Presence Of Perforation Research Articles

Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?

PurposeThe aim of this study is to determine the predictable factors that affect the clinical course, especially the hospital stay, the operation performed, and to determine factors that will be helpful in deciding whether in-hospital or outpatient treatment is appropriate.MethodsWe retrospectively collected medical data for patients who had been diagnosed with acute diverticulitis at Inje University Sanggye Paik Hospital between January and December 2016. In total, 117 patients were enrolled in this study. We examined clinical factors, including age, sex, body mass index, pain, body temperature, white blood cell count, C-reactive protein, nil per os (NPO) time, hospital duration, computed tomography (CT) findings, location of diverticulitis, operation performed, and presence of comorbidity (e.g., hypertension and diabetes mellitus).ResultsIn the multivariate analysis, the statistically significant factor related with hospital duration was the presence of perforation on the CT scan (P < 0.001). Longer NPO time was related with pain score (>7) (P = 0.011). Operations were mainly performed in patients with left-sided colonic diverticulitis (P = 0.012).ConclusionWe suggest a perforation finding on the CT scan, a severe pain score at least above 7 on a numeric rating pain scale, and a left-sided lesion are absolute indications for in-hospital management.

Morphological reassessment and molecular phylogenetic analyses of Amauroderma s.lat. raised new perspectives in the generic classification of the Ganodermataceae family.

Ganodermataceae is a remarkable group of polypore fungi, mainly characterized by particular double-walled basidiospores with a coloured endosporium ornamented with columns or crests, and a hyaline smooth exosporium. In order to establish an integrative morphological and molecular phylogenetic approach to clarify relationship of Neotropical Amauroderma s.lat. within the Ganodermataceae family, morphological analyses, including scanning electron microscopy, as well as a molecular phylogenetic approach based on one (ITS) and four loci (ITS-5.8S, LSU, TEF-1α and RPB1), were carried out. Ultrastructural analyses raised up a new character for Ganodermataceae systematics, i.e., the presence of perforation in the exosporium with holes that are connected with hollow columns of the endosporium. This character is considered as a synapomorphy in Foraminispora, a new genus proposed here to accommodate Porothelium rugosum (≡ Amauroderma sprucei). Furtadoa is proposed to accommodate species with monomitic context: F. biseptata, F. brasiliensis and F. corneri. Molecular phylogenetic analyses confirm that both genera grouped as strongly supported distinct lineages out of the Amauroderma s.str. clade.

De Garengeot hernisinin perfore apendisit ile birlikteliği: Nadir bir olgu sunumu

De Garengeot hernia is defined as the presence of the appendix vermiformis in the femoral hernia sac by a French surgeon, Rene Jacques Croissant de Garengeot, in 1731 . In literature, there are less than 100 cases. This clinical entity is usually diagnosed peroperatively and it is rarely noticed preoperatively on tomography scan. In this paper, it was aimed to present a patient admitting the emergency service with abdominal pain, diagnosed as De Garengeot hernia with perforated appendicitis preoperatively and undergone laparoscopic appendectomy. Depending on the presence or absence of acute infection of the appendix vermiformis, presence of perforation / abcess, type of surgical approach and whether appendectomy and hernia repair are performed sımultaneously or not, there are different treatment modalities. In our case, laparoscopic appendectomy with abscess drainage was performed and hernia repair is planned as a delayed secondary intervention.

Feasibilty of early surgical intervention for acute appendicitis in gravid patients

Background: Acute appendicitis is the most common surgical non-obstetric pathology during pregnancy. Unnecessary hesitation and hence delay in surgical intervention for acute appendicitis in pregnancy is common. In this background, while attempting early suspicion and surgical intervention (appendectomy) in our patients, we encountered no mortality and no significant morbidity in the in immediate postoperative period. Materials and Methods: This prospective study was carried over a period of 3.5 years from June 2012 to November 2015, in the department of surgery, GMC (Government Medical College) Srinagar. Patients included were only those who had features of acute appendicitis on clinical grounds and/or imaging studies (ultrasound). Objective: Our aim was to study the feasibility of early suspicion and surgical intervention in patients with features of acute appendicitis in pregnancy. Results: The mean age of the patients was 28.84 years, ranging from 21 to 38 years. The mean gestational age of our patient cohort was 17.4 weeks (6-35 weeks). Majority of the patients presented in the 2nd trimester (55.9%) followed by 1st trimester (29.4%). The Alvarado score of the patients ranged from 5 to 9 (mean 6.76). WBC (white blood cell count) of our patients ranged from 5800 to 22400 (average 14150). Neutrophill count ranged from 64.4% to 92.2% (mean 79.20%). USG diagonosed 20 patients as acute appendicitis (58.82%) and 14 patients as negative for appendicitis (41.2%) with a sensitivity of 60.6% and specificity of 71.42 %. Intraoperatively 31 patients (22 inflamed and 9 perforated) had features of acute appendicitis, one had early lump formation, and two had grossly normal appendix. All patients were followed up strictly for 2 months postoperatively and no obstetrical complication was recorded. Conclusion: Diagnosis of acute appendicitis in pregnancy can be difficult; however, surgical intervention should be performed with any suspicion. Fetal morbidity and mortality are high in the presence of perforation and generalized peritonitis. For minimizing the unnecessary delay in diagnosis and surgery, high clinical suspicion can only be supplemented and not replaced by imaging studies. Ultrasound is not only safe in pregnancy but also easily available and affordable. The decision to perform laparotomy should be based on clinical findings and diagnostic imaging. Delays over 24 hours for intervention increase the risk of perforation. We noted no immediate fetal or other major complications in our patients, hence we recommend early surgical intervention in patients with suspicion of acute appendicitis in pregnancy. There is also need for some unequivocal diagnostic scoring system which should be highly predictive of acute appendicitis in pregnancy, early in the course of disease before giving way to complications.

Effects of prognostic factors on overall and disease-free survival in patients with stage I–III colorectal cancer

&lt;b&gt;Introduction&lt;/b&gt;: The aim of this study was to retrospectively analyze predictive factors for overall survival (OS) and disease-free survival (DFS) rates in patients with stage I, II, or III colorectal cancer who underwent surgical treatment.&lt;br /&gt; &lt;b&gt;Material and methods&lt;/b&gt;: Files and electronic data of 120 patients with stage I, II, or III colorectal cancer who underwent surgery between 2008 and 2012 in the Department of General Surgery of Izmir Bozyaka Research and Training Hospital were retrospectively analyzed. The effects of several prognostic factors for DFS and OS were investigated.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt; There were 45 (37.5%) female and 75 (62.5%) male patients; mean age was 65.51 ±11.29 years. In univariate analysis, length of DFS was found to be associated with presence of perforation, lymphovascular invasion, preoperative carcinoembryonic antigen (CEA) value and positive surgical margin. Presence of comorbidities, American Society of Anesthesiologists (ASA) score, histological grade of tumor, presence of lymphovascular invasion, preoperative CEA value, preoperative albumin value, number of metastatic lymph nodes and positive surgical margin were found to be independent prognostic factors for DFS. Cox regression analysis indicated radial surgical margin and presence of perforation had statistical significance for DFS (p value of 0.008 and 0.025, respectively). &lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;: There are numerous prognostic parameters affecting postoperative survival in colorectal cancers. Prospective studies and studies on a larger scale are necessary in order to more accurately designate clinical prognostic factors that have an effect on survival time and to identify new biological and molecular markers.

Dynamic Video Endoscopyin Eustachian tube dysfunction: is it better than impedance audiometry

Objectives: 1. To find out which among dynamic slow motion video endoscopy (DSVE) and impedance audiometry is a better investigation for diagnosis of Eustachian tube dysfunction in the cases of middle ear disorders. 2. To correlate the Eustachian dysfunction with nasal pathology.Material and methods:  A case control study done on a total of 84 patients (168 ears) where ear complaints either unilateral or bilateral (total 95 ears) having middle ear disease were taken as cases. Patients without any ear and nasal complaints and normal ears of the case group were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of Eustachian dysfunction in the two groups. Impedance audiometry was performed in all cases by William’s or Toynbee’s test, depending on the presence of perforation. Nasal pathologies were identified by endoscopy or CT-scan.Results: On comparing DSVE findings with impedance audiometry, a strong association was found by applying Mc Nemar Chi square test. However, no significant correlation was found between results obtained on impedance audiometry with middle ear disease. In the mechanical type of dysfunction, we found nasal, paranasal or nasopharyngeal pathology in all the cases. In unilateral otitis media, the contralateral healthy ear was also associated with Eustachian dysfunction.Conclusion: DSVE is a better investigation than impedance audiometry for diagnosing Eustachian dysfunction in cases of chronic otitis media, especially the functional type. Nasal, paranasal or nasopharyngeal pathologies should be looked for in all cases of mechanical type of dysfunction and adequately addressed.

Dynamic Video Endoscopyin Eustachian tube dysfunction: is it better than impedance audiometry

Objectives: 1. To find out which among dynamic slow motion video endoscopy (DSVE) and impedance audiometry is a better investigation for diagnosis of Eustachian tube dysfunction in the cases of middle ear disorders. 2. To correlate the Eustachian dysfunction with nasal pathology.Material and methods:  A case control study done on a total of 84 patients (168 ears) where ear complaints either unilateral or bilateral (total 95 ears) having middle ear disease were taken as cases. Patients without any ear and nasal complaints and normal ears of the case group were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of Eustachian dysfunction in the two groups. Impedance audiometry was performed in all cases by William’s or Toynbee’s test, depending on the presence of perforation. Nasal pathologies were identified by endoscopy or CT-scan.Results: On comparing DSVE findings with impedance audiometry, a strong association was found by applying Mc Nemar Chi square test. However, no significant correlation was found between results obtained on impedance audiometry with middle ear disease. In the mechanical type of dysfunction, we found nasal, paranasal or nasopharyngeal pathology in all the cases. In unilateral otitis media, the contralateral healthy ear was also associated with Eustachian dysfunction.Conclusion: DSVE is a better investigation than impedance audiometry for diagnosing Eustachian dysfunction in cases of chronic otitis media, especially the functional type. Nasal, paranasal or nasopharyngeal pathologies should be looked for in all cases of mechanical type of dysfunction and adequately addressed.

Clasificarea uneltelor din piatră şlefuită din situl de la Porţ-„Corău” / The Typological Clasification of the Polished Stone Tools from Porţ-„Corău”

The site of Porț-“Corău” (Sălaj County) represents the same neolithic settlement as Suplacu de Barcău-“Corău” site (Bihor County), belonging and defining the Suplac cultural group, included in the Cluj-Cheile Turzii-Lumea Nouă-Zau-Iclod-Suplac complex, redefined also as Zau culture. In both areas, but especially at Porț, a large number of polished stone tools (about 1700), showing different working stages, were discovered along with raw material showing traces of manufacture. The sistematic investigations, conducted by Doina Ignat at Suplacu de Barcău, lead to the discovery of more than 500 polished stone tools, making the site of “Corău” the richest one in this type of artifacts in the whole country. She had created a typology for chiesels, axes, adzes and smashing stones, each category being divided into types and subtypes.The preventive diggings from Porț gave us not only more polished stone artifacts, but also the possibility to reconsider their typology. First we must add some categories to those defined by D. Ignat: strikers, axe-chiesels, and tools used only for manufacturing the stone tools: sandstone slabs for polishing and stone slabs used for cutting/splitting the preforms. Second, and more important, we must redefine the types and subtypes of each category, based on common and general criterias. We have chosen usually the shape to define the type and the long profile to define the subtipe, adding here the presence of perforation. The main forms found for chiesels, axes and adzes are: rectangular, elongated, trapezoidal, oval, quadrilateral. The long profiles can be: rectangular, plain-rounded, plainconvex, rounded, oblique. Different combination between shapes and profiles appear. No chronological value can be given to the typology, the lithic material can be dated only by its context. The typology remains open for other types and subtypes based on the same criteria.

Barium appendicitis: A single institution review in Japan

AIMTo review clinical experience with barium appendicitis at a single institution.METHODSA retrospective review of patients admitted with a diagnosis of acute appendicitis, from January 1, 2013 to December 31, 2015 was performed. Age, gender, computed tomography (CT) scan findings if available, past history of barium studies, pathology, and the presence of perforation or the development of complications were reviewed. If the CT scan revealed high density material in the appendix, the maximum CT scan radiodensity of the material is measured in Hounsfield units (HU). Barium appendicitis is defined as: (1) patients diagnosed with acute appendicitis; (2) the patient has a history of a prior barium study; and (3) the CT scan shows high density material in the appendix. Patients who meet all three criteria are considered to have barium appendicitis.RESULTSIn total, 396 patients were admitted with the diagnosis of acute appendicitis in the study period. Of these, 12 patients (3.0%) met the definition of barium appendicitis. Of these 12 patients, the median CT scan radiodensity of material in the appendix was 10000.8 HU, ranging from 3066 to 23423 HU (± 6288.2). In contrast, the median CT scan radiodensity of fecaliths in the appendix, excluding patients with barium appendicitis, was 393.1 HU, ranging from 98 to 2151 HU (± 382.0). The CT scan radiodensity of material in the appendices of patients with barium appendicitis was significantly higher than in patients with nonbarium fecaliths (P < 0.01).CONCLUSIONBarium appendicitis is not rare in Japan. Measurement of the CT scan radiodensity of material in the appendix may differentiate barium appendicitis from routine appendicitis.

Use and Accuracy of Computed Tomography Scan in Diagnosing Perforated Appendicitis

Perforated appendicitis has major implications on patient care. The ability of computed tomography (CT) scan to distinguish perforation in the absence of phlegmon or abscess is unknown. The purpose of this study is to assess the use and accuracy of CT scans in diagnosing perforated appendicitis without phlegmon or abscess. A retrospective chart review of 102 patients who underwent appendectomy from 2011 to 2013 was performed. Patient demographics and operative and postoperative course were recorded. Two radiologists were then blinded to operative findings and CT scans reread and results correlated. Findings on CT scan were also analyzed for correlation with perforation. Univariate and multivariate statistical analysis was performed. Of the 102 patients, 49 were perforated and 53 nonperforated. Analysis of patient populations demonstrated patients with perforation were significantly older (45 vs 34 years, P = 0.002), had longer operative times (132 vs 81 minutes, P = 0.001), and longer length of stay (8.2 vs 1.5 days, P < 0.001). Nineteen perforations (37%) were correctly diagnosed by CT scan. The sensitivity of CT scan to detect perforation was 38 per cent, specificity 96 per cent, and positive predictive value of 90 per cent. After multivariate analysis of significant variables, three were demonstrated to significantly correlate with presence of perforation: presence of extraluminal air (odds ratio [OR], 28.9; P = 0.02); presence of intraluminal fecalith (OR, 5.7; P = 0.03); and wall thickness greater than 3 mm (OR, 3.2; P = 0.02). CT scan has a low sensitivity for diagnosing perforated appendicitis without abscess or phlegmon. Presence of extraluminal air bubbles, increased wall thickness, and intraluminal fecalith should increase suspicion for perforation and are highly correlated with outcomes after appendectomy.

Can Postoperative Nutrition be Favourably Maintained by Oral Diet in Patients with Emergency Temporary Ileostomy? A Tertiary Hospital Based Study.

Temporary ileostomy is an emergency procedure performed in cases having septic peritonitis in presence of perforation or obstruction or gangrene of small intestine. These patients usually suffer from gross malnutrition following surgery. To measure nutritional status of patients with emergency temporary ileostomy and to determine whether their postoperative nutrition can be favourably maintained by oral diet alone. Sixty patients were enrolled for the study on the basis of inclusion and exclusion criteria during the study period from January 2012 to December 2013. Oral feeding was started as soon as ileostomy started functioning and patients expressed hunger, about 48-72 hours postoperatively. An individualized diet chart was formulated for each patient using Harris Benedict Equation. Nutritional assessment was done on 1) 1(st) day of oral feeding, 2) After 7 days of oral feeding, 3). After three months of oral feeding. Nutritional parameters (anthropometric, biochemical) employed were tabulated and statistically analysed with SPSS v 17, Chicago. Out of 60 patients, 36 males and 24 females were enrolled in the study. The patients were in the age group of 20-60 years with a mean age of 45 years. After 7 days of oral nutrition the nutritional status deteriorated with a significant decrease in body weight (p<0.001) and serum haemoglobin (p <0.001). However, at the end of the study, the patients had their nutritional status restored satisfactorily with normalization of basic parameters like bodyweight, haemoglobin and serum albumin (p<0.001). Proper dietary advice and oral nutrition were found to be sufficient for gradual restoration and maintenance of satisfactory nutritional status in the postoperative period.

Sequential decision tree using the analytic hierarchy process for decision support in rectal cancer

The aim of the study is to determine the most appropriate method for construction of a sequential decision tree in the management of rectal cancer, using various patient-specific criteria and treatments such as surgery, chemotherapy, and radiotherapy. An analytic hierarchy process (AHP) was used to determine the priorities of variables. Relevant criteria used in two decision steps and their relative priorities were established by a panel of five general surgeons. Data were collected via a web-based application and analyzed using the "Expert Choice" software specifically developed for the AHP. Consistency ratios in the AHP method were calculated for each set of judgments, and the priorities of sub-criteria were determined. A sequential decision tree was constructed for the best treatment decision process, using priorities determined by the AHP method. Consistency ratios in the AHP method were calculated for each decision step, and the judgments were considered consistent. The tumor-related criterion "presence of perforation" (0.331) and the patient-surgeon-related criterion "surgeon's experience" (0.630) had the highest priority in the first decision step. In the second decision step, the tumor-related criterion "the stage of the disease" (0.230) and the patient-surgeon-related criterion "surgeon's experience" (0.281) were the paramount criteria. The results showed some variation in the ranking of criteria between the decision steps. In the second decision step, for instance, the tumor-related criterion "presence of perforation" was just the fifth. The consistency of decision support systems largely depends on the quality of the underlying decision tree. When several choices and variables have to be considered in a decision, it is very important to determine priorities. The AHP method seems to be effective for this purpose. The decision algorithm developed by this method is more realistic and will improve the quality of the decision tree.

Ex vivo pig training model for esophageal endosopic submucosal dissection (ESD) for endoscopists with experience in gastric ESD

Esophageal endoscopic submucosal dissection (ESD) has developed in recent years because of its high rate of en bloc resection. However, for many endoscopists, technical difficulty and risks of complications are great barriers to performing esophageal ESD. In this study, we developed an original training model for esophageal ESD using isolated pig esophagus and assessed this ex vivo model in endoscopists with experience in gastric ESD. Three endoscopists without experience in esophageal ESD but with some experience in gastric ESD performed esophageal ESD of artificial lesions in 10 consecutive sessions using this ex vivo model. The en bloc resection rate, operation time, number of muscularis propria layer injuries, and presence of perforation were recorded. We evaluated the effectiveness of this training in the three endoscopists by comparing results from the first five sessions (former period) with those from the last five sessions (latter period). All three endoscopists achieved en bloc resections in all trials. In the former period, injury to the muscularis propria layer for each of the three endoscopists occurred a mean of 2.2 (1-3), 0.6 (0-1), and 3.2 (1-6) times, respectively. Perforation occurred in one session performed by one endoscopist. In the latter period, the mean number of muscularis propria layer injuries for each of the three endoscopists decreased to 0.2 (0-1), 0.2 (0-1), and 0.8 (0-2), respectively. The time of operation shortened from 35.0 (25-40), 36.4 (30-50), and 29.8 (23-43)min to 23.0 (16-31), 25.6 (23-28), and 29.2 (21-37)min, respectively. This original ex vivo training model was helpful to endoscopists with experience in gastric ESD in acquiring the basic skills for performing esophageal ESD.

Evaluation of Second Look Procedures for Pediatric Cholesteatomas

This study aims to identify factors that may help predict recurrence, the need for second-look operations, and other outcomes in the pediatric population. Case series with chart review. Tertiary medical center. Five hundred and seventeen ears in 493 patients underwent primary acquired cholesteatoma resection over a 37-year period. Demographic (age, sex, and other medical conditions), cholesteatoma laterality, presence of perforation or otorrhea on otoscopic exam, preoperative and most recent audiologic data, and detailed intraoperative data were collected. Overall, 47.2% of patients underwent second-look operations, with 48.0% having recurrent cholesteatoma visualized with attic recurrence being the most common location. In total, 22.7% of all patients in this study had recurrent disease. Factors at initial operation associated with a statistically significant increased risk of recurrence included cholesteatoma in the sinus tympani (odds ratio = 2.09; 95% confidence interval, 1.36-3.22) and incus destruction (1.65; 1.01-2.71). The authors have successfully identified multiple factors at the time of initial operation that can have significant postoperative implications.

RECIST and Choi criteria for response assessment (RA) in patients with inoperable and metastatic gastrointestinal stromal tumours (GISTs) on imatinib mesylate. Cambridge GIST study group experience

10019 Background: Imatinib Mesylate (IM) induces an overall response rate of 84% in patients (pts) with metastatic GISTs. Standard RA is by RECIST criteria. This may underestimate the true benefit of IM in such pts. Choi et al observed ↓ in size (10%) and or density (D) (15%) correlated well with disease specific survival. We report our experience using both RECIST and Choi criteria for RA in GIST pts on IM. Methods: Between 2003 and 06, 24 pts with metastatic or inoperable GISTs were treated with IM. 50 lesions (Liver 20, Omentum 21, Primary 9) were identified at presentation on contrast CT (Siemens multi slice CT, IV Niopam, GE PACS system). 3 monthly CT was used for RA until tumour progression (PD) or death. Parameters recorded were: 1.Largest dimension 2. Lesion density (Mean Hounsfield units, HFU) 3.New lesions 4.Any new features. RECIST and Choi criteria were both applied for RA. Results: N=50. At 3 months (m) only 16% of the lesions achieved partial response (PR) by RECIST and 24% increased in size by a mean of 22.5% (Range 3–150%). RA as measured by Choi criteria revealed 88% of lesions had either a 10% ↓ in size or a 15% ↓ in D at 3 m. Mean ↓ in D was 29% (95% CI 24.6–33.4). At 18 m 50% of the lesions achieved PR and 20% had PD by RECIST criteria, and with Choi criteria 68% RR was recorded. Calcification, haemorrhage and perforation within the lesions spuriously altered the mean D value in 15% of the lesions which made assessment by Choi criteria difficult. In 5 pts new hepatic cystic lesions (range 2–22) appeared with a mean D of 16 HF. None were detected in extra-hepatic sites. 4 pts showed new calcifications within lesions 3–18 m on IM. Enhancing nodules within lesions were seen in 4 pts predating clinical PD by 6–18 m. Conclusions: Choi criteria were found to be reproducible in our pts. RRs at 3 months using Choi criteria (88%) were far greater than by RECIST criteria (16%). RRs were more similar at 18 m (68% Choi vs 50% RECIST).Using density for RA can become unreliable in the presence of perforation, calcification and haemorrhage. These criteria should be evaluated by a radiologist experienced in assessing the response to IM in GISTs with awareness of their limitations. No significant financial relationships to disclose.

Teste de germinação com acondicionamento dos rolos de papel em sacos plásticos

O teste de germinação é realizado em laboratório, sob condições de ambiente controlado e favorável, visando a obtenção da mais completa e rápida germinação dos lotes de sementes. O substrato utilizado deve manter umidade suficiente para o processo de germinação, sendo que, muitas vezes os rolos de papel umedecidos necessitam ser acondicionados em sacos plásticos. O excesso de umidade também pode ser prejudicial à germinação, provocando atraso ou paralisação do desenvolvimento das plântulas. Essas alterações podem tornar o teste não representativo da verdadeira qualidade do lote. O objetivo do trabalho foi avaliar o efeito de embalagens plásticas, no acondicionamento dos conjuntos de rolo de papel mais sementes, durante o teste de germinação conduzido em germinadores de câmara vertical tipo B.O.D., visando a maximização dos resultados. Foram avaliadas duas espessuras (0,033 mm e 0,050 mm) e a presença ou a ausência de perfurações (128 furos de 5mm de diâmetro por face de 60 cm x 40 cm), nos sacos plásticos transparentes utilizados durante a realização do teste de germinação, para as seguintes espécies: milho doce (cv. 'Doce Cristal' e cv. 'Super Doce'), feijão (cv. 'Pérola' e cv. 'IAC-Carioca Tybatã') e soja (cv. 'Embrapa-48' dois lotes). Para sementes de milho doce e feijão, os tratamentos plástico grosso ou fino perfurados e plástico fino inteiro promoveram os melhores resultados do teste de germinação. Concluiu-se que, a espessura do plástico e a presença ou ausência de perfurações são fatores que interferem nos resultados do teste de germinação conduzido em germinadores de câmara vertical tipo B.O.D.

An analytical model for predicting the productivity of perforated wells

In this work, we present an analytical model for the prediction of the productivity of perforated wells. The basic building block of the model is an analytical solution for single-phase Darcy flow to a single perforation in a semi-infinite porous medium. We have expanded this solution to describe the flow to a well with regularly spaced arrays of equidistant perforations along the wellbore wall. The end result is a formula for the perforation skin as a function of perforation length and radius, shot density, perforation phasing, permeability anisotropy, perforation damage and formation damage. Partially perforated wells can be handled with the help of the total skin formula of Jones and Watts [Jones, L.G., Watts, J.W., 1971. Estimating Skin Effect in a Partially Completed Damaged Well. J. Pet. Technol. (February), 249–252.]. The results of the model compare fairly well with the results of previous numerical flow simulations. The model can be readily implemented in a standard spreadsheet program and may be used as an alternative to the current semi-analytical method of Karakas and Tariq [Karakas, S.M., Tariq, S.M., 1991. Semianalytical Productivity Models for Perforated Completions. SPE Prod. Eng. (February), 73–82.]. It is shown that this method does not properly account for permeability anisotropy, which results in overly optimistic well productivities, particularly in the presence of perforation and formation damage.

Radiological investigation in acute diverticulitis.

Optimal management of acute sigmoid diverticulitis depends on evaluation of the severity of the inflammatory process, in which radiological investigation is a useful but probably underutilized adjunct to clinical assessment. Plain abdominal radiography shows abnormalities in 30-50 per cent of patients but these tend to be non-specific and more accurate information is obtainable from a contrast enema. Although the quality of images produced by a water-soluble contrast agent is inferior to that with barium, the former is less hazardous in the presence of perforation and provides sufficient information to permit rational management decisions to be made. Ultrasonography and computed tomography (CT) are particularly useful in visualizing abscesses. They may be helpful in following the progression or resolution of suppuration and in guiding percutaneous aspiration when appropriate. Despite early reports to the contrary, CT is no more specific than a contrast enema in the diagnosis of acute diverticulitis. Radionuclide scans have little role in the routine assessment of acute diverticulitis and magnetic resonance imaging has not been adequately evaluated. Water-soluble contrast enema is safe, widely available and probably the most useful early supplementary investigation.

Acute abdomen: intestinal obstruction

Intestinal obstruction is a common and dangerous surgical emergency that is associated with a high mortality if managed inappropriately; results are usually good if it is diagnosed and treated early. Obstruction of the small intestine and large intestine are fundamentally different in their cause and management (although differentiation between the two merges in distal small-intestine and proximal large-intestine obstruction). In general, obstruction of the small intestine presents with colicky abdominal pain and vomiting, whereas distension and absolute constipation tend to be more common in obstruction of the large intestine. The causes of intestinal obstruction can be mechanical or paralytic in origin, and can be subdivided into small- and large-intestinal obstruction. Obstruction of the large intestine accounts for about 80% of all intestinal obstructions (the most common cause in ‘developed countries’ is adhesions), whereas adenocarcinoma of the colon is the most common cause of obstruction of the large intestine. A number of pathophysiological changes occur in intestinal obstruction, and these changes determine the clinical picture. Obstruction of the small intestine is characterized by dehydration and hypovolaemia due to fluid losses; obstruction of the large intestine is influenced by the competency of the ileocaecal valve. These features are diagnosed clinically and by radiography, but the decision to operate is a clinical (based on abdominal examination and clinical suspicion of potential pathology). Despite improvements in management, the mortality ranges from 10–30% (depending on type of obstruction and the presence of perforation) in the UK.

A multivariate analysis of otological, surgical and patient‐related factors in determining success in myringoplasty

The aim of this study was to evaluate the effects of smoking and other prognostic factors on long-term surgical outcome and hearing results in myringoplasty. Retrospective cohort. Tertiary medical centre. Eighty myringoplasty operations were analysed retrospectively from the charts of 74 patients who underwent myringoplasty between January 2000 and November 2002 at the First ENT Clinic of Ataturk Training and Research Hospital, using the chi-squared test, Fisher's exact test, t-test and multiple logistic regression statistical analysis. The effects of prognostic factors and smoking on myringoplasty were investigated by variables noted from patients' files such as smoking status, operation type, duration of dry period of the diseased ear, peroperative otorrhoea, status of the opposite ear, presence of perforation at admission, place of perforation, size of perforation, status of middle ear mucosa, presence of cholesteatoma and tympanosclerosis, ossicular status, previous and related surgery, experience of the surgeon, presence of anterior overhang, presence of valsalva manoeuvre, postoperative antiobiotic cover and income per day. The overall take rate of the myringoplasty graft was 71%. Based on the univariate analysis, smoking status of the patients (P = 0.008), status of the opposite ear (P = 0.01), size of perforation (P = 0.009) and the experience of the surgeon (P = 0.002) were found to be statistically significant (P < 0.01) prognostic factors influencing the success rate of the operations. Multiple logistic regression analysis was subsequently carried out on these prognostic factors and yielded the following classification (95% CI): senior surgeon (OR = 14.3), non-smoking patient (OR = 11.4), longer duration of dry period of the diseased ear (OR = 5.3), normal opposite ear (OR = 5.0) and small perforation (OR = 4.8). A non-smoking patient, a longer dry ear, a healthy opposite ear, a relatively smaller perforation and a senior surgeon were found to be significant prognostic factors positively influencing the success rate of myringoplasty.