A total of 142 patients (6.7%) with perforated HD were enrolled in the study. A 1:2 matching method was used to compare the clinical information of HD patients with and without bowel perforation during the neonatal period. The risk factors for bowel perforation were identified using univariate and multivariate logistic risk regression analyses.
RESULTS
Perforation site was present in the proximal ganglionic bowel in 101 (71.1%) cases and the distal aganglionosis segment in 41 (28.9%) cases. Adjacent marginal tissue from the perforated intestine revealed varying degrees of inflammatory cell infiltration, and the severity of enterocolitis was higher in the proximal ganglionic bowel than in the distal aganglionosis segment ( < 0.05). In the univariable and multivariable logistic analyses, clinical symptoms, such as vomiting (adjusted OR = 2.06, 95% CI: 2.01-2.88, < 0.05), and inflammation index in hematologic tests, such as neutrophil proportion (adjusted OR = 1.09, 95% CI: 1.05-1.33, < 0.05) and CRP (adjusted OR = 2.13, 95% CI: 1.01-3.27, < 0.05) were associated with increased risk for perforated HD.
CONCLUSION
Clinical Hirschsprung disease-associated enterocolitis (HAEC) highly correlated with perforated HD. Timely treatment of HAEC should be appropriate therapeutic approaches to prevent perforated HD.
PubMed: 35198516
DOI: 10.3389/fped.2022.807607 -
Plastic and Reconstructive Surgery.... Oct 2022While the anterolateral thigh (ALT) flap is the most commonly employed thigh-based flap for microvascular reconstruction, its counterpart, the anteromedial thigh (AMT)...
UNLABELLED
While the anterolateral thigh (ALT) flap is the most commonly employed thigh-based flap for microvascular reconstruction, its counterpart, the anteromedial thigh (AMT) flap, is a useful but underdescribed alternative when ALT perforators are absent or lacking. This review aims to assess the existing literature describing the anatomy and vascular territories supplying the AMT flap.
METHODS
A systematic review was performed in accordance with PRISMA guidelines. Ovid MEDLINE, Embase, and Web of Science were queried for records pertaining to the study question using Medical Subject Heading terms such as "anteromedial thigh flap" and "free tissue transfer." Study characteristics and anatomic descriptors (including number and type of perforators, origin, and pedicle course supplying the AMT flap) were collected.
RESULTS
A total of 21 studies representing 723 AMT flaps were identified and included for analysis. Dominant perforators supplying the AMT flap most commonly included the descending lateral circumflex femoral artery (dLCFA; 35%) or the medial branch of the dLCFA (mdLCFA; 33.6%). Average pedicle length ranged from 7.5 to 10.6cm. The majority of AMT perforators were septocutaneous (n = 852, 63.8%) compared with musculocutaneous (n = 483, 36.2%). Perforators to the AMT were absent in 7.6 to 9.1% of clinical cases.
CONCLUSIONS
The variable vascular anatomy of the AMT flap has prevented its widespread adoption in reconstruction. As knowledge regarding pertinent perforator anatomy of the AMT flap increases, so may its utility as an alternative to the ALT flap. This review summarizes the spectrum of anatomy of the AMT vasculature described in the literature to date.
PubMed: 36299817
DOI: 10.1097/GOX.0000000000004546 -
Journal of Vascular Surgery. Venous and... Sep 2020The objective of this study was to evaluate complications of Greenfield (Boston Scientific, Marlborough, Mass) stainless steel inferior vena cava (IVC) filters on...
OBJECTIVE
The objective of this study was to evaluate complications of Greenfield (Boston Scientific, Marlborough, Mass) stainless steel inferior vena cava (IVC) filters on follow-up computed tomography (CT) imaging and to elucidate associated risk factors.
METHODS
Ninety-three patients with CT studies obtained for other reasons after Greenfield IVC filter placement (2007-2014) were retrospectively studied. Greenfield filters were placed permanently in those with venous thromboembolism and an expected lifelong contraindication to anticoagulation or life expectancy <6 months. Patients' demographic data, procedural characteristics, and imaging studies were reviewed and factors associated with perforation rates were analyzed.
RESULTS
A total of 190 follow-up CT imaging studies were available for review. In total, filter-associated IVC thrombus (n = 10 [10.7%]) and pulmonary embolism breakthrough (n = 4 [4.3%)] were documented by contrast-enhanced CT. Perforation was evident in 18 patients (19.4%) with an average indwelling time of 256 days. No symptomatic perforation and no strut fracture were documented. There was no significant difference in perforation rate with respect to age of the patient (P = .61), sex (P = 1.00), or history of malignant disease (P = .40). The filter perforation rate and number of perforating struts were significantly higher in patients with longer indwelling time (>90 days) than in patients with shorter indwelling time (<90 days; P < .01). Caval cross-sectional areas of patients who experienced IVC filter perforations at >90 days were significantly smaller than those of nonperforated patients (284 vs 358 mm; P < .01).
CONCLUSIONS
Stainless steel Greenfield filters remain a relatively safe option for patients requiring permanent mechanical filtration.
Topics: Adult; Aged; Aged, 80 and over; Computed Tomography Angiography; Female; Foreign-Body Migration; Humans; Male; Middle Aged; Phlebography; Predictive Value of Tests; Prosthesis Design; Prosthesis Implantation; Retrospective Studies; Stainless Steel; Time Factors; Treatment Outcome; Vascular System Injuries; Vena Cava Filters; Vena Cava, Inferior
PubMed: 32063523
DOI: 10.1016/j.jvsv.2019.12.070 -
Gland Surgery May 2023The deep inferior epigastric perforator (DIEP) flap has been performed since the early 1990s. This represented a significant advancement from the prior autologous... (Review)
Review
The deep inferior epigastric perforator (DIEP) flap has been performed since the early 1990s. This represented a significant advancement from the prior autologous options that required removal of all or a portion of various muscle groups. Over the years numerous advancements and modifications have been made to DIEP flap reconstruction that have further facilitated our ability to provide this option following mastectomy. Advancements with preoperative preparation, intraoperative techniques, and postoperative management have served to determine eligibility for DIEP flap reconstruction, improve surgical outcomes, reduce complications, reduce surgical operative time, and facilitate postoperative monitoring. Preoperative advancements have included vascular imaging to identify perforators. Intraoperative advancements have included using the internal mammary perforators as the optimal recipient vessels rather than the thoracodorsal, having a two-team approach with microsurgical reconstruction to reduce operative time and improve outcomes when compared to the single surgeon strategy, using a venous coupler rather than hand sewing the anastomosis, using tissue perfusion technology to determine the perfusion limits within the flap. Postoperative advancements include the use of technology to optimally monitor flaps as well as the use of using enhanced recovery after surgery pathways to improve the postoperative experience and promote early and safe discharge from the hospital. This manuscript will review the evolution of the DIEP flap as it relates to comparing our earlier techniques and strategies compared to our current techniques and strategies following mastectomy and breast reconstruction.
PubMed: 37284710
DOI: 10.21037/gs-22-636 -
Anatomical Record (Hoboken, N.J. : 2007) Mar 2020Chronic tympanic membrane perforations (TMP) can be a source of significant morbidity from hearing loss, recurrent middle ear infections, changes in lifestyle, and risk...
Chronic tympanic membrane perforations (TMP) can be a source of significant morbidity from hearing loss, recurrent middle ear infections, changes in lifestyle, and risk of cholesteatoma formation. Laboratory experiments of TMP have been fraught by the rapid and high rate of spontaneous healing observed in animal models. There is controversy on the minimal time that perforations in animal models must have in order to be considered chronic TMP and thus have clinical relevance, with authors suggesting time periods of perforation patency of 8-12 weeks. In this article, we sought to create a clinically significant experimental model that could yield a high rate of perforation patency for at least 8 weeks. Animals undergoing acute TMP were exposed to three different experimental situations to delay the healing of the perforation: fractionated radiation, topical lipopolysaccharide application, and a combined dexamethasone and mitomycin C (DXM/MC) solution. In our study, the use of DXM/MC reliably produced TMP lasting at least 8 weeks in 86.48% of the cases without the need to reopen the perforation, infolding the edges of the membrane, or using physical barriers to prevent TMP closure. Histologically, the resulting perforated tympanum showed hyaline changes of the remnant tympanum and hyperkeratosis of the squamous epithelia of the external auditory canal. We believe that this model is reproducible and has potential use in experiments of delayed healing of TMP. Anat Rec, 303:619-625, 2020. © 2019 American Association for Anatomy.
Topics: Animals; Disease Models, Animal; Mice; Tympanic Membrane; Tympanic Membrane Perforation; Wound Healing
PubMed: 31260172
DOI: 10.1002/ar.24220