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PubMed1992

Esophageal perforation: an 8-year review of a multispecialty clinic's experience.

Esophageal perforation is the most serious perforation of the gastrointestinal tract, and despite early diagnosis and treatment, mortality remains high. Twenty-four cases of esophageal perforation seen at a large multispecialty clinic between 1983 and 1991 were retrospectively reviewed. Thirteen patients presented with acute perforation, five with subacute, and six with chronic perforation. Eighteen (75%) of 24 perforations resulted from iatrogenic causes, and the rest were spontaneous. Of the iatrogenic perforations, therapeutic endoscopy and paraesophageal surgical complications were responsible for 55% and 33%, respectively. Chest pain, fever, and dyspnea were common presenting signs and symptoms of acute perforation, whereas dysphagia and supraventricular arrhythmia were more prominent features of chronic perforation. All but seven patients had surgical intervention. An overall mortality rate of 46% was noted, and despite early diagnosis and treatment, this mortality was associated with the severity of underlying disease.

Adult↗
PubMed2004

Colonoscopic perforations: incidence, management, and outcomes.

Fiberoptic colonoscopy provides superior diagnostic and therapeutic capabilities in the treatment of lower gastrointestinal disease processes. A well-recognized, but uncommon, complication during the procedure is perforation. The purpose of this study was to determine the incidence of colonoscopic perforation, define risk factors, assess the management of these complications, and evaluate outcomes. From January 1997 through December 2003, 43,609 colonoscopies were performed in our medical center. There were 14 (0.032%) perforations (1 in 3115 procedures); 7 from diagnostic and 7 from therapeutic procedures. General surgeons performed 1243 procedures (2.9%), and their rate of perforation was 0.080 per cent compared with 0.031 per cent for gastroenterologists during the same period. Half of the perforations occurred in the rectosigmoid, and the most common mechanism was mechanical (n = 6). Perforation was identified immediately during endoscopy in 50 per cent of the patients. Thirteen of 14 perforations were treated within 24 hours; 1 was delayed 48 hours. Initial surgical management was undertaken in 11/14 patients. Initial nonoperative treatment was attempted in three and was successful in only one patient. The mean length of stay following perforation was 11.2 days (range, 4-36 days). Three patients (21.4%) had 7 postoperative complications. Colonoscopic perforations are uncommon but can be recognized early and managed surgically with acceptable morbidity and postoperative length of stay.

Adult↗
PubMed1992

Diagnosis and management of esophageal perforations.

Esophageal perforation remains a difficult diagnostic and management problem. Recommendations regarding treatment remain controversial. A 15-year experience with perforation of the esophagus from all causes was reviewed at Louisiana State University and Veterans Administration, Medical Centers (Shreveport, LA). The majority of the injuries involved the thoracic esophagus (28 or 54%), followed by the cervical (21 or 40%), and the intraabdominal esophagus (3 or 6%). Iatrogenic causes constituted most of the injuries (52%), followed by external trauma (23%), barogenic rupture (15%), and ingested foreign bodies (10%). Diatrizoate methylglucamine 66 per cent, sodium diatrizoate 10 per cent (Gastrografin; Squibb, Princeton, NJ) contrast studies and flexible esophagoscopy were performed in 44 and 22 patients, respectively. In the cervical esophagus, contrast studies were more sensitive and specific than endoscopy (P less than .01), but both studies were equally effective as diagnostic methods in thoracic perforations. Cervical perforations were treated with either drainage alone (7 patients) or primary repair with drainage (14 patients) with an operative mortality of 4.8 per cent. Several procedures were used in thoracic perforations, which carried a mortality of 36 per cent and were more lethal than cervical tears (P less than 0.2). Any thoracic esophageal perforation treated more than 24 hours after the onset of symptoms, irrespective of what procedure was used, was associated with a significantly higher mortality than if operated on earlier (P less than .001). Five patients with perforated carcinomas were treated by esophageal resection with no mortality. Significantly higher mortality was seen with a delay in diagnosis, thoracic perforations, and Boerhaave's Syndrome. A subset of patients with perforated carcinomas may benefit from esophageal resection with delayed reconstruction.

Adolescent↗
PubMed1987

Surgical management of esophageal perforation.

The recognition and management of esophageal perforation remain a problem. Diagnostic and treatment delays are common, and controversy continues regarding approaches to surgical intervention. Overall survival has increased with improved adjunctive modalities; however, morbidity and mortality remain high. A total of 115 consecutive cases of nonmalignant esophageal perforation were reviewed. There were 69 thoracic, 27 cervical, and 19 abdominal perforations. Etiology of the perforations was iatrogenic in 65 patients, traumatic in 28, and spontaneous perforation in 22. Symptoms included pain (71%), fever (51%), dyspnea (24%), and crepitus (22%). Contrast roentgenography was used in 78 patients and demonstrated the perforation in all but two patients. All but 20 patients had operations. In the last decade, the survival rate was 11.4 per cent for patients treated within 24 hours of perforation. Survival significantly improved in the last 10 years because of hyperalimentation, cardiopulmonary monitoring, and better antibiotic coverage. Treatment of choice is primary closure with drainage, regardless of the duration of the perforation. In selected patients who have cervical esophageal perforation, nonoperative management has a role.

Esophageal Diseases↗
PubMed1986

Duodenal ulcer perforation: the effect of H2 antagonists?

One hundred and two patients with perforated duodenal ulcers over a 13 year period (1970 to 1982) have been prospectively followed-up at a special gastric clinic. Of the 37 patients with perforation of their acute ulcer, 34 were treated by oversew and three had an initial definitive operation (vagotomy and drainage). The remaining 65 patients presented with perforation of a chronic ulcer and 54 were treated by oversew and 11 underwent definitive surgery--nine had vagotomy and drainage and two had partial gastrectomies. Seven of the 34 patients (20.5%) with acute ulcer perforation treated by simple oversew subsequently required definitive ulcer surgery at a mean 17.5 months after perforation and 31 of the 54 patients (57.4%) with chronic ulcer perforations required definitive surgery at a mean 27.4 months after perforation. The introduction of H2 antagonists in 1977 did not alter the re-operation rate in patients with chronic ulcer perforation managed by oversew. Results of this study provide further evidence in favour of treating patients with perforation of their chronic duodenal ulcer by definitive surgery whenever possible.

Acute Disease↗
PubMed1993

Is ulcer recurrence after simple closure of perforated duodenal ulcer predictable?

OBJECTIVE: To study whether factors such as age, duration of pre-perforation symptoms, size of perforation and operative evidence of chronicity could predict recurrence of ulcer after simple closure of perforated duodenal ulcers, thus enabling patients at high risk of recurrence to be subjected to definitive surgery instead of simple closure of perforation. DESIGN: Retrospective. One hundred and fifty-two patients who had undergone simple closure of duodenal ulcer perforation in the last 10 years were included in the study. SETTING: A postgraduate research and teaching institution. PATIENTS AND MEASUREMENTS: Patients were subjected to a personal interview and Visick grading of symptoms 1-10 years after simple closure of duodenal ulcer perforation. Ninety of them underwent esophagogastroduodenoscopic evaluation. RESULTS: Symptomatic ulcer recurrence rate was 23.1% by Visick grading and 42.2% on endoscopy. Ulcer symptom recurrence rate had no correlation with patient's age, duration of pre-perforation symptoms, or size of perforation, but correlated significantly with operative evidence of chronicity (p < 0.001). However, 7 of 35 symptomatic recurrences would have been missed by the use of this criterion alone. Endoscopic evidence of recurrence also correlated only with operative evidence of chronicity. False positives and false negatives with Visick grading showed that this symptomatic evaluation was unsatisfactory even for selecting patients for further endoscopic workup. CONCLUSION: Though not infallible, evidence of chronicity of ulcer at laparotomy may be a useful predictor of recurrence of ulcer after simple closure of perforated duodenal ulcer.

Adult↗
PubMedDate not supplied

Helicobacter pylori infection in patients with perforated duodenal ulcer.

AIM: Perforation is the commonest complication of duodenal ulcer. Helicobacter pylori is found in 95% patients with duodenal ulcer. However, there is paucity of reports on prevalence of H. pylori infection in patients with duodenal ulcer perforation. We, therefore compared the incidence of H. pylori infection in patients with duodenal ulcer perforation with the incidence in patients having complicated duodenal ulcers and non-ulcer dyspepsia. PATIENTS AND METHODS: The study was conducted on 45 patients (complicated duodenal ulcer 15, duodenal ulcer perforation 15, non-ulcer dyspepsia 15). Per-operative punch antral biopsies were taken in patients with duodenal ulcer perforation whereas endoscopic punch biopsies of antrum were taken in patients with non-ulcer dyspepsia. The criteria for H. pylori positivity was i) growth of H. pylori on culture, ii) combination of rapid urease test (RUT) and Giemsa staining, combination of RUT and Gram stain being positive for H. pylori. RESULTS: While 9 of 15 cases with complicated duodenal ulcer, 7 of 15 cases with non-ulcer dyspepsia were positive for H. pylori, none of the patients with duodenal ulcer perforation tested positive for H. pylori (p < 0.000). All patients with perforated duodenal ulcer had histological gastritis (H. pylori -ve). Fourteen of 15 patients (9 H. pylori +ve, 5 H. pylori -ve) with complicated duodenal ulcer and 9 of 15 patients (7 H. pylori +ve) with non-ulcer dyspepsia had histological gastritis. CONCLUSION: Patients with duodenal ulcer perforation do not have H. pylori infection. H. pylori negative patients of duodenal ulcer may have more predilection for perforation.

Adolescent↗
PubMedDate not supplied

Color Doppler sonographic appearance of renal perforating vessels in subjects with normal and impaired renal function.

PURPOSE: The purpose of this study was to assess the prevalence and color Doppler sonographic characteristics of perforating vessels-small arteries and veins connecting the intrarenal vasculature with the capsular plexus-in healthy subjects, in hypertensive patients, and in patients with renal failure due to hypertensive nephroangiosclerosis or ischemic nephropathy. METHODS: Fifteen healthy subjects 24-34 years old, 15 healthy subjects 68-80 years old, 25 hypertensive patients, 25 patients with hypertension and chronic renal failure (15 mild, 10 severe), and 12 patients with hypertension and chronic renal failure and acute renal insufficiency due to ischemic nephropathy underwent color Doppler sonography of both kidneys. RESULTS: The few perforating arteries in healthy and hypertensive patients had various resistance indices and flow toward the capsule. Perforating veins in these patients were much more common than perforating arteries. Perforating arteries with a lower mean resistance index than the mean interlobar resistance index and flow toward the capsule were detected in 76% of kidneys in the patients with mild chronic renal failure and in 20% of those in patients with severe chronic renal failure. Only a few perforating veins were seen in patients with chronic renal failure. In 64% of the kidneys with renal artery stenosis detected in the patients with chronic renal failure complicated by acute renal insufficiency, there were perforating arteries with flow toward the kidney and a mean resistance index higher than the mean interlobar resistance index. CONCLUSIONS: Perforating vessels are recognizable using color Doppler sonography both in healthy subjects and in patients with renal failure. The prevalence and flow characteristics of perforating vessels differ between healthy subjects, patients with mild and with severe chronic renal failure, and patients with chronic renal failure complicated by acute renal insufficiency caused by renal artery stenosis.

Adult↗
PubMed1995

High rates of perforation are found in endovaginal ultrasound probe covers before and after oocyte retrieval for in vitro fertilization-embryo transfer.

OBJECTIVES: To study perforation rates of sterile transvaginal ultrasound probe covers before and after oocyte retrieval (OPU) in an IVF-ET program. METHODS: Transvaginal ultrasound probe sheaths from two different manufacturers were studied, Cook Innoray (Cook-Canada #TTUPS-100) and Swemed Lab (Frolunda Sweden #715). After controlled ovarian stimulation, OPU was done using the needle guide of a sterile sheathed 5-MHz transvaginal ultrasound transducer (ATL Bothell, Washington, USA). A newer designed Cook probe cover supplied by the manufacturer was also tested after the company was made aware of our initial perforation results. Following each OPU, probe covers were examined for perforations by filling them with water and checking for leaks. If perforations were found, the vaginal transducer was disinfected by soaking for 20 min in 2% gluteraldehyde (Formac). Twenty unused sterile probe covers from each manufacturer were also tested for perforations. RESULTS: After OPU we found 10/13 (75%) old Cook, and 35/43 (81%) Swemed probe covers to be perforated (NS). Only 5/20 (25%) of the new design Cook probe covers were perforated post OPU (p = 0.000005). Analysis of unused probe covers revealed 13/20 (65%) Cook, and 5/20 (25%) Swemed probe covers to be perforated (P = 0.02). None of 10 new design unused Cook probe covers were perforated before use.

Embryo Transfer↗
PubMed1997

Effects of fibroblast growth factor on the healing process of tympanic membrane perforations in an animal model.

After traumatic perforation of the tympanic membrane (TM), healing occurs spontaneously in most cases, although occasional perforations will fail to close. Healing of epithelia at any site involves cell movement, with injury providing the stimulus to initiate changes in the behavior of cells that are normally static. Epidermal proliferation at the margins of the TM perforation can be accelerated by using such growth factors as epidermal growth factor, basic fibroblast growth factor (bFGF) and hyaluronan. bFGF is chemotactic and mitogenic for both fibroblasts and endothelial cells and is also mitogenic for keratinocytes. The effect of bFGF is significant in the enhancement of fibroblast production and angiogenesis. In this study, bFGF was used to enhance the healing process of chronic TM perforations in a guinea pig animal model. Chronic perforations were created since acute TMs could heal spontaneously without using any bioactive substance. In all, 30 TMs of 15 guinea pigs were used. A thermal myringotomy loop was employed to create a subtotal TM perforation at the area of the pars tensa. After establishing a permanent, non-infected perforation, bFGF in buffered saline solution was applied as 400 ng/day to 15 ears, while the opposite (control) ear was treated with only saline solution. At 20 days, 13 of 15 perforations treated with bFGF had closed. Light microscopy was used to assess organization of the healed TMs. The effects of bFGF on the healing process of TM perforations were compared in treated and non-treated ears.

Animals↗
PubMed2005

Septocutaneous perforators of the peroneal artery relative to the fibula: anatomical basis of the use of pedicled fasciocutaneous flap.

There are many studies describing the perforating branches of the peroneal artery but none of them identifies their locations relative to fibula. The aim of this study was to demonstrate the locations of the perforators relative to the fibula and to present a case, treated with an adipofascial flap, based on one of these small arteries. In this study, nine fresh male cadavers' legs injected with colored latex were dissected for demonstration of the longitudinal axis of these perforators. A large incision was made on the lateral part of the leg from the head of the fibula to the ankle. The peroneal perforating vessels were displayed. The posterior margin of the fibula was marked with needles from proximal to distal just above every perforator. The distance between the needle and the perforator was recorded. Their diameters were measured at the level of fascial emergence. There were four to seven perforating vessels; the larger vessels were near the proximal end of the fibula with an average of 1.1 mm and a minimum of 0.8 mm. We found that these branches were not parallel to fibula, but aligned in an oblique projection from posterior to anterior and from distal to proximal because of the course of the intermuscular septum between the soleus and peroneus longus muscles. The lowermost vessel was 1.7 cm away from the posterior margin of the fibula while the uppermost vessel was 0.25 cm away from the posterior ridge of the fibula. Adipofascial or fasciocutaneous flaps, which have important advantages in covering small to medium sized defects, can be based on the perforators of the peroneal artery. But for the centralization of the flap pedicle, the locations of the perforators, which are aligned from the lateral malleolus to the fibular head in oblique direction and from the posterior to the anterior must be taken into consideration. This knowledge is crucial for the flap design and the centralization of the vessels.

Adipose Tissue↗
PubMed1999

Histological dissociation between intra- and extraparenchymal portion of perforating small arteries after experimental subarachnoid hemorrhage in dogs.

This study was conducted to investigate whether the intraparenchymal and extraparenchymal portions of small cerebral arteries show different histopathological changes after subarachnoid hemorrhage (SAH). SAH was produced in dogs by a two-hemorrhage method, and the dogs were perfusion-fixed at 7 and 14 days after SAH. Normal untreated animals were also examined to determine whether or not the histological and morphological changes in the perforating arteries were affected by the perfusion pressure during perfusion-fixation. Control dogs, which received cisternal injection of saline, and untreated normal dogs, which were divided into two groups depending on the perfusion pressure during perfusion-fixation, were also examined. Microvascular corrosion casts produced by arterial injection of polyester resin were examined by scanning electron microscopy (SEM) with morphometric analysis of the caliber of the small perforating arteries. Slices sectioned parallel to the pontine surface were examined by SEM and by light microscopy with morphometric analysis of the luminal diameter and wall thickness of the small perforating arteries. Corrosion casts showed irregular width with folds in the perforating arteries 7 days after SAH. Sectioned slices showed an increased wall thickness of the perforating arteries with intimal corrugation 7 days after SAH. Morphometric analysis revealed that the extraparenchymal portion of the perforating arteries showed no significant differences between any of the groups tested; however, the intraparenchymal portion showed a significant decrease of luminal diameter 7 days after SAH, and a significant increase of wall thickness 7 and 14 days after SAH. The perfusion pressure during perfusion-fixation did not affect the histological changes in the perforating arteries. The results of this study showed that the vasoconstrictive response of the perforating arteries to SAH was different between the extraparenchymal and the intraparenchymal portion, and showed that the intraparenchymal portion of the perforating arteries constrict after SAH, which may affect cerebral ischemia during cerebral vasospasm by increasing total cerebrovascular resistance.

Animals↗
PubMed1994

Repair of temporomandibular joint disc perforation using a synovial membrane flap in Macaca fascicularis monkeys: light and electron microscopy studies.

Previous studies have demonstrated that experimentally produced perforations in the discs of Macaca fascicularis monkeys lead to osteoarthrosis. Synovial membrane hyperplasia also was demonstrated in monkey and human joints with disc perforations. The hypothesis was advanced that a synovial flap obtained from within the affected joint would be the most appropriate tissue to repair chronic disc perforation. To test this hypothesis, four adult M fascicularis monkeys were anesthetized and 4- to 6-mm perforations were made in the posterolateral aspects of the avascular discs bilaterally. The wounds were sutured leaving the perforations open, and the animals were fed their normal diet. After 4 weeks, one joint in each monkey was reopened and a repair was performed using a double-layered flap from the synovial lining of the superior and inferior recesses. Four weeks after repair, the animals were killed and the temporomandibular joints (TMJs) were removed en bloc and decalcified. The joints were sectioned into lateral, middle, and medial sections and were photographed using a stereomicroscope and then processed for light and electron microscopy. The same processing was done to four intact joints that were used as controls. Eight weeks following perforation, the joint components showed degenerative changes consistent with osteoarthritis. Close to the perforations the disc showed loss of collagen, vacuolation of extracellular matrix, accumulation of dense proteoglycan-like material, and the appearance within the disc of type A or macrophage-like cells of the synovium. The discal tissue away from the perforation showed high cellularity and vascularity. The temporal and condylar surfaces showed denudation, fibrillation, osteophytes, and chondrocytic clustering, all characteristics of osteoarthrosis. The surgically repaired discs were intact and the articular surfaces showed no degenerative changes. Discal collagen was restored and appearance of myofibroblasts and elastogenesis were a consistent feature of the repaired disc. The vascularity of the condylar cartilage of the repaired joints appeared similar to that of embryonic cartilage. The reversibility of the degenerative alterations following discal repair in this experimental model should provide the basis for a rational and useful method for surgical repair of TMJ disc perforation using intraarticular synovial tissue.

Animals↗
PubMed1991

Increased pulmonary artery perforating potential of pulmonary artery catheters during hypothermia.

The rate of major complications from the use of pulmonary artery (PA) catheters has been reported to be as high as 9%, 0.2% of which may be attributed to PA perforation, a catastrophe with a fatal outcome more than 50% of the time. Although an uncommon event generally, more than one third of catheter-related PA perforations occur during cardiac surgery. Several factors act to advance the balloon-tipped PA catheter into the distal PA, where, during hypothermia, the catheter hardens and, thus, may be more likely to perforate the vessel. The relative contribution of hypothermia, itself, to the perforating potential of previously used, triple-lumen PA catheters (n = 5) was examined in vitro by mounting them in a temperature-controlled testing chamber, at a 90 degrees incident angle to a polyethylene membrane, which represented the PA wall. The membrane was made to pulsate 80 times/min against the PA catheter until it was perforated. Each catheter was tested 5 times each at 3 temperatures. At 35 degrees C, 30 degrees C, and 25 degrees C, the number of pulsations to produce perforation (perforation rate) was 488 +/- 280, 309 +/- 242, and 97 +/- 234, respectively. The perforation rates differed significantly between temperatures (P less than 0.01), but not between catheters or tests at the same temperature. This study demonstrates that perforation of a model PA by a triple-lumen PA catheter is 500% more likely during hypothermia.

Cardiac Catheterization↗
PubMed2005

Anatomical study of the cutaneous perforator arteries and vascularisation of the biceps femoris muscle.

UNLABELLED: We present an anatomical study that describes the distribution of the cutaneous perforators (CP) of both heads of the biceps femoris muscle. MATERIAL AND METHODS: In this study, we dissected 18 legs from nine cadavers. The study was centered on the biceps femoris muscle and musculocutaneous perforator arteries from both muscular heads. Only perforator arteries with comitant vein diameters of over 0.5 mm were selected. The vascular origin and length were also studied. In all cases, measurements were taken from the bicondyle line. RESULTS: The measurements taken from the muscle bellies of the biceps gave the following results; for the long head 33.91 cm as medium length (SD = 2.70) and for the short head 23.85 cm as medium length (SD = 2.96). The total number of perforator arteries obtained from the two muscle bellies was 139, with the greatest percentage located in the lower half of the thigh. The majority follow an intramuscular route (80.48%) and less frequently they are septals (19.52%). The lengths of perforator arteries from its origin in the axial vessel of the muscle to the subcutaneous fat were, for the short head 5.01+/-1.33 (3.0-10.0), whereas the same measurement, in the long head was 4.54+/-1.36 (2.5-9.0). The principal vascular origin of the perforator arteries was the popliteal artery in both muscle bellies, whilst the second arterial vessel in importance was the first and second profunda perforator artery. CONCLUSION: From the results obtained in our work, we can deduce that it is always possible to locate perforator arteries in both muscle bellies; most frequently they have intramuscular distribution and are located in the proximity of the vascular septum. Their most common origins are the popliteal artery and first and second profunda perforator artery. Finally, it is possible to design pedicle and free flaps, with less morbidity and more versatility than musculocutaneous flaps.

Arteries↗
PubMed2006

Distal shunt obstruction in children with myelomeningocele after bladder perforation.

PURPOSE: We studied short-term complications and particularly the signs of shunt dysfunction after augmented bladder perforation in patients with myelomeningocele and ventriculoperitoneal shunts. MATERIALS AND METHODS: In our series of bladder augmentations in 27 patients with myelomeningocele and a ventriculoperitoneal shunt in the last 10 years (1994 to 2004) we noted 4 who were 8 to 16 years old at our institute with bladder perforation 2 to 5 years after augmentation. Three patients received a colonic augmentation and 1 received an ileal augmentation. One patient underwent surgery for small bowel obstruction 2 years after the primary operation, when a hole in the augmented bladder was identified and oversewn. The other 3 bladder perforations occurred spontaneously or after failure to catheterize. An additional patient with spontaneous perforation underwent auto-augmentation elsewhere. RESULTS: After primary open abdominal surgery and enterocystoplasty there was no sign of shunt dysfunction in any patient. Bladder perforation and leakage of free urine into the abdominal cavity occurred in 4 of the 5 patients. In those patients severe symptoms of shunt dysfunction, including headache and high intracranial pressure, were noted 2 to 7 days after perforation. In patient 1 there was only urine leakage into a small cavity close to the bladder and no acute signs of post-perforation shunt dysfunction. In all cases the shunt was externalized for 1 to 6 weeks without further complications. CONCLUSIONS: In patients with myelodysplasia who have bladder perforation and free urine in the abdominal cavity the peritoneum is chemically inflamed by urine. Resorption of cerebral liquor may be disturbed, leading to shunt dysfunction and high intracranial pressure. Therefore, it is important for the urologist to recognize and evaluate postoperative signs and symptoms of increased intracerebral pressure in patients with bladder perforation. If found, early computerized tomography of the brain is recommended.

Adolescent↗
PubMed1996

The use of a surgical assist device to reduce glove perforations in postdelivery vaginal repair: a randomized controlled trial.

OBJECTIVE: Our purpose was to compare the effectiveness of a surgical assist device, SutureMate, to decrease glove perforations during postdelivery vaginal repair. STUDY DESIGN: This was a prospective randomized trial. After delivery surgeons who needed to perform vaginal repair were randomized to use the surgical assist device or to perform the repair in the usual fashion. After the repair, gloves were collected and the operator was asked to complete a standardized data form that was submitted with the gloves. The gloves were tested for perforations within 24 hours by the Food and Drug Administration-approved hydrosufflation technique. Comparisons were made with chi(2) statistics with p < 0.01 taken as being statistically significant with the use of a Bonferoni adjustment for multiple comparisons. RESULTS: A total of 476 glove sets were evaluated. The use of the surgical assist device significantly reduced the overall glove perforation rate from 28.3% in the control arm to 8.4% in the study arm (p = 0.0001). Rates of perforation varied with level of training and expertise but fell in all groups that used the device. Family physicians had the highest perforation rate in the control arm and benefited most from the device. A total of 76% of perforations were located in the thumb, index, and second fingers of the nondominant hand. Perforations were recognized in only 16% of the glove sets. The level of satisfaction with the device was mixed, but overall 50% of operators indicated that they were either satisfied or very satisfied with the device. CONCLUSION: The rate of glove perforation in postdelivery vaginal repair is high. The surgical assist device significantly reduced the rate of glove perforations.

Delivery, Obstetric↗
PubMed1999

Endoscopic perforating vein surgery.

Perforator incompetence, caused by primary valvular incompetence or by previous deep venous thrombosis, contributes to ambulatory venous hypertension and the development of chronic venous disease. Although the exact role and contribution of perforators to the development of ulcers are still debated, poor results of nonoperative management to prevent ulcer recurrence justify surgical attempts at perforator ligation, in addition to ablation of superficial reflux. The endoscopic technique of perforator interruption has significantly fewer wound complications than the open technique and is the preferred method for ablation of medial perforating veins. Interruption of incompetent perforators with ablation of the superficial reflux, if present, effectively and durably decreases symptoms of CVI and rapidly heals ulcers. Ulcer recurrence following correction of perforator and superficial reflux in patients with post-thrombotic syndrome is much higher than in patients with primary valvular incompetence. A prospective randomized trial is needed to define the long-term benefits of interrupting incompetent perforators in all patients with advanced chronic venous disease and which patients with post-thrombotic syndrome should undergo perforator interruption.

Animals↗