Fish Mouth Research Articles

Digital Pancreatoscopy for Extent of Disease and Guided Biopsies of Downstream Intraductal Papillary Mucinous Neoplasms of the Pancreas

Evaluation of intraductal papillary mucinous neoplasms (IPMNs) remains a challenge, especially in regards to determining malignant potential. Certain high-risk features, such as main duct involvement, presence of mural nodules, and dilation of the main pancreatic duct suggest a higher likelihood of malignancy. We propose that direct visualization with digital pancreatoscopy can aid in risk stratification and assess extent of disease and main duct involvement. A 68 year old female was evaluated at our center for idiopathic recurrent acute pancreatitis, persistent abdominal pain, and unintentional weight loss. Past medical history was notable for recently diagnosed diabetes and prior cholecystectomy for presumed biliary pancreatitis. Liver function tests were normal. An MRI showed dilated main pancreatic duct and enlarged pancreatic head with a main duct stricture. Endoscopic examination demonstrated a fish mouth appearance of the ampulla. EUS showed marked dilated upstream main pancreatic duct with echogenic material filling the downstream duct. An ERCP was performed. Pancreatogram revealed dilated main duct and side branches with a filling defect in the head of the pancreas. A pancreatic sphincterotomy was performed. Pancreatoscopy demonstrated thick fluid and a lesion with fish-egg-appearing growths intermixed with villous fronds limited to the downstream duct in the head of the pancreas. The extent of the pancreatoscopy exam was confirmed with concurrent fluoroscopic examination. Guided biopsies were obtained from the lesion. A 5 Fr by 13 cm pancreatic stent was successfully placed at the end of the procedure. Pathology revealed fragments of low-grade papillary mucinous epithelium. Based on these features, the patient underwent pancreaticoduodenectomy with partial gastrectomy (Whipple). The final surgical pathology revealed IPMN of the pancreas, with low and high grade dysplasia, and foci which were suspicious for microinvasion. She had 13 negative lymph nodes. IPMNs have malignant potential, with risk varying from 15-60% depending on the presence of high risk features. Digital pancreatoscopy is a useful tool for visualizing main duct or mixed-type IPMN and for guiding biopsies in the downstream pancreatic duct. Digital pancreatoscopy can aid in visualizing the extent of tumor which determines the extent of surgical resection. Watch the video: https://goo.gl/fWj683

Failure analysis of the left waterwall tube of boiler furnace in the steam power plant based on thickness changes and pressure

PurposeThe purpose of this paper is to analyze the failure of the left waterwall tube of a boiler furnace in the steam power plant which led to cracks and rupture. Macro visual observation showed the rupture like a fish mouth with slag adhering at the outer surface of the tube. Magnetite as a protective layer was peeled off. Changes in the thickness were analyzed through dimensional measurement. In this research, an analysis to find the cause and determine the fracture mechanism is presented.Design/methodology/approachA physical analysis was performed through visual observation of changes in the thickness. Micro visual testing with a metallography test provided the data required to measure the change of grain size. The mechanical analysis used Von Mises criteria and API 530 standard and provided the pressure limits data.FindingsThe thickness of the tube decreased at the peak curvature of the tube. The smallest thickness at the peak curvature of the tube was 0.108 inches. The working pressure was 40.74 percent from permit limits with Von Mises calculations. The percentage of pressure calculated by the API standard was 48.42 percent from permit limits. Larger crystal grains occurred only in the nearby area of the oxide layer and at the end of the crack tip. It indicated that part of the inner surface had a relatively high temperature and plastic deformation occurred because of the pressure from inside the tube. Combining all these factors ruptured the tube at this location because the cross-section could not hold up the pressure.Originality/valueThe analysis of this discussion focuses on the combined effect of those factors causing the ability to decrease stress being received. It restricts the tube from holding up the stress and furthermore it will generate fractures.

Is there an association between flow diverter fish mouthing and delayed-type hypersensitivity to metals?-a case-control study.

Flow diverters are increasingly used in the treatment of complex and giant intracranial aneurysms. However, they are associated with complications like late aneurysmal rupture. Additionally, flow diverters show focal structural decrease in luminal diameter without any intimal hyperplasia. This resembles a "fish mouth" when viewed en face. In this pilot study, we tested the hypothesis of a possible association between flow diverter fish-mouthing and delayed-type hypersensitivity to its metal constituents. We retrospectively reviewed patient records from our center between May 2010 and November 2015. A total of nine patients had flow diverter fish mouthing. A control group of 25 patients was selected. All study participants underwent prospective patch test to detect hypersensitivity to flow diverter metal constituents. Analysis was performed using logistic regression analysis and Wilcoxon sign rank sum test. Univariate and multivariate analyses were performed to test variables to predict flow diverter fish mouthing. The association between flow diverter fish mouthing and positive patch test was not statistically significant. In multivariate analysis, history of allergy and maximum aneurysm size category was associated with flow diverter fish mouthing. This was further confirmed on Wilcoxon sign rank sum test. The study showed statistically significant association between flow diverter fish mouthing and history of contact allergy and a small aneurysmal size. Further large-scale studies are needed to detect a statistically significant association between flow diverter fish mouthing and patch test. We recommend early and more frequent follow-up imaging in patients with contact allergy to detect flow diverter fish mouthing and its subsequent evolution.

Z Lengthening of Achilles Tendon through Three Longitudinal Mini Incisions

Category: Ankle Introduction/Purpose: Achilles tendon lengthening is considered an integral step in management of major foot and ankle deformities. Many procedures were described. Selective gastrocnemius recession is sometimes useful but is insufficient in severe equinus deformities in which the Achilles tendon itself needs to be lengthened. Z lengthening is sufficient to correct severe equinus deformities but is associated with marked scarring and tension on the wound after correction of the deformity. Percutaneous triple hemisection is an alternative but has the disadvantages of uncontrolled lengthening and risk of rupture in correcting severe deformities. In this study, a new technique of Z lengthening through three small longitudinal incisions to avoid the disadvantages of open Z lengthening and percutaneous triple hemisection was evaluated. Methods: Three longitudinal incisions of 1 to 1.5 cm were done, one over the most distal portion of the Achilles tendon and the second and third incisions over the midportion and the upper end of the tendon. Through the distal incision, the distal part of the tendon was split into two equal halves and the medial half was detached from the calcaneus and sutured. The suture was then passed using an artery forceps to the middle and then the superior incision with gentle pulling to complete the splitting of the two halves. Then, the lateral half was detached from the tendon proximally. Then, the equinus was corrected and the two halves were sutured together through the middle incision with removal of excess tendon. Longitudinal incisions were preferred to avoid fish mouth opening with deformity correction and to leave a chance to convert to open lengthening should posterior capsular release found necessary. Results: Ten patients with severe fixed equinus deformity alone or as an element of more complex foot deformities with clinically and radiologically reasonable ankle joints that can be preserved were included in the study. Three patients had poliomyelitis, two had Charcot-Marie Tooth syndrome, two had cerebral palsy, two had idiopathic equinocavus deformity and one had posttraumatic deformity. The average age was 24 years (range: 14-36). The follow up was at least six months. Equinus deformity was successfully corrected in all patients and the Achilles lengthening procedure was successful in all cases without need to convert to the classic open technique. No wound healing problems were encountered and the extensive scarring associated with open Z lengthening of the Achilles tendon was not encountered. Conclusion: Z lengthening of the Achilles tendon using three mini incisions can be a good option to treat severe equinus deformities with avoiding the complications of open Z lengthening and the percutaneous triple hemisection. It has however a limitation when posterior ankle capsular release is needed, but in such cases, the incisions can be connected converting the procedure to an open Z lengthening. Further studies are needed with larger number of cases and with comparison to other methods of Achilles lengthening.

Critical Failure Analysis of Superheater Tubes of Coal-Based Boiler

This paper highlights a methodology for failure investigation of superheater tubes made of the material T-22 of a coal-based boiler. The process includes visual observation, the identification of sampling locations, the determination of the bulk chemical composition of the base alloy, microstructural investigation using optical microscopy, the exploration of finer structural details using a scanning electron microscope (SEM), the evaluation of hardness over samples obtained from different locations, the fractographic analysis of different failed locations, the X-ray diffraction (XRD) study of corrosion products adhered to inner surfaces, and the determination of the nature of the failure. Within a span of four months, three successive failures of superheater tubes were reported. The tubes were observed to have undergone significant wall thinning. Microscopic examinations using SEM on the failed region and a region some distance away on the as-received tubes were conducted in order to determine the failure mechanism. Layer-wise oxidation corrosion (exfoliation) in the inner surface was observed. Apart from major cracking, a number of nearly straight line crackings were observed in the longitudinal direction of both tubes. Close to cracking/bulging, void formation/de-cohesion of grain boundary indicated creep deformation under service exploitation. The failure mechanism was identified to be a result of excessive oxidation corrosion along the inside wall to reduce thickness, the spheroidization of alloy carbides and the coarsening of precipitate as well as creep void formation along grain boundary leading to inter-granular cracking with material flow near regions covered with thick scales. Moreover, there was a drastic reduction in bulk hardness of alloy and finally ‘thin lip fish mouth’ fractures.

Overheated pipe due to scale: Field failure investigation and finite element analysis

Through a field failure investigation and finite element analysis, a study on overheated pipe due to scale was performed. The field failure samples were collected from primary reformer convection tube made of material based on ASTM A 335 grad P91 modified specification. The type of the object was a fin tube coil. The tube shows rupture with the shape of fish mouth accompanied by bulging. The analysis performed using finite element mimics the actual field conditions. It was discovered that long term overheating due to scale both at the outside and in the inside of the tube hinders the smooth heat transfer process. This consequently leads to poor heat transfer and violates the original design philosophy. Metallurgical evaluation proves this verdict. Furthermore, the finite element analysis also supports the conclusion.

頭蓋内血行再建を安全確実に行うための原則と工夫

Introduction: Although improvements in endovascular treatment have decreased the frequency of bypass surgery, cerebral vascular reconstructions are still important. Many critical points are required to achieve a reliable bypass patency. We describe our experience and techniques for bypass surgery, especially focusing on the superficial temporal artery to middle cerebral artery (STA-MCA) bypass.Materials and methods: Over a period of 5 years, STA-MCA bypass was performed for 42 patients with atherosclerotic internal carotid artery or middle cerebral artery occlusion, or hemodynamic ischemia; 35 patients with moyamoya disease; and 97 patients with complex cerebral aneurysms. Mean occlusion time, bypass patency, hyperperfusion, ischemic complication, and postoperative delayed wound healing were assessed.Results: Within 42 ischemic cases, the mean occlusion time of the STA-MCA procedure was 20 minutes 16 seconds. No ischemic complications due to temporal occlusion occurred. Acute bypass occlusion (occlusion within 2 weeks after operation) occurred in 1 case of STA-MCA for moyamoya disease and 1 case of STA-MCA bypass for a patient with ischemic occlusion. Perioperative ischemic stroke was observed in 4 patients with ischemic occlusion and 1 patient with moyamoya disease.Conclusion: To perform a safe and reliable vascular reconstruction, off-the-job training, a bloodless operative field, selection of an appropriate donor and recipient artery, use of the “fish mouth” method for trimming the donor artery, and an intima-to-intima everting suture are necessary.

Musculoskeletal manifestations in sickle cell anemia

Sickle cell anemia is an inherited hemoglobin disorder characterized by substitution of glutamic acid by valine at the sixth position of the beta globin chain. The sequence of events leads to pain crisis. Ischemia of the tissues resulting from decreased blood flow is believed to occur in pain crisis. Repeated or prolonged sickling causes red cell death in the form of hemolytic anemia. The majority of hospital admissions are due to painful crisis. These patients are at increased risk for both osteomyelitis and infarction of the long bones. Magnetic resonance imaging has been shown to be helpful in the diagnosis of early osteomyelitis and its differentiation from infarction in sickle cell disease patients with acute bone crisis. Others findings include dactylitis, medullary infarcts, diploic space widening, fish mouth vertebrae, and avascular necrosis. We present a case series on the various musculoskeletal manifestations of sickle cell disease.

…and the golden fish of the Oxus

…and the golden fish of the Oxus

Intraductal Papillary Mucinous Neoplasm of the Pancreas Presented with Dual, Gastric, and Duodenal Fish Mouth Sign

Intraductal Papillary Mucinous Neoplasm of the Pancreas Presented with Dual, Gastric, and Duodenal Fish Mouth Sign

Intraductal Papillary Mucinous Neoplasm (IPMN) of Pancreas in Elderly Patient

Figure 1: Enlargement of the pancreas with diffuse heterogeneous low density lesions and possible pancreatic duct dilatation can be noted (red arrow) . Figure 2: Mucin-producing tumor, distal common bile duct and pancrease (fish mouth papilla). Figure 3: Intraductal papillary mucinous neoplasm (IPMN) composed of columnar tumor cells with low-grade dysplasia (HE 100X, HE 200X). Clinical Presentation A 79 year old man complained generalized weakness with epigastric pain about 2 days. On physical examination, he was found to have soft, painful, tenderness over the epigastric region. A contrast enhanced abdomen CT showed enlargement of the pancreas with diffuse heterogeneous low density lesions and possible pancreatic duct dilatation can be noted (Figure 1). ERCP (Endoscopic Retrograde Cholangiopancreatography) reported suspect mucin-producing tumor, distal common bile duct and pancreas (Figure 2). It was taken biopsy by the ERCP and histopathological examination of the biopsies showed intraductal papillary mucinous neoplasm (IPMN) with low-grade dysplasia (Figure 3). IPMN was reported as a “mucin-producing tumor” by Kazuhiko Ohashi in 1982. Clinical symptoms include abdominal pain, nausea and vomiting. Once a doctor has reason to believe that a patient may have an IPMN, he or she can confirm that suspicion using one of a number of imaging techniques. These include computerized tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance cholangiopancreatography (MRCP). These tests will reveal dilatation of the pancreatic duct or one of the branches of the pancreatic duct. IPMN are important because some of them progress to invasive cancer (transform from a benign tumor to a malignant tumor) if they are left untreated. Just as colon polyps can develop into colon cancer if left untreated, so too do some IPMN progress into an invasive pancreatic cancer. IPMN therefore represent an opportunity to treat a pancreatic tumor before it develops into an aggressive, hard-to-treat cancer.

The Valveless Saphenous Vein Graft Technique for EC-IC High-Flow Bypass: Technical Note

Extracranial to intracranial (EC-IC) high-flow bypass using radial artery or saphenous vein (SV) graft has remained vital for complex aneurysms. If an Allen test is positive, the radial artery cannot be harvested because of poor palmer collateral circulation. The valves are thought to be one of causes of SV graft failure. Herein we illustrate the "valveless SV graft technique" as bypass conduits. Between August 2014 and December 2014 at the Department of Neurosurgery at Teishinkai Hospital, 4 patients whose Allen test was positive underwent EC-IC bypass with the valveless SV graft for complex internal carotid artery (ICA) aneurysm. After SV harvesting, we identified the SV valve, cut it, and performed an end-to-end anastomosis using the fish mouth trimming technique. Graft patency was confirmed by computed tomography angiography. We have not encountered any problems related to graft failure, and all valveless SV grafts were patent during the follow-up period (median, 210 days; interquartile range, 93-287 days). The valveless SV graft technique is a useful technique in patients with complex ICA aneurysms who undergo EC-IC high-flow bypass with therapeutic ICA occlusion and whose Allen tests are positive.

Small-scale capture, transport and tank adaptation of live, medium-sized Scombrids using "Tuna Tubes".

The transport of live fish is a crucial step to establish fish culture in captivity, and is especially challenging for species that have not been commonly cultured before, therefore transport and handling methods need to be optimized and tailored. This study describes the use of tuna tubes for small-scale transport of medium-sized pelagic fish from the Scombridae family. Tuna tubes are an array of vertical tubes that hold the fish, while fresh seawater is pumped up the tubes and through the fish mouth and gills, providing oxygen and removing wastes. In this study, 19 fish were captured using rod and line and 42 % of the captured fish were transported alive in the custom-designed tuna tubes to an on-shore holding tank: five mackerel tuna (Euthynnus affinis) and three leaping bonito (Cybiosarda elegans). Out of these, just three (15.8 % of total fish) acclimatized to the tank’s condition. Based on these results, we discuss an improved design of the tuna tubes that has the potential to increase survival rates and enable a simple and low cost method of transporting of live pelagic fish.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1391-y) contains supplementary material, which is available to authorized users.

Analysis of Prey of Mandarin Fish and Large Mouth Bass and Distribution of Fish Population in Lake Paro, Korea

We quantified temporal and spatial changes in the habitat for fish populations, the distribution of mandarin fish(Siniperca scherzeri) and an introduced species, largemouth bass(Micropterus salmoides) in Lake Paro and inflowing streams. The number of fish species identified in Lake Paro and the tributary streams included 10 families, 24 species and 10 families 30 species, respectively. The dominant fish species in Lake Paro were Zacco platypus, Hemibarbus labeo, Squalidus gracilis majimae, S. scherzeri and Tridentiger brevispinis, Z. platypus, Z. koreanus, and S. gracilis majimae in the inflowing streams. Although the habitat segregation for S. scherzeri and M. salmoides occurs, these two species showed the use of the fishes of the family Gobiidae as an important prey item based on IRI analysis. S. scherzeri and M. salmoides preyed mainly on T. brevispinis(67.4 %) and R. brunneus(84.0 %), respectively. The species preyed on by S. scherzeri and M. salmoides were benthic fishes that inhabit shallow water depths around the lake and have little swimming ability.

English

Bacteria diseases are widespread and can be of particular importance in fish farming. Bacteria exist as micro flora in water until certain environmental conditions such as poor water quality occur, which could impose a stress on fish, thereby making them vulnerable to infection, most especially by pathogenic bacteria. This study was carried out to assess and compare the bacteria diversities and population in Clarias gariepinus, Sarotherodon melanotheron and Oreochromis niloticus, in the three grow out ponds of the aquaculture unit of the Department of Marine Science and Lagoon Front of the University of Lagos. It also aims at determining their public health significance. The experiment was carried out between May-September 2013. Water samples were collected from the three grows out ponds in the Department of Marine Sciences and from Lagos lagoon Front of the University of Lagos. In each case, water samples were analysed for the possible indicator organisms of faecal and industrial pollutions such as Escherichia coli, Staphylococcus aureus, Salmonella spp., feacal streptococcus, Vibrio spp., and Clostridium spp. From the result obtained, all the bacteria listed above were first seen as common bacteria in all the samples of water analysed. Further studies (biochemical tests) also reveal bacteria such as Klebsiella spp., Proteus spp., Enterobacter aerogenes, Citrobacter spp. and Pseudomonas aeroginosa. Moreover, the same indicator bacteria seen in water samples were also detected in the different body parts (flesh, mouth, gill and gut) of each of the fish species analysed, both from the Departmental ponds and Lagoon front, except Clostridium perfringes (C. welchii), Vibrio cholera and Salmonella typii which were found in the gut of those fish species from the departmental ponds A-C and in the mouth, gill and gut of the fishes from lagoon front. The population of each of these bacteria was found to be highest in the gut region, followed by the gill, the mouth and least in the flesh. There was no significant difference in the population of each of the bacterial across pond water (P>0.05). Same is the case with each bacteria analysed across body parts of the fish species (skin, mouth, gill and gut) in the Departmental ponds, that is, no significant difference (P>0.05). But, when compared with the lagoon front (both for water and fish samples) the difference was highly significant (P<0.05). None of the population of the bacteria in the ponds exceeds the limit for human consumption. The bacteria load in the lagoon fish (skin, mouth, gill and gut) was higher than the recommended limit for human consumption. Therefore, they are not fit for consumption most especially samples from the mouth, gill and gut, except effective processing treatment is employed before consumption. Due policy should also be taken by the government to curtail the tradition of indiscriminate discharge of untreated effluent into the lagoon. Key words: Bacteria load, Clarias gariepinus, Sarotherodon melanotheron and Oreochromis niloticus, Lagos lagoon.

A Case Report of Ehlers-Danlos and Goldenhar Syndromes

A 23- year-old Thai female presented with skin laxity and delayed wound healing. Physical examination revealed asymmetry of face and hypertelorism of both eyes. Microtia of right ear, right periauricular pit, multiple fish mouth and cigarette paper scars were found. There were hyperextension of elbows and knees, 10 degrees and 15 degrees, respectively, Passive hyperflexion of the 5th finger more than 90 degrees was demonstrated. According to Villefranche’s criteria, she had all major criteria for the diagnosis of Ehlers-Danlos syndrome, classic type. She also had hemifacial microsomia and ocular abnormalities that were compatible with Goldenhar syndrome. To our knowledge, a case of Ehlers-Danlos syndrome associated with Goldenhar syndrome has never been reported. This article presents the case of co-incidence of these two rare syndromes.

Harlequin ichthyosis: The third babies with harlequin ichthyosis in a family

Harlequin ichthyosis: The third babies with harlequin ichthyosis in a family

Sneaky fish use suction for stealthy hunting

Imagine you are a small crustacean. You might be minding your own business, until suddenly you feel it: a wave of water signaling the approach of a predatory fish. Luckily, your escape response is incredibly fast. All you need is that brief warning wave to scoot away in the nick of time. Furthermore, your fishy pursuer probably uses a suction-based strike, and suction feeding requires a fish to be very close to its prey for success. Given the rapid approach of the fish, and the comparatively huge wave it must send toward the copepod, it seems remarkable that fish can catch anything at all. Yet many fish survive by suction feeding, and they are remarkably successful predators. This raises an interesting question: how can fish ever get close enough to prey for suction feeding while avoiding detection?The wave produced by the front of a swimming fish is called a bow wave, and it should provide ample stimulation to frighten away prey. And somehow, the prey doesn't escape. They hardly seem to notice the bow wave at all. Fish must have some way of sneaking up on small prey that does not elicit an escape response.Brad Gemmel and his colleagues at the University of Texas suspected that fish might be able to actively avoid detection by manipulating their own bow wave. The group of researchers filmed predatory interactions between zebrafish and copepods using tomographic particle image velocimetry, a technique to visualize fluid movement in a 3-D volume. By measuring the bow wave and fluid strain between the fish and the prey, they hoped to find some clue as to the fish's apparent stealth.Surprisingly, the researchers noticed that during predatory strikes, the fluid forces from the bow wave on the prey were much smaller than expected. However, a normally swimming fish that was not approaching prey had a much stronger bow wave. In fact, somehow, the feeding fishes were targeting the change in their bow wave. The fluid strain was weakest in the plane of the prey. But how were the fish doing it? Gemmel and colleagues decided to look for some change in behavior just before the suction strike that did not appear during normal swimming and found there was one chief difference in the fish between predatory and non-predatory swimming. When a fish approached a copepod, it opened its mouth just slightly before the actual feeding strike. During routine swimming, the fish's mouth did not open.By opening its mouth ever so slightly, the zebrafish created suction: sucking its own bow wave in to hide it from the copepod. This hydrodynamic stealth has never been observed before. It's a clever co-option of a mechanism that was already being used for feeding – and given the prevalence of suction feeding among fishes, hydrodynamic stealth may be more common than anyone expected.

Discussion of “Hydraulic Principles of the 2,268-Year-Old Dujiangyan Project in China” by Shanghong Zhang, Yujun Yi, Yan Liu, and Xingkui Wang

Discussion of “Hydraulic Principles of the 2,268-Year-Old Dujiangyan Project in China” by Shanghong Zhang, Yujun Yi, Yan Liu, and Xingkui Wang

Closure to “Hydraulic Principles of the 2,268-Year-Old Dujiangyan Project in China” by Shanghong Zhang, Yujun Yi, Yan Liu, and Xingkui Wang

Closure to “Hydraulic Principles of the 2,268-Year-Old Dujiangyan Project in China” by Shanghong Zhang, Yujun Yi, Yan Liu, and Xingkui Wang