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Journal of Oral Science Jun 2015To facilitate safe placement of orthodontic anchor screws (miniscrews), we investigated the frequency of maxillary sinus perforation after screw placement and the effect...
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.
Topics: Adult; Bicuspid; Bone Screws; Female; Humans; Male; Maxilla; Maxillary Sinus; Molar; Torque; Young Adult
PubMed: 26062857
DOI: 10.2334/josnusd.57.95 -
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 -
International Journal of Surgery... 2013Acute perforated peptic ulcer is a leading cause of generalized peritonitis and its management has continued to be a challenging task in our environment. (Review)
Review
BACKGROUND
Acute perforated peptic ulcer is a leading cause of generalized peritonitis and its management has continued to be a challenging task in our environment.
OBJECTIVE
There is a paucity of published reports on acute perforated peptic ulcers in our environment. This study was conducted to evaluate the different pattern of risk factors clinical presentations, management and clinical outcome of patients with acute perforated peptic ulcer in our setting and to highlight the factors that continue to account for the high mortality and morbidity as seen here.
METHOD
A retrospective study where data of seventy-six (76) patients managed for generalized peritonitis due to acute peptic ulcer perforation over a five year period (January 2006-December 2010) were retrieved from medical records of Enugu State University of Science and Technology Hospital (ESUTH). The patients' biodata, clinical and operative findings and treatment outcome were extracted and analysed, after institutional ethical approval was secured. All other cases of generalized peritonitis not traceable to acute peptic ulcer perforation were excluded from the study.
RESULTS
There were76 patients; 58 males and 18 females (M:F = 3.2:1) Their ages ranged from 20 to 80years with a mean of 39.5yr and SD ± 13.10years. Majority of the patients 49(64.4%) were 40years of age and below and only 24 (31.6%) had a previous history suggestive of chronic peptic ulcer disease. Twenty five (32.9%) patients presented within 24 h of onset of symptoms of perforation with a mortality of 8.0%. Slightly more than half of our patients 39(51.3%) presented between 24 and 48 h with mortality of 17.9%. Twelve patients (15.8%) presented between 48 and 72 h and the mortality in this group was 58.3%. The latter two groups accounted for most of the mortality in our series. All perforations were anterior perforations within the first 2.5 cm of the duodenum and all had simple closure with pedicled omental patch and peritoneal toilet with copious volumes of warm normal saline. Postoperatively all received Helicobacter pylori eradication therapy and proton pump inhibitors for at least two months.
CONCLUSION
Patient groups who presented early had low mortality rates, but patient groups who presented late had higher mortality rates. Overall mortality was 21%.
Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nigeria; Peptic Ulcer Perforation
PubMed: 23403213
DOI: 10.1016/j.ijsu.2013.01.015 -
BMC Surgery Mar 2017Surgical glove perforation is a common event. The operating staff is not aware of the perforation until the procedure is complete, sometimes in as high as 70% of the...
BACKGROUND
Surgical glove perforation is a common event. The operating staff is not aware of the perforation until the procedure is complete, sometimes in as high as 70% of the incidences. Data from Ethiopia indicates that the surgical workforce suffers from a very surgery related accidents, however there is paucity of data regarding surgical glove perforation. The main objective is to describe the incidence and patterns of surgical glove perforation during surgical procedures and to compare the rates between emergency and elective surgeries at one of the main hospitals in Addis Ababa Ethiopia.
METHODS
This is a prospective study, performed at the Minilik II referral hospital, Addis Ababa. All surgical gloves worn during all major surgical procedures (Emergency and Elective) from June 1-July 20, 2016 were collected and used for the study. Standardised visual and hydro insufflation techniques were used to test the gloves for perforations. Parameters recorded included type of procedure performed, number of perforations, localisation of perforation and the roles of the surgical team.
RESULTS
A total of 2634 gloves were tested, 1588 from elective and 1026 from emergency procedures. The total rate of perforation in emergency procedures was 41.4%, while perforation in elective surgeries was 30.0%. A statistically significant difference (P < 0.05) was found in between emergency and elective surgeries. There were a very high rate of perforations of gloves among first surgeons 40.6% and scrub nurses 38.8% during elective procedures and among first surgeons (60.14%), and second assistants (53.0%) during emergency surgeries. Only 0.4% of inner gloves were perforated. The left hand, the left index finger and thumb were the most commonly perforated parts of the glove. Glove perforation rate was low among consultant surgeons than residents.
CONCLUSIONS
Our reported perforation rate is higher than most publications, and this shows that the surgical workforce in Ethiopia is under a clear and present threat. Measures such as double gloving seems to have effectively prevented cutaneous blood exposure and thus should become a routine for all surgical procedures. Manufacturing related defects and faults in glove quality may also be contributing factors.
Topics: Elective Surgical Procedures; Emergencies; Equipment Failure; Ethiopia; Gloves, Surgical; Humans; Incidence; Prospective Studies; Surgical Procedures, Operative
PubMed: 28320370
DOI: 10.1186/s12893-017-0228-8 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jan 2023To study the anatomical characteristics of thoracoacromial artery perforator flap(TAAP), and to explore the advantages and disadvantages of TAAP in head and neck...
To study the anatomical characteristics of thoracoacromial artery perforator flap(TAAP), and to explore the advantages and disadvantages of TAAP in head and neck reconstruction. Four fresh cadavers (8 hemichests) were collected for anatomical observation, the blood supply of chest skin was observed through autopsy, the presence, number, location, caliber, and landmark on the chest surface of all thoracoacromial artery perforators per hemichest were recorded, including the distance of each from the midpoint of the clavicle. The diameters of the thoracoacromial artery and perforating vessels were measured with vernier calipers (accuracy 0.05 mm), the pedicle length and thickness were measured with a cm scale (accuracy: 1 mm) after the flap was obtained, and the retained photos were recorded. No perforating branch (12.5%) was found on one side of the 8 hemichests, two perforating branches (12.5%) were found on one hemichest, and one perforating branches (75.0%) were found on the rest of the hemichests. The perforating point was about between the clavicular head of pectoralis major (clavicular part) and the sternocostal head (sternocostal part). The vessels at the beginning of perforation were generally bulky, with an average diameter of 2.25 mm, however, the vessel diameter was significantly reduced after the perforation of the flap. The pedicle length of thoracoacromial artery perforator flap ranged from 5.43 cm to 9.03 cm, with an average length of 7.14 cm. The pedicle length from the exit point of perforator muscle gap to the flap was 2.32-4.63 cm, with an average length of 3.28 cm. The distance between the exit point of perforator muscle space and the lower edge of the midpoint of the clavicle was 3.31-4.52 cm, with an average distance of 3.77 cm. The thoracoacromial artery perforator flap has some advantages such as similar color as head, neck and maxillofacial region, stable blood supply, relatively consistent vascular pedicle length and caliber size, relatively larger flap, less damage to pectoralis major muscle, and protection of chest shape, thoracic movement and shoulder joint movement function. Although the clinical application of this flap is limited by the uncertainty of perforating vessels, postoperative asymmetry of the nipple and residual chest scar, it still has a broad application prospect in head and neck reconstruction.
Topics: Humans; Perforator Flap; Plastic Surgery Procedures; Head; Neck; Arteries
PubMed: 36597360
DOI: 10.13201/j.issn.2096-7993.2023.01.001 -
International Archives of... Oct 2017Tympanic membrane perforation is a relatively common problem that predisposes patients to varying degrees of conductive hearing loss. The objective of this study...
Tympanic membrane perforation is a relatively common problem that predisposes patients to varying degrees of conductive hearing loss. The objective of this study is to evaluate and analyze the frequency dependence hearing loss in tympanic membrane perforation based on the size and the site of perforation. For the study, I selected 71 patients' (89) ears for the cross-sectional study with tympanic membrane perforations; I examined the size and the site of perforations under the microscope and classified them into small, moderate, large, and subtotal perforations, and into anterior central, posterior central, malleolor central, and big central perforations. I measured mean level of speech frequencies hearing loss, and its relation with the site and the size of the perforation analyzed. The mean hearing loss at different sizes of the perforation at all speech frequencies was 37.4 dB, with ABG of 26.6 dB, and its maximum loss was detected in subtotal perforation of 42.3 dB, with ABG of 33.7 dB, at 500 Hz frequency, while in relation to the sites, it was 38.2 dB, with ABG of 26.8 dB, and its maximum loss was detected in big central site perforation of 42.1 dB, with ABG of 33.6 dB, at 500 Hz frequency. The hearing loss was proportionally related with the sizes of the perforations, and the posterior site had greater impact on the hearing than anterior site perforations. This was also applied to the frequency dependence hearing level, as was detected to be worse at lower frequencies as 500 Hz, than those of 1000-2000 Hz.
PubMed: 29018495
DOI: 10.1055/s-0037-1598597 -
Current Problems in Diagnostic Radiology 2018Urgent appendectomy has long been the standard of care for acute appendicitis. Six randomized trials have demonstrated that antibiotics can safely treat appendicitis,...
PURPOSE
Urgent appendectomy has long been the standard of care for acute appendicitis. Six randomized trials have demonstrated that antibiotics can safely treat appendicitis, but approximately 1 in 4 of these patients eventually requires appendectomy. Overall treatment success may be limited by complex disease including perforation. Patients׳ success on antibiotic therapy may depend on preoperative identification of complex disease on imaging. However, the effectiveness of computed tomography (CT) in differentiating complex disease including perforated from nonperforated appendicitis remains to be determined. The purpose of this study was to assess the preoperative diagnostic accuracy of CT in determining appendiceal perforation in patients operated for acute appendicitis.
METHODS
We performed a retrospective review of pathology and radiology reports from consecutive patients who presented to the emergency department with suspicion for acute appendicitis between January 2012 and May 2015. CT scans were re-reviewed by abdominal imaging fellowship-trained radiologists using standardized criteria, and the radiologists were blinded to pathology and surgical findings. Radiologists specifically noted presence or absence of periappendiceal gas, abscess, appendicolith, fat stranding, and bowel wall thickening. The overall radiologic impression as well as these specific imaging findings was compared to results of pathology and operative reports. Pathology reports were considered the standard for diagnostic accuracy.
RESULTS
Eighty-nine patients (65% male, average age of 34 years) presenting with right lower quadrant pain underwent CT imaging and prompt appendectomy. Final pathology reported perforation in 48% (n = 43) of cases. Radiologic diagnosis of perforation was reported in 9% (n = 8), correctly identifying perforation in 37.5% (n = 3), and incorrectly reporting perforation in 62.5% of nonperforated cases per pathology. Radiology missed 93% (n = 40) of perforations postoperatively diagnosed by pathology. There was no secondary finding (fat stranding, diameter >13mm, abscess, cecal wall thickening, periappendiceal gas, simple fluid collection, appendicolith, and phlegmon) with a clinically reliable sensitivity or specificity to predict perforated appendicitis. Surgeon׳s report of perforation was consistent with the pathology report of perforation in only 28% of cases.
CONCLUSIONS
The usefulness of a CT for determining perforation in acute appendicitis is limited, and methods to improve precision in identifying patients with complicated appendicitis should be explored as this may help for improving risk prediction for failure of treatment with antibiotic therapy and help guide patients and providers in shared decision-making for treatment options.
Topics: Adult; Appendectomy; Appendicitis; Diagnosis, Differential; Female; Humans; Intestinal Perforation; Male; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 28162864
DOI: 10.1067/j.cpradiol.2016.12.002 -
Gland Surgery Apr 2016Magnetic resonance angiography (MRA) is an extremely useful preoperative imaging test for evaluation of the vasculature of donor tissue to be used in autologous breast... (Review)
Review
Magnetic resonance angiography (MRA) is an extremely useful preoperative imaging test for evaluation of the vasculature of donor tissue to be used in autologous breast reconstruction. MRA has sufficient spacial resolution to reliably visualize 1 mm perforating vessels and to accurately locate vessels in reference to a patient's anatomic landmarks without exposing patients to ionizing radiation or iodinated contrast. The use of a blood pool contrast agent and the lack of radiation exposure allow multiple studies of multiple anatomic regions in one examination. The following article is a detailed description of our MRA protocol developed with our radiologists with examples that illustrate the utility of MRA in perforator flap breast reconstruction.
PubMed: 27047787
DOI: 10.3978/j.issn.2227-684X.2015.07.05 -
World Journal of Emergency Surgery :... 2014Dermatomyositis is an autoimmune disease characterized by proximal myopathy, cutaneous Gottron papules and heliotrope rash; intestinal involvement associated to acute... (Review)
Review
INTRODUCTION
Dermatomyositis is an autoimmune disease characterized by proximal myopathy, cutaneous Gottron papules and heliotrope rash; intestinal involvement associated to acute vasculitis is less common but could be a life-threatening condition.
METHODS
A 21-year-old woman, affected by dermatomyositis, presented to our attention with a three-day story of severe abdominal pain, no bowel movement and biliary vomit. She was diagnosed with acute abdomen. A CT scan with bowel contrast demonstrated the presence of a leakage from the retroperitoneal aspect of duodenum. The surgical and clinical management in the light of literature review is presented.
RESULTS
Our first approach consisted in primary repair of the duodenal perforation with omentopexy. Post-operative course was complicated by hemorrhage. A reintervention showed a new perforation associated with multiple ischemic intestinal areas. We performed a gastroenteric anastomosis with functional exclusion of the damaged duodenum and positioning of drainages to create a biliary fistula. A nutritional enteric tube and an open abdomen vacuum-assisted closure system to monitor the fistula creation and to prevent abdominal contamination and collections were positioned. To reduce the amount of biliary leakage, a percutaneous transhepatic biliary drainage was placed, with progressive fistula flow disappearance in four months.
CONCLUSIONS
In patients with dermatomyositis, when clinical findings and symptoms suggest abdominal vasculitis, it is very important to be aware of the risk of bowel and particularly duodenal perforations. Open abdomen treatment favors control of contamination by gastrointestinal contents, offers temporary abdominal closure, helps ICU care and delays definitive surgery.
PubMed: 26085838
DOI: 10.1186/1749-7922-9-48