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PubMed2005

The facial artery perforator flap for reconstruction of perioral defects.

BACKGROUND: The concept of the facial artery perforator flap was developed to gain more freedom for reconstruction of perioral defects. Single perforators of the facial artery should supply a large area of facial skin for a pedicled perforator flap. METHODS: Five fresh cadavers yielding 10 facial arteries were dissected after Microfil vascular injection to study distribution, number, length, and diameter of facial artery perforators. Five clinical cases with cancer-related perioral defects were reconstructed with facial artery perforator flaps. In two cases, additional regional flaps were used. Surgical technique was governed by the aesthetic unit principle and Doppler identification of the facial artery, which was used as a guideline for identification of suitable facial artery perforators. RESULTS: Cadaver dissection showed a large number of evenly distributed facial artery perforators (average, 5.7; range, three to nine). The average perforator length was 25.2 mm (range, 13 to 51 mm). The average perforator diameter was 1.2 mm (range, 0.6 to 1.8 mm). In all clinical cases, a suitable facial artery perforator was identified to meet reconstructive demands. Flaps were rotated up to 180 degrees. Four flaps survived completely. One flap showed minor distal necrosis. CONCLUSIONS: The facial artery perforator flap offers a versatile tailor-made flap, because of the reliable presence of perforators, with a large arc of rotation and an aesthetically pleasing donor site. The thin pedicle makes it an ideal flap for one-stage reconstruction without secondary revisions.

Aged↗
PubMed2006

Free tensor fascia lata perforator flap as a backup procedure for head and neck reconstruction.

Free tissue transfer is an essential part of the head and neck reconstruction. Despite several flap options, free perforator flaps have become very popular for head and neck. Anterolateral thigh perforator flap has multiple advantages among other options and is preferred by most of the reconstructive microsurgeons. Besides its advantages, sometimes it is impossible to harvest an anterolateral thigh perforator flap, and the surgeon has to shift to another option. Between January 2002 and June 2005, 5 tensor fascia lata perforator flaps were used for head and neck reconstruction because anterolateral thigh perforator flap could not be elevated due to absence or insufficient musculocutaneous perforators. Only 1 flap was reexplored and salvaged by redoing the venous anastomosis. All flaps survived without any other problem. Donor sites were covered by split-thickness skin grafts in 4 patients and closed directly in 1 of them. Doppler examination is important in planning of anterolateral thigh perforator; if the signals of the perforators are absent or very weak, the surgeon can shift to another flap. This decision may also be made during the operation when insufficient perforators are seen. Based on our experience, tensor fascia lata perforator flap is a safe alternative when anterolateral thigh perforator harvest is not possible. Tensor fascia lata perforator flap can be harvested from the same anatomic region with almost same morbidity.

Adult↗
PubMed2006

Acquired perforating dermatosis: clinicopathological features in twenty-two cases.

BACKGROUND: The term of acquired perforating dermatosis (APD) comprises the perforating dermatoses occurring in adult patients. Clinical and histological features of the disease are not uniform, and may resemble any of the four classic perforating disorders: elastosis perforans serpiginosa, reactive perforating collagenosis, perforating folliculitis or Kyrle's disease. Chronic renal failure and/or diabetes mellitus usually accompany this skin disease. OBJECTIVE: The aim of this study was to delineate the clinical and histopathological features of acquired perforating dermatosis and to investigate the potential relationship between this disease and associated conditions. METHODS: Twenty-two patients with acquired perforating dermatosis were enrolled in this study. Clinical findings of acquired perforating dermatosis and the spectrum of associated diseases were investigated. Haematoxylin and eosin sections were re-examined, and immunohistochemical stainings (elastic van Gieson and Masson trichrome stains) and periodic acid-Schiff stain were also used for histopathological evaluation. RESULTS: Different clinical types of lesions resembling reactive perforating collagenosis, perforating folliculitis or Kyrle's disease were observed. Histopathological features were consistent with any of the four types of perforating dermatoses. Most of the patients (86.4%) had at least one systemic disease. Chronic renal failure (72.7%) and diabetes mellitus (50%) were the most commonly associated conditions. Most of the patients with diabetes mellitus (90.9%) had chronic renal failure due to diabetic nephropathy. All of the patients with chronic renal failure were on dialysis treatment. The other associated conditions were hepatitis (27.3%), anti-HCV Ab-positivity (13.6%), hypothyroidism (9.1%) and tuberculosis lymphadenitis (4.5%). Of the 22 patients, 13.6% were otherwise healthy, and 9.1% were renal transplant recipients. CONCLUSION: Clinicopathological findings of our study indicate that the cases with APD represent the broad spectrum of perforating disorders rather than the variants of the same disease. Although APD is frequently associated with diabetes mellitus and chronic renal failure, this skin disorder may also develop in patients with other systemic disorders, and in those without any medical problems. This skin disease is probably linked to dialysis treatment in patients with chronic renal failure due to diabetes mellitus or other causes.

Adult↗
PubMed1996

Differential involvement of group II and group III mGluRs as autoreceptors at lateral and medial perforant path synapses.

1. Previous reports have shown that group III metabotropic glutamate receptors (mGluRs) serve as autoreceptors at the lateral perforant path, but to date there has been no rigorous determination of the roles of other mGluRs as autoreceptors at this synapse. Furthermore, it is not known which of the mGluR subtypes serve as autoreceptors at the medial perforant path synapse. With the use of whole cell patch-clamp and field excitatory postsynaptic potential (fEPSP) recording techniques, we examined the groups of mGluRs that act as autoreceptors at lateral and medial perforant path synapses in adult rat hippocampal slices. 2. Consistent with previous reports, the group III mGluR agonist (D,L)-2-amino-4-phosphonobutyric acid reduced fEPSPs and excitatory postsynaptic currents (EPSCs) in the dentate gyrus. However, the group-II-selective agonist (2S,1'R,2'R,3'R)-2-(2,3-dicarboxycyclopropyl)glycine (DCG-IV) also reduced fEPSPs and EPSCs, suggesting that multiple mGluR subtypes may serve as autoreceptors at perforant path synapses. 3. Selective activation of either medial or lateral perforant pathways revealed that micromolar concentrations of (L)-2-amino-4-phosphonobutyric acid (L-AP4) reduce fEPSPs in lateral but not medial perforant path, suggesting group III involvement at the lateral perforant pathway. Conversely, DCG-IV and 2R, 4R-4-aminopyrrolidine-2,4-dicarboxylate, another group-II-selective mGluR agonist, potently reduced fEPSPs at the medial but not lateral perforant path, suggesting that a group II mGluR may act as an autoreceptor at the medial perforant path-dentate gyrus synapse. 4. Antagonist studies with group-selective antagonists such as (2S,3S,4S)-2-methyl-2-(carboxycyclpropyl)glycine (MCCG; group II) and alpha-methyl-L-AP4 (MAP4; group III) suggest differential involvement of each group at these synapses. The effect of L-AP4 at the lateral perforant path synapse was blocked by MAP-4, but not MCCG. In contrast, the effect of DCG-IV was blocked by application of MCCG, but not MAP4. 5. Previous studies suggest that the effect of L-AP4 at the lateral perforant path synapse is mediated by a presynaptic mechanism. In the present studies, we found that concentrations of DCG-IV that reduce transmission at the medial perforant path synapse reduce paired-pulse depression and do not reduce kainate-evoked currents recorded from dentate granule cells. This is consistent with the hypothesis that DCG-IV also acts by a presynaptic mechanism.

Animals↗
PubMedDate not supplied

Is intraluminal clip application an appropriate treatment for iatrogenic gastric perforation?

BACKGROUND: The standard treatment of iatrogenic perforation has been an urgent operation. Recently, endoscopic clip application was recommended particularly for iatrogenic perforations. This study was designed to investigate the usage of surgical clips for gastric perforations. METHOD: Forty male rats were allocated to four groups. Following a midline laparotomy, a 5-mm gastrotomy was made at the fundic part of the stomach and through this ostomy a pre-pyloric perforation was created in all groups. In group I, the perforation site was closed with polypropylene sutures. In group II, the perforation site was closed extraluminally by vascular surgical clips. In group III, the perforation site was closed intraluminally by the same number of clips. In group IV, control group, the perforation site was left open. The animals were sacrificed on the 4th postoperative day. The healing of the perforation site was evaluated by the bursting pressure and the hydroxyproline content of the suture line. RESULTS: Measurements revealed no differences in bursting pressure and hydroxyproline levels between the intraluminal clip application group (group III) and the group in which the perforation site was left open (group IV) (p > 0.05). Higher bursting pressures and hydroxyproline levels were observed in groups I and II compared to control group (p < 0.05). CONCLUSIONS: These results suggest that gastric perforations are not strengthened by intraluminal clip application. Further detailed clinical studies are necessary in order to conclude that intraluminal clip application is an appropriate treatment for iatrogenic perforation.

Animals↗
PubMed1992

An animal model of chronic tympanic membrane perforation.

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: long-standing TM perforation. The ideal animal model must have a TM perforation that is permanent, well-epithelialized, 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.

Animals↗
PubMed2002

Arterial perforation during infrainguinal lower limb angioplasty does not worsen outcome: results from 1409 patients.

PURPOSE: To assess the prevalence and clinical significance of arterial perforation during lower limb angioplasty and determine the outcome of patients suffering this complication. METHODS: The radiology department records of 1409 patients (878 men; mean age 69.6 years) undergoing peripheral angioplasty in 1532 limbs between January 1996 and December 1998 were studied to identify patients with a perforated vessel. RESULTS: Fifty-two (3.7%) perforations occurred. Patients with a perforation were significantly older (median 74.8 years versus 69.6, p=0.03) and were more likely to be diabetic (p=0.01). The median age of a smoker with a perforation was 68 years versus 78 years for nonsmokers (p=0.02). Among the perforations, 29 resolved without intervention, 6 required temporary balloon occlusion, 15 were coil embolized, and 2 needed both balloon and coil treatment. Twenty-four (46%) of the 52 patients had a clinically successful angioplasty despite the perforation. No patient needed further urgent intervention. Seven patients underwent subsequent surgery to treat the underlying vascular disease that had prompted treatment initially; no one was treated for complications of the perforation. Due to the more extensive nature of the procedure, subintimal angioplasty was associated with an unsurprising increase in the rate of perforation (RR, 2.06; 95% CI, 1.19-3.56; p=0.01). In no case did the perforation prejudice the eventual outcome of the patient. CONCLUSIONS: Arterial perforation during angioplasty is more common in the elderly and in diabetics. The perforation itself does not influence the ultimate outcome of the case; rather, it is the underlying vascular pathology.

Aged↗
PubMedDate not supplied

Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis.

BACKGROUND AND PURPOSE: The risk of intraprocedural aneurysm perforation in patients with previously ruptured aneurysms tends to be higher than that of patients with previously unruptured aneurysms, but a statistically significant difference has not been shown. Our purpose was to define the rates of occurrence and of morbidity and mortality associated with aneurysmal perforation associated with coil embolization. METHODS: A meta-analysis of the results from 17 published retrospective reports of aneurysm perforations complicating therapy with Guglielmi detachable coils (GDCs) was performed. Rates of perforation and associated morbidity and mortality in previously ruptured and unruptured aneurysms were calculated. The mechanism of perforation was noted. RESULTS: The risk of intraprocedural perforation was significantly higher in patients with ruptured aneurysms compared with patients with unruptured aneurysms (4.1% vs 0.5%; P <.001). The combined risk of permanent neurologic disability and death associated with intraprocedural aneurysm perforation was 38% for ruptured aneurysms and 29% for unruptured aneurysms. The morbidity and mortality rates with perforations caused by coils (39%) and microcatheters (33%) were similar. The morbidity and mortality rate for microguidewire perforations was considerably lower (0%, n = 4) than the rates for coils and microcatheters, but number of cases was too low to indicate statistical significance. CONCLUSION: The risk of aneurysm perforation during GDC therapy is much higher in patients with previously ruptured aneurysms than in those with unruptured aneurysms. The morbidity and mortality rates are substantial for perforations caused by coils and microcatheters, whereas they seem to be much lower for perforations caused by microguidewires.

Aneurysm, Ruptured↗
PubMed2005

Correlation of perforating vein incompetence with extent of great saphenous insufficiency: cross sectional study.

AIM: To explore the correlation between perforating vein incompetence and the extent of great saphenous vein insufficiency according to Hach. METHODS: Duplex ultrasound was used to determine the number of incompetent perforators and diameter of perforating veins, and the level of great saphenous vein reflux and the presence or absence of deep reflux in 118 lower limbs (59 patients). There were 19 limbs with no clinical evidence of venous disease (CEAP - clinical, etiological, anatomical, pathological grade 0), 16 limbs with telangiectasias only (CEAP grade 1), 36 limbs with varicose veins (CEAP 2), 26 limbs with edema (CEAP 3), and 21 limb affected with lipodermatosclerosis but not ulcer (CEAP 4). RESULTS: Both the number of incompetent perforators and the average diameter of duplex detectable perforators per limb correlated significantly with the extent of great saphenous vein insufficiency (Pearson correlation coefficients were 0.55 and 0.44, respectively; P<0.001 for both). The number of incompetent perforators and the average diameter of perforators per limb were significantly higher with the deteriorating CEAP grade (Kruskal-Wallis H test; P<0.001). The mean number of incompetent perforators per limb did not differ significantly in the absence or presence of deep reflux (0.8-/+1.26 vs 1.3-/+1.6, t test, P=0.172), the average diameter of perforators per limb was higher in the presence of deep reflux (2.4-/+2 mm vs 3.7-/+1.1 mm, t test, P=0.023). CONCLUSION: The extent of great saphenous vein insufficiency correlated with an increase in the number and the diameter of perforators. The perforators' association with deep venous reflux was much poorer. Clinical presentation worsened with the deteriorating duplex signs of perforators' incompetence.

Cross-Sectional Studies↗
PubMed2005

[Evaluation of calf muscle pump function after subfascial endoscopic perforator dissection].

INTRODUCTION: Perforating vein incompetence can be demonstrated in many cases of chronic venous insufficiency. Subfascial endoscopic perforating vein surgery has become an accepted method in the treatment of perforator insufficiency over the past decade. However, what the hemodynamic consequences of perforating vein interruption are, is not clear. OBJECTIVE: To analyse the results of endoscopic perforating vein surgery performed in the authors' department over the past four years. To compare the outcome of the operation in patients with deep venous reflux with those who only had superficial and perforating vein reflux. To analyze the changes in calf muscle pump function with photoplethysmography carried out before and after the operation. METHODS: Subfascial endoscopic perforator dissection was performed on 53 patients who suffered from severe chronic venous insufficiency mainly with active ulcer. With the follow-up of 51 patients, a prospective clinical trial was carried out which consisted of physical examination and Doppler ultrasound, six weeks after the operation and every three months thereafter. The data were analyzed with standard statistical methods. RESULTS: Clinical symptoms improved and proved to be durable in 33 (64%) of 51 patients during the follow-up. The healing rate of 40 patients with venous ulcer was 82% after the operation. 62% of the patients were ulcer-free on a long term. While of the 33 patients with deep venous reflux 17 (52%) showed durable improvement, of the 18 patient who had only superficial and perforating vein insufficiency only 2 patients did not experience improvement. Average venous refilling time of the 33 patients who underwent photoplethysmography increased from 12.5 sec to 14.6 sec after endoscopic perforating vein surgery although significant improvement was demonstrated only on patients who had only superficial venous reflux together with perforating vein insufficiency. CONCLUSIONS: Subfascial endoscopic perforating vein surgery proved to be a successful alternative in the authors' clinical trial in treating patients with severe chronic venous insufficiency. Mid-term evaluation showed excellent results with patients without deep venous reflux and acceptably good outcome with patients with deep venous insufficiency. Improvement of clinical symptoms after endoscopic perforator dissection was followed by significant improvement of calf muscle pump function only on patients without deep venous reflux.

Adult↗
PubMedDate not supplied

Evaluation of the perforating veins of the lower extremity using high resolution duplex imaging.

The purpose of this study was to evaluate duplex imaging as a means of assessing perforating veins in patients with longstanding venous stasis ulceration. Thirty patients with nonhealing venous stasis ulcers and twenty normal volunteers serving as controls were evaluated with a standard 8-MHz imaging probe and integrated pulsed Doppler. The internal diameter of perforating veins was measured and perforators were grouped into one of four categories based on functional criteria: competent perforator with venous flow (C); incompetent perforator with venous flow (IC); competent perforator with arteriovenous flow (C-AVC); incompetent perforator with arteriovenous flow (IC-AVC). Sixteen of the patients with ulcers were subsequently studied by ascending venography and in 11 patients, intraoperative identification of perforating veins was made during the Rob procedure. In this subset of patients the vessel was categorized as competent or incompetent regardless of flow signal. There were significant differences in mean perforator diameter between ulcer patients and normal volunteers. Duplex imaging identified 93 perforators and venography a total of 70. In all 16 extremities, duplex imaging made the diagnosis of significant perforating vein incompetence, verified by venography. Intraoperative findings demonstrated an excellent correlation with duplex imaging. We believe duplex imaging to be a promising new modality for evaluation of the perforating veins of the lower extremity.

Adult↗
PubMed2005

Abdominal foregut perforations in children: a 10-year experience.

PURPOSE: Intraabdominal foregut perforations in children are rare. We conducted a retrospective review with the aim of defining their etiologies, treatment, outcomes, and prognosis. METHODS: Abdominal foregut perforations treated during a 10-year period were reviewed. Perforations secondary to blunt or penetrating trauma and inadvertent perforations sustained, recognized, and repaired during surgical procedures, were excluded. RESULTS: Fourteen perforations were identified, including 1 esophageal, 8 gastric, and 5 duodenal perforations. Seven perforations (50%) occurred in the neonatal period. Of the 7 neonates, 3 (43%) were premature. Nine patients (64%) had significant comorbidities. Six (43%) perforations were spontaneous, 5 (36%) were iatrogenic, and 3 (21%) were direct complications of underlying conditions. Primary repair of the perforation was completed in 11 patients (79%), and staged repair in 1 patient. Significant morbidities related to the perforation occurred in 36% of patients. Twelve patients (86%) survived to discharge. The 10 long-term survivors are on full oral feeds. CONCLUSIONS: Pediatric abdominal foregut perforations have diverse etiologies. Half occur in neonates, evenly divided between term and premature babies. Major comorbidities are common. One third are iatrogenic and potentially preventable. Primary repair should be performed when feasible. Patients who survive the initial complications have excellent long-term outcomes.

Abdominal Injuries↗
PubMed1995

Risk and prognostic factors of gut perforation after orthotopic liver transplantation for biliary atresia.

The aim of this study was to assess the risk and prognostic factors of gut perforation after orthotopic liver transplantation in children with biliary, atresia using univariate and stepwise regression analysis. Among 51 pediatric recipients who underwent transplantation because of biliary atresia after failure of portoenterostomy, 10 patients (20%) had 19 episodes of gut perforations after 14 transplantations. The median delay between transplantation and perforation was 13 days. These perforations were treated either by suture (n = 21) or ostomy (n = 11). The study of preoperative and perioperative variables showed that children with gut perforation were in surgery for a significantly longer period of time including a longer period of receiving hepatectomy and undergoing portal venous clamp. These children also needed large amounts of blood transfused during hepatectomy. After transplantation there was no difference regarding total steroid doses and early occurrence of cytomegalovirus disease between the two groups. Stepwise regression analysis identified three factors associated with the occurrence of gut perforation: duration of transplant operation, posttransplant intra-abdominal bleeding requiring reoperation, and early portal vein thrombosis. During the postoperative course, severe fungal infections were significantly more frequent in the gut perforation group. The 3-year patient survival rate was 70% in the group with gut perforation and was not different from the group without perforation (80%). This study shows that children with previous portoenterostomy carry a high risk of developing gut perforation after liver transplantation. This is especially true for those patients with the most difficult hepatectomies, which are responsible for the iatrogenic injury of the bowel. Other risk factors pointed out in this study were splanchnic congestion in case of prolonged portal venous clamp time or early portal vein thrombosis and repeated trauma of the bowel caused by reoperations. On the other hand, other well known risk factors, such as steroid therapy and viral diseases, were not involved in the occurrence of gut perforations in this study. Besides emergent surgical treatment, this type of complication requires aggressive therapy against fungal infections.

Biliary Atresia↗
PubMed1996

Perforated colorectal cancer.

PURPOSE: Perforations are rare but serious complications of colorectal cancer, with mortality rates of 30 to 40 percent. The aim of this retrospective study was to investigate possible indicators of prognosis and causes of death and to evaluate the risk of this complication by comparing results in perforated tumors with uncomplicated cancers or large-bowel perforations attributable to benign causes. METHODS: Data of postoperative and long-term results of 35 patients with perforated colorectal cancers were compared in 868 patients with uncomplicated cancers and 130 patients with large-bowel perforations attributable to benign diseases. Postoperative survival in perforated cancers (mortality, 40 percent) was determined by degree of peritonitis, septic state, and tumor stages. RESULTS: Comparison of the three groups demonstrated advanced tumor stages, a higher rate of septic organ failures, and higher mortality rates for perforated cancers. Long-term survival depended on tumor stages but did not differ in perforated and uncomplicated cancers. CONCLUSIONS: A cumulative effect of malignancy and sepsis may be responsible for the high postoperative mortality in malignant perforation. Patients with perforated cancers represent the highest risk group in colonic perforation.

Aged↗
PubMed2004

Helicobacter pylori and perforated peptic ulcer prevalence of the infection and role of non-steroidal anti-inflammatory drugs.

AIMS: To study the prevalence of Helicobacter pylori infection in patients with perforated peptic ulcer, to compare it with the prevalence in patients with uncomplicated ulcer, and to assess the role of non-steroidal anti-inflammatory drugs in this prevalence. METHODS: Consecutive patients with perforated peptic ulcer were included in this retrospective study. As a control group, patients undergoing elective outpatient evaluation for the investigation of dyspepsia during the same time period and found to have a peptic ulcer at endoscopy were included. A 13C-urea breath test was carried out in all patients to diagnose H. pylori infection. RESULTS: Sixteen patients with perforated peptic ulcer and 160 with non-complicated peptic ulcer were included. Sixty-two percent of the patients with perforated peptic ulcer were infected by H. pylori, while the microorganism was detected in 87% of the patients without this complication (P = 0.01). Non-steroidal anti-inflammatory drugs intake was more frequent (P = 0.012) in patients with perforated peptic ulcers (56%) than in those without perforation (26%). H. pylori prevalence in perforated peptic ulcers was of 44% in patients with non-steroidal anti-inflammatory drugs intake, but this figure increased up to 86% when only patients not taking non-steroidal anti-inflammatory drugs were considered (P = 0.09). In the multivariate analysis, non-steroidal anti-inflammatory drugs intake was the only variable that correlated with peptic ulcer perforation [odds ratio, 3.6 (95% confidence interval, 1.3-10); P = 0.016]. CONCLUSION: The mean prevalence of H. pylori infection in patients with perforated peptic ulcer is, overall, of only about 60%, which contrasts with the 90-100% figure usually reported in non-complicated ulcer disease. However, the most important factor associated with H. pylori-negative perforated peptic ulcer is non-steroidal anti-inflammatory drugs use, and if this factor is excluded, prevalence of infection is almost 90%, similar to that found in patients with non-perforating ulcer disease.

Adult↗
PubMed2006

Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model (with video).

BACKGROUND: Perforation is an uncommon but potentially devastating complication of colonoscopy. Surgical closure is the standard of care. Immediate endoluminal closure of a perforation would avoid the morbidity and mortality associated with general anesthesia, laparotomy, and surgical repair. OBJECTIVES: To evaluate the feasibility and safety of full-thickness endoscopic closure of colonic perforations with a prototype endoscopic suturing device, the Eagle Claw, in a porcine model. DESIGN: Endoscopic animal experimental study of closure of colon perforation by using a porcine model. SUBJECTS: Ten pigs were included in the study. INTERVENTIONS: The Eagle Claw was used to close small perforations (1.5 to 2 cm) of the colon created by needle-knife with the animal under general anesthesia by using the endoluminal route. All animals received intravenous antibiotics and were allowed to eat after 24 hours. MAIN OUTCOME MEASUREMENTS: The animals were monitored daily for signs of sepsis and peritonitis. On day 7, they were euthanized. The peritoneal cavity was examined for fecal peritonitis, and the colon perforation site was checked for wound dehiscence and pericolic abscess formation. RESULTS: Endoscopic closure of the colon perforation was successful in 7 animals, and they recovered well without any sepsis or peritonitis. Necropsy did not reveal fecal peritonitis or pericolonic abscess formation at the site of perforation, and the perforation healed well. Closure was successful in 1 animal, but necropsy revealed dehiscence of the colon perforation site. Endoscopic closure was unsuccessful in 2 animals, and these were euthanized immediately. CONCLUSIONS: Closure of acute perforation of the colon is feasible with the Eagle Claw endoscopic suturing device in a porcine model.

Animals↗
PubMed2005

Immediate repair of the tympanic membrane to prevent persistent perforation after intentional removal of long-lasting tubes.

OBJECTIVE: Our purpose was to evaluate efficiency of immediate repair of the tympanic membrane perforation after intentional removal of the long-lasting tubes. METHODS: This study was done in 36 ears of 27 patients who had either Goode-T or Paparella-II silicone tube insertion due to chronic OME or ROM and tube removal. Only the ears in which tube removal was performed due to no longer need for middle ear ventilation were included to the study. After removal of the tube, the perforation edges were refreshed and Steri-Strip (3M) patch was adhered on the perforation site. Otoscopic, tympanometric and audiologic data were reported. RESULTS: Mean duration of the tube persistence was 49.58+/-11.94 months. It was found that there were two subgroups in the study group: those under regular follow-up (20 ears), and the ears which were out of regular follow-up (16 ears). Mean tube persistence times were 34.10 and 52.11 months in these subgroups, respectively (chi2-test, p=0.056). In six ears (16.67%), persistent perforation (PP) was found. PP rate (PPR) was higher in group-B (25%) than in group-A (10%) (chi2-test, p>0.1). The rest perforation was anteriorly marginal in five of six PP (83.33%). The PPR in the ears in which rest perforation was anteriorly marginal was 35.71% (5/14) while it was 4.54% (1/22) in the ears with central rest perforation (chi2-test, p<0.02). CONCLUSIONS: Even immediate repair of the perforation after removal of the long-lasting tubes resulted in a high PPR. The data in this study documented that this high PPR was associated with type and localisation of rest perforation and tube persistence time. Anteriorly, marginal perforations had about eight times higher risk of PP and longer tube persistence caused higher anterior marginal perforations after tube removal.

Acoustic Impedance Tests↗
PubMed2005

NMDA receptor antagonists block heterosynaptic long-term depression (LTD) but not long-term potentiation (LTP) in the CA3 region following lateral perforant path stimulation.

High-frequency stimulation of lateral perforant path is accompanied by a heterosynaptic long-term depression (LTD) of medial perforant path synaptic responses in both the dentate gyrus and the CA3 region of the hippocampus. We reported previously that LTP induction at lateral perforant path-CA3 synapses is unaffected by NMDA antagonists. However, it is not known if heterosynaptic LTD that is observed in the CA3 region following lateral perforant path stimulation also is independent from NMDA receptors. We address this question in anesthetized adult rats using systemic administration of the competitive NMDA receptor antagonist CPP. Induction of lateral perforant path-CA3 LTP produced a sustained heterosynaptic depression of medial perforant path-CA3 responses. Systemic administration of CPP (10 mg/kg) was ineffective in blocking the induction of LTP at lateral perforant path-CA3 responses. However, heterosynaptic LTD of medial perforant path-CA3 responses was blocked completely by CPP. These data indicate that NMDA receptors are not required for the induction of lateral perforant path-CA3 LTP, but are involved in the induction of heterosynaptic LTD that accompanies lateral perforant path activity. The requirement for NMDA receptors for heterosynaptic LTD suggests one functional role of NMDA receptors at termination fields of the lateral perforant path.

Adaptation, Physiological↗