Journal articles on the topic 'Perforations'
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Onken, Flurina, Moritz Senne, Alfred Königsrainer, and Dörte Wichmann. "Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis." Journal of Clinical Medicine 11, no. 19 (September 28, 2022): 5748. http://dx.doi.org/10.3390/jcm11195748.
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Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications.
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Matsuda, Y., T. Kurita, Y. Ueda, S. Ito, and T. Nakashima. "Effect of tympanic membrane perforation on middle-ear sound transmission." Journal of Laryngology & Otology 123, S31 (May 2009): 81–89. http://dx.doi.org/10.1017/s0022215109005155.
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AbstractTympanic membrane perforation causes a sound conduction disturbance, and the size of this conduction disturbance is proportional to the perforation area. However, precise evaluation of perforation size is difficult, and there are few detailed reports addressing this issue. Furthermore, such evaluation becomes more difficult for irregularly shaped perforations. This study conducted a quantitative evaluation of tympanic membrane perforations, using image analysis equipment.A significant correlation was found between the degree of sound conduction disturbance and the perforation area; this correlation was greater at low frequencies following a traumatic perforation. The conductive disturbance associated with chronic otitis media was significantly greater at low frequencies. Circular perforations caused only minor conduction disturbance. Perforations in the anteroinferior quadrant were associated with greater conduction disturbance. Traumatic spindle-shaped perforations and malleolar perforations were associated with greater conduction disturbance.
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Derbyshire, Edmund, Pali Hungin, Claire Nickerson, and Matthew Rutter. "Colonoscopic perforations in the English National Health Service Bowel Cancer Screening Programme." Endoscopy 50, no. 09 (March 28, 2018): 861–70. http://dx.doi.org/10.1055/a-0584-7138.
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Abstract Background Perforation is the most serious adverse event associated with colonoscopy. In this study of data from the English National Health Service Bowel Cancer Screening Programme, we aimed to describe the presentation and management of perforations, and to determine factors associated with poorer outcomes post-perforation. Methods The medical records of patients with a perforation following the national screening colonoscopy were retrospectively examined. All colonoscopies performed from 02/08/2006 to 13/03/2014 were studied. Bowel Cancer Screening Centres across England were contacted and asked to complete a detailed dataset relating to perforation presentation, management, and outcome. Results 263 129 colonoscopies were analyzed, and the rate of perforation was 0.06 %. Complete data were reviewed for 117 perforations: 70.1 % of perforations (82/117) occurred during therapeutic colonoscopies; 54.9 % (62/113) of patients with perforations who were admitted to hospital and in whom data were complete underwent surgery; 26.1 % (30/115) of hospitalized patients left the hospital with a stoma and 19.1 % (22/115) developed post-perforation morbidity. Perforations not detected during colonoscopy were significantly more likely to require surgery (P = 0.03). Diagnostic perforations were significantly more likely to require surgery (P = 0.002) and were associated with higher rates of post-perforation morbidity (P = 0.01). At presentation, the presence of abdominal pain (P = 0.01), a pulse rate > 100 beats per minute (P = 0.049), and a respiratory rate > 20 breaths per minute (P = 0.01) were significantly associated with the patient having surgery. Conclusions This is the largest retrospective observational case series in Europe to describe post-perforation presentation, management, and outcomes. We have confirmed that perforation leads to surgical intervention, stoma formation, and post-perforation morbidity. Perforations not recognized during the colonoscopy were significantly more likely to require surgery. Diagnostic perforations were at greater risk of requiring surgery and developing post-perforation morbidity.
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Grupp, Katharina, Rainer Grotelüschen, Faik Güntac Uzunoglu, Bianca Hofmann, Alexandra König, Daniel Perez, Maximillian Bockhorn, Jakob Robert Izbicki, and Kai Bachmann. "C-Reactive Protein in the Prediction of Localization of Gastrointestinal Perforation." European Surgical Research 60, no. 5-6 (2019): 179–85. http://dx.doi.org/10.1159/000501806.
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Aim: Information regarding the localization of the anatomic site of gastrointestinal (GI) tract perforation is essential for the following surgical procedure. The purpose of this study was to evaluate the significance of C-reactive protein (CRP) and other circulating markers for the prediction of the localization of intra-abdominal hollow organ perforation. Methods: Measurements of serum markers were analyzed in 423 patients with GI tract perforations, who were divided according to the intraoperative diagnosis into colorectal and upper GI tract perforation groups. Results: Levels of CRP were higher in patients with colorectal perforations than in upper GI tract perforations (p < 0.001). Moreover, high levels of CRP were associated with increased mortality of patients with hollow organ perforations (p = 0.009), which was largely driven by the subset of patients with perforations of the upper GI tract (p = 0.001). Conclusion: Increased CRP levels predict worse clinical outcome in patients with intra-abdominal hollow organ perforations and are associated with perforations in the colorectal tract. Thus, CRP might be a useful marker for preoperative risk stratification and prediction of the localization of the perforation site.
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Al-Taha, Wadhah Hussein Abdulrazzaq. "Effect of the Circular Perforations on the Heat Transfer Enhancement by the Forced Convection from the Rectangular Fins." DJES 11, no. 3 (September 1, 2018): 62–70. http://dx.doi.org/10.24237/djes.2018.11310.
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This study aims to investigate the effect of the circular perforation of the rectangular fin on the enhancement of the heat transfer by forced convection. The solid rectangular fin considered as a reference for comparison purpose with the perforated fin. The parameters taken into consideration are thermal properties and geometrical dimensions of the fin and its perforations. The area and heat transfer gain of the perforations fins were considered being the main parameters in this study. The results of this study showed that the heat dissipation was improved when used the perforation fins compared with the equivalent solid fin. The enhancement quantity of the heat dissipation from the fin depends on the thermal conductivity, the perforation dimension, thickness, longitudinal and lateral spacing. Finally, the perforating of the fins enhances the rate of heat dissipation as well as decreases the weight of the fin
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Kouzmanova, Yaneta, and Ivanka V. Dimitrova. "PREVALENCE OF IATROGENIC PERFORATIONS ACCORDING TO THEIR LOCATION AND AFFECTED ROOT SURFACES." International Journal of Advanced Research 10, no. 7 (July 31, 2022): 794–800. http://dx.doi.org/10.21474/ijar01/15099.
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Background: The location of the endodontic perforation has shown a strong correlation with the healing process and successful outcome. The aim of this study was to determine the prevalence of iatrogenic perforations according to their location and affected root surfaces. Materials and methods: Over a period of 7 years, 100 cases of iatrogenic root perforations were recorded from the digital radiographs of each case. The perforations were classified according to the following criteria: (1) perforation location – cervical, furcation, stripping, lateral, and apical (2) affected root surface. The prevalence of different types of perforation was calculated and subjected to statistical analysis. Results: Among all types of perforations, the most common are those located in the furcation area of the molars (46%), followed by lateral root perforation (35.8%). The mesial root surfaces are most often affected by iatrogenic perforations (71.9%), followed by the distal ones (21%). Conclusion: Prior to root canal treatment, it is essential to assess the morphologic conditions in the key areas prone to iatrogenic perforations.
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Geun Eom, Young, and Youn Jib Chung. "Perforated Ray Cells in Korean Caprifoliaceae." IAWA Journal 17, no. 1 (1996): 37–43. http://dx.doi.org/10.1163/22941932-90000622.
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Perforated ray cells are recorded for the first time in species of Lonicera, Sambucus, Viburnum, and Weigela (Caprifoliaceae) that grow in Korea, These ray cells have simple perforations in Lonicera and Sambucus which have vessel elements with simple perforations, and have scalariform perforation s or variant types of scalariform perforations in Viburnum and Weigela which have vessel elements with scalariform perforations. In Korean Caprifoliaceae the perforations of ray cells are similar to the types of perforation plates in the vessel elements of the same wood.
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Najam, Muhammad Atif, Urwa Sarwar, Maqbool Raza, Khalid Azam Khan, Humaira Saleem, Najm u. Saqib Niazi, Muhammad Rashid, and Naeem Riaz. "ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES." PAFMJ 71, Suppl-3 (December 28, 2021): S440–444. http://dx.doi.org/10.51253/pafmj.v1i1.7935.
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Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study
Design: Descriptive study.
Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018
Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia.
Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....
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Singh, Mahavir, Satish Dalal, and Mridul Gera. "Spectrum of gastrointestinal perforation peritonitis in 462 consecutive patients in tertiary care institute of North India." International Surgery Journal 8, no. 10 (September 28, 2021): 2993. http://dx.doi.org/10.18203/2349-2902.isj20213982.
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Background: Gastrointestinal perforation is one of the common surgical emergencies in developing countries. The diagnosis is mainly clinical and is aided by radiological investigations. This study was designed to highlight the spectrum of hollow viscus perforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgical treatment, postoperative complications, and mortality.Methods: The study was a hospital‑based observational study and included 462 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included.Results: Overall stomach was the most common site of perforation (33%). Ileum (26%) was the second common site of perforation. Duodenal perforations were seen in 88 (19%) cases whereas appendicular perforations were seen in 46 (10%) cases. Colonic perforations were least common. Acid peptic disease was the most common etiology of stomach perforations. Enteric fever (63%) was the most common etiology of jejuno-ileal perforation. Other causes include tuberculosis (23%), trauma (8%), malignancy (3%) and idiopathic in rest. Males were six times more commonly affected than females. Peak incidence was noted in the 2nd and 3rd decades of life.Conclusions: Spectrum of perforation peritonitis cases in developing world is different from developed countries The Western literature suggests that foreign body, ischemia, radiotherapy, diverticula, and Crohn’s disease are the main causes of perforations. In contrast to this, infection is the most common cause for perforations in developing countries.
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Tamae, A., and S. Komune. "Clinical study of transcanal closure of tympanic membrane perforations using a collagen sponge." Journal of Laryngology & Otology 129, S2 (February 23, 2015): S21—S26. http://dx.doi.org/10.1017/s0022215114002333.
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AbstractMaterials and methods:We used an artificial dermis (Terdermis®), which is an atero-collagen sponge covered with a sheet of silicon.Patients:Nineteen ears of 17 patients with perforation of the tympanic membrane under various conditions, including large and wet perforations, underwent operation using this collagen sponge.Results:The success rate of closure after the initial surgery was 8/19. The overall success rate of closure after initial and re-operation was 14/19. The success rate of closure was 12/14 for small-sized perforations, 1/4 for middle-sized perforations and 1/1 for a large-sized perforation. Middle- and large-sized perforations required multiple surgeries. The success rate of closure was 11/11 for dry perforations, 3/4 for perforations with light otorrhoea and 0/4 for perforations with extensive otorrhoea.Conclusion:This surgery is a low-cost and minimally invasive surgery and has a high closure rate. This surgery is effective on small-sized, dry perforations although it can also close middle- and large-sized dry perforations.
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Spandow, Odd, and Sten Hellström. "Animal Model for Persistent Tympanic Membrane Perforations." Annals of Otology, Rhinology & Laryngology 102, no. 6 (June 1993): 467–72. http://dx.doi.org/10.1177/000348949310200611.
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Topically applied hydrocortisone was used to develop an animal model for persistent tympanic membrane (TM) perforations. Hydrocortisone suspension was applied on the margins of TM perforations of standardized size in rats once daily for 10 days. The healing patterns of the TMs were mapped weekly and, when the perforations were about to close, daily. After 50 days, all hydrocortisone-treated perforations were open, whereas the controls closed within 9 to 12 days. At 3 months, when one third of the perforations still were open, the TMs were studied by otomicroscopy and light microscopy. All TMs were thickened and covered by keratin and wax. The thickened epidermal layer at the border of the TM perforations that remained open also draped the surface of the perforation facing the middle ear cavity. The thickened connective tissue layer contained abundant fibroblasts with their axes of length oriented at random. Both application of 1.4% hyaluronan and wounding of the perforation border enhanced the healing rate of the hydrocortisone-induced chronic TM perforation.
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V.V, Athira, and Sruthy S. "Investigation on the use of cold formed perforated steel sections as columns and purlins." International Journal of Engineering & Technology 7, no. 4.5 (September 22, 2018): 716. http://dx.doi.org/10.14419/ijet.v7i4.5.25066.
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Perforations are required in columns and purlins of a trussed building for making connections, for fixing electrical fixtures etc. An inves- tigation was undertaken to study the effect of perforations in cold-formed C and Z sections used as columns and purlins. For this purpose, finite element model was developed using ANSYS software. Six different shapes of perforations were considered to investigate the shape that gives maximum buckling load. The perforation pattern which is optimum for the individual section was applied to frames and then to the building and optimum type of perforation is suggested. Buckling loads of frames and building with and without perforation was done separately and results were compared. By considering perforations with equal area, linear buckling analysis was done and stress pattern around perforation was studied. Even though the area reduction was equal, differently shaped perforations gave different buckling load. In this case, stress concentration has an important role; buckling load is higher for the shape with least stress concentration.
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Belbase, Narayan Prasad, Sagar Khatiwada, Sushim Bhujel, Ravi Gupta, Hari Prasad Upadhyay, and Deepak Belbase. "Spectrum of Gastrointestinal Perforations in a Tertiary Care Hospital of Central Nepal: An Analytical cross-sectional study." Journal of Society of Surgeons of Nepal 25, no. 2 (December 30, 2022): 58–62. http://dx.doi.org/10.3126/jssn.v25i2.50812.
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Introduction: Perforations of the gastrointestinal tract are frequently encountered surgical emergencies associated with high morbidity and mortality. This study was conducted to evaluate different spectrum of gastrointestinal tract perforations, their presentations, mode of surgery, complications and factors associated with mortality.
Methods: This was an analytical cross-sectional study conducted in the Surgical Gastroenterology Department at College of Medical Sciences, Bharatpur, Chitwan, Nepal from October 1st 2021 to October 31st 2022. Patients undergoing emergency laparotomy for GI tract perforations were included in this study. Patients demographics, comorbidities, preoperative investigation, site and cause of perforation, type of surgery and postoperative complications were recorded.
Results: A total 100 patients with gastrointestinal perforations were analyzed. The mean age was 46.55 years. Male predominance with M:F=1.56:1 was seen. Almost 54% patients presented after 24 hrs of onset of pain. Peptic ulcer disease as a cause of perforation was seen in 26%, trauma in 23% cases, appendicular perforation in 20%, malignant perforation in 8%, tubercular perforation in 7% and foreign body perforation in 3% cases. Duodenal, appendicular and colorectal perforations were seen in 28%, 20% and 17% cases respectively. Total morbidity was 54% and mortality was 13%. Increasing age, delayed presentation, presence of comorbidities, systolic blood pressure less than 100 mm Hg, oliguria, presence of malignancy were significantly associated with high mortality.
Conclusion: Perforations of duodenum, appendix and colorectum are commonly encountered. Acid peptic disease, trauma and infections are the leading causes of perforations. Increasing age, delay in presentation, comorbidities, oliguria and hypotension are the factors associated with high mortality.
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Lavanya, M. "A STUDY ON CORRELATION OF SIZE AND SITE OF TYMPANIC MEMBRANE PERFORATION WITH DEGREE OF CONDUCTIVE HEARING LOSS IN CHRONIC OTITIS MEDIA." UP STATE JOURNAL OF OTOLARYNGOLOGY AND HEAD AND NECK SURGERY VOLUME 9, ISSUE 1 (June 15, 2021): 19–23. http://dx.doi.org/10.36611/upjohns/volume9/issue1/4.
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Background: Tympanic membrane perforations are common cause of hearing loss. This study was designed to analyze the relation between tympanic membrane perforation and conductive hearing loss. Materials and Methods: In this prospective study, patients with dry tympanic membrane perforations of safe type were included. The patients were divided into groups in according to size, site and duration of perforation. Based on the inclusion and exclusion criteria a total of 100 patients were included in this study. All the patients clinical data was analyzed statistically using paired t-test. Results:Hearing loss increased as the size of perforation increased. Posterior quadrant perforations were associated with more hearing loss as compared to anterior quadrant perforations. Also duration of disease was in linear relation with mean hearingloss. Conclusions: The degree of conductive hearing loss as a result of tympanic membrane perforation would be expected with the size, site and duration of perforation. Keywords: Tympanic membrane, Conductive hearing loss, Perforation, hearing loss, posterior quadrant, ear.
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Bertrand, Gaspard, Jérôme Rivory, Maud Robert, Jean-Christophe Saurin, Élise Pelascini, Olivier Monneuse, Laurent Gruner, et al. "Digestive perforations related to endoscopy procedures: a local management charter based on local evidence and experts’ opinion." Endoscopy International Open 10, no. 04 (April 2022): E328—E341. http://dx.doi.org/10.1055/a-1783-8424.
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Abstract Background and study aims Perforations are a known adverse event of endoscopy procedures; a proposal for appropriate management should be available in each center as recommended by the European Society of Gastrointestinal Endoscopy. The objective of this study was to establish a charter for the management of endoscopic perforations, based on local evidence. Patients and methods Patients were included if they experienced partial or complete perforation during an endoscopic procedure between 2008 and 2018 (retrospectively until 2016, then prospectively). Perforations (size, location, closure) and management (imagery, antibiotics, surgery) were analyzed. Using these results, a panel of experts was asked to propose a consensual management charter. Results A total of 105 patients were included. Perforations occurred mainly during therapeutic procedures (91, 86.7%). Of the perforations, 78 (74.3 %) were diagnosed immediately and managed during the procedure; 69 of 78 (88.5 %) were successfully closed. Closures were more effective during therapeutic procedures (60 of 66, 90.9 %) than during diagnostic procedures (9 of 12, 75.0 %, P = 0.06). Endoscopic closure was effective for 37 of 38 perforations (97.4 %) < 0.5 cm, and for 26 of 34 perforations (76.5 %) ≥ 0.5 cm (P < 0.05). For perforations < 0.5 cm, systematic computed tomography (CT) scan, antibiotics, or surgical evaluation did not improve the outcome. Four of 105 deaths (3.8 %) occurred after perforation, one of which was attributable to the perforation itself. Conclusions Detection and closure of perforations during endoscopic procedure had a better outcome compared to delayed perforations; perforations < 0.5 cm had a very good prognosis and CT scan, surgeon evaluation, or antibiotics are probably not necessary when the endoscopic closure is confidently performed. This work led to proposal of a local management charter.
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Meshram, Sunita, and Manoj Lal. "Clinico-bacteriological profile of non-traumatic perforation peritonitis cases attending a tertiary care hospital of central India region." International Surgery Journal 5, no. 6 (May 24, 2018): 2185. http://dx.doi.org/10.18203/2349-2902.isj20182219.
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Background: Peptic ulcer, typhoid and appendicitis constitute the common causes of non-traumatic perforation, tuberculosis, ascariasis, amoebiasis and roundworm infestation are less common. An increasing incidence of perforation of gastrointestinal tract provoked us to study various aspects of non-traumatic perforation of gastrointestinal tract.Methods: The present study was carried out in 165 patients of non-traumatic gastrointestinal perforation, admitted in the surgical wards of sanjay Gandhi Memorial Hospital associated with S. S. Medical College, Rewa (M.P.), India, in the period from August 2002 to July 2003. All medical and surgical management was done, and necessary investigations were performed. A careful record of pre, per and postoperative findings were made in each in the proforma. All the cases were advised to attend surgical outpatient Department regularly for follow up.Results: Maximum number of cases were due to peptic perforation 70.91% followed by typhoid perforations 26.06% and appendicular perforations 3.03%. Highest incidence of peptic perforation was recorded in the age group of 41-60 years (42.74%), typhoid perforation in age group of 21-40 years (42.74%), typhoid perforation in age group of 21-40 and 41-60 years of age group (40%). Pain abdomen was present in all cases of perforations Next common symptoms in peptic perforations was constipation and distension (90.5%). In typhoid perforations distension constipation (93.03%) followed by abdominal distension (83.72%) and in appendicular distension (80.0%) followed by abdominal distension (40.0%) cases. 51.2%cases of peptic perforation were operated, 58.1% typhoid perforations were operated and 100% cases of appendicular perforation were operated.Conclusions: It is concluded from the study that non-traumatic gastrointestinal perforation is a common emergency surgical problem encountered by a general surgeon. The need for an early and accurate management is necessary, because if not treated timely the result will be fatal.
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Aneesa, Mirza, Samreen Siraj, and Arshid Ali. "Correlation of tympanic membrane perforations with hearing loss." International Journal of Otorhinolaryngology and Head and Neck Surgery 5, no. 5 (August 27, 2019): 1213. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20193857.
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<p class="abstract"><strong>Background:</strong> Tympanic membrane perforations are common cause of hearing loss. This study was designed to analyze the relation between tympanic membrane perforation and hearing loss.</p><p class="abstract"><strong>Methods:</strong> In this prospective study, patients with dry tympanic membrane perforations of safe type were included. The patients were divided into groups in according to size, site and duration of perforation. </p><p class="abstract"><strong>Results:</strong> 49 patients with 70 dry tympanic membrane perforations were studied. Data was analyzed statistically using paired t-test. Hearing loss increased as the size of perforation increased. Posterior quadrant perforations were associated with more hearing loss as compared to anterior quadrant perforations. Also duration of disease was in linear relation with mean hearing loss.</p><strong>Conclusions:</strong>The degree of conductive hearing loss as a result of tympanic membrane perforation would be expected with the size, site and duration of perforation.<p> </p>
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Sarcevic, Iva, Diana Gregor Svetec, and Dubravko Banic. "Influence of perforations on the reduction of the compressive strength of corrugated cardboard." Journal of Physics: Conference Series 2321, no. 1 (August 1, 2022): 012016. http://dx.doi.org/10.1088/1742-6596/2321/1/012016.
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Abstract Perforations on corrugated cardboard boxes serve as a separation line for converting the transport packaging into the shelf-ready display tray. Various perforations placed on different sides of the case affect the structural integrity of the transportation box. The objective of this paper is to determine how much the compressive strength decreases under the influence of perforations and which of the explanatory variables: type of perforation, angle of perforation position or quality of perforated corrugated cardboard, affect the strength of corrugated cardboard the most. Samples were cut from 3 quality of E-flute corrugated cardboard and 3 types of perforations were positioned in 5 defined directions. The samples with and without perforation were measured using an edge crush tester and then compared. Further analysis showed that the angle of the perforation had the greatest effect on the compressive strength. The overall results show that the position of the perforation at an angle of 0° has the greatest influence on the reduction of the compressive strength for all quality of the corrugated cardboard and for all types of perforations, while the reduction of the compressive strength is the lowest at an angle of 70°.
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Dawood, Mohammed. "Frequency Dependence Hearing Loss Evaluation in Perforated Tympanic Membrane." International Archives of Otorhinolaryngology 21, no. 04 (February 28, 2017): 336–42. http://dx.doi.org/10.1055/s-0037-1598597.
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Introduction Tympanic membrane perforation is a relatively common problem that predisposes patients to varying degrees of conductive hearing loss. Objective 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. Methods 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. Results 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. Conclusions 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.
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Donahue, Laura. "Spontaneous Intestinal Perforation." Neonatal Network 26, no. 5 (September 2007): 335–51. http://dx.doi.org/10.1891/0730-0832.26.5.335.
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SPONTANEOUS INTESTINAL perforations (SIPs) have been documented to occur in as many as 8.4 percent of very low birth weight (VLBW) newborns.1Gastrointestinal (GI) perforations first appeared in the literature in 1825 when Siebold described a gastric perforation in an estimated 34-week-gestational-age infant.2Thelander in 1939 described the first cases of spontaneous perforation in three stillborn infants as perforations proximal to the ileocecal valve.3
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Maurice, Andrew, Hassan Malik, Thomas Pearson, and Benjamin Dodd. "PS01.025: CONSEQUENCES OF MUCOSAL PERFORATION FROM LAPAROSCOPIC HELLER MYOTOMY: A SYSTEMATIC REVIEW." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 57. http://dx.doi.org/10.1093/dote/doy089.ps01.025.
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Abstract Background Mucosal perforation is a common complication of Laparoscopic Heller Myotomy (LHM) for achalasia. Perforations discovered intra-operatively are usually treated with laparoscopic suturing. Perforations not identified at the time of operation generally present with sepsis and a leak. We aimed to document every reported case of mucosal perforation in the literature following this procedure and define the prognostic significance of this complication. Methods A systematic literature search was performed using the PubMed database with the key-phrases ‘achalasia’ and ‘laparoscopy’ or ‘laparoscopic’. All English-language case series and trials were included that reported at least one mucosal perforation from 1997 to 2017. Two researchers appraised the literature for inclusion. For centers with multiple publications, the largest series was chosen for inclusion. Results Of 901 articles retrieved, 100 studies were included after duplicates were excluded. 672 mucosal perforations were reported in 8705 LHM procedures (7.7%, range 0.5–30%). 635 perforations were identified intra-operatively. 609 (96%) were repaired with laparoscopic suturing with or without fundoplication and no clinical sequelae. 22 (3.5%) were converted to open procedures. No deaths or long-term morbidity was reported in procedures where perforations were identified intra-operatively. There were 37 definitive missed mucosal perforations that were identified post-operatively. 3 patients died. For those that survived, 22 returned to theatre, 2 were treated with radiological drainage and 10 were managed conservatively with long-term antibiotics. Due to differences in reporting nomenclature and definitions, the actual rate of missed mucosal perforations may be higher. Conclusion Mucosal perforation during LHM is rarely of prognostic significance if it is repaired with laparoscopic suturing at the time. Mucosal perforations identified post-operatively can result in re-operation, sepsis, prolonged hospital stay and death. Care should be taken to ensure any mucosal perforation is detected and repaired intra-operatively. Disclosure All authors have declared no conflicts of interest.
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Li, Guohua, Youxiang Chen, Xiaojiang Zhou, and Nonghua Lv. "Early Management Experience of Perforation after ERCP." Gastroenterology Research and Practice 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/657418.
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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.
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T., Anjaneya, and Vilas Crithic H. V. "Clinical evaluation, management and outcome of hollow viscus perforations." International Surgery Journal 6, no. 8 (July 25, 2019): 2780. http://dx.doi.org/10.18203/2349-2902.isj20193083.
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Background: Gastrointestinal perforation is the third most common cause for exploratory laparotomy as an emergency. With the advent of drugs against acid peptic disease the incidence of peptic ulcer perforations is on decline. The advent of laparoscopy and endoscopy has played decisive role in the diagnosis and management of gastric and colorectal perforations. Aim of the study is to study the clinical outcome, surgical management and postoperative complication of peritonitis secondary to hollow viscus perforation.Methods: This was prospective study of 50 cases. All patients admitted and treated with perforation secondary to Hollow viscus perforations in surgical wards of M S Ramaiah Medical College, Bangalore, during the period of April 2016 to October 2017. Patients with peritonitis secondary to hollow viscus perforation admitted was evaluated and the diagnosis was made.Results: Out of 50 patients, most were male patients between 30-50 years age group. Duodenal ulcer perforation led the list. 4 were gastric, 37 were duodenal, 3 were jejunal, 6 cases were ileal. However colonic perforations were not observed. Wound infection leads the list of postoperative complications with faecal leak and burst abdomen following residual abscess. Almost all perforations were treated surgically.Conclusions: It was thought that with the introduction of better H2 receptor blockers and proton pump inhibitors, incidence of peptic perforations would decrease. Early recognition of perforations, prompt surgical intervention, adequate drainage, recognition of co-morbid conditions and complications would help in reduction of morbidity and mortality.
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Devdikar, Shrutik, Shifa A. Kalokhe, and Lisha Suraj. "A CASE SERIES OF 5 RARE ABDOMINAL EMERGENCIES." International Journal of Advanced Research 10, no. 12 (December 31, 2022): 971–79. http://dx.doi.org/10.21474/ijar01/15930.
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Gastrointestinal perforation is a common cause of acute abdomen due to peritonitis. The etiology and pathophysiology of gastrointestinal perforations is varied and can range from a small prepyloric perforation that is relatively clean to transection of small or large bowel with spillage of contents in peritoneum with gross contamination. Some of these are more common than others. Here we present 6 cases of rare perforations presenting to us in the casualty, their management and postoperative course in hospital. Methods: We will be assessing the cases of patients, their history, clinical presentation, radiological imaging who presented with acute abdomen secondary to bowel perforation and were intraoperatively diagnosed to have a rare pathology and assess the management and postoperative outcomes. Results: In this case series, 5 rare cases of GI perforations are highlighted including rare cases of posterior gastric perforation, DJ transection, jejunal transection, jejunal perforation, large mesenteric tear and sigmoid colon perforation. All these cases required a different approach in managing intraoperatively. Conclusion: Gastrointestinal perforation is a common cause of acute abdomen and requires emergency surgical intervention. CT imaging has become a fundamental part of the preoperative evaluation and can determine site and cause of perforation.Gastrointestinal tract perforations can occur due to various causes, and most of these perforations are emergency conditions that require early recognition and timely surgical treatment the mainstay of treatment for bowel perforation is surgery. Atypical presentation of perforation can be a challenge to surgeons andshould be prepared to deal with it.
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Bali, Rajandeep Singh, Sushant Verma, P. N. Agarwal, Rajdeep Singh, and Nikhil Talwar. "Perforation Peritonitis and the Developing World." ISRN Surgery 2014 (April 2, 2014): 1–4. http://dx.doi.org/10.1155/2014/105492.
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Background. Perforation peritonitis is the one of the commonest emergency encountered by surgeons. The aim of this paper is to provide an overview of the spectrum of perforation peritonitis managed in a single unit of a tertiary care hospital in Delhi. Methods. A retrospective study was carried out between May 2010 and June 2013 in a single unit of the department of Surgery, Lok Nayak Hospital, Delhi. It included 400 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included. Results. The commonest cause of perforation peritonitis included 179 cases of peptic ulcer disease (150 duodenal ulcers and 29 gastric ulcers) followed by appendicitis (74 cases), typhoid fever (48 cases), tuberculosis (40 cases), and trauma (31). The overall mortality was 7%. Conclusions. Perforation peritonitis in India has a different spectrum as compared to the western countries. Peptic ulcer perforation, perforating appendicitis, typhoid, and tubercular perforations are the major causes of gastrointestinal perforations. Early surgical intervention under the cover of broad spectrum antibiotics preceded by adequate aggressive resuscitation and correction of electrolyte imbalances is imperative for good outcomes minimizing morbidity and mortality.
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Chanania, Rakesh Kumar, Lakshay Goyal, Sanjeev Gupta, Gagandeep Chanania, and Sahil Heer. "An Audit on Gastrointestinal Perforation in a Tertiary Care Teaching Hospital Based in Northern Part of India: A Study of 100 Cases." Annals of International Medical and Dental Research 8, no. 1 (January 15, 2022): 106–16. http://dx.doi.org/10.53339/aimdr.2022.8.1.15.
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Background: A prospective study was conducted on 100 patients of perforation peritonitis: To find out the incidence of gastro intestinal perforation in various age groups, sex, riral or urban, socio economic status, To find out the various causes and sites of gastra intestinal perforartions, To determine various types of procedures being done to treat gastro intestinal perforations.Methods:The study population consisted of 100 patients of perforation peritonitis admitted at surgical wards of Rajindra Hospital, Patiala. Patients underwent necessary investigations such as Blood counts, biochemical analysis and urine analysis. X-ray Abdomen and chest / USG Abdomen/Pelvis CT-Abdomen (as and when required). All diagnosed patients were subjected to surgery. In all cases, operative findings and postoperative course were followed up for three months. Final outcome was evaluated on the basis of clinical, operative and radiological findings. In pre-pyloric and duodenal perforation, GRAHAM’S PATCH REPAIR carried out. In Ileal and Jejunal perforations, primary closure or exteriorization done depending upon the condition of the gut and duration of the symptoms. The patient outcome was assessed by duration of hospital stay, wound infection, wound dehiscence, leakage/entero-cutaneous fistula, intra-abdominal collection/abscess, ileostomy related complications and reoperation. Wound infection was graded as per SSI grading.Results:Most common age group for perforation was 21-40 years (50%) followed by 41-60 (33%) years in present study. Mean age of the patients is 37.91 + 13.15 years with male predominance (78%) in our study. 4% of the patients were of upper socio-economic status while 32% of the patients were of middle and 64% of the patients were of lower socio-economic status.Abdominal pain was seen in 100% of the patients while abdominal distension was present in 69% of the patients. Nausea/Vomiting was seen in 61% of the patients while Fever and Constipation was seen in 53% and 86% of the patients respectively. Diarrhoea was seen in 3% of the patients. Tenderness, guarding & rigidity, distension, obliteration of liver dullness and evidence of free fluid were present in 100% of the patients. Bowel sounds were not detected in all the patients. Most common perforations were Duodena(37%), Ileal (25%), Gastric (25%) followed by Appendicular (9%), Jejunal (4%) and Colonic perforation (2%). The most common etiology of gastrointestinal perforations was Peptic ulcer followed by Typhoid, Appendicitis, Tuberculosis, Trauma, Malignancy and non-specific infection.In Gastric perforations, Peptic ulcer was the most common cause of perforation followed by Trauma. In Ileal perforations, Typhoid was the most common cause of perforation followed by Tuberculosis and non-specific infection. In Appendicular perforations, most common cause was Appendicitis. In Jejunal perforations, most common cause was Trauma. In Colonic perforations, most common cause was Malignancy.Conclusions:The incidence of gastrointestinal perforations was common in 21-40 years age group followed by 41-60 years age group with male preponderance in our study. The most common site of perforations was Gastro-duodenal followed by Ileal perforations and the most common cause for these perforations was peptic ulcer followed by typhoid. The most common procedure done to treat gastrointestinal perforations was primary closure, resection and anastomosis, appendectomy and stoma formation. However, small sample size and short follow up period were the limitations of the present study.
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Amoils, C. Philip, Robert K. Jackler, Henry Milczuk, Kevin E. Kelly, and Keli Cao. "An Animal Model of Chronic Tympanic Membrane Perforation." Otolaryngology–Head and Neck Surgery 106, no. 1 (January 1992): 47–55. http://dx.doi.org/10.1177/019459989210600127.
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Previous investigations into the healing and reconstruction of tympanic membrane (TM) perforations have involved animal models with acute TM perforations. A problem with the acute TM perforation model is that most acute TM perforations will heal spontaneously, both in animals and human beings. A second inadequacy of acute perforation models is that they are not analogous to the salient problem in human beings: Longstanding TM perforation. The ideal animal model must have a TM perforation that is permanent, well-eplthelialized, and free from infection. The perforation must also be subtotal to preserve a rim of membrane for experimental manipulations, in the chinchilla, we have identified a hardy animal with a short, wide ear canal and relatively large tympanic membranes. Thermal myringectomy, followed by medial infolding of TM microflaps, has resulted in permanent, subtotal chronic TM perforations in the chinchilla animal model. Of the 19 chinchillas (38 TMs) perforated, chronic subtotal perforations were created in 32 ears, 6 to 8 weeks after the initial procedure (84% success). Persistent infection or TM regeneration despite reperforation was recorded in 6 ears (16%) failure). This model is currently being used to assess various biomembrane scaffolds impregnated with growth-promoting substances in the regeneration of a physiologically sound TM, initially in our animal model and then in human beings. We envision the development of a biomembrane disc impregnated with biorecombinant growth factors that may provide a simple office technique for the repair of chronic, non-infected TM perforations.
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Verma, Hemkant, Siddharth Pandey, Kapil Dev Sheoran, and Sanjay Marwah. "Surgical Audit of Patients with Ileal Perforations Requiring Ileostomy in a Tertiary Care Hospital in India." Surgery Research and Practice 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/351548.
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Introduction. Ileal perforation peritonitis is a frequently encountered surgical emergency in the developing countries. The choice of a procedure for source control depends on the patient condition as well as the surgeon preference.Material and Methods. This was a prospective observational study including 41 patients presenting with perforation peritonitis due to ileal perforation and managed with ileostomy. Demographic profile and operative findings in terms of number of perforations, site, and size of perforation along with histopathological findings of all the cases were recorded.Results. The majority of patients were male. Pain abdomen and fever were the most common presenting complaints. Body mass index of the patients was in the range of 15.4–25.3 while comorbidities were present in 43% cases. Mean duration of preoperative resuscitation was14.73+13.77hours. Operative findings showed that 78% patients had a single perforation; most perforations were 0.6–1 cm in size and within 15 cm proximal to ileocecal junction. Mesenteric lymphadenopathy was seen in 29.2% patients. On histopathological examination, nonspecific perforations followed by typhoid and tubercular perforations respectively were the most common.Conclusion. Patients with ileal perforations are routinely seen in surgical emergencies and their demography, clinical profile, and intraoperative findings may guide the choice of procedure to be performed.
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Vtorenko, V. I., A. P. Rozumnyy, V. V. Loktev, V. G. Mikhailov, R. R. Mudarisov, and V. V. Varyasin. "Clinical Observation of Pseudomembranous Colitis Complicated with Multiple Colon Perforations." Doctor.Ru 20, no. 11 (2021): 58–61. http://dx.doi.org/10.31550/1727-2378-2021-20-11-58-61.
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Objective: To present a clinical observation of a patient with pseudomembranous colitis (PMC) complicated with multiple colon perforations, and of post-surgery recovery. Key Points. Severe PMC can cause complications, such as toxic dilatation and perforation on colon, requiring emergency surgery. Clinical observation demonstrates the advisability of extended surgery for a patient with PMC complicated with perforations. Conclusion. PMC is a dangerous disease; a severe disease can cause colon perforation and require emergency surgery. Near-total colon excision in perforation in patients with PMC is justified and a most advisable type of surgery. Keywords: pseudomembranous colitis, multiple perforations, general peritonitis.
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Mikhail, Philopatir, Nicklas Howden, Mohammad Monjur, Prajith Jeyaprakash, Christian Said, Adam Bland, Damien Collison, et al. "Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis." Open Heart 9, no. 2 (October 2022): e002076. http://dx.doi.org/10.1136/openhrt-2022-002076.
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Coronary perforation is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We studied incidence, outcomes and temporal trends following PCI-related coronary artery perforation (CAP).MethodsProspective systematic review and meta-analysis including meta-regression using MEDLINE and EMBASE to November 2020. We included ‘all-comer’ PCI cohorts including large PCI registries and randomised controlled trials and excluding registries or trials limited to PCI in high-risk populations such as chronic total occlusion PCI or cohorts treated only with atheroablative devices. Regression analysis and corresponding correlation coefficients were performed comparing perforation incidence, mortality rate, tamponade rate and the rate of Ellis III perforations against the midpoint (year) of data collection to determine if a significant temporal relationship was present.Results3997 studies were screened for inclusion. 67 studies met eligibility criteria with a total of 5 568 191 PCIs included over a 38-year period (1982–2020). The overall pooled incidence of perforation was 0.39% (95% CI 0.34% to 0.45%) and remained similar throughout the study period. Around 1 in 5 coronary perforations led to tamponade (21.1%). Ellis III perforations are increasing in frequency and account for 43% of all perforations. Perforation mortality has trended lower over the years (7.5%; 95% CI 6.7% to 8.4%). Perforation risk factors derived using meta-regression were female sex, hypertension, chronic kidney disease and previous coronary bypass grafting. Coronary perforation was most frequently caused by distal wire exit (37%) followed by balloon dilation catheters (28%). Covered stents were used to treat 25% of perforations, with emergency cardiac surgery needed in 17%.ConclusionCoronary perforation complicates approximately 1 in 250 PCIs. Ellis III perforations are increasing in incidence although it is unclear whether this is due to reporting bias. Despite this, the overall perforation mortality rate (7.5%) has trended lower in recent years. Limitations of our findings include bias that may be introduced through analysis of multidesign studies and registries without pre-specified standardised perforation reporting CMore research into coronary perforation management including the optimal use of covered stents seems warranted.PROSPERO registration numberCRD42020207881.
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Garwood, Robert A., Mark D. Sawyer, E. J. Ledesma, Eugene Foley, and Jeffrey A. Claridge. "A Case and Review of Bowel Perforation Secondary to Metastatic Lung Cancer." American Surgeon 71, no. 2 (February 2005): 110–16. http://dx.doi.org/10.1177/000313480507100204.
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Gastrointestinal tract perforation (GITP) secondary to metastatic lung cancer is extremely rare. We present a case of small bowel perforation secondary to metastatic lung cancer. The objective of this study was to review the current literature and further characterize the incidence, histology, and risk of GITP secondary to lung cancer metastasis. A Medline search was done to identify all the cases of GITP attributed to metastatic lung cancer reported in the literature. Data was collected and analyzed from a collection of cases in the medical literature since 1960. We identified 98 cases of perforated lung cancer metastasis to the small intestine. Four gastric perforations, three colonic perforations, and one appendiceal perforation were also identified but not analyzed. The mean age was 64.5 years. There was a male predominance of 89 per cent versus 11 per cent female. Perforations occurred most often in the jejunum (53%) followed by ileum (28%). Combined jejunum-ileum lesions accounted for 4 per cent of perforations. No duodenal perforations were reported, though a specific site was not determined in 13 per cent of cases. Small bowel perforations were most often caused by adenocarcinoma (23.7%), squamous cell carcinoma (22.7%), large cell carcinoma (20.6%), and small cell carcinoma (19.6%). The prevalence of small bowel perforation secondary to a given primary lung cancer histology varied by region. The mean survival was 66 days with 50 per cent of patients not surviving past 30 days. Despite a high incidence of lung cancer, small bowel perforation secondary to lung cancer metastasis remains relatively rare. Perforated metastases occur more often in men and are found more commonly in the jejunum. Small bowel perforations are caused most often by adenocarcinoma; however, squamous cell and large cell carcinoma metastases are more likely to result in perforation. Small bowel perforation in this setting has a significant impact on mortality, decreasing 1-year survival to less than 3 per cent.
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Sun, Feng, Peng Jia, and Shifeng Xue. "Continuum Damage Modeling of Hydraulic Fracture from Perforations in Horizontal Wells." Mathematical Problems in Engineering 2019 (May 27, 2019): 1–12. http://dx.doi.org/10.1155/2019/9304961.
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The perforations play an important role in determining the near-wellbore fracture geometry during the stimulation phase. To address the impact of perforations on fracture geometry in horizontal wells, a 3D coupled hydromechanical finite element model is developed and employed. Based on the theory of continuum damage mechanics, scalar damage variable governs the degradation of the stiffness of the solid. Damage affects the crack element modeling that is used to consider crack behavior and construct a crack-tracking algorithm to simulate propagation. The model was validated against the analytical solutions and perforation fracture experiments. The results indicate that perforation can be used to control the fracturing pressure and propagation behavior of the initial fracture, which has a further effect on the fracture geometry of near-wellbore region in horizontal wells. Optimizing perforation parameters can direct the propagation of the initial fracture toward the preferred fracture plane. The results demonstrate an improved capability to depict the 3D near-wellbore fracture geometry and fracture propagation with a continuum damage model. The model enables the optimization of orientations and perforation parameters, so that most efficient perforating completions can be designed for hydraulic fracture stimulation.
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Freeman, Hugh J. "Spontaneous Free Perforation of the Small Intestine in Crohn’s Disease." Canadian Journal of Gastroenterology 16, no. 1 (2002): 23–27. http://dx.doi.org/10.1155/2002/284958.
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Spontaneous free perforation of the small intestine is a rare but often dramatic event in the clinical course of Crohn’s disease. Fifteen new cases of spontaneous free perforation of the small intestine - nine female patients and six male patients – were discovered in a series of 1000 consecutively evaluated patients with Crohn’s disease seen during a period spanning 20 years, for an estimated frequency of 1.5%. Spontaneous free perforation was the presenting clinical feature of Crohn’s disease in nine (60%) of the newly discovered cases. Most perforations were located in the ileum rather than in the jejunum, and there were no duodenal free perforations. One patient with extensive intestinal disease presented with concomitant free perforations of the jejunum and ileum, while a second patient had two free ileal perforations that developed independently, separated by about six years. No perforations were the result of a superimposed malignant process, ie, adenocarcinoma or lymphoma. There have been no mortalities, and the subsequent clinical course of these patients has been limited to a minority requiring corticosteroid or immunosuppressive medications, or further surgical resections.
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Langerth, Ann, Bengt Isaksson, Britt-Marie Karlson, Jozef Urdzik, and Stefan Linder. "ERCP-related perforations: a population-based study of incidence, mortality, and risk factors." Surgical Endoscopy 34, no. 5 (September 26, 2019): 1939–47. http://dx.doi.org/10.1007/s00464-019-06966-w.
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Abstract Background Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to perforations in a population-based study. Methods Between May 2005 and December 2013, a total of 52,140 ERCPs were registered in GallRiks, a Swedish nationwide, population-based registry. A total of 376 (0.72%) were registered as perforations or extravasation of contrast during ERCP or as perforation in the 30-day follow-up. The patients with perforation were divided into fatal and non-fatal groups and analyzed for mortality risk factors. The case volume of centers and endoscopists were divided into the upper quartile (Q4) and the lower three quartile (Q1–3) groups. Furthermore, fatal group patients’ records were reviewed. Results Death within 90 days after ERCP-related perforations or at the index hospitalization occurred in 20% (75 out of 376) for all perforations and 0.1% (75 out of 52,140) for all ERCPs. The independent risk factors for death after perforation were malignancy (OR 11.2, 95% CI 5.8–21.6), age over 80 years (OR 3.8, 95% CI 2.0–7.4), and sphincterotomy in the pancreatic duct (OR 2.8, 95% CI 1.1–7.5). In Q4 centers, the mortality was similar with or without pancreatic duct sphincterotomy (14% vs. 13%, p = 1.0), but in Q1–3 centers mortality was higher (45% vs. 21%, p = 0.024). Conclusions ERCP-related perforations are severe adverse events with low incidence (0.7%) and high mortality rate up to 20%. Malignancy, age over 80 years, and sphincterotomy in the pancreatic duct increase the risk to die after a perforation. The risk of a fatal outcome in perforations after pancreatic duct sphincterotomy was reduced when occurred at a Q4-center. In the case of a complicated perforation a transfer to a Q4-center may be considered.
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Sarandeses-García, Adolfo, Giorgio Sulsenti, Manuel López-Amado, and José Martínez-Vidal. "Septal perforations closure utilizing the backwards extraction-reposition technique of the quadrangular cartilage." Journal of Laryngology & Otology 113, no. 8 (August 1999): 721–24. http://dx.doi.org/10.1017/s0022215100145025.
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AbstractNasal septal perforations are anatomical defects of the nasal septum, causing dynamic alterations in nasal physiology which may lead to variable symptoms and otolaryngological referral.Repair of nasal septal perforations continues to remain a difficult surgical problem, and nowadays there is no definitive solution for their successful surgical closure.Thirty patients with small- or medium-sized anterior nasal septal perforations were treated with a simple technique of backwards extraction-reposition of the quadrangular cartilage. Prior nasal septal surgery and repeated cautery were the most common cause of perforation. After a minimum follow-up of two years the success rate for relief of symptoms and closure of the perforation was 87 per cent.This technique showed very good results in small-sized and selected cases with medium-sized perforations, but the mucosal dissection employed is not suitable for medium to large perforations.
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Mirza, Aram J., Abdulsalam Y. Taha, Jaafar S. Aldoori, Jawad M. Hawas, and Kawa W. Hassan. "Coronary artery perforation complicating percutaneous coronary intervention." Asian Cardiovascular and Thoracic Annals 26, no. 2 (January 16, 2018): 101–6. http://dx.doi.org/10.1177/0218492318755182.
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Background Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. We aimed to evaluate the management of coronary artery perforation in Sulaimaniyah, Iraq. Methods A retrospective review of our medical records from 2009 to 2016 identified 24 patients (15 males, 9 females) with coronary artery perforation. Mean age was 60 ± 9.2 years (range 40–74 years). Standard diagnostic angiography or percutaneous interventions were performed. Coronary artery perforation was diagnosed by worsening of symptoms, hypotension, or angiographic evidence of type I (extraluminal crater), II (myocardial or pericardial blushing), or III (contrast streaming or cavity spilling) perforation. Stenosis was graded as >85%, 60%–85%, or < 60%. Once coronary artery perforation was diagnosed, heparin was reversed, antiplatelets were stopped, and pericardial effusions were aspirated. Type II and III coronary artery perforations were sealed using covered stents or repeated brief balloon inflations. Results The most frequently injured artery was the left anterior descending ( n = 14, 58.3%). Type II and III coronary artery perforations constituted the majority ( n = 18, 75%). Thirteen (54.2%) patients had severe coronary stenosis. Perforations were caused by stents ( n = 10), angioplasty wires ( n = 8), and balloons ( n = 6). Fifteen perforations were sealed with covered stents, 2 by balloon inflations, and 7 resolved spontaneously. Pericardial effusion was drained in 13 (54.2%) patients. No patient required surgery, and none died. Conclusion The low rate and early management of coronary artery perforations, mainly by covered stents, were the hallmarks of this study.
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ILGAR, Mehtap, and Tuna ŞAHİN. "GASTROİNTESTİNAL PERFORASYON TANISINDA KULLANILAN GÖRÜNTÜLEME YÖNTEMLERİ VE GÖRÜNTÜLEME BULGULARI." Cukurova Anestezi ve Cerrahi Bilimler Dergisi 5, no. 2 (August 31, 2022): 199–205. http://dx.doi.org/10.36516/jocass.1142545.
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Purpose: To evaluate the imaging methods used in patients diagnosed with gastrointestinal perforation (GIP) and the contribution of these methods to the diagnosis.
Methods: Preoperative radiological examinations of 73 patients 18 years old or older whose surgical results indicated GIP were retrospectively evaluated. The perforation sites were divided into 4 groups, namely the first segment of the gastroduodenum, part of the small intestine beginning with the second segment of the duodenum, the colorectum, and the appendix. Esophageal perforations were considered as a separate group and excluded from the study.
Findings: Fifty-two (71.2%) of the patients were male. The mean age of the patients was 45.1±18.2 years with a range of 18-87 years. Forty (54.8%) patients had perforations of the appendix and 25 (34.2%) patients had perforations of the gastroduodenum. Computed tomography (CT) was performed in 56 (76.7%) of the patients, ultrasonography (USG) in 55 (75.3%), and radiography (RG) in 48 (65.8%). The evaluation of RG images of the patients for the presence of subdiaphragmatic free air showed that 50% of the patients with non-appendix perforations had subdiaphragmatic free air. The most common findings in the USG results of the patients with appendix perforations were an increase in the diameter and heterogeneity of mesenteric fatty tissue, while the most common USG finding in the patients with the other perforations was free fluid. The site of perforation was accurately determined in 83.9% of the patients diagnosed with non-appendix perforations by CT.
Conclusion: CT is the most preferred imaging modality and has the most diagnostic value in the diagnosis of GIP. It is also useful in determining the perforation site.
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Romano, Stefania, Carmela Somma, Antonio Sciuto, Warissara Jutidamrongphan, Daniela Pacella, Francesco Esposito, Marta Puglia, Claudio Mauriello, Khanin Khanungwanitkul, and Felice Pirozzi. "MDCT Findings in Gastrointestinal Perforations and the Predictive Value according to the Site of Perforation." Tomography 8, no. 2 (March 3, 2022): 667–87. http://dx.doi.org/10.3390/tomography8020056.
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Background: 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. Methods: 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. Results: 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. Conclusions: 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.
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Jellinge, M. E., S. Kristensen, and K. Larsen. "Spontaneous closure of traumatic tympanic membrane perforations: observational study." Journal of Laryngology & Otology 129, no. 10 (September 7, 2015): 950–54. http://dx.doi.org/10.1017/s0022215115002303.
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AbstractBackground:The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy.Methods:The study comprised 133 consecutive patients with a total of 137 perforations. Data were evaluated in terms of aetiology, location and size of perforation, audiometric findings, closure rate, and closure time.Results:The overall closure rate was 97 per cent. For patients with a known closure time within three months, the median closure time was between three and four weeks. The probability of spontaneous closure over time was further analysed with Kaplan–Meier plots, for those perforations with known closure times and for all perforations including those with unknown closure times. Perforation size was the only significant determining factor for closure time.Conclusion:Small perforations had a high probability of spontaneous closure within three to four weeks, justifying a watchful waiting policy. Larger uncomplicated perforations might warrant early surgical repair, depending on the patient's needs and the availability of surgery.
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Mohammed, Haider, Emad Khazal, and Hussein Sultan. "Studying the Effect of Perforation Parameters on Vertical Well Performance." Basrah journal for engineering science 20, no. 2 (2020): 48–59. http://dx.doi.org/10.33971/bjes.20.2.6.
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This paper presents a pressure drop analysis in perforated vertical wellbores for different perforation parameters. The effect of the density of the perforations (number of perforation), the phase angle of the perforations, the diameter of the perforation and the flow rate of the crude oil from the perforations on the pressure drop and the productivity index of the perforated vertical wellbores were studied. The analysis of the vertical wellbore was performed numerically using ANSYS FLUENT 15.0 software. Three dimensional, steady-states, turbulent and incompressible fluid flow is assumed during the numerical solution of the governing equations. The results of this study show that, increased perforation density of the perforated vertical wellbore caused an increase in pressure drop, and also, decreased productivity index due to increasing the friction losses. Friction pressure drop has a significant effect on crude oil flow into the wellbore. When the main velocity is 1.5 m/s and the inlet velocity from the perforations is 2 m/s, the friction pressure drop is about 66 % and the acceleration pressure is approximately 34 % of the total pressure drop.
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Guyette, Thomas W., and Bonnie E. Smith. "Effect of Septal Perforations on Measures of Nasal Resistance." Cleft Palate-Craniofacial Journal 34, no. 2 (March 1997): 129–34. http://dx.doi.org/10.1597/1545-1569_1997_034_0129_eospom_2.3.co_2.
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Objective The purpose of this investigation was to determine the effect of septal perforations on posterior and anterior rhinomanometric measures of nasal resistance In an analog model. Design The data were analyzed using a repeated-measures ANOVA. Nasal resistance was the dependent variable, while type of rhinomanometry, septal perforation size, and position of resistance (proximal vs. distal) were nominal scale independent variables. Participants The analog model used in this study was similar to that described by Warren and Devereux (1966), except that the nasal cavities of the model were modified to create septal perforations. Outcome Measures The main dependent measure was nasal resistance. Results An important finding of this investigation was that septal perforations resulted in large differences (> 3 cm H2O/L/sec) between posterior and anterior nasal resistance values in the bilateral proximal resistor condition. Conclusions Anterior rhinomanometry may underestimate true nasal resistance when a septal perforation Is present, because the septal perforation prevents accurate measurement of nasopharyngeal pressure. Posterior rhinomanometric measures should accurately reflect nasal resistance despite septal perforations, because the perforation does not invalidate the estimate of nasopharyngeal pressure.
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Araki, Naoto, and Nobuo Morita. "Quantitative Analysis of the Effect of Perforation Interaction on Perforation Stability Using the Finite Element Method." SPE Journal 25, no. 05 (April 27, 2020): 2234–50. http://dx.doi.org/10.2118/199328-pa.
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Summary Oil and gas reservoirs are normally completed as either openhole or perforated wells. Although a perforated well has hundreds of perforations, a single perforation is normally used for perforation interaction analysis, assuming the perforations are shot symmetrically and the stress state around a perforation is symmetric in both vertical and horizontal directions. However, for the single/double spiral perforations shot in inclined wells, no vertical and horizontal symmetry surfaces exist. The required elements for a multiperforation model are more than 10,000, which results in complex mesh generation and long computation time. In this study, we investigate perforation interaction to find the optimal perforation design that yields the highest productivity while maintaining mechanical stability. The practical implications of this work to the field are (1) the drawdown to cause perforation instability for gas flow is significantly less than oil flow. Therefore, when the gas flow becomes dominant either by enhanced oil recovery with CO2 or by low bottomhole flowing pressure below bubblepoint, the drawdown should be reduced to avoid sand production. (2) For inclined wells, the X-shaped staggered orientation perforations are the best pattern to delay onset of sand production without significantly reducing the well productivity. (3) For near-vertical wells, the conventional nonstaggered perforation pattern delays the onset of sand production due to the stress reduction in the vertical direction compared with the commonly used staggered perforation patterns.
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P. K., Hota, Mahesh S. V., and Reddy Dilip Kumar. "Outcome of surgeries for non-traumatic hollow viscous perforations." International Surgery Journal 5, no. 8 (July 24, 2018): 2888. http://dx.doi.org/10.18203/2349-2902.isj20183209.
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Background: Patients with non-traumatic hollow viscous perforations present challenge to the surgeons and outcome depends upon location and surgeon skills. Present study was to investigate the outcome of surgeries for non-traumatic hollow viscous perforations.Methods: This is a prospective observational study carried out in surgical wards in Mamata General Hospital between October 2015 and September 2017 over a period of 02 years. Evaluation of all the patients fulfilling the inclusion and exclusion criteria with respect to history, physical findings, operative findings and postoperative complications in line with the predetermined objectives was done. Various treatment modalities available and their outcome were also evaluated.Results: Benign causes of gastrointestinal perforation constituted majority of non-traumatic gastrointestinal perforations. Peptic ulcer perforation (68%) was the major cause of gastrointestinal perforation. Most common site for non-traumatic gastrointestinal perforations was duodenum (48%). Simple closure with omental patch was the operative procedure done for all cases of peptic ulcer perforation and appendicectomy for appendicular perforation. Ileal perforations secondary to typhoid perforation were treated with resection and end-to-end anastomoses in the present study. Colonic perforation was managed with Hartmann’s procedure. Most common complication was SSI (34%). Mortality was 8% and was due to septicemia.Conclusions: Aggressive resuscitation and early meticulous surgery is required to decrease morbidity and mortality in hollow viscous perforation cases.
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Lou, Z. C., and Z. H. Lou. "A moist edge environment aids the regeneration of traumatic tympanic membrane perforations." Journal of Laryngology & Otology 131, no. 7 (May 15, 2017): 564–71. http://dx.doi.org/10.1017/s0022215117001001.
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AbstractObjective:To review the history of moist therapy used to regenerate traumatic tympanic membrane perforations.Study design:Literature review.Methods:The literature on topical agents used to treat traumatic tympanic membrane perforations was reviewed, and the advantages and disadvantages of moist therapy were analysed.Results:A total of 76 studies were included in the analysis. Topical applications of certain agents (e.g. growth factors, Ofloxacin Otic Solution, and insulin solutions) to the moist edges of traumatic tympanic membrane perforations shortened closure times and improved closure rates.Conclusion:Dry tympanic membrane perforation edges may be associated with crust formation and centrifugal migration, delaying perforation closure. On the contrary, moist edges inhibit necrosis at the perforation margins, stimulate proliferation of granulation tissue and aid eardrum healing. Thus, moist perforation margins upon topical application of solutions of appropriate agents aid the regeneration of traumatic tympanic membrane perforations.
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Masood, Irfan, Zain Majid, Ali Rafiq, Waqas Rind, Aisha Zia, and Sajjad Raza. "Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis." Case Reports in Surgery 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/318678.
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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.
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Sahni, Dimple, Bikramjit Singh, K. S. Uppal, Sanjeev Bhagat, Dinesh Sharma, and Girish Dogra. "Study of effect of 1% sodium hyaluronate application on tympanic membrane perforation." International Journal of Otorhinolaryngology and Head and Neck Surgery 4, no. 5 (August 25, 2018): 1246. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20183695.
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<p class="abstract"><strong>Background:</strong> Topical applications of hyaluronic acid have been found to have beneficial effects on closure of tympanic membrane perforations.<strong> </strong>The aim of the study was to evaluate the role of 1% sodium hyaluronate in the repair of small or medium sized dry central tympanic membrane perforation and improvement in hearing following closure of tympanic membrane perforation.</p><p class="abstract"><strong>Methods:</strong> 50 patients with dry central perforation of inflammatory or traumatic origin were taken up. Maximum of 4 applications of 1% sodium hyaluronate were given at weekly intervals. Final mapping for closure of tympanic membrane perforation and hearing assessment was done after 3 months. </p><p class="abstract"><strong>Results:</strong> 26 perforations closed completely while 18 perforations showed significant reduction in size. Thus 44 or 88% perforations showed positive response to 1% sodium hyaluronate application. Hearing Improvement was observed on pure tone audiometry with the average hearing gain in patients after complete closure of tympanic membrane perforation was 12.40 dB with p value of 0.001.</p><p class="abstract"><strong>Conclusions:</strong> Study showed the beneficial effects of 1% sodium hyaluronate application in closure of small and medium size perforations of tympanic membrane perforation and improvement in hearing.</p><p class="abstract"> </p>
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H. B., Shashikumar, Madhu B. S., and Shyama S. "Gastro intestinal perforations: an audit from a tertiary care teaching hospital, Mysore, India." International Surgery Journal 5, no. 11 (October 26, 2018): 3484. http://dx.doi.org/10.18203/2349-2902.isj20184613.
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Background: Peritonitis secondary to hollow viscus perforation is one of the most frequently encountered surgical emergencies in India. The objective of this study was to study the demographic and clinical profile of gastro intestinal perforations and surgical procedures done for the same in a tertiary care teaching hospital.Methods: This study was performed on 46 cases of hollow viscus perforation admitted in K. R. Hospital from January to June 2018. The presenting symptoms, age and sex profile, risk factors, site of perforation, the surgical procedure they underwent, post-operative complications were assessed and analyzed.Results: The most common age group affected was 21-30 years out of which 89.1 % were males. Gastric perforations were the most common type (56.5%) and jejunal perforations were the least common (6.5%). Abdominal pain was the main presenting symptom in all the cases. Fever was found to be a significant history in cases of ileal perforation (p=0.001) as was history of trauma in cases of jejunal perforation (p=0.001). Guarding, rigidity and air under the diaphragm were seen consistently in most cases. Graham’s patch repair was the most common surgical procedure performed. Ileostomy was the most common surgery done for ileal perforations. Wound infections were the most common post-operative complication observed and death occurred in 13% of cases mostly due to sepsis and cardio pulmonary complications.Conclusions: This study showed an increased incidence of perforation in younger age group which is alarming. The rise in the frequency of gastric perforations points towards an unhealthy lifestyle and dietary habits.
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N, Naseema, Ravindran D, and Santhi T. "Relationship between size and site of tympanic membrane perforations and pure tone audiometry results." Journal of Medical and Scientific Research 10, no. 4 (October 3, 2022): 216–21. http://dx.doi.org/10.17727/jmsr.2022/10-40.
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Background: Chronic otitis media is a condition commonly presenting with tympanic membrane perforation and resulting in conductive hearing loss. The aim of the study was to assess the relationship between the site and size of tympanic membrane perforation with the degree of hearing impairment in patients with inactive chronic otitis media of mucosal type. Methods: Hospital based cross sectional study of 174 patients with tympanic membrane perforation at government medical college, Alappuzha from November 2017 to March 2019. Patients were enrolled based on history and clinical examination findings. Images obtained by otoendoscopy were analyzed by measuring the percentage area of membrane perforation in relation to total area of the tympanic membrane using adobe acrobat area tool. Degree of hearing loss was calculated by pure tone audiometry test and calculating the average hearing thresholds at frequencies of 500Hz, 1000Hz, 2000Hz and 4000Hz. Results: The age distribution of patients ranged from 14 to 72 years with a mean age of 41.78years. Male to female ratio was 1.59:1. The degree of hearing loss increased as the size of the perforation increased which was statistically significant (p <0.001). Posterior quadrant perforations resulted in more hearing impairment than anterior quadrant perforations. Conclusion: The size of the tympanic membrane perforation is closely related to the degree of hearing loss and posterior quadrant perforations have more degree of hearing impairment than anterior quadrant perforations which signifies improvement in hearing in patients with chronic otitis media by reconstructive surgeries, especially for perforations involving the posterior quadrant.
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Stenfors, Lars-Eric. "Repair of tympanic membrane perforations using hyaluronic acid: An alternative to myringoplasty." Journal of Laryngology & Otology 103, no. 1 (January 1989): 39–40. http://dx.doi.org/10.1017/s0022215100107984.
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AbstractFifteen dry, small or medium-sized tympanic membrane perforations were treated by local application of 1 per cent hyaluronic acid after excision of the perforation rim. The duration of the perforations ranged from two months to ten years. Fourteen of the perforations were covered within 15±7.4 (S. D.) days and 5 ± 2.4 (S.D.) applications were needed to achieve closure. Hyaluronic acid treatment of dry tympanic membrane perforations not exceeding one quadrant seems to be an alternative to surgical myringoplasty.
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Park, Chul-Soon. "Optimizing of Discharge Performance through Perforation in Lithium-ion Batteries." Korea Industrial Technology Convergence Society 28, no. 2 (June 30, 2023): 75–83. http://dx.doi.org/10.29279/jitr.2023.28.2.75.
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The discharge of lithium-ion batteries using perforation has gained attention as an environmentally -friendly alternative to the commonly employed salt water method. In this study, we optimize the discharge method using perforation by identifying the optimal perforation pattern and number. It involves forming perforations that penetrate the lithium-ion battery, resulting in complete discharge without generating wastewater containing hazardous substances. The study is conducted based on four different perforation patterns, and the optimal pattern and number are determined using temperature and residual voltage measurements. The results show that the voltage drop rate remains constant regardless of the type of perforation pattern, and the 1-row pattern exhibits superior results in terms of the heating temperature. This research contributes to the development of an eco-friendly and effective discharge method for lithium-ion batteries using perforation. Furthermore, the voltage drop experiment reveals that there is no significant improvement in the discharge time beyond the eight perforations. Consequently, the optimal number of perforations is determined to be eight.