Absence Of Leakage Research Articles

Моделирование процесса диагностики утечек на основе двухальтернативной гипотезы с учетом помех от стохастичности потребления в гидравлической системе

Let's consider mathematical models and methods for diagnosing leaks in hydraulic pipeline systems. As part of the task, two subtasks can be distinguished: identifying the fact of a leak based on the use of a two-alternative hypothesis, as well as mathematical models for determining the location and size of the leak. The task of determining the location and size of the leak has been investigated in sufficient detail. Attention in this work is paid to the development of algorithms for diagnosing hydraulic systems for the presence or absence of leakage. It is proposed to solve both problems as a complex problem of leak diagnostics for hydraulic pipeline systems. The software created based on the results of the research can be used for automated control and monitoring of hydraulic systems. Based on the collected data on the parameters of the hydraulic system, such as pressure, consumption of the target product, etc., a model can be created that can include probability distributions, expected values for parameter variations. The solution to the specific problem of leak detection may vary depending on the type of hydraulic system. The main focus of this work is on leak detection based on a two-alternative hypothesis to determine the existence of a leak in a hydraulic system, taking into account the noise generated by the random selection of the target product by consumption. Leaks are classified as natural, resulting from emergency situations, and leaks also include unsanctioned selections of the target product.

Effect of microaneurysms on the anti-VEGF treatment for diabetic macular edema: A retrospective cross-sectional study.

Although anti-vascular endothelial growth factor (VEGF) treatment is effective for treating diabetic macular edema (DME), the effect of the microaneurysm (MA) status on the therapeutic efficacy of an anti-VEGF treatment remains unclear. Our current study investigated the effects of the number and the presence or absence of leaking MAs on DME and the efficacy of anti-VEGF therapy. A total of 51 eyes of 47 DME patients were administered anti-VEGF treatment. Fluorescence angiography results were used to determine the number of MAs and the presence or absence of leakage, with these findings matched to the optical coherence tomography maps. The correlation between the number of MAs and the retinal thicknesses and the influence of the leaking MAs was examined in order to definitively determine the effect of the anti-VEGF treatment. There was a correlation between the number of MAs and the retinal thickness of the sector in both the 6 mm (correlation coefficients: 0.42) and 3 mm (0.34) sectors (P < .001). There was also a correlation between the number of MAs and the retinal thickness in both the 6 mm (0.31) and 3 mm (0.24) sectors after undergoing the treatment (P < .01). There was a significant difference between the mean thickness of the leaking versus the non-leaking MAs in the 6 mm (388 ± 87 μm) and 3 mm (477 ± 108 μm) sectors before treatment (P < .01). There was also a significant difference for the retinal thickness between the sectors with and without leaking MAs after the treatment (P < .01). The degree of retinal edema before treatment is associated with the number of MAs and the presence of leaking MAs. Anti-VEGF treatment is less effective for focal macular edema with large numbers of MAs, which includes leaking MAs.

154. EVALUATION OF BLOOD FLOW IN RECONSTRUCTED GASTRIC TUBE AND IDENTIFICATION OF OPTIMAL ANASTOMOSES IN ESOPHAGECTOMY

Abstract Background Anastomotic leakage in esophageal cancer surgery may be reduced by the evaluated blood flow to the reconstructed organ, but it is difficult to evaluate quantitatively arterial and venous blood flow. This study aimed to evaluate quantitatively blood flow that has not been possible before, and to determine the relationship between the blood flow in the gastric tube with anastomosis leakage using near-infrared spectroscopy. Methods This single-center, observational study included 50 patients aged 51 to 82 who underwent radical esophagectomy with gastric tube reconstruction for esophageal cancer from June 2022 and January 2023. Regional tissue oxygen saturation was measured at the antrum (point X), the anastomotic point (point Z), and the midpoint between points X and Z (point Y) before and after gastric tube formation. These, alongside the decreasing rate of oxygen saturation at the three points, were investigated in relation to anastomosis leakage. Results Regional tissue oxygen saturation at points X and Z after gastric tube formation was significantly lower in the presence of leakage than in its absence. The decreasing rate of regional tissue oxygen saturation at point Z was significantly higher in the presence of leakage than in its absence. There was no significant difference in the decreasing rate of regional tissue oxygen saturation at point X and Y between the presence and absence of leakage. The cut-off decreasing rate of the rSO2 was 29.4%. Conclusion Regional tissue oxygen saturation levels may be useful for measuring blood flow and may be a predictor of anastomosis leakage.

Gracilis Muscle Interposition: A Valuable Tool for the Treatment of Failed Repair of Post-partum Rectovaginal Fistulas-A Single-Center Experience.

Rectovaginal fistulas (RVFs) account for approximately 40% of anorectal complications from obstetrical trauma. Treatment can be challenging requiring multiple surgical repairs. Interposition of healthy transposed tissue (lotus or Martius flap or gracilis muscle) has been used for recurrent RVF. We aimed to review our experience with gracilis muscle interposition (GMI) for post-partum RVF. A retrospective analysis of patients who underwent GMI for post-partum RVF from February 1995 to December 2019 was undertaken. Patient demographics, number of prior treatments, comorbidities, tobacco use, postoperative complications, additional procedures, and outcome were assessed. Success was defined as absence of leakage from the repair site after stoma reversal. Six of 119 patients who underwent GMI did so for recurrent post-partum RVF. Median age was 34.2 (28-48) years. All patients had at least 1 previously failed procedure [median: 3 (1-7)] including endorectal advancement flap, fistulotomy, vaginoplasty, mesh interposition, and sphincteroplasty. All patients underwent fecal diversion prior to or at initial procedure. Success was achieved in 4/6 (66.7%) patients; 2 underwent further procedures (1 fistulotomy and 1 rectal flap advancement) for a final 100% success rate as all ileostomies were reversed. Morbidity was reported in 3 (50%) patients, including wound dehiscence, delayed rectoperineal fistula, and granuloma formation in one each, all managed without surgery. There was no morbidity related to stoma closure. Gracilis muscle interposition is a valuable tool for recurrent post-partum RVF. Our ultimate success rate in this very small series was 100% with a relatively low morbidity rate.

Healthy bladder storage and emptying functions in community-dwelling women measured by a 2-day bladder health diary.

The prevalence of healthy bladder storage and emptying function in community-dwelling women is not well established. A planned secondary analysis of a US cross-sectional study designed to validate a bladder health instrument was conducted in women aged ≥18 years. A subset was invited to complete the novel 2-day bladder health diary capturing bladder storage and emptying experiences. Overall healthy bladder function was defined as ≤8 waking/daytime voids and ≤1 void during sleeping/nighttime; along with the absence of leakage, urgency, emptying difficulties (initiation, flow, efficacy, relief of urge sensation) and pain. Descriptive statistics of healthy bladder functions and regression models of factors associated with healthy function are reported. Of the 383 invited, 237 (62%) eligible women returned complete dairies. Of these, 12% (29/237) met criteria for overall healthy bladder function. Most (96%) denied pain, 74% had healthy daytime and 83% had healthy nighttime voiding frequency, 64% were continent, 36% reported healthy emptying and 30% denied any urgency episodes. Middle income (odds ratio [OR]:95% confidence interval [CI] = 11.4:1.9-67.4 for $75k-$99 999 vs. $25 000-$49 999), Graduate education (4.8:1.4-17) and previously seeking treatment for bladder problems (OR:95%CI = 0.1; 0-0.9) were associated with overall healthy function. The prevalence of overall healthy bladder function was very low based on our strict definition of health as measured on a 2-day diary. However, most women had healthy voiding frequency and denied pain or urinary leakage. Postvoid dribbling and urgency most commonly contributed to an overall unhealthy bladder. Further investigation is needed to determine whether these diary derived measures are meaningful for patient-oriented bladder health research.

ВСЕГДА ЛИ ИСКУССТВЕННОЕ ЛЕСОВОССТАНОВЛЕНИЕ МОЖЕТ БЫТЬ ЛЕСОКЛИМАТИЧЕСКИМ ПРОЕКТОМ?

Currently, forest climatic projects aimed at enhancing the carbon sequestration in forest ecosystems are becoming very popular. The main requirements for such projects include additionality, permanence and the absence of leakage. Compliance with these requirements ensures that the project fulfils the tasks at which it is aimed. Predictive modelling can be one of the tools for checking the compliance of forest climate projects with the above principles. The purpose of the study was to assess the prospects for carbon accumulation during the implementation of reforestation projects in the Krasnoyarsk and Irkutsk regions. An assessment of the carbon balance in the territory of artificial reforestation projects was carried out at the baseline (natural regeneration of Betula spp. and Populus tremula L.) and during the implementation of the forest climatic project (planting of Pinus sylvestris L.) with a forecast for 100 years. The results show that during the implementation of the project, the achieved level of emissions is higher and the level of carbon sequestration is lower compared to the baseline, which contradicts the principle of additionality, and, therefore, artificial reforestation cannot be considered as a forest climatic project. The highest efficiency in carbon sequestration for mixed plantations is predicted for mixtures of Pinus sylvestris with 20–30 percent of small-leaved species (Betula spp. and Populus tremula). However, the implementation of artificial reforestation projects can be essential for the reproduction of valuable forest resources, but in this case it is necessary to take into account the way the obtained phytomass of trees is used, since the length of the carbon conservation period will depend on this.

Аналіз характеристик кумулянтної системи виявлення витоків рідини у трубопроводах

Acoustic noise signals that are generated by fluid leakage due to a leak in the pipeline have in general case non-Gaussian distribution, so for the further development of acoustic contact leak detection together with correlation-spectral methods it is advisable to use methods used for probabilistic analysis of non-Gaussian processes, in particular cumulant methods of noise diagnostics. The principle of cumulant method of liquid leakage detection in pipelines during operation is considered, which is based on the use of cumulants to distinguish acoustic noise signals registered at the control points of the pipeline section, namely on use of the distance between the cumulant vectors of signals and the mutual correlation function of signals. The block diagram of the cumulant system for liquid leakage detection is given. In order to use the cumulant leakage detection system for power plant diagnosis, a layout of the acoustic leak detection system has been developed, which is a hardware-software complex that performs the collection, registration and statistical processing of acoustic noise signals, as a result of which a decision is made on the presence or absence of leakage, the parameters of the hardware part of the system were given. To obtain estimates of the statistical characteristics of real leakage signals, an installation was used that allows to perform physical modeling of fluid leakage in a pipeline in standing water under sustainable conditions, with fixed leak dimensions and pressure level control. Acoustic noise generated by the flow of fluid moving in the heat pipeline is used as interference. Using the statistical characteristics of real signals, the characteristics of the cumulant leakage detection system were determined – leakage signal attenuation; the maximum distance between the transducers at which the leakage is detected; detector sensitivity; the influence of bandpass filtering on these characteristics is investigated. Keywords: acoustic contact leak detection, liquid leakage detector, acoustic noise signals, cumulant analysis

Buccal mucosal graft urethroplasty in male cats with traumatic complete urethral rupture.

To evaluate the feasibility of buccal mucosal graft urethroplasty for repairing complete urethral rupture in cats. 15 male domestic shorthair cats with traumatic complete urethral rupture. In each cat, a section of buccal mucosa was harvested, sutured, and formed into a tubule by use of an 8F indwelling catheter as support. This tubular graft was connected to both ruptured ends of the urethra to renew the urinary passage. The catheter was left in place until the absence of leakage was confirmed by positive contrast retrograde urethrography. After spontaneous urination was confirmed, cats were discharged from the hospital. Six months later, urethrography was repeated and owners were asked to score their cats' urinary function and quality of life. 13 cats recovered well following surgery, with no complications in the oral cavity or surgical site and no signs of difficulty or discomfort when urinating. Urethrography 2 weeks and 6 months after surgery revealed no stricture or leakage in the abdominal cavity. The 2 remaining cats developed a urethral stricture and underwent second surgery with a successful outcome. At the 6-month follow-up, 14 cats had only mild urinary signs, and 1 cat had incontinency. Owners indicated they were delighted (n = 14) or pleased (1) with their cats' quality of life. Buccal mucosa was found to be a good source of graft tissue for performance of urethroplasty in male cats, yielding satisfactory outcomes with few postoperative complications. The described technique may be suitable for severe and complicated cases of urethral rupture in male cats.

Frequency of Success in Surgery of Vesicovaginal Fistula by Layered Closure with Graft Repair

Introduction: Vesicovaginal fistulae is abnormal communication between bladder and vagina that cause continous dribling of urine. It is physically, mentally and socially distressing condition. There are various approaches for surgeries of these urogenital fistulae with different success-rate that depend upon the experience of surgeon and surgical procedures. This study can help us to estimate the success rate of layered repair with graft in vaginal route to make stragedy to adopted in severe patient. Objective: To determine frequency of success in surgery on vesic-ovaginal fistulae by layered closured with graft repair procedures among patients admitted in Isra University. Setting: Obstetrics &amp; Gynecology department in Isra university hospital Duration: 6 months from 10.2.2014 to 10.8.2014 Study Design: Case series Subject and methods: A total of 100 patients after having surgery for vesicovaginal fistula by layered closure with graft repair was included in this study. History and examination of all subjects were taken. The follow up visit was planned after 3 weeks of surgery. All women was questioned for recurrence of continuous urinary leakage and that without such symptoms proved by absence of leakage on methylene blue dye test was labeled as ‘success’. Results: - Frequency of success in surgery on vesic-ovaginal fistulae by layered closured with graft repair procedures was observed in 88% cases. Conclusion: The success rate of VVF repair by layered closured with graft repair procedures is high. It is concluded that obstetric urogenital fistula is a preventable condition. Keywords: Vesicovaginal fistulae, Layered closured, Graft repair, urogenital fistula

Biocompatibility and patency of a novel titanium vascular anastomotic device in a pig jugular vein

This study aimed to evaluate the biocompatibility and patency of our newly developed titanium vascular anastomotic device (TVAD) in a pig jugular vein. TVAD was made of commercially pure grade 2 titanium. The patency and anastomotic time were simultaneously confirmed in an ex-vivo system developed by the authors and in vivo using pig jugular veins. Five 8-month-old pigs, with body weights of 50–60 kg, underwent anastomosis of both jugular veins using the device. Graft patency was evaluated for 12 weeks by biplane angiography and sonography. All tissue biopsy samples were analysed by histology. In all 10 cases, the anastomosis was completed in < 5 min. The vessel lumen was not damaged, and the inner vessel wall was completely endothelialised at the anastomotic site. No foreign body reactions were observed at the vessel lumen, vessels, and outer vessel walls by histopathologic analysis. Patency and absence of leakage at the anastomotic site of the follow-up period were confirmed clearly by angiography and sonography. This preliminary animal study proved that our newly developed device is a very promising tool for intima-to-intima contact anastomosis. TVAD can be used as a feasible and safe medical tool for vessel anastomosis.

Use of Tubo-Ovarian Ligation Via Colpotomy as A Potential Method for Sterilization in Mares

The goal of this study was to develop a safe, effective, and economical method for permanent sterilization of mares based upon tubo-ovarian ligation performed via colpotomy. In this study, we evaluated the application of a nylon cable tie (zip-tie) to the ovarian pedicle and oviduct of mares to induce ovarian ischemia and tubal ligation without removal of ovaries. Initially, efficiency of zip-ties on the ovarian pedicle was tested in vitro and in vivo. Based on the absence of leakage through the zip-tie ligated vessels in anatomic specimens, we confirmed the potential efficacy of the technique. Next, ligation of the ovarian pedicle via a standing colpotomy was conducted in five mares. Although the surgical procedure in these mares appeared to be quick and efficient, all five mares were noted to develop ovarian adhesions to surrounding abdominal viscera in either one or both ovaries postoperatively. Ovarian ischemia led to loss of ovarian activity based upon ultrasound examination, which was confirmed by a low plasma progesterone concentration in four of the five mares. During the postoperative period, four mares demonstrated clinical signs related to the ovarian adhesions and were euthanized. The postoperative complications associated with ovarian adhesions to abdominal viscera presented significant challenges, limiting the success of this study. While this technique resulted in ovarian ischemia and atrophy in four out of the five mares, we were unable to assess long-term effects on the health and reproduction of the mares due to the ovarian adhesions to the surrounding tissues and the potential for secondary complications. Although technically feasible, tubo-ovarian ligation via colpotomy does not appear to be a viable option for sterilization of mares using the described technique due to ovarian adhesions post procedure.

Miami Pouch: A Simple Technique for Efficient Continent Cutaneous Urinary Diversion

To report a contemporary series of Miami pouch (MP) enriched with a full technical description and step-by-step video to contribute to wider use. A retrospective charts review of all patients who had a MP at our center between January 2016 and December 2017 was performed. The MP technique uses the terminal 15cm of ileum and the right colon to build an intestinal heterotopic pouch located in the right iliac fossa and connected to the skin by an efferent catheterizable tube. Primary outcome was continence defined as the absence of leakage between clean intermittent self-catheterization (CISC) with a maximal interval of 4 hours between each CISC. Fifteen patients had MP during the study period. Thirty-day postoperative Clavien III complications were observed in 2 (13.3%) patients. At 39 months of median follow-up, continence was obtained for all patients except for 2 patients whom reported intermittent night-time leakages due to long intervals (5 to 7 hours) between 2 CISC. No significant alteration of renal function was reported and no stenosis of the efferent tube neither difficulty to perform CISC was observed. For patients who are candidates for radical cystectomy and not eligible for orthotopic neobladder, intestinal heterotopic pouch with a cutaneous continent urinary diversions as MP may be a reliable alternative. Patients should be informed of the existence of a valid alternative to ileal conduit since it may fit their expectations of a preserved body image without urine collecting appliances.

Frequency of the requirement of inappropriate uncuffed tracheal tube size for pediatric patients: a retrospective observational analysis

BackgroundThe insertion of inappropriately sized uncuffed endotracheal tubes (ETTs) with a tight seal or presence of air leakage may be necessary in children. This study aimed to analyze the frequency of the requirement of inappropriately sized uncuffed ETT insertion, air leakage after the ETT was replaced with one of a larger size, and factors associated with air leakage after ETT replacement.MethodsPatients under 2 years of age who underwent oral surgery under general anesthesia with uncuffed ETTs between December 2013 and May 2015 were enrolled. The ETT size was selected at the discretion of the attending anesthesiologists. A leak test was performed after intubation. The ETT was replaced when considered necessary. Data regarding the leak pressure (PLeak) and inspiratory and expiratory tidal volumes were extracted from anesthesia records. We considered a PLeak of 10 < PLeak ≤ 30 cmH2O to be appropriate. The frequencies of the requirement of inappropriately sized ETTs, absence of leakage after ETT replacement, ETT size difference, and leak rate were calculated. A logistic regression was performed, with PLeak, leak rate, and size difference included as explanatory variables and presence of leakage after replacement as the outcome variable.ResultsOut of the 156 patients enrolled, 109 underwent ETT replacement, with the requirement of inappropriately sized ETTs being observed in 25 patients (23%). ETT replacement was performed in patients with PLeak ≤ 10 cmH2O; leakage was absent after replacement (PLeak < 30 cmH2O) in 52% of patients (25/48). In the multivariate logistic model, the leak rate before ETT replacement was significantly associated with the presence of leakage after replacement (p = 0.021).ConclusionsInappropriately sized ETTs were inserted in approximately 23% of the patients. The leak rate may be useful to guide ETT replacement.

Neural Network Techniques for Detecting Intra-Domestic Water Leaks of Different Magnitude

Nowadays, water leak control at different levels is a necessary tool for sustainable water resource management. Research shows that more than one third of the world’s drinking water is lost during its transfer to users, and that leakages on users’ properties vary between 2 and 13% of total residential water demand, are very frequent and difficult to detect. Thanks to the advances in Internet of Things solutions for smart metering devices, it is possible to gather household water consumption information with high spatial and temporal resolution and to analyse them. This article applies several supervised Machine Learning (ML) techniques for the automatic detection of leakages of different magnitudes - even smaller than the meter sensitivity – in pipes within the dwelling, by using data collected by smart meters installed at the connection of users to the distribution network in an Italian town. The results obtained are compared with the performance of an “empirical algorithm” previously presented by the authors, able to automatically identify leakages by checking if the hourly flow rate is never zero during the whole day, but not able to distinguish the size of the leakages. Experimental results over about 40,500 records show that ML techniques significantly improve the detection performance both in discriminating between presence and absence of leakages and in discriminating different-size leakages.

Remote leakage method in heat supply systems out flow

This paper describes the method of remote sensing of the existence or absence of leaks in functioning heat supply systems developed on the basis of the application of a two-alternative hypothesis. To achieve this goal, we proposed to apply a method for determining the location and volume of leaks, based on the use of energy equivalents. We proposed to check for leakage between static assessments of the state of heat supply systems according to data from a remote manometric survey, with the help of which a simultaneous poll of pressure sensors in the end nodes of the system in question is performed. In the event of sudden changes in the estimated system parameters, it is concluded that there is a leak. If the results of two neighboring evaluations are relatively stable, then a conclusion is made about the absence of leakage. The considered problems are based on mathematical models of flow distribution for a heat supply system. The results of a computational experiment are compared with the results of calculating the parameters in the system based on the results of gauge surveying.

CryoMem: A 4–300-K 1.3-GHz Hybrid 2T-Gain-Cell-Based eDRAM Macro in 28-nm Logic Process for Cryogenic Applications

This letter demonstrates the first CMOS logic compatible cryogenic memory solution operating from 4 to 300 K designed in the 28-nm high-K metal gate (HKMG) CMOS. With the growing applications of cryogenic systems from quantum computing to space electronics, there is a need for memory capable of reliable functionality. While the prevailing low-temperature memories suffer from temperature scalability and integrability, the proposed test chip of 1-kb 2T hybrid gain cell-based embedded DRAM macro overcomes these issues while providing $10^{6} \times $ better retention time, 1.3-GHz peak frequency at 4 K, sub nW/kb array refresh power, and $1.7\times $ energy efficiency at 4 K compared to 300 K. This is due to the near absence of leakage, improved ON current, and subthreshold slope which leads to enhanced performance of critical path circuits at lower temperatures.

Swept-source optical coherence tomography angiography vitreo-retinal segmentation in proliferative diabetic retinopathy.

To identify a new cortical vitreous segmentation protocol for non invasive standardised investigation of Neovascularisation (NV) with detection of regression of NV activity in Proliferative Diabetic Retinopathy (PDR). Retrospective study. One hundred and eighty-six eyes of 93 consecutive diabetic patients (mean age: 52.6 ± 11.0 years) imaged using Topcon Triton® Swept-Source Optical Coherence Tomography Angiography (SS-OCTA) from June 2015 to January 2017. Scans were performed through the macula, optic disc and areas of possible NV in mid-peripheral retina using 6 × 6 mm and/or 9 × 9 mm raster-patterns in three segmentation protocols: Vitreo-Retinal (VRS), Outer-Vitreous (OVS) and Core-Vitreous Segmentation (CVS). Any suspicion of PDR was confirmed in all patients by Heidelberg® Widefield-Fundus-Fluorescein-Angiography (WF-FFA) and/or Optos® Ultra-WF-FFA (UWF-FFA). Inter-observer reproducibility of NV diagnosis and agreement between SS-OCTA and UWF-FFA were assessed. Primary outcome was the identification of an effective and reproducible segmentation protocol. Secondary outcome was the identification of NV regression after treatment. Sensitivity-specificity reached, respectively, the value of 100 to 100 in detecting NVD, and 96.6 to 100 in detecting NVE in compared areas. SS-OCTA was able to confirm absence of blood flow within the residual NV plexus when using VRS protocol in 30 eyes in which regression of NV with absence of leakage was documented on FFA. Three segmentation protocols (VRS, OVS and CVS) with different but complementary characteristics, allowed a reproducible and standardised investigation of NVD and NVE. The proposed new SS-OCTA cortical vitreous segmentation protocols may be of value when identifying and assessing NV-activity (VRS, OVS and CVS) or NV-regression (VRS) in PDR and therefore, response to therapy.

Calculation of Thermodynamically Efficient Law of Variation of Velocity of Liquid Piston during Compression in Second Stage of Volumetric Hybrid Piston Power Machine

Techniques of determining the velocities of a piston for performing isothermal and polytropic processes of compression in the absence of leakage in the second stage of the compressor section of a hybrid power machine are considered. The laws of variation of the velocities of the piston over time (relative to the crank angle) and their average value are determined. A comparison of the instantaneous and average velocities of the piston for performing isothermal and polytropic processes of compression to the instantaneous and average velocities of a piston possessing a crank drive is performed. It is shown that the isothermal process of compression is not practically realizable with the use of a crank drive, while the polytropic process of compression may be realized with index of polytropy 1.15–1.2 and higher.

Primary laparoscopic approach to repair perforated peptic ulcer. A retrospective cohort study

Perforated peptic ulcer is a serious complication of peptic ulcer disease and carries high risk for morbidity and mortality. Although the incidence of peptic ulcer disease has decreased in recent decades, the percentage of patients with perforated peptic ulcer requiring emergency surgery remains constant. The use of laparoscopic management as a first choice for the treatment of the perforation is growing but is not routine in many centers. Clinical and surgical data on 42 patients underwent surgical treatment for perforated peptic ulcer from January 2012 to December 2016 were collected. Laparoscopic repair of the perforation with a three-port technique was made in all cases. The Boey scoring system was used to predict the prognosis. All patients underwent suture-closure of the ulcer, and omental patch through laparoscopy without conversion to open surgery. Duodenal leakages occurred in 3 patients (7.1%), then treated with a conservative approach and resolved on the 10th postoperative day. Two patients (4.7%) had deep space infections in the first week after surgery, therefore subdiaphragmatic and pelvic abscess were drained by ultrasound guidance. Four patients (9.5%) died up to 30-day post-surgery due to progression of multisystem organ failure in absence of leakages or infections. All these patients were American Society of Anesthesiologists Classification >III and Boey Score 3. Our data show that a primary laparoscopic approach in patients with peptic ulcer perforation is associated with postoperative advantages and acceptable rates of morbidity and mortality, essentially related to high Boey Score. Therefore, we suggest that the surgical repair of PPU could be always started laparoscopically.

Use of a new transanal irrigation device for bowel disorder management by patients familiar with the irrigation technique: a prospective, interventional, multicenter pilot study

BackgroundThe aim of this study was to evaluate the feasibility of transanal irrigation (TAI) with a new medical device incorporating an electric pump, the IryPump®R Set.MethodsAn interventional, prospective, open-label, non-comparative, multicenter pilot study on TAI was conducted at three French university hospitals. Patients with experience of TAI were enrolled for a 1-month period during which 5 consecutive TAIs were performed using the IryPump®R Set (B.Braun Melsungen AG Melsungen, Germany). The study’s primary efficacy criterion was successful TAI, defined as (i) use of the patient’s usual irrigation volume of water, (ii) stool evacuation, and (iii) the absence of leakage between TAIs. The first two TAIs were not taken into account in the main analysis. The secondary outcome measures were device acceptability, bowel dysfunction scores, tolerability, and safety.ResultsFifteen patients were included between November 2016 and May 2017, and 14 were assessed in the main analysis. The TAI success rate was 72.4% (21 out of 29 procedures). The bowel dysfunction scores at the end of the study did not differ significantly from those recorded on inclusion. A high proportion of patients (> 70%) reported that TAI was feasible with the new medical device. There were no serious adverse events or device-related adverse events. At the end of the study, 50% of the participants were willing to consider further use of the new device.ConclusionsIn patients familiar with TAI, using a new medical device incorporating an electric pump was feasible. Levels of patient satisfaction were high, especially with regard to comfort of use and a feeling of security during TAI.