Perforation Group Research Articles

Prediction of Intestinal Perforation by Daily Radiographic Findings in Very Low Birth Weight Infants With Meconium Ileus

BackgroundThis study aimed to develop a prediction model for intestinal perforation from meconium ileus (MI) based on findings from plain X-ray images. MethodsVery low birth weight (VLBW) infants with MI hospitalized in two tertiary centers between 2011 and 2022 were included in this study. We retrospectively reviewed clinical parameters and assessed plain X-ray images from 0 to 5 days of age. The standardized transverse diameter of intestinal gas (STDI) was calculated by dividing the largest diameter of the intestinal gas by the distance from the upper edge of L1 to the lower edge of L4. We then compared the STDI of patients with and without intestinal perforation. ResultsAmong 81 VLBW infants with MI, intestinal perforation occurred in 6 (7 %). Among known risk factors, significant differences were observed between the two groups regarding pregnancy-induced hypertension (p = 0.03), weeks of gestation (p < 0.01), birthweight (p = 0.02), and indomethacin administration (p < 0.01). The mortality rate was higher in the perforation group (33 %) than in the non-perforation group (3 %) (p = 0.021). There were significant differences between the perforated and non-perforated groups regarding STDI except at 0 days of age. The positive and negative predictive cut-off values of STDI were respectively 0.08 and 0.93 on day 0, 0.30 and 1.00 on day 1, 0.33 and 0.97 on day 2, 0.33 and 1.00 on day 3, 0.29 and 1.00 on day 4, and 0.33 and 0.98 on day 5, respectively. ConclusionsOur novel prediction model, using STDI, predicted intestinal perforation in VLBW infants with MI. Levels of EvidenceLevel Ⅲ

Comparison of Short-term Outcomes Between Schneiderian Membrane Perforation and Non-perforation Patients after Simultaneous External Elevation and Implantation.

To compare short-term outcomes between membrane perforation and non-perforation patients after simultaneous external elevation with implantation. In this retrospective observational study, 60 maxillary posterior tooth-loss patients with an insufficient amount of residual bone for direct implantation were enrolled. All patients underwent simultaneous external elevation and implantation, and were divided into perforation and non-perforation groups according to the postoperative Schneiderian membrane status. Of the 60 patients, 30 cases (35 implants) were assigned to the membrane perforation group, and 30 (44 implants) were allocated to the non-perforation group. There were no statistically significant differences in baseline data (p>0.05). In the perforation group, the mean vertical bone gain (VBG) at 6 and 12 months was 6.02±2.14 mm and 5.37±2.22 mm, resp., compared to 6.78±2.59 mm and 6.42±2.64 mm in the non-perforation group, resp. (both p>0.05). Preoperative median Schneiderian membrane thickness (SMT) in the perforation group was 0.77 mm, which was statistically significantly thinner than the 1.24 mm measure in the non-perforation group (p< 0.05); however, there was no statistically significant difference between two groups at 12 months postoperatively (0.80 mm vs 1.25 mm, p>0.05). The marginal bone loss at 1 year after implant restoration in the perforation and non-perforation groups was 0.16±0.10 mm and 0.22±0.12 mm, resp. During postoperative follow-up, the implant survival rate was 100% in the two groups. The incidence of postoperative nasal bleeding in the perforation group was statistically significantly higher compared with that in the non-perforation group (50% vs 16.7%, p<0.05), whereas no statistically significant differences were observed in the incidence of facial swelling, intraoral bleeding, wound dehiscence and acute/chronic sinusitis between the two groups (p>0.05). Schneiderian membrane perforation after simultaneous external elevation and implantation do not adversely affect short-term clinical and radiographic outcomes.

Outcomes of endoscopic modified cartilage-perichondrium tympanoplasty on different sized perforations

ObjectivesTo evaluate the anatomic and functional outcomes of type1 tympanoplasty with endoscopic modified butterfly cartilage-perichondrium technique. MethodsIn our modification, perichondrium was elevated circumferentially till the attached part of the composite graft was approximately same size and shape of the perforation, cartilage was trimmed based on the perforation but 0.5 mm larger. Cartilage portion of the graft was placed medial to the edge of the perforation, then perichondrium was rolled out and draped on the circumferential raw surface of remaining tympanic membrane around. ResultsAt 4 months postop, the anatomic integrity rate of the tympanic membrane perforation for small & medium sized perforation and large sized perforation group were 100 % and 94 % (p > 0.05). For the small & medium perforation group, the mean pre and 4 months postop ACs were 30 ± 8 dB and 18 ± 6.4 dB (p < 0.01). The mean pre and 4 months postop ABGs were 19 ± 11 dB and 9 ± 3 dB (p < 0.01). For the large perforation group, the mean pre and 4 months postop ACs were 43 ± 12.5 dB and 21.5 ± 7 dB (p < 0.01). The mean pre and 4 months postop ABGs were 34 ± 8.5 dB and 12.5 ± 6 dB (p < 0.01). The differences of mean 4 months postop ACs and mean 4 months postop ABGs between the two groups were not significant (p > 0.05). ConclusionsCompared to the conventional inlay butterfly cartilage tympanoplasty technique, large or marginal perforations can be sealed more securely by this modification.

Radiographic outcomes of lateral sinus floor elevation at sites without perforations and sites with perforations managed with a resorbable membrane: A retrospective study.

To evaluate the radiographic outcomes of lateral sinus floor elevation with simultaneous implant placement at sites without sinus membrane perforation (SMP) and sites with SMP managed with a resorbable membrane. One hundred and thirty-nine patients and 170 implants (56 perforation, 114 non-perforation) were included. Cone-beam computed tomography (CBCT) images were taken before surgery (T0), immediately after surgery (T1) and 6 months after surgery (T2). Post-operative augmentation parameters, including endo-sinus bone gain (ESBG) along the implant axis, mean new bone height (NBH) surrounding the implant and augmentation volume (AV), were measured at T1 and T2. At T1, there were no significant differences in ESBG, NBH and AV between the two groups. At T2, although ESBG did not significantly differ between the two groups, NBH (8.50 ± 1.99 mm vs. 9.99 ± 2.52 mm, p = .039) and AV (519.37 ± 258.38 mm3 vs. 700.99 ± 346.53 mm3, p < .001) were significantly lower in the perforation group. The shrinkage of graft material from T1 to T2, including ΔESBG (p = .002), ΔNBH (p < .001) and ΔAV (p < .001), was higher in the perforation group. SMP during LSFE with simultaneous implant placement is associated with greater resorption of the grafted area at a 6-month follow-up.

Elucidating the Benefit of Perforated vs Non-Perforated Membranes in Guided Bone Regeneration: An in Vivo Histologic Evaluation and Histomorphometric Analysis.

Non-perforated Polytetrafluoroethylene (PTFE) membranes are effectively utilized in guided bone regeneration (GBR) but may hinder cell migration due to limited interaction with the periosteum. This study compared bone regeneration using occlusive or perforated membranes combined with acellular collagen sponge (ACS) and recombinant human bone morphogenic protein-2 (rhBMP-2) in a canine mandibular model. Male beagle dogs (n&#61;3) received two mandibular defects each to compare ACS/rhBMP-2 with experimental (perforated group) and control (non-perforated group) membranes (n&#61;3 defects/group). Tissue healing was assessed histomorphologically, histomorphometrically and through volumetric reconstruction using microcomputed tomography. The perforated group showed increased bone formation and reduced soft tissue formation compared to the non-perforated group. For the primary outcome, histomorphometric analysis revealed significantly greater total regenerated bone in the perforated group (67.08 ± 6.86%) relative to the nonperforated group (25.18 ± 22.44%) (p &#61; 0.036). Perforated membranes had less soft tissue infiltration (32.91 ± 6.86%) compared to non-perforated membranes (74.82 ± 22.44%) (p &#61; 0.036). The increased permeability of membranes in the perforated group potentially enabled periosteal precursor cells greater accessibility to rhBMP-2. The availability may have accelerated their differentiation into mature bone-forming cells, contributing to the stimulation of new bone production, relative to the non-perforated group.

Inhibition of Panx1 reduces neuroinflammatory response and alleviates brain damage in septic mice

Objective: This study mainly investigates whether Pannexin 1 protein (i.e. Panx1) plays a role in the progression of brain injury in sepsis mice and its potential mechanisms. Methods: A total of 45 clean grade adult male C57BL/6 healthy mice were selected and divided into three groups using a random number table method, namely the sham group, the cecal ligation perforation (CLP) group, and the CBX pretreatment plus cecal ligation perforation (CBX+CLP) group, with 15 mice in each group. Excluding the Sham group, the remaining two groups of study mice were used to prepare sepsis brain injury models using the CLP method. The CBX+CLP group was injected into the lateral ventricles of both sides of the mouse half an hour before the modeling process, with a total amount of 1 μL CBX, which was injected into the bilateral lateral ventricles of the other two groups of mice with the same dose of physiological saline solution. 24 hours after the completion of modeling, three groups of mice were evaluated for neurological behavior. Subsequently, all mice were euthanized. After the cardiac perfusion phase, brain tissue of the mice was taken to observe the pathological damage of the hippocampal tissue. The effective content of IL-1β and TNF‐α in the mouse's hippocampal tissue was measured, and the expression of Panx1 protein, Caspase-1, NLRP3 protein, as well as NLRP3, Panx1, Caspase-1, TNF‐α, IL-1β were measured the mRNA of corresponds to its expression status. Results: Compared with Sham group mice, the neurobehavioral score of CLP group mice significantly decreased, and the pathological damage degree of hippocampal neurons in mice was significant. The expression levels of inflammatory factors IL-1β and TNF‐α were increased, and the corresponding expression levels of Panx1, NLRP3, Caspase-1 proteins and mRNA were increased. The mRNA expression levels of inflammatory factors IL-1β and TNF were also increased (P&lt;0 05), compared to the CLP group mice, the CBX+CLP group mice showed an increase in neurobehavioral scores, a reduction in pathological damage to hippocampal tissue, a decrease in the expression of inflammatory factors IL-1β and TNF‐α, a decrease in the expression levels of NLRP3, Panx1, Caspase-1 proteins, and corresponding mRNA, and a corresponding decrease in the mRNA expression of the two inflammatory factors (P&lt;0 05). Conclusion: Inhibiting Panx1 can reduce the degree of neural inflammatory response, thereby improving brain damage in sepsis mice, which may be related to the limited activation of NLRP3 inflammasomes.

Impact of osteosclerosis on cervical pedicle screw insertion using preoperative CT-based navigation.

Preoperative computed tomography (CT)-based navigation is used for cervical pedicle screw (CPS) insertion to mitigate the risk of spinal cord and vertebral artery injury. In vertebrae with osteosclerosis due to degeneration or other factors, however, probing may not proceed easily, with difficulty creating the CPS insertion hole. This study investigated the impact of osteosclerosis on the accuracy of CPS insertion. A total of 138 patients with CPS inserted at the C3-C7 level using preoperative CT navigation were retrospectively analyzed. Pre- and postoperative CT was employed to investigate screw position and Hounsfield unit (HU) values at the lateral mass to evaluate the degree of osteosclerosis in the CPS insertion pathway. Among 561 CPS insertions, the Grade 3 perforation rate was 1.8%, and the Grade 2 or higher perforation rate was 8.0%. When comparing insertions with and without CPS perforation, HU values were significantly higher in the perforation group (578 ± 191 vs. 318 ± 191, p < 0.01). The frequency of CPS insertion into the mid-cervical spine was also significantly greater in the perforation group (68.9% vs. 62.5%, p < 0.01). Logistic regression analysis revealed that a high HU value at the lateral mass (odds ratio 1.09, 95% confidence interval: 1.07-1.11, p < 0.01) was a significant independent factor associated with CPS deviation. The screw perforation rate of Grade 2 or higher in CPS insertion using preoperative CT-based navigation was 8.0%. Since osteosclerosis was an independent factor related to CPS deviation, additional care may be required during insertion into affected vertebrae.

Diagnostic value of identifying location and amount of free gas in the abdominal cavity by multidetector computed tomography in patients with acute gastrointestinal perforation

Objective: To evaluate the relationships between the location and extent of diffusion of free intraperitoneal air by multi-slice spiral CT (MSCT) and between the location and size of acute gastrointestinal perforation. Methods: This was a descriptive case series. We examined abdominal CT images of 33 patients who were treated for intraoperatively confirmed gastrointestinal perforation (excluding appendiceal perforation) in the Department of General Surgery, Nanfang Hospital between January and September 2022. We identified five locations of intraperitoneal air: the subphrenic space, hepatic portal space, mid-abdominal wall, mesenteric space, and pelvic cavity. We allocated the 33 patients to an upper gastrointestinal perforation (n=23) and lower gastrointestinal perforation group (n=10) base on intraoperative findings and analyzed the relationships between the locations of free gas and of gastrointestinal perforation. Additionally, we established two models for analyzing the extent of diffusion of free gas in the abdominal cavity and constructed receiver operating characteristic (ROC) curves to analyze the relationships between the two models and the size of the gastrointestinal perforation. Results: In the upper gastrointestinal perforation group, free gas was located around the hepatic portal area in 91.3% (21/23) of patients: this is a significantly greater proportion than that found in the lower gastrointestinal perforation group (5/10) (P=0.016). In contrast, free gas was located in the mesenteric interspace in 8/10 patients in the lower gastrointestinal perforation group; this is a significantly greater proportion than was found in the upper gastrointestinal perforation group (8.7%, 2/23) (P<0.010). The sensitivity of diagnosis of upper gastrointestinal perforation base on the presence of hepatic portal free gas was 84.8% and the specificity 71.4%. Further, the sensitivity of diagnosis of lower gastrointestinal perforation base on the presence of mesenteric interspace free gas was 80.0% and the specificity 91.3%. The rates of presence of free gas in the subdiaphragmatic area, mid-abdominal wall, and pelvic cavity did not differ significantly between the two groups (all P>0.05). Receiver operating characteristic curves showed that when free gas was present in four or more of the studied locations in the abdominal cavity, the optimal cutoff for perforation diameter was 2 cm, the corresponding sensitivity 66.7%, and the specificity 100%, suggesting that abdominal free gas diffuses extensively when the diameter of the perforation is >2 cm. Another model revealed that when free gas is present in three or more of the studied locations, the optimal cutoff for perforation diameter is 1 cm, corresponding to a sensitivity of 91.7% and specificity of 76.2%; suggesting that free gas is relatively confined in the abdominal cavity when the diameter of the perforation is <1 cm. Conclusion: Identifying which of five locations in the abdominal cavity contains free intraperitoneal air by examining MSCT images can be used to assist in the diagnosis of the location and size of acute gastrointestinal perforations.

Incidence and clinical outcomes of perforations during mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke: A retrospective, multicenter, and multinational study.

Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p < 0.001; TICI 2b-3: 56.5% vs 88.3%, p < 0.001). Functional outcomes were also worse in the perforation group (mRS 0-1 at 3 months: 22.7% vs 36.6%, p = 0.031; mRS 0-2 at 3 months: 28.8% vs 53.9%, p < 0.001). Mortality was higher in the perforation group (30.3% vs 16.8%, p = 0.008). This study reveals that while the occurrence of vessel perforation in MT for AIS due to MeVO is relatively rare, it is associated with poor functional outcomes and higher mortality. The findings highlight the need for increased caution and specialized training in performing MT for MeVO. Further prospective research is required for risk mitigation strategies.

Investigation of the effects of in ovo taurine injection on hatching characteristics and stress reduction potential.

In ovo application is the process of administering some nutrients or components into the egg. The main purpose of this application is to ensure that some nutrients are provided to chicks with a short incubation period. Few studies were conducted with taurine in fertile eggs; especially, no observation of hatchability and chick quality has been found. In addition, taurine has an anti-stress impact that fights oxidative factors. To assess the hatchability and chick quality after in ovo taurine administration. To determine the stress that may occur as a result of in ovo application and whether taurine has a stress-reducing effect. A total of 1200 fertile eggs from a 34-week-old broiler breeder (Ross 308) flock were categorized into 4 groups with 75 eggs per replicate: control (uninjected), taurine group (0.30mL dissolved taurine in distilled water), sham control (sterile distilled water) and perforation (eggs perforated and then waxed). On day 14 of incubation, an in ovo injection was administered to the albumen. Data on hatching parameters and hepatic HSP70 levels were obtained using relevant formulas and western blotting, respectively. Control chicks exhibited higher hatchability than other groups, with the taurine group showing the lowest hatchability. The HSP70 levels were the highest in the perforation group compared to the control group. An increase of 21.37% in the taurine group and 83.45% in the sham control group was observed compared to the control group. The findings suggest that in ovo application may induce increased stress, whereas taurine may have positive effects in mitigating the stress caused by in ovo application.

Incidence and Outcome of Iatrogenic Gallbladder Perforation during Laparoscopic Cholecystectomy in a Tertiary Care Hospital

Introduction: in developing countries, patients getting admitted into hospital is influenced by gallbladder stone. In this study, the incidence and outcome of iatrogenic gallbladder perforation during laparoscopic cholecystectomy was observed and studied for further development in this sector in a tertiary care hospital. Aim of the study: The aim of this study was to find out the incidence and outcome of iatrogenic gallbladder perforation during laparoscopic cholecystectomy. Methods: This prospective observational study was conducted in Department of Surgery, Combined Military Hospital (CMH) Dhaka, Bangladesh during the period from June 2018 to November 2018. This study had institutional review board approval and informed consent for 100 patients age range 31-70 years (mean 50.3±10.6) in gallbladder perforation group and in no perforation group the range was 25 to 62 years (mean 47.9±12.3). The patients went through laparoscopic cholecystectomy through four port and gallbladder was removed through hepigastric port. The ultrasonographic report of all patients were collected. Result: In the present study, majority 86 patients were found normal body weight (BMI 18.5-24.9 kg/m2) but female patients were high in number of affected list, 14(73.7%) in gallbladder perforation group and 56(69.1%) in no perforation group. A single stone is mainly found in no perforation group which is 32(39.5%). Multiple stone is found less in both of the groups respectively. Staying in the hospital was also higher in gallbladder group in comparison with no perforation group. Conclusion: According to the study, perforation in gallbladder due to laparoscopic cholecystectomy is not deniable (19%). This can result in peroperative pain and more stay in hospital.

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma.

Primary congenital glaucoma causes vision loss if intraocular pressure is uncontrolled. Nonpenetrating deep sclerectomy is effective in treating primary congenital glaucoma. However, the effects of inadvertent trabeculodescemetic window perforation remain unclear. This retrospective cohort study included patients with primary congenital glaucoma who underwent nonpenetrating deep sclerectomy between 2014 and 2021. The perforation group had intraoperative trabeculodescemetic window perforations; the non-perforation group did not. The primary outcome was intraocular pressure between the groups over 15months. The secondary outcomes included surgical success and complications. The study included 74 eyes of 44 patients. The cohort comprised 31 perforated and 43 non-perforated eyes. Both groups showed significant intraocular pressure reduction without significant between-group differences in complete (68 vs. 77%), qualified (19 vs. 9%), or failed (13 vs. 14%) treatments. The median intraocular pressure decreased from 39 to 14mmHg in the perforation group and 35 to 12mmHg in the non-perforation group. Of the 74 treated eyes, 68 (92%) showed no complications. An inadvertent trabeculodescemetic window perforation during nonpenetrating deep sclerectomy for primary congenital glaucoma did not significantly affect intraocular pressure outcomes compared to non-perforated cases over 15months. Nonpenetrating deep sclerectomy reduced intraocular pressure regardless of intraoperative perforation in patients with primary congenital glaucoma. Perforation of the trabeculodescemetic window was associated with a low incidence of postoperative complications.

The evaluation of nasolacrimal duct injury in Le Fort I osteotomy patients.

Although Le Fort I surgeries are safe and successful procedures; nasolacrimal duct injuries may be observed due to these surgeries. The study aimed to investigate the prevalence of nasolacrimal duct injury in Le Fort I osteotomy patients. The authors conducted a retrospective cohort study consisting of patients who underwent Le Fort I osteotomies between 2017 and 2021 in the Erciyes University Faculty of Dentistry. The primary predictor variables were the distance of the nasolacrimal canal to the outer cortex of the maxilla and the nasal floor, as well as the superior-inferior level of the superiorly positioned screw inserted in the maxilla aperture region relative to the nasolacrimal canal. The outcome variable was the presence of a nasolacrimal duct injury. Mann Whitney U test was used for quantitative variables between the two groups. A Pearson chi-squared analysis was used to compare categorical data. A p-value <0.05 was considered statistically significant. A total of 290 nasolacrimal canals were evaluated in 145 patients, 87 females, and 58 males. The mean age was 23.47± 6.67. There was a statistically significant relationship between screw level and nasolacrimal canal perforation (p<0,001). The distance between the most anterior border of the nasolacrimal canal and the outer cortical of the maxilla was significantly less in the perforation group (p<0,001). The fixation screw was significantly closer to the nasolacrimal canal in the perforation group (p<0,001). In Le Fort I surgery, nasolacrimal duct injury may occur during screw fixation to the aperture region. Superiorly positioned fixation screws in the aperture region may damage the nasolacrimal canal. In patients where the nasolacrimal canal is close to the outer cortex, care should be taken when applying the fixation screws to the aperture region to avoid damaging the canal.

The role of biomarkers in predicting perforated cholecystitis cases: Can the c-reactive protein albumin ratio be a guide?

Gallbladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. Despite advancements in imaging technology and biochemical analysis, perforations are still diagnosed intraoperatively in some cases. This situation has revealed the need for new markers in the diagnosis of perforation. In this study, we aimed to analyze the role of biomarkers in the diagnosis of perforated cholecystitis cases. In this retrospective study, blood samples (white blood cells (WBC), hemoglobin, platelet count, C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), urea, creatinine, glucose, amylase, lipase, aspartate ami-notransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin) were analyzed in patients who were diagnosed with acute cholecystitis in the emergency department. One hundred seventy patients were divided into two groups according to the presence or absence of gallbladder perforation. Sixty-three (37.1%) patients had perforation. Transition from laparoscopy to open operation, intensive care unit admission, length of hospital stay, and mortality were higher in the perforated group compared to the non-perforated group. When we analyzed the patients according to laboratory findings, there was a difference in WBC, NLR, CRP, albumin, and CAR parameters in the perforation group. In regression analysis, CRP and CAR performed better. Our study showed that CRP and CAR may be diagnostic biomarkers with low specificity and sensitivity in predicting GBP in patients with acute cholecystitis. This marker is a low-cost and easily accessible parameter that may help clinicians make an early diagnosis and plan appropriate treatment for this condition with high morbidity and mortality.

Comparative study of imaging features in uncomplicated and complicated acute appendicitis.

Acute appendicitis is a common cause of acute abdominal pain necessitating surgical intervention. While the traditional treatment has been urgent appendectomy, recent studies suggest that an antibiotics-first approach can be safe for uncomplicated cases. Classifying appendicitis into uncomplicated and complicated categories is crucial for guiding treatment decisions and predicting patient outcomes. This study aims to evaluate the distinct imaging findings associated with uncomplicated appendicitis and its complicated subtypes-phlegmonous, gangrenous, and perforated appendicitis-to aid in differential diagnosis. This retrospective observational study was conducted from January 2014 to December 2023 and included 1,250 patients (492 women, 758 men) who underwent an appendectomy with available pathology results. After excluding 56 patients with normal pathology, 52 with non-appendicitis pathologies, and 48 with inaccessible computed tomography (CT) images, 1,094 patients were analyzed. CT images were evaluated for appendiceal diameter, wall thickness, cecal wall thickness, periappendiceal fat stranding, effusion, lymphadenopathy, intraluminal and free periappendiceal air, mucosal hyperenhancement, and the presence of appendicolith. The diameter of the appendix, along with the presence of periappendiceal air, effusion, and intraluminal appendicolith, were significantly higher in the perforated appendicitis group compared to other groups (p<0.05). Periappendiceal fat stranding, evaluated as a binary variable, did not show significant differences among the groups. Appendiceal wall thickness was higher in the perforated group and lower in the non-perforated gangrenous group compared to the uncomplicated group (p<0.05). No significant correlation was found for mucosal hyperenhancement between the appendicitis subgroups. Intraluminal air, though normal in a healthy appendix, was a specific predictor of complicated appendicitis when combined with other findings. This study provides a detailed analysis of distinct imaging findings associated with uncomplicated and complicated appendicitis. Key differentiators such as appendiceal diameter, periappendiceal air, effusion, and intraluminal appendicolith are crucial for accurate diagnosis. The findings highlight the importance of these parameters in distinguishing various types of appendicitis, offering valuable insights for clinical practice. Future prospective studies and advanced imaging techniques are needed to validate these findings and enhance the diagnosis and management of acute appendicitis and its complications.

A study on the diagnostic and predictive value of neutrophil-to-lymphocyte ratio for early perforation in acute appendicitis

Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) for early perforation of the appendix in patients with acute appendicitis (AA). Methods Two hundred and 80eighty patients with the first episode of AA within 48 hours and not yet treated with antibiotics were included in this study retrospectively; divided into two groups by the presence or absence of perforation. The clinical data, traditional inflammatory indexes, and NLR were compared between the two groups. The predictive value of inflammatory indexes on the early appendiceal perforation was explored. Results Patients in the perforated group were older, with higher blood WBC, NEU% and NLR, lower LYM% and PLT, higher serum CRP and PCT, and longer hospitalization time. Multivariate regression analysis revealed that high WBC, NEU%, NLR, CRP, PCT, and low LYM% were independent risk factors for early appendiceal perforation. The ROC curves revealed that the predictive value of WBC, CRP, and PCT for early appendiceal perforation was low. NLR, LYM%, and NEU% had a higher predictive value, with AUC values of 0.947, 0.928, and 0.920, respectively. NLR had the highest predictive value. The diagnostic Cut-off value of NLR is 10.83 with a sensitivity of 0.963, and a specificity of 0.850. Conclusion NLR can be used as an effective and sensitive predictive maker of early appendiceal perforation in AA patients. It is easy to generate from existing routine clinical laboratory testing for AA and can be included in complete blood count (CBC) as a routine or add-on value.

Risk prediction of CISS classification in endovascular treatment of basilar artery stenosis

ObjectiveTo investigate the incidence of ischemic stroke complications after endovascular treatment for basilar artery stenosis used preoperative high-resolution magnetic resonance vascular wall imaging (HRMR/VWI) and diffusion-weighted imaging (DWI). MethodsThe clinical data of 47 patients with severe symptomatic basilar artery stenosis (stenosis rate ≥70 %) treated with endovascular therapy at the Neuro-interventional Center from December 2017 to December 2021 were retrospectively analyzed. High-resolution magnetic resonance angiography (HRMR VWI) and DWI were used to evaluate the location of atherosclerotic plaque at basilar artery stenosis and the distribution of cerebral infarction lesions in all patients before surgery.According to the CISS classification system for ischemic stroke, patients were divided into a perforation group and a hypoperfusion group, and the general situation, plaque distribution, and incidence of ischemic stroke complications 7 days after endovascular treatment in the two groups were analyzed. ResultsThere was no significant difference in baseline data between the two groups. After 7 days of intravascular treatment, the incidence of ischemic stroke was higher in the perforation group (20.0 %) than in the hypoperfusion group (0.0 %), and the difference was statistically significant (P = 0.027). A significant association was found between the perforation group and the hypoperfusion group for the incidence of ischemic stroke at 7 days (P = 0.003, OR = 2.347; 95 % CI = 2.056–4.268). There were a higher proportion of ventral plaques (74.1 %) and a lower proportion of dorsal plaques (33.3 %) in the hypoperfusion group, which were 15.0 % and 90.0 % in the perforation group, respectively (χ2 = 16.045, P < 0.001; χ2 = 15.092, P < 0.001). There was no significant difference in the proportion of left and right plaques between the two groups. ConclusionsThe risk of ischemic stroke is greater in patients with perforator artery obstruction undergoing endovascular therapy, and lower in patients with hypoperfusion/embolus removal.

Clinical characteristics and risk factors of IgA vasculitis with intussusception and intestinal perforation.

Intussusception is the most common surgical complication of IgA vasculitis (IgAV), and intestinal perforation is usually associated with intussusception. If they are not recognised and treated in a timely manner, serious consequences may occur. The objective is to summarise the clinical features of IgAV complicated by intussusception and intestinal perforation and explore its risk factors. The clinical data of 32 patients with IgAV complicated by surgical complications (25 cases of intussusception and 7 cases of intestinal perforation) were retrospectively analysed. A total of 160 IgAV children with gastrointestinal (GI) involvement but without surgical complications were randomly selected as a control group. Binary logistic regression analysis was performed to explore the risk factors for IgAV with intussusception and intestinal perforation. Compared with the intussusception group, the intestinal perforation group had a significantly higher number of patients with GI symptoms prior to skin purpura and GI bleeding, a significantly higher number of days of abdominal pain, a significantly higher Wong-Baker score, and a significantly higher white blood cell count. Multivariate logistic regression analysis indicated that age ≤7 years, GI symptoms prior to skin purpura, abdominal pain intensity (Wong-Baker scale) and timing of glucocorticoid treatment were independent risk factors of IgAV with intussusception and intestinal perforation. Age less than 7 years, severe abdominal pain, and GI symptoms prior to skin purpura were risk factors for IgAV with intussusception and intestinal perforation. Early use of glucocorticoids may prevent intussusception and intestinal perforation.

ANALYSIS OF MEDIUM-TERM RESULTS ACHIEVED AFTER MICROFRACTURES AND PERFORATIONS (DRILLING) IN LOCALIZED CHONDRAL LESIONS IN THE KNEE JOINT

Introduction: The main advantage of perforative techniques is their atraumatic, non-invasiveness and possibly being done under arthroscopic control. Purpose: This study aims to compare two methods of operative techniques in the treatment of chondral lesions of the knee. Materials and methods: The clinical study included 237 symptomatic patients with chondral defects from the period of 2010 – 2018. Patients were divided into 2 groups. The first group included 49 (32.11%) patients with arthroscopic micro-fractures. The second group included 54 (35.49%) patients with arthroscopic subchondral perforation (drilling). The term of follow-up was 36 months. Each patient had at least 4 documented follow-up visits. Results: Results from grading scales – Lysholm, KOS, MRI – scales, as well as our own scale for evaluating knee function (PS) scale, were documented in each patient's separate file. The average pre-operative Lysholm score was 41.5 ± 6.6 in the microfracture group and 43.0 ± 5.6 in the perforation group. At the 36th-month average, Lysholm's score increased to 86.9 ± 7.3 in the microfracture group and to 86.1 ± 6.6 in the perforation group. During the study, it was also found that a correlation exists between the received results and the age of the patient, the size of the chondral defect, and the tracking period. Conclusion: The effectiveness of osteoperforative techniques relies on many factors: the age of the patient, the size of the defect, and the tracking period. In the end, mesenchymal stimulation of chondrogenesis results in positive mid-term results in patients with small-sized chondral lesion.

In Vitro Comparison of the Accuracy of Cone-Beam Computed Tomography Scanning and Electronic Apex Locators in Detection of Simulated Root Perforations in Different Localizations

IntroductionThis study aimed to compare the accuracy of cone-beam computed tomographic (CBCT) scanning and 2 different electronic apex locators (EALs) in the detection of simulated root canal perforations in different localizations. MethodsEighty human mandibular premolars were prepared and divided into 2 groups according to the localization of the perforation area, having a 1-mm diameter. The distance between the occlusal edge and the beginning of the perforation was measured under a stereomicroscope (actual working length) using 2 EALs (Propex II [Dentsply Maillefer, Ballaigues, Switzerland] and Dentaport ZX [J. Morita, Tokyo, Japan]) (electronic working length) and CBCT images (CBCT working length). The calculations were made by subtracting the actual working length from the electronic working length and the CBCT working length to determine the differences. ResultsIn the apical third perforation group, there was a significant difference between Dentaport ZX and CBCT imaging. There was no significant difference between Dentaport ZX and Propex II and Propex II and CBCT measurements. In the middle third perforation group, Propex II was significantly more successful than CBCT imaging. In addition, there was no significance between the accuracy of Propex II in detecting the perforation area between the apical third perforation group and the middle third perforation group. CBCT imaging was more accurate in detecting the perforation area in the apical third perforation group than in the middle third perforation group. ConclusionsIn cases in which the root canal perforation was in the apical third of the root, both the EAL and CBCT imaging were successful in determining the perforation area, whereas the success rate of all devices used in this study decreased when the perforation area was in the middle third of the root.