Majority Of Perforations Research Articles

Perforation Plate Pit Membrane Remnants in Vessels of Sarraceniaceae: Possible Indicators of Relationship and Ecology

SCHNEIDER, E. AND S. CARLQUIST (Santa Barbara Botanic Garden, 1212 Mission Canyon Road, Santa Barbara, CA 93105). Perforation plate remnants in vessels of Sarraceniaceae: possible indicators of relationships and ecology. J. Torrey Bot. Soc. 131: 1-7. 2004.-All three genera of Sarraceniaceae possess pit membrane remnants in perforations: the abundance of pit membrane remnants parallels the number of bars per perforation plate: most in Heliamphora, fewer in Sarracenia, fewest in Darlingtonia. Heliamphora perforation plates were reported earlier, so Darlingtonia (monotypic) and two species of Sarracenia are considered here. The majority of perforations lack extensive pit membrane remnants, but occasional meshwork-like remnants can be seen at the lateral ends of a number of perforations. Perforations intermediate in size and morphology between perforations and lateral wall pits (pit membranes nearly intact, but containing numerous pores) often occur at upper and lower ends of perforation plates. Pit membrane remnants of this type have been reported in scalariform perforation plates of families thought to be closely related to Sarraceniaceae (Clethraceae, Cyrillaceae, Ericaceae). Species of all four families in which pit membranes are present occur in highly mesic or bog habitats.

Complication rates of colonoscopy in an Australian teaching hospital environment

Quality assurance is an important part of health-care delivery. With the high level of awareness relating to adverse events from medical care, demonstration of a high standard of practice in gastroenterology is desirable. To determine the incidence of significant complications or death within 30 days of an outpatient colonoscopy, and confirm that these are in keeping with international standards. A retrospective audit of linked endoscopy and other hospital databases and selected medical records was carried out, based on reports of 30,463 colonoscopies performed between 5 September 1989 and 31 December 1999 in the three Western Australian public teaching hospitals. A total of 23,508 colonoscopies was performed on an outpatient basis between 5 September 1989 and 31 December 1999. Post-procedural complications identified (and incidence) were: bleeding episodes 49 (0.21%), colonic perforation 23 (0.1%), abdominal pain 22 (0.09%), and others 19 (0.08%). A total of 196 patients died within 30 days of undergoing colonoscopy (0.83%), although only three deaths were attributable to the procedure itself (incidence 0.01%). Two were inpatients at the time of the procedure (outpatient mortality rate 0.004%). The combined incidence of bleeding and perforation was not significantly different between consultant endoscopists and unassisted trainees (incidence 0.21% vs 0.20%, P=0.98). The incidence of bleeding and perforation is similar to other reported series and reflects procedures performed by personnel with a wide range of endoscopic experience. The incidence of complications was not greater for trainees compared with consultant endoscopists. All bleeding episodes and the majority of perforations were associated with a therapeutic intervention. Diagnostic colonoscopy in particular is a very safe procedure.

Endoscopic perforation of the colon: lessons from a 10-year study.

To assess the incidence, clinical features, and management of endoscopic colon perforations in a large number of patients at a major medical teaching center. A retrospective review of medical records of all patients with colon perforations from endoscopy over a 10-yr period. A total of 10,486 colonoscopies were performed over a 10-yr period. There were 20 (0.19%) perforations and two (0.019%) deaths related to colonoscopy and two perforations with no deaths in 49,501 sigmoidoscopies (0.004%). The majority of perforations (65%) occurred in the sigmoid colon. The mean age of the patients was 72 yr (range, 48-87 yr). Multivariate analysis using gender and age showed that female gender was an independent predictor of a higher risk of perforation (p < 0.05). Electrocautery injury (36%) and mechanical injury (32%) from the tip and shaft of the endoscope were the major causes for perforation. Most patients (91%) presented within 48 h of endoscopy. Nine patients (47%) required a surgical resection with primary anastomosis; seven (37%) required a simple closure. The average hospital length of stay was 7.7 +/- 2.8 days. Although trainee endoscopists were involved in only 20% of the colonoscopies performed, eight (40%) perforations occurred while the training fellow was involved in the case. However, this increased risk of perforation with a training fellow was not statistically significant (p = 0.625). Colonoscopy can result in significant morbidity and carries a small risk of death. Sigmoidoscopy has lower risk. The following situations may represent increased risk to colonoscopy patients: unusual difficulty in traversing the sigmoid colon; difficult examinations in female patients, and difficult examinations performed by trainee physicians.

Endoscopic perforation of the colon: lessons from a 10-year study

OBJECTIVES: To assess the incidence, clinical features, and management of endoscopic colon perforations in a large number of patients at a major medical teaching center. METHODS: A retrospective review of medical records of all patients with colon perforations from endoscopy over a 10-yr period. RESULTS: A total of 10,486 colonoscopies were performed over a 10-yr period. There were 20 (0.19%) perforations and two (0.019%) deaths related to colonoscopy and two perforations with no deaths in 49,501 sigmoidoscopies (0.004%). The majority of perforations (65%) occurred in the sigmoid colon. The mean age of the patients was 72 yr (range, 48–87 yr). Multivariate analysis using gender and age showed that female gender was an independent predictor of a higher risk of perforation ( p < 0.05). Electrocautery injury (36%) and mechanical injury (32%) from the tip and shaft of the endoscope were the major causes for perforation. Most patients (91%) presented within 48 h of endoscopy. Nine patients (47%) required a surgical resection with primary anastomosis; seven (37%) required a simple closure. The average hospital length of stay was 7.7 ± 2.8 days. Although trainee endoscopists were involved in only 20% of the colonoscopies performed, eight (40%) perforations occurred while the training fellow was involved in the case. However, this increased risk of perforation with a training fellow was not statistically significant ( p = 0.625). CONCLUSIONS: Colonoscopy can result in significant morbidity and carries a small risk of death. Sigmoidoscopy has lower risk. The following situations may represent increased risk to colonoscopy patients: unusual difficulty in traversing the sigmoid colon; difficult examinations in female patients, and difficult examinations performed by trainee physicians.

Vessels in Roots and Rhizomes of Dryopteris crassirhizoma (Dryopteridaceae) from Heilongjiang Province, China

In the present study, tracheary elements in roots and rhizomes of Dryopteris crassi- rhizoma were observed with scanning electron microscopy (SEM). SEM observation revealed that all tracheary elements in both organs were vessels. These vessel elements have end-wall perfo- ration plates and lateral-wall perforation plates. End-wall perforation plates in roots are more specialized than in rhizomes; they are all scalariform and obliquely positioned in end walls. Most end-wall perforations, especially in the center portion of end-wall perforation plates, lack pit membrane remnants, but pit membrane remnants are relatively abundant in some end-wall per- forations of roots and rhizomes. It is noteworthy that several larger perforations on lateral walls usually are grouped together and form local lateral-wall perforation plates. Wide perforations alternating with narrow perforations characterize vessels of roots and rhizomes. In addition, the majority of perforations in lateral-walls have porose pit membranes or pit membrane remnants, range from intact pit membrane to nearly devoid of pit membrane remnants. Some vessels in rhizomes have several facets in which long scalariform pits have various degrees of porose mem- branes. These vessels contact several other tracheary elements for transferring materials.

Nontraumatic perforation of the small bowel

Small intestinal perforation is an infrequent but often fatal complication of a variety of disorders. Treatment of 76 adults with nontraumatic perforation occurring during a 21 year period was reviewed. The majority of perforations were due to mechanical causes, malignancy, and Crohn's disease. An abdominal mass (53 percent, p < 0.05) and fever (81 percent, p < 0.01) were most frequently documented in patients with Crohn's disease, whereas a positive result on fecal occult blood testing (77 percent, p < 0.025) was common in those with malignant perforations. Otherwise, clinical and laboratory manifestations, including radiographic evidence of free air, were inconstant. The overall mortality rate was 29 percent, with 65 (86 percent) of the patients undergoing operation. Survival was independent of diagnostic delay (p > 0.10). In general, despite various causes and delays in diagnosis, resection and primary anastomosis remains an effective treatment for perforation of the small bowel.

The ENT problems following the Birmingham bombings.

The ENT problems following the Birmingham bombings of 1974 are presented. It is during the positive phase of bomb blast that the tympanic membrane ruptures. Spalling is a likely explanation for the mechanism of rupture of the tympanic membrane specially in large perforations. Tympanic membrane defects involving 80 per cent of the surface area of the drumhead or more persisted, whereas those involving less than 80 per cent healed with conservative treatment. The majority of perforations (81.4 per cent) healed spontaneously, with a three-layered membrane. A month should be allowed for the healing of every 10 per cent loss of the surface area of the drumhead. During surgical repair of persistent perforations, the malleus handle was found to be on a deeper plain than the long process of the incus. Tympanic membrane perforations did not protect the inner ear, the sensorineural deafness producing either a high tone or a flat loss. One in four of the victims seen in the hospital complained of deafness. A patient who suffered blast injuries to the lung also developed cord palsy.