Area Of Obstruction Research Articles

Design and Implementation of a Wireless Fluid Level Display System Using Ultrasonic Sensing Technique

The wireless fluid level indicator comprises a sensing and transmitting circuit for detecting and transmitting the levels of fluids from a container to the receiving circuit which receives and displays the amount of the measured volume. This has been achieved using an ultrasonic sensor (HC-SR04), a firmware (PIC16F648A/PIC16F876A microcontroller programmed in C/assembly languages), an encoder (HT12E) and a radio frequency (RF) transmitter transmitting at a bandwidth of 433MHz to an RF receiver interfaced with a decoder (HT12D), liquid crystal display (LCD) and a Buzzer. The device when tested measured water levels and transmitted same over a distance of up to 98.5 meters in open areas and up to 50 meters in highly obstructed areas. The average response time was also estimated to be 0.1 second. As a contact-less depth detection system, the device finds useful applications in measurement of fluid levels in homes and industries where concentrates, table water, transmission oils are produced, without affecting the chemical or physical properties of such substances-an advantage over the contact methods used in fluid level detection.
 Aims: To design and implement a wireless microcontroller based fluid level display system using ultrasonic sensing method.
 Study Design: By encoding the Transmitter module to sense and detect the amount of water level, while the decoder module decodes the received data and display the result.
 Place and Duration of Study: Department of Physics, University of Agriculture Makurdi, Benue State, Nigeria, between November 2018 and April 2019.
 Methodology: An RF transceiver, encoder/decoder (HT12E/HT12D), a 2x16 Liquid display module, 4MHz crystal oscillator, a buzzer and other peripherals were interfaced to two 8-bit controllers; PIC16F648A and PIC16F876A. The controllers were programmed in C/Assembly languages to enable effective communication of the system. The system was then calibrated to read and transmit water level values from a 30-centimeter deep tank over a distance of 1.0 - 98.5 meters.
 Results: The system was tested to have maximum sensitivity over a distance of 98.5 meters in non-obstructed areas and 50 meters in obstructed areas. The average response time was also estimated to be 0.5 seconds.
 Conclusion: The design and implementation of a wireless fluid level display system using ultrasonic sensing technique has been successfully done. The system workability is suitable for deployment and usage in domestic and industrial purposes.

THE CONNECTION BETWEEN POLYSOMNOGRAPHY RESULTS, EPWORTH SCORES AND DRUG-INDUCED SLEEP ENDOSCOPY FINDINGS IN PATIENTS WITH OSAS

Objective: To determine the usefulness of drug-induced sleep endoscopy (DISE) and evaluate correlations between DISE findings, polysomnography and Epworth sleepiness scale values. Material and Method: Included in this study are patients with major OSAS symptoms and apnea-hypopnea index (AHI) values between 5 and 30 who were scheduled for soft palate surgery. The patients were sedated with propofol (0.25 cc/kg) in the operating room for examination of obstructive regions. Anatomical structures affected by obstruction were observed with flexible endoscopy. The images from this examination were analyzed with Ulead video study. Patients with soft palate pathologies were operated and the endoscopic examination repeated postoperatively. Changes in pre- and post-operative obstruction areas were compared with changes in pre- and post-op PSG and Epworth sleepiness scale values. Results: Changes in retropalatal area values were correlated with changes in AHI values. The most important factor affecting this correlation was the formation of base of tongue pathology, despite being absent preoperatively. We also determined the correlation between patients’ Epworth scores, AHI and retropalatal area. Changes in the retropalatal area following OSAS surgery were correlated with changes in AHI and Epworth scores. Conclusion: DISE is an effective diagnostic technique in OSAS with advantages such as a low radiation risk, cost effectiveness and precise findings.

Magnetic Compression Anastomosis for the Treatment of Post-Transplant Biliary Stricture.

A number of different conditions can lead to a bile duct stricture. These strictures are particularly common after biliary operations, including living-donor liver transplantation. Endoscopic and percutaneous methods have high success rates in treating benign biliary strictures. However, these conventional methods are difficult to manage when a guidewire cannot be passed through areas of severe stenosis or complete obstruction. Magnetic compression anastomosis has emerged as an alternative nonsurgical treatment method to avoid the mortality and morbidity risks of reoperation. The feasibility and safety of magnetic compression anastomosis have been reported in several experimental and clinical studies in patients with biliobiliary and bilioenteric strictures. Magnetic compression anastomosis is a minimally traumatic and highly effective procedure, and represents a new paradigm for benign biliary strictures that are difficult to treat with conventional methods.

The usefulness of Valsalva computed tomography as an assessment tool for the Eustachian tube

To determine the usefulness of 'computed tomography (CT) with Valsalva maneuver (VM)' (Valsalva CT) for localizing lesions of the eustachian tube (ET) and identifying characteristics of ET dysfunction (ETD). In this case-control study, 12, 17, and 25 patients with obstructive ETD (OETD), patulous eustachian tube (PET), and conductive hearing loss (control), respectively, underwent Valsalva CT in the supine position. The visualized length to total length ratio of the cartilaginous ET (VTRET) with and without VM were compared in the three groups. In the OETD group, obstructed areas of the ET were identified on multiplanar reconstructed images. VTRET without VM in the PET group was significantly higher than that in the control and OETD groups (p-values, 0.003 and 0.007, respectively). However, there was no significant difference between the control and OETD groups (p=0.053). VTRET with VM in the PET group was significantly higher than that in the other two groups (p<0.001), whereas that in the control group was significantly higher than that in the OETD group (p<0.001). In the OETD group, the obstructed area was clearly identified, and there were one, one, six, and eight patients in the isthmus; bony portion and isthmus; bony portion, isthmus, and cartilaginous portion; and isthmus and cartilaginous portion subgroups, respectively. Valsalva CT is particularly valuable as a visualization assessment tool for identifying obstructed areas in the OETD. It may help future research of disease-specific mechanical characteristics of the ET on controlling pressure variables.

Coronary collaterals in patients with ST-elevation myocardial infarction presenting late after symptom onset

The role of coronary collaterals in ST-elevation myocardial infarction (STEMI) remains controversial. So far, studies examining the effect of collaterals on outcome mainly focused on patients presenting early after symptom onset. We sought to investigate the prognostic influence of coronary collateralization in patients presenting with prolonged ischemia late after symptom onset. The study is a subanalysis of a randomized trial addressing thrombus aspiration in STEMI patients presenting between 12 and 48h after symptom onset with a follow-up period of a minimum of 4years. A total of 95 patients with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 or 1 prior to percutaneous coronary intervention (PCI) were included in the analysis. Of these, 62 patients (65%) had none or poor coronary collateralization according to the Rentrop classification (Rentrop grade 0 or 1) compared to 33 (35%) with well-developed collateralization (Rentrop grade 2 or 3). In comparison, patients with well-developed collateralization had a smaller area of microvascular obstruction (2.1 ± 3.8 vs. 4.5 ± 4.9% of left ventriclular mass (%LV), p = 0.03) and infarct size (27.9 ± 11.7 vs. 34.8 ± 17.2% LV, p = 0.047) on magnetic resonance imaging. Further, mortality at 4-years follow-up was lower (6% Rentrop grade 2 or 3 vs. 25% Rentrop grade 0 or 1, p = 0.02). Poor collateralization was an independent predictor of long-term mortality on multivariate Cox regression analyses in addition to cardiogenic shock and unsuccessful PCI during the index procedure. Sufficient coronary collateralization has a positive impact on microvascular obstruction, infarct size and long-term mortality in STEMI patients presenting between 12 and 48h after symptom onset.

Development, validation and application of a 3D printed model depicting adenoid hypertrophy in comparison to a Nasoendoscopy

BackgroundThe exploration of tridimensional (3D) technology of computational tomography and the development of valid 3D printed models may improve the assessment of adenoid obstruction. The identification of an enlarged adenoid in childhood would streamline the referral of appropriately selected cases to an otolaryngologist, leading to early treatment of affected children when indicated. The objective of this study is to validate the use of a 3D printed model depicting adenoid hypertrophy based on the pediatric otolaryngologist, head and neck surgeon (OHNS) participants assessment.MethodsA cross-sectional study was performed to develop and validate 3D depictions, including print-outs, of the nasopharynx including different degrees of Adenoidal Hypertrophy (AH). The print-outs were obtained from 14 Cone-beam computed tomography (CBCT) scans of 14 children (12 boys, 2 girls; mean age of 10.61 years) representing grades 1, 2, 3, and 4 nasopharyngeal adenoidal obstructions, according to a previously Nasoendoscopy-graded (NE) classification by a licensed OHNS. The prevalence of AH in this study was 36%. Two OHNS were recruited to assess the print-outs representing two different representations of the nasopharyngeal airway, the lumen (LU) and adenoid mass (AD). LU and AD were visualized in 2D - pictures- and in 3D – printed prototypes. Intraclass correlation was used to assess intra- and inter-reliability. The validity of our depictions was analyzed through comparison (accuracy and correlation) to the reference standard (NE). The data were clustered to calculate the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). Cross-tab and Pearson’s T-test were performed.ResultsOverall, the 3D depiction tools showed different diagnostic capabilities. AD representations showed strong (AD 2D, 75%) to almost perfect (AD 3D, 88%) accuracy compared to NE. Excellent sensitivity and specificity were observed for the AD 3D (100, 70%), as well as adequate PPV and NPV (66 and 97% respectively), with only 5% of false-negative cases.ConclusionThe use of Dolphin software for the acquisition of a 3D printed prototype of the nasopharyngeal adenoidal region seems promising. These prototypes may be a practical and readily available alternative for the assessment of the nasopharyngeal obstructed area. CBCT in children must be taken under strong solid indications. Early referral to an OHNS for a full assessment remains the main objective in children with unclear symptoms.

A Refined SNR Based Stochastic Model to Reduce Site-Dependent Effects

Site-dependent effects are now the key factors that restrict the high accuracy applications of Global Navigation Satellite System (GNSS) technology, such as deformation monitoring. To reduce the effects of non-line-of-sight (NLOS) signal and multipath, methods and models applied to both of the function model and stochastic model of least-squares (LS) have been proposed. However, the existing methods and models may not be convenient to use and not be appropriate to all GNSS satellites. In this study, the SNR features of GPS and GLONASS are analyzed first, and a refined SNR based stochastic model is proposed, in which the links between carrier phase precision and SNR observation have been reasonably established. Compared with the existing models, the refined model in this paper could be used in real-time and the carrier phase precision could be reasonably shown with the SNR data. More importantly, it is applicable to all GNSS satellite systems. Based on this model, the site observation environment can be assessed in advance to show the obstruction area. With a bridge deformation monitoring platform, the performance of this model was tested in the aspect of integer ambiguity resolution and data processing. The results show that, compared with the existing stochastic models, this model could have the highest integer ambiguity resolution success rate and the lowest noise level in the data processing time series with obvious obstruction beside the site.

Orbezoar: A Superabsorbent Polymer Causing Small Bowel Obstruction in a Toddler.

Foreign body ingestions are not uncommon in children between 6 months and 3 years. The majority are managed conservatively and <1% necessitate surgery (1,2). Superabsorbent polymers are materials, which retain a substantial amount of liquid allowing them to expand considerably (3). As such, toys made of these materials pose a serious risk if ingested and the majority have been recalled (4). Orbeez (Maya Toys, Cypress, CA), a superbsorbent polymer bead product, is marketed for children and studies have suggested that ingestion is unlikely to cause clinically significant intestinal obstruction (5,6). We report the case of a 19-month-old girl who presented with emesis and fussiness following ingestion of Orbeez beads. Given the persistence of obstructive symptoms, she underwent a diagnostic laparoscopy, which demonstrated multiple dilated loops of small bowel and a clear transition point in the mid-jejunum. This segment of the bowel was externalized (Fig. 1). A 3 cm Orbeez bead and multiple small fragments were extracted from a transverse enterotomy (Fig. 2). The patient subsequently did well.FIGURE 1: Mid-jejunal bowel with focal area of obstruction (arrow) resulting in proximal small bowel dilation.FIGURE 2: Transverse enterotomy with subsequent removal of 3 cm superabsorbent polymer (Orbeez) foreign body.Despite previous reports suggesting that Orbeez is safe, this first report of ingestion necessitating surgical exploration highlights the need for heightened awareness when exposure to superabsorbent polymer is suspected.

Experimental Investigation of the Debris Configurations Effects on the Scour Hole Morphology at Circular Bridge Piers

The hydraulic conditions and river bed morphology at bridge piers get extremely changed with debris accumulations. In this study, a series of tests were conducted to understand the scour hole geometry behaviour during debris accumulation at circular bridge pier. Three groups of rectangular debris were tested under clear water condition with 27 tests. The most dangerous shapes from these groups were specified and the effects of debris thickness, width and length were elaborated. The results show that the scour depth, width and length increased as the percentage of obstructed area of debris to the flow area increased. Hence, the modification factor of scour hole dimensions increased. The study concluded that the modification debris coefficient for scour hole depth, width and length increased to 2.397, 2.308 and 2.145 when the obstructed area of debris to the flow area increases from 2.07% to 26.89%, respectively. More notifications should be considered in protection work around bridge piers subjected to debris accumulation.

Can you get there from here? An analysis of walkability among PulsePoint CPR alert dispatches

BackgroundBystander CPR before the arrival of EMS is a major factor in out of hospital cardiac arrest (OHCA) survival. To recruit trained bystanders, mobile phone-based alert systems have been developed, but their limitations are not well understood. ObjectiveWe investigated the effects of landscape features on the capabilities of the PulsePoint CPR dispatch platform in Allegheny County, Pennsylvania. We hypothesized that landscape features would reduce walkable area within dispatch zones and that larger alert radii could mitigate these effects. MethodsCPR alert location data were obtained from the Allegheny County 911 PulsePoint deployment from July 2016–2019 (n = 1100). PulsePoint, a smartphone-based citizen CPR dispatch platform, alerts volunteers to public OHCAs within 400 m. Digital maps of alerts were generated for walkability analysis using the image Labeler MATLAB polygon tool. Unwalkable areas were labeled, classified into five categories, and quantified. ResultsOf the 1100 events analyzed, encompassing 212 mi2, 357 (32.45%) had no impediments to walkability. Within a 400 m radius of partially impeded events, the median proportion of obstructed area was 0.2250 (Min: 0.0005, Max: 0.8338, IQR: 0.3004, Sx: 0.1923). When the alert radius was expanded to 468 m, the median increased to 0.2336 (Min: 0.0016, Max: 0.8597, IQR: 0.3064, Sx: 0.1950). The percentages of total unwalkable area by each category were: terrain (54.286%), water (24.674%), road w/o crosswalk (11.3197%), railroad (7.4100%), private property (2.3102%). ConclusionsIn this region, most PulsePoint alerts had unwalkable areas, mostly from terrain and water. Contrary to our initial hypotheses, moderately increasing dispatch radius did not improve walkability.

Quantitative T1 Mapping for Detecting Microvascular Obstruction in Reperfused Acute Myocardial Infarction: Comparison with Late Gadolinium Enhancement Imaging.

ObjectiveTo compare native and post-contrast T1 mapping with late gadolinium enhancement (LGE) imaging for detecting and measuring the microvascular obstruction (MVO) area in reperfused acute myocardial infarction (MI).Materials and MethodsThis study included 20 patients with acute MI who had undergone 1.5T cardiovascular magnetic resonance imaging (CMR) after reperfusion therapy. CMR included cine imaging, LGE, and T1 mapping (modified look-locker inversion recovery). MI size was calculated from LGE by full-width at half-maximum technique. MVO was defined as an area with low signal intensity (LGE) or as a region of visually distinguishable T1 values (T1 maps) within infarcted myocardium. Regional T1 values were measured in MVO, infarcted, and remote myocardium on T1 maps. MVO area was measured on and compared among LGE, native, and post-contrast T1 maps.ResultsThe mean MI size was 27.1 ± 9.7% of the left ventricular mass. Of the 20 identified MVOs, 18 (90%) were detected on native T1 maps, while 10 (50%) were recognized on post-contrast T1 maps. The mean native T1 values of MVO, infarcted, and remote myocardium were 1013.5 ± 58.5, 1240.9 ± 55.8 (p < 0.001), and 1062.2 ± 55.8 ms (p = 0.169), respectively, while the mean post-contrast T1 values were 466.7 ± 26.8, 399.1 ± 21.3, and 585.2 ± 21.3 ms, respectively (p < 0.001). The mean MVO areas on LGE, native, and post-contrast T1 maps were 134.1 ± 81.2, 133.7 ± 80.4, and 117.1 ± 53.3 mm2, respectively. The median (interquartile range) MVO areas on LGE, native, and post-contrast T1 maps were 128.0 (58.1–215.4), 110.5 (67.7–227.9), and 143.0 (76.7–155.3) mm2, respectively (p = 0.002). Concordance correlation coefficients for the MVO area between LGE and native T1 maps, LGE and post-contrast T1 maps, and native and post-contrast T1 maps were 0.770, 0.375, and 0.565, respectively.ConclusionMVO areas were accurately delineated on native T1 maps and showed high concordance with the areas measured on LGE. However, post-contrast T1 maps had low detection rates and underestimated MVO areas. Collectively, native T1 mapping is a useful tool for detecting MVO within the infarcted myocardium.

Robust Special Strategies Re sampling for Mobile Inertial Navigation Systems

The mobile navigation services in an obstructed area can be extremely challenging especially if the Global Positioning System (GPS) is blocked. In such conditions, users will find it difficult to navigate directly on-site. This needs to use inertial sensor in order to determine the location as standalone, low cost and ubiquity. However, the usage of accurate inertial sensor and fast localization module in the system would lead the phenomenon of sample impoverishment, which it is contribute computation burden to the system. There are different situation of the sample impoverishment, and the solution by using special strategies resampling algorithm cannot be used or fitted in different cases in altogether. Adaptations relating to particle filtering attribute need to be made to the algorithm in order to make resampling more intelligent, reliable and robust. In this paper, we are proposes a robust special strategy resampling algorithm by adapting particle filtering attribute such as; noise and particle measurement. This adaptation is used to counteract sample impoverishment in different cases in altogether. Finally, the paper presents the proposed solution can survive in three (3) types of sample impoverishment situation inside mobile computing platform.

Chiari malformation and syringomyelia.

Chiari malformation was first described over a century ago, and consists of posterior fossa anomalies that generally share the feature of cerebellar tonsillar descent through the foramen magnum. Our understanding of this disorder was initially based on autopsy studies, and has been greatly enhanced by the advent of MRI. The surgical management of Chiari anomalies has also evolved in a parallel fashion. Although the exact surgical technique varies among individual surgeons, the goals of surgery remain constant and consist of relieving brainstem compression and cranial nerve distortion, restoring the normal flow of CSF across the foramen magnum, and reducing the size of any associated syrinx cavity. Syrinx cavities are most commonly associated with Chiari anomalies, yet primary spinal syringomyelia (PSS) can be caused by traumatic, infectious, degenerative, and other etiologies that cause at least a partial CSF flow obstruction in the spinal subarachnoid space. As with syringomyelia associated with Chiari anomalies, the main goal of PSS surgery is to reestablish CSF flow across the area of obstruction. In addition to MRI, myelography with CT can be very helpful in the evaluation and management of these patients by identifying focal regions of CSF obstruction that may be amenable to surgical intervention. Future directions for the treatment of Chiari anomalies and syringomyelia include the application of advanced imaging techniques, more widespread use of genetic evaluation, large-scale outcome studies, and the further refinement of surgical technique.

2142 Endoscopic Management Cases for Small Bowel Obstruction

INTRODUCTION: Small bowel obstruction (SBO) is a common disease in the gastrointestinal surgery field. Although causes of SBO are highly variable, surgical management is usually selected for adhesive obstruction if nasogastric tube decompression has failed. There have been no reports of endoscopic cure for SBO, despite several reports of endoscopic management of colonic voluvulus or malignant colonic obstruction. Here we report three cases in which endoscopic reduction was safely performed for SBO. CASE DESCRIPTION/METHODS: Case1: An 86-year-old woman developed obstruction one month after right hemicolectomy for colorectal cancer. Preprocedural CT scan imaging detected a lumen caliber change near the ileocolonic anastomosis, and no recovery sign was acquired even after decompression treatment by nasogastric tube for 3 days. Colonoscopy with fluoroscopy showed ileum kinking at 10 cm proximal from the anastomosis. Case2: A 68-year-old woman developed obstruction during hospitalization for myelodysplastic syndrome. She had past surgcal history of 7 caesarean sections. Preprocedural CT scan imaging showed terminal ileum with transition point at 20 cm from ileocecal valve. Colonoscopy was performed after one week of conservative management. Colonoscopy with fluoroscopy revealed strong angulation and stricture accompanied by ulcerations at the terminal ileum. Case3: A 79-year-old woman developed obstruction one year after cystectomy with Indiana pouch reconstruction for bladder cancer. There was no improvement sign after 5 days of nasogastric tube and supportive treatment. Colonoscopy with fluoroscopy revealed ileum kinking 20 cm proximal to the ileocolic anastomosis, consistent with preprocedural imaging. In all 3 cases, the scope passed through the obstruction site following insertion of a guide wire and stiff catheter through above the obstruction area. All obstructions were successfully released. The passage of the contrast intraoperatively through the site was clearly observed. In Case 3 was added balloon dilation after the endoscope withdrawal. All patients were discharged without additional surgery or postprocedural complications, with 1.5-4 months follow up. DISCUSSION: We report three cases in which endoscopic treatment safely treated for SBO likely due to adhesions. Endoscopic management could release the obstruction earlier than predictable course in these three cases. These cases show the potential for endoscopic treatment to replace surgical treatment in a certain type of SBO.

P3095Left ventricular thrombus formation after ST-elevation myocardial infarction: a prospective observational CMR study

Abstract Background Left ventricular (LV) thrombus formation is a severe complication after acute ST-segment elevation myocardial infarction (STEMI). The incidence and determinants of LV thrombus formation are still a matter of controversy. Purpose We aimed to assess the incidence as detected by cardiac magnetic resonance (CMR) imaging as well as the determinants of LV thrombus formation in contemporary reperfused STEMI patients. Methods This prospective observational study included 530 consecutive STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR was performed at a median of 3 days (interquartile range 2–4 days) after symptom onset for the evaluation of LV thrombus formation as well as LV function and infarct severity. Results LV thrombi were detected in 17 patients (3.2% of the overall cohort). The incidence of LV thrombi in anterior STEMI patients (n=247) was 6.9%. In all patients presenting with LV thrombus left anterior descending artery (LAD) was identified as culprit lesion. The occurrence of thrombi was significantly associated with reduced LV ejection fraction (LVEF) (p&lt;0.001), larger LV end-diastolic volume (p&lt;0.001) and LV end-systolic volume (p&lt;0.001), larger areas of microvascular obstruction (MVO) (p=0.003) and larger infarct size (IS) (p&lt;0.001). Furthermore, increased levels of peak high sensitivity cardiac Troponin T (p&lt;0.001) and hyperlipidaemia (p=0.038) were significantly related to LV thrombi. In multivariable analysis including IS, LVEF and MVO, only LVEF (odds ratio: 0.91 (95% confidence interval: 0.87–0.96); p=0.001) emerged as independent predictor of LV thrombus formation. Conclusion The risk of LV thrombus formation remains considerable in contemporary treated STEMI patients, especially in those with LAD as culprit lesion. Among CMR parameters of LV dysfunction and infarct severity, only baseline LVEF, but not IS or MVO, independently predicted LV thrombus formation after STEMI.

1627 Segmental Colitis Associated With Diverticulosis: An Emerging Entity Among the Non-Specific Colitis

INTRODUCTION: An 86 y/o male with diverticulosis and hypertension, arrived at the ER due to intermittent episodes of bright rectal bleeding associated with lower quadrant abdominal pain since 3 weeks ago. Laboratories without anemia, leukocytosis, eosinophilia or any other abnormality. CT abd/pelvic revealed a segmental area of concentric mural thickening and narrowing of the lumen of the sigmoid colon, concerning for a mass. No prior colonoscopies or GI alarming features. GI service consulted for diagnostic endoscopic procedure. CASE DESCRIPTION/METHODS: Sigmoidoscopy was remarkable for severe diverticular disease of the rectal mucosa with associated significant erythema, exudative material and loss of vascular pattern consistent with an inflammatory process. At 20 cm from the anal verge, a luminal narrowing covering &gt; 90% of the lumen extended up to 27 cm. Pathology report from the area of obstruction showed acute over chronic inflammation without granulomas, microorganisms or dysplasia. He was started on rectal mesalamine and a 14-day course of oral antibiotics (metronidazole and ciprofloxacin). Surgery service consulted which agreed with medical management. Within two weeks after completion of antibiotics, colonoscopy was performed revealing marked improvement of the luminal narrowing evidenced in the previous colonoscopy at 20cm, including less degree of inflammation and fewer loss of vascular pattern among the segmental area within multiple diverticuli. Biopsies taken from the same narrowing were remarkable for chronic inflammation without dysplasia. All findings were consistent with segmental colitis associated with diverticulosis (SCAD). DISCUSSION: SCAD is an inflammatory process that affects colonic luminal mucosa in areas that are affected by diverticulosis. The prevalence is 1.5 – 11.4% among those with diverticular disease. The pathogenesis of SCAD is unclear. The clinical presentation is not specific and thus similar to other pathologies, including inflammatory bowel disease, for which makes this condition difficult to diagnose. There are currently no guidelines for its management. It is frequently based on the administration of salicylates, antibiotics and surgical intervention for refractory cases. Currently it is unclear if SCAD is in fact a spectrum of IBD or if it is itself a separate entity. The rarity of SCAD supports the claim that further research is needed to better understand the disease and thus improve its management and clinical outcomes.

Swallowing outcomes after pediatric epiglottopexy.

Persistent sleep apnea following tonsillectomy and adenoidectomy in children requires additional evaluation. One of the common areas of persistent upper airway obstruction in these children is the base of the tongue and lingual tonsils as well as epiglottic prolapse. Depending on the site of obstruction on sleep endoscopy or a cine MRI, surgical procedures include base of tongue reduction and lingual tonsillectomy with or without epiglottopexy. To assess the swallowing outcomes in children undergoing epiglottopexy with lingual tonsillectomy. A retrospective case series review of children undergoing epiglottopexy with or without lingual tonsillectomy. All patients underwent an epiglottopexy with lingual tonsillectomy using coblation. A detailed evaluation including a sleep study, sleep endoscopy, and thorough swallowing assessment preoperatively as well as postoperatively was performed. Five children underwent epiglottopexy with lingual tonsillectomy for obstructive sleep apnea. Epiglottopexy improved sleep apnea with Apnea Hypopnea Index (AHI) falling significantly from 4.6 to 0.5 (p < 0.05). All patients had a normal swallowing assessment postoperatively with functional endoscopic evaluation of swallowing (FEES) revealing no evidence of aspiration and penetration. In our case series epiglottopexy with lingual tonsillectomy is a safe and effective technique, which improves sleep apnea in pediatric patients. It does not affect the swallowing mechanism, and the epiglottis still retains the laryngeal protective role.

Transesophageal Echocardiographic Predictor of Significant Right Ventricular Outflow Tract Obstruction After Tetralogy of Fallot Repair

The optimal method for reconstruction of the right ventricular outflow tract in tetralogy of Fallot repair is yet to be established. Transatrial repair with pulmonary valve preservation avoids the detrimental effects of ventriculotomy and transannular patch; however, because of moderately hypoplastic pulmonary valve, these techniques are associated with undesirable residual right ventricular outflow tract gradients resulting in reoperations. The study sought to define intraoperative echocardiographic predictors of significant right ventricular outflow tract obstruction after tetralogy of Fallot repair. From July 2016 to December 2017, 58 patients with tetralogy of Fallot underwent repair with direct intraoperative pressures measuring and intraoperative transesophageal echocardiography performing after tetralogy of Fallot repair completion. Multivariate analysis was performed using logistic regression analysis to identify independent predictors of right ventricular outflow tract obstruction. One year after tetralogy of Fallot repair, significant right ventricular outflow tract obstruction was present in 12 patients (20.6%): 10 patients (26.2%) after pulmonary valve-sparing procedure and 2 patients (12.5%) after transannular patch (P = 0.35). Right ventricular outflow tract z-score lower than -3.2 had the best predictive value for significant residual right ventricular outflow tract obstruction (area under the curve = 0.979, P < 0.001). Multivariate analysis found that the right ventricular outflow tract z-score reached a statistical significance as a predictor of significant right ventricular outflow tract obstruction (P < 0.0001). Right ventricular outflow tract z-score <-3.2 measured by intraoperative transesophageal echocardiography is an indicator of postoperative right ventricular outflow tract obstruction right after surgery and a predictor of obstruction development following tetralogy of Fallot repair.

Small intestinal obstruction by sunflower seed bezoar

Abstract Bezoars are rare mass formations in the gastrointestinal tract caused by consumption of indigestible materials such as plant fibers (Phytobezoars) or hair (Trichobezoars). We report a case of a 12-year-old boy who presented with abdominal pain, nausea and vomiting without any other clinical findings. Radiographic findings showed an area of obstruction in the small bowel, which we confirmed by performing an exploratory laparotomy. The treatment consisted of surgical removal of the obstructing bezoar from the distant ileum as well as excision of an incidentally identified Meckel's diverticulum. Postoperative discussions revealed, that the patient had ingested a large amount of unshelled sunflower seeds, which had caused a mass formation and obstruction of his small bowel. The patient did not suffer any complications during or after surgery and experienced a rapid recovery. Bezoars should be considered among adolescents presenting with intestinal obstruction, especially among baseball players.

Feasibility and utility of dual-energy chest CTA for preoperative planning in pediatric pulmonary artery reconstruction.

The purpose of this study was to assess in pediatric pulmonary artery (PA) reconstruction candidates the feasibility and added utility of preoperative chest computed tomography angiography (CTA) using dual-energy technique, from which perfused blood volume (PBV)/iodine maps can be generated as a surrogate of pulmonary perfusion. Pediatric PA reconstruction patients were prospectively recruited for a new dose-neutral dual-energy CTA protocol. For each case, the severity of anatomic PA obstruction was graded by two pediatric cardiovascular radiologists in consensus using a modified Qanadli index. PBV maps were qualitatively reviewed and auto-segmented using Siemens syngo.via software. Associations between Qanadli scores and PBV were assessed with Spearman correlation (r) and ROC analysis. Effective radiation doses were estimated from dose-length product and ICRP 103k-factors, using cubic Hermite spline interpolation. 19 patients were recruited with mean (SD) age of 6.0 (5.1), 11 (57.9%) female, 11 (73.7%) anesthetized. Higher QS correlated with lower PBV, both on a whole lung (r = - 0.54, p < 0.001) and lobar (r = - 0.50, p < 0.001) basis. The lung with lowest absolute PBV was predictive of the lung with highest Qanadli score, with AUC of 0.70 (95% CI 0.47-0.93). Qualitatively, PBV maps were heterogeneous, corresponding to multifocal PA stenoses, with decreased iodine content in areas of most severe obstruction. In conclusion, dual-energy chest CTA is feasible for pediatric PA reconstruction candidates. PBV maps show deficits in regions of more severe anatomic obstruction and may serve as a novel biomarker in this population.