Sign Of Leakage Research Articles

Sealing of the Cystic Duct During Transgastric NOTES® Cholecystectomy Is Reliable Using BELA, a New Flexible Bipolar Forceps

Introduction: To perform a safe NOTES cholecystectomy there is a need for a reliable tool to seal the cystic duct. Current endoscopic clips have been tried but shown not to be sufficient for sealing of the cystic duct during NOTES cholecystectomy. A new flexible device for bipolar coagulation from Ethicon Endosurgery, BELA, has been tested for sealing of the cystic duct in a porcine non-survival and survival model. Methods: Initially three gallbladders including the cystic duct were used for testing in vitro on the bench. Each cystic duct was sealed using the BELA-device. Five seals were tested. The burst-pressure of the seals were measured injecting saline into the gallbladder through a two-channel nasogastric tube connected to a pressure transducer. Secondly, the cystic duct was sealed and divided in vivo during cholecystectomy in four non-survival animals. The hepatic duct was ligated above the confluence of the cystic duct. A two-channel nasogastric tube was inserted through the papilla into the common bile duct. The seal was tested using saline injection through the tube into the common bile duct. Finally, cholecystectomy was performed in four survival animals using the BELA to seal the cystic duct. At post mortem two weeks later the common bile-duct was dissected and the hepatic duct was ligated above the confluence of the cystic duct ad a two-channel tube was inserted through the papilla. The seals were tested injecting saline into the common bile duct. Results: The burst pressure of the cystic duct seal ex vivo was 285-320 mmHg. Measuring the base line bile-duct pressure in vivo the pressure was 49.5 mmHg and the mean burst pressure of the cyctic duct seal was 160 mmHg (152-165). All survival pigs lived throughout the experiment without complications. At post mortem there was no sign of post operative leakage from the seals. The mean burst pressure was 427 mmHg (273-727). Conclusion: The BELA seals hold a pressure ex vivo more than three times the bile-duct base-line pressure and in the survival NOTES cholecystectomy model they hold more than eight times the base-line pressure after two weeks. Therefore, sealing of the cystic duct with the new bipolar device, BELA, seems sufficient.

Environmental and safety monitoring of the natural gas underground storage at Stenlille, Denmark

Abstract The Stenlille natural gas underground storage is located 70 km SE of Copenhagen and has been in operation since 1989. For safety reasons and to protect the environment it is necessary to monitor the storage carefully. Natural gas is being stored in an anticlinal structure with an expected gas storage capacity of about 3 billion Nm 3 (volume under ‘normal’ conditions) in the upper Triassic Gassum Sandstone Formation 1500–1600 m below the surface; it replaces saline formation water. So far, nineteen deep wells have been drilled on and around the structure. The 300 m thick clay sequence of the Lower Jurassic Fjerritslev Formation above the gas storage reservoir has acted as an efficient seal, since no sign of gas leakage has been observed in the monitoring well located in a sand stringer 15 m above the gas reservoir. Other monitoring wells have been located in order to check for possible lateral escape of natural gas. A baseline study on naturally occurring hydrocarbons performed before the natural gas storage came into operation indicated the presence of only trace amounts hydrocarbon gases in the subsurface of the Stenlille area. Results of analysis by the headspace and sorbed gas methods on drill-cuttings suggest that low-temperature thermal generation of hydrocarbon gases (δ 13 C 1 : −47 to −42‰; δ 13 C 2 : −34 to −30‰) has taken place in organic-rich marine shale below 1300 m. Low concentrations of dissolved methane (<0.5 mg/l) of bacterial origin (δ 13 C 1 : −90 to −62‰) were found in shallow groundwater that is used for water supply in the Stenlille area. After the start of injection of natural gas in 1989 (C 1 :C 2 :C 3 = 91:6:2; δ 13 C 1 : −47‰), no increase in methane concentration and no higher hydrocarbon gases were observed during the regular analysis of groundwater from 10 shallow wells located above the underground natural gas storage. However, a sudden increase in dissolved methane concentration from 0.02 to 27 mg/l was measured in a 130 m deep observation well after a minor gas leakage had been detected at a new deep drilling into the natural gas storage in 1995. Nonetheless, no increase in methane was observed in shallow groundwater at the same locality. Occasional higher concentrations of dissolved methane (up to 15 mg/l) were encountered in shallow observation wells in low permeability layers. Stable isotope analyses (δ 13 C 1 : −69 to −52‰) and radiocarbon dating show that the gas does not originate from the underground gas storage because the methane was less than 300 years old, but it may have formed due to local microbial activity.

Bowel Visualization as a Sign of Cerebrospinal Fluid Leakage on Radionuclide Cisternography

Bowel Visualization as a Sign of Cerebrospinal Fluid Leakage on Radionuclide Cisternography

Patch technique for repair of a dural tear in microendoscopic spinal surgery

A dural tear is a common but troublesome complication of endoscopic spinal surgery. The limitations of space make repair difficult, and it is often necessary to proceed to an open operation to suture the dura in order to prevent leakage of cerebrospinal fluid. We describe a new patch technique in which a small piece of polyglactin 910 is fixed to the injured dura with fibrin glue. Three pieces are generally required to obtain a watertight closure after lavage with saline. We have applied this technique in seven cases. All recovered well with no adverse effects. MRI showed no sign of leakage of cerebrospinal fluid.

IV therapy: recognizing the differences between infiltration and extravasation

Infiltration and extravasation are complications that can occur during intravenous therapy administered via either peripheral or central venous access devices. Both can result in problems with the siting of future venous access devices, nerve damage, infection and tissue necrosis. The nurse is the key to reducing the risk of infiltration and extravasation, through her knowledge and skill in cannulation and the intravenous administration of drugs (by bolus injection or infusion). The nurse must also be able to recognize the early signs and symptoms of infiltration and extravasation and act promptly and effectively to limit tissue damage. The first sign of possible leakage of drugs into the tissues is pain and discomfort, so patients must be informed of what symptoms to look out for and be asked to report any change in sensation as soon as they are aware of it. Finally, accurate documentation of the event is vital to facilitate patient care and in case of litigation.

Treatment of a Groin Lymphatic Fistula with Negative Pressure Wound Therapy

IntroductionGroin lymphatic fistulas are a troublesome finding after limb revascularization surgery. Its management represents a difficult task for the clinician. ReportWe report our experience in the treatment of such a condition with negative-pressure wound therapy (NPWT) in a 70-year-old man which benefited from extra-anatomic prosthetic axillofemoral bypass. After a week of treatment, the fistula dried up and closure was obtained with simple suture under local anaesthesia. Follow-up at 9 months showed stable coverage without any sign of leakage. DiscussionThis study depicts NPWT as an effective non-invasive treatment in the management of groin lymphocutaneous fistula.

Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy

Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma. Patients undergoing rectal resection with LA were eligible to participate. If there was no radiological sign of anastomotic leakage after 7 days, patients were randomized to EC or LC. The primary endpoints were postoperative morbidity and mortality 90 days after the initial resection. Some 186 patients were analysed. There were no deaths within 90 days and overall morbidity rates were similar in the EC and LC groups (31 versus 38 per cent respectively; P = 0.254). Overall surgical complication (both 15 per cent; P = 1.000) and reoperation (both 8 per cent; P = 1.000) rates were similar, but wound complications were more frequent after EC (19 versus 5 per cent; P = 0.007). Small bowel obstruction (3 versus 16 per cent; P = 0.002) and medical complications (5 versus 15 per cent; P = 0.021) were more common with LC. Median (range) hospital stay was reduced by EC (16 (6-59) versus 18 (9-262) days; P = 0.013). Early stoma closure is feasible in selected patients, with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate. NCT00428636 (http://www.clinicaltrials.gov).

Randomized Multicenter Controlled Study of Endoscopic and Surgical Closure of a Gastric NOTES Access Perforation in a Porcine Model

Introduction & Aims: In NOTES procedures it is essential to be able to perform secure closure of the access perforation. The aim of this study was to compare endoscopicaly sutured closure of a gastric access perforation using the T-tag tissue apposition system, (TAS) with closure via laparotomy in a randomized multicenter study. Methods: The gastric NOTES perforation was created using a needle knife and a 20 mm CRE balloon. For the study 30 pigs (18-38 kg) were used. After a diagnostic peritoneoscopy, where the pelvic organs were identified, the endoscope was withdrawn into the stomach. The animals were then randomized to either endoscopic closure with TAS-suture technique (in some cases with the addition of clips), or laparotomy with surgical closure using running resorbable 4-0 monofilament suture of the gastric perforation. The abdominal wall was closed with a running resorbable monofilament in the fascia and running nonresorbable suture for the skin. The time from randomization to endoscopic closure and withdrawal of the endoscope and operation time skin-to-skin were measured, as was recovery time and weight gain at day 7 and 14. At necropsy, adhesions, abscesses or peritonitis were recorded. Results: Of the 30 pigs, 27 survived without complications. Closure time using endoscopic technique was significantly longer than with open surgery, 23, 1 min (12-43) versus 12, 5 min (9-17,6). On average 2 sutures were needed for endoscopic closure. The median incision length in the surgical group was 11 cm (9-14). Recovery time post op was the same in both groups, but there was a tendency in favor of the endoscopic group. There was no difference in post op weight gain. One pig in the endoscopic group died within 12 hours post procedure in septicemia, without signs of leakage from the gastric perforation. Another pig in the Endoscopic group was euthanized after 7 days due to rectal prolapse, without any sign of leakage from the gastric perforation at necropsy. In the laparotomy group one pig was euthanized after 7 days due to incisional hernia, but no sign of leakage was recorded. At necropsy on day 14 there was significantly more intra abdominal adhesions in the laparotomised group, mainly between stomach, liver and abdominal wall. In both groups there were some adhesions between the gastric perforation site and the omentum. Five of the 16 pigs in the surgical group had wound infections. Conclusion: A gastric NOTES access perforation can safely be closed endoscopicaly using TAS sutures + clips. Moreover, animals in the endoscopic group had significantly less adhesions at autopsy and a tendency to recover faster post operatively, compared with open surgery.

Artificial dural sealant that allows multiple penetrations of implantable brain probes

This study reports extensive characterization of the silicone gel (3-4680, Dow Corning, Midland, MI), for potential use as an artificial dural sealant in long-term electrophysiological experiments in neurophysiology. Dural sealants are important to preserve the integrity of the intracranial space after a craniotomy and in prolonging the lifetime and functionality of implanted brain probes. In this study, we report results of our tests on a commercially available silicone gel with unique properties that make it an ideal dural substitute. The substitute is transparent, elastic, easy to apply, and has re-sealing capabilities, which makes it desirable for applications where multiple penetrations by the brain probe is desirable over an extended period of time. Cytotoxicity tests (for up to 10 days) with fibroblasts and in vivo tests (for 12 weeks) show that the gel is non-toxic and does not produce any significant neuronal degeneration when applied to the rodent cortex even after 12 weeks. In vivo humidity testing showed no sign of CSF leakage for up to 6 weeks. The gel also allows silicon microprobes to penetrate with forces less than 0.5 mN, and a 200-μm diameter stainless steel microprobe with a blunt tip to penetrate with a force less than 2.5 mN. The force dependency on the velocity of penetration and thickness of the gel was also quantified and empirically modeled. The above results demonstrate that the silicone gel (3-4680) can be a viable dural substitute in long-term electrophysiology of the brain.

Vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl

The author reports a case of vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl. The initial urethrovaginal fistula and vaginal stenosis resulted from pelvic trauma after a traffic accident, with subsequent surgical urethral realignment and anterior colporrhaphy without success. The patient had continuous urinary incontinence for a duration of 11 years after surgery, and was finally diagnosed with urethrovaginal fistula with primary multiple vaginal calculi in our hospital. Surgeries were performed to remove the stones and repair the urethrovaginal fistula. Colpoplasty was also given by an obstetrician-gynecologist to solve the vaginal stenosis. After the procedure, the girl urinated normally. At her 3-month follow-up, the patient had no sign of urine leakage.

Natural History of Plasma Leakage in Dengue Hemorrhagic Fever

Although plasma leakage is the major cause of mortality and morbidity in patients with dengue hemorrhagic fever (DHF), a detailed assessment of the natural course of this process is still lacking. We employed serial ultrasound examination to delineate the locations and the timing of plasma leakage and to evaluate the usefulness of ultrasound in detecting plasma leakage in DHF. Daily ultrasound examinations of the abdomen and right thorax were performed in 158 suspected dengue cases to detect ascites, thickened gall bladder wall and pleural effusions. Cases were classified into dengue fever (DF), DHF or other febrile illness (OFI) based on serology and evidence of plasma leakage including hemoconcentration and pleural effusion detected by chest radiograph. Ultrasonographic evidence of plasma leakage was detected in DHF cases starting from 2 days before defervescence and was detected in some cases within 3 days after fever onset. Pleural effusion was the most common ultrasonographic sign of plasma leakage (62% of DHF cases one day after defervescence). Thickening of the gallbladder wall and ascites were detected less frequently (43% and 52% of DHF cases respectively) and resolved more rapidly than pleural effusions. The size of pleural effusions, ascites and gall bladder wall thickness in DHF grade I and II were smaller than those of grade III patients. Ultrasound detected plasma leakage in 12 of 17 DHF cases who did not meet the criteria for significant hemoconcentration. Ultrasound examinations detected plasma leakage in multiple body compartments around the time of defervescence. Ultrasonographic signs of plasma leakage were detectable before changes in hematocrits. Ultrasound is a useful tool for detecting plasma leakage in dengue infection.

Tracheal replacement with an aortic autograft

Tracheal replacement after extensive resection remains a challenge for the thoracic surgeon. We propose an innovative solution: the use of an aortic autograft. After an experimental work on animals with aortic autografts and allografts [Martinod E, Seguin A, Pfeuty K, Fornes P, Kambouchner M, Azorin JF, Carpentier AF. Long-term evaluation of the replacement of the trachea with an autologous aortic graft. Ann Thorac Surg 2003;75(5):1572-8; Martinod E, Seguin A, Holder-Espinasse M, Kambouchner M, Duterque-Coquillaud M, Azorin JF, Carpentier AF. Tracheal regeneration following tracheal replacement with an allogenic aorta. Ann Thorac Surg 2005;79(3):942-8], we present the first human case of long tracheal replacement with an aortic autograft. In this case we replaced 7 cm of a tumoral trachea using an aortic infra-renal autograft supported by a silicone stent. The early postoperative course was uneventful. The stent was removed at three months. The patient died at six months from an acute pulmonary infection without any sign of anastomosis leakage or graft rupture. A new field of clinical study has to be investigated.

A gallbladder flap for reconstruction of the common bile duct. An experimental study on pigs.

In this article we investigate whether a gallbladder flap could be used for reconstruction of the common bile duct (CBD), thereby providing drainage via an intact sphincter of Oddi. Eight LWD pigs were used for the experiments. The gallbladder was dissected from its fossa, care being taken not to damage its vessels. The CBD was then displayed and approximately 5 mm resected. In two pigs a tube, and in six pigs a sphere, was constructed from the gallbladder flap. Anastomoses were constructed between the gallbladder flap and the CBD. Blood samples were drawn and on day 10 a laparotomy and an intraoperative cholangiography was performed. No pigs showed any sign of biliary leakage and standard liver parameters were not affected by surgery. In the two pigs who had a tube constructed, cholangiography showed extrahepatic stenosis and intrahepatic biliary dilatation. In the six pigs who had a sphere constructed, cholangiography was without any sign of extrahepatic stenosis or intrahepatic dilatation. Reconstruction of the CBD by way of a gallbladder flap seems to be a safe procedure to accomplish biliary drainage. This procedure could be of clinical significance for reconstruction of the CBD after resections for benign strictures and tumors, and for reconstruction after blunt or penetrating trauma. In this article we investigate whether a gallbladder flap could be used for reconstruction of the common bile duct (CBD), thereby providing drainage via an intact sphincter of Oddi.

Severe hypotony after macular translocation surgery with 360-degree retinotomy

PURPOSE: To report a case of severe hypotony after macular translocation with 360-degree retinotomy.DESIGN: Interventional case report.METHODS: A 50-year-old woman with myopic neovascular maculopathy underwent macular translocation with 360-degree retinotomy in her left eye.RESULTS: After the second procedure of silicone oil removal, severe hypotony developed. No clear sign of leakage was found. Pure perfluoropropane gas tamponade was then performed, which resulted in temporal resolution of severe hypotony, but the hypotony recurred as the gas bubble was absorbed. Ten weeks after the second surgery, the hypotonous eye was refilled with silicone oil. No apparent cyclitic membrane was observed intraoperatively. After this procedure, the choroidal and retinal folds regressed; intraocular pressure has been between 5 and 7 mm Hg for more than 4 months thereafter.CONCLUSION: Severe hypotony can occur as a complication of otherwise uneventful macular translocation with 360-degree retinotomy.

Asymptomatic Helicobacter pylori gastritis is associated with increased sucrose permeability.

Our aim was to investigate whether there are changes in permeability to sucrose in asymptomatic Helicobacter pylori gastritis. Nineteen asymptomatic subjects with Helicobacter pylori-associated gastritis with no or mild mucosal atrophy and 19 age- and sex-matched normal controls were studied by peroral load of sucrose (100 g). The fraction of the given oral dose of sucrose excreted in urine was increased in subjects with Helicobacter pylori gastritis (median 0.08% versus 0.04% in controls). Sucrose excretion was not related to atrophy, intestinal metaplasia, or inflammation in the gastric mucosa. However, sucrose permeability was related to the degree of inflammatory (neutrophil) activity, since moderate activity was associated with higher sucrose excretion than mild activity (median 0.13% vs 0.07%). Asymptomatic Helicobacter pylori gastritis was associated with an increased sucrose permeability, which could be a sign of gastric mucosal leakage. This could have implications for the diseases and complications associated with Helicobacter pylori infection.

Zuverlässigkeit des Nachweises von fetalem Fibronectin mit Hilfe des monoklonalen Antikörpers FDC-6

Detection of amniotic fluid in the vagina is commonly used to diagnosed rupture of amniotic membranes. In 1991 an immunoassay was introduced which is based on the detection of a fetal fibronectin isoform using the monoclonal antibody FDC-6. Fetal fibronectin is said to be absent from normal adult tissues and plasma, but present in fetal tissues. The low concentration of fetal fibronectin in maternal plasma is said not to interfere with the test results. Theoretically, demonstration of significant amounts of fetal fibronectin in vaginal secretions may be considered an unequivocal sign of leakage of amniotic fluid or, at least, of pre-rupture stretching of the membranes. We evaluated results of the membrane immunoassay and enzyme immunoassay, which are both based on the monoclonal antibody FDC-6. Fetal fibronectin has been determined in a clinically unambiguous context in amniotic fluid as well as in vaginal swabs and blood samples. In amniotic fluid, all membrane immunoassays performed were positive. The concentration of fetal fibronectin during the third trimester of pregnancy was lower than in the second trimester. Only 9/15 cases were positive for fetal fibronectin if vaginal swabs were taken 12 hours after unequivocal rupture of membranes and no amniotic fluid was visible in the vagina. Vaginal swabs of women with regular contractions showing cervical dilation of > 2 cm were positive for fetal fibronectin in all cases (20/20) whereas no fetal fibronectin could be determined in vaginal swabs obtained from clinically inapparent pregnant women. In all blood samples of pregnant women fetal fibronectin was detected and, surprisingly, also in blood samples of non-pregnant women, as well as in vaginal swabs of non-pregnant women with vaginal bleeding. In cases of unequivocal rupture or intactness of membranes, the results of both assays correspond well with the clinical findings. 12 hours after rupture of membranes the test may become negative if no amniotic fluid is visible in the vagina. As all blood samples had been positive for fetal fibronectin we conclude that vaginal bleeding will probably interfere with the test. The most surprising result is the apparent presence of fetal fibronectin in the blood samples of non-pregnant women. This observation can only be explained by a cross-reaction of the FDC-6 antibody with hepatic fibronectin.

Evidence for an Ideal Transparent Anodic Oxide Film on Zirconium

The properties of a transparent oxide formed on zirconium by anodic oxidation in carbonate buffer are described. The transparent oxide has all the properties of an ideal valve‐metal oxide. The film grows via a high field conduction mechanism. The potential and film thickness both increase linearly with time under constant‐current growth conditions to well over 100 V with no sign of electronic leakage or breakdown. When the oxide is grown at a current density of 93 μA/cm2, the electric field in the oxide is 4.1 MV/cm, and the oxide is anisotropic with parallel and perpendicular to the field. The relative permittivity is 38.3 at the anodizing field, and the oxide shows electrostrictive effects similar to those exhibited by other valve‐metal oxides with high relative permittivities. Both the refractive index and the relative permittivity increase when the field is removed, and there is a corresponding decrease in film thickness of just under 1%. Cathodic reduction inserts hydrogen into the oxide to a limited depth, and the outer layer thus formed is optically absorbing. Subsequent anodic oxidation removes the hydrogen and returns the film to its initial transparent state.

A new method for long-term lumbar pressure monitoring with a fiber optic catheter

A new method for long-term monitoring of cerebrospinal fluid (CSF) pressure in the spinal canal using a catheter with a fiberoptic pressure monitor is described. This method has been used in the investigation of 16 patients with communicating hydrocephalus (CH). Duration of monitoring ranged from 2-48 hours without any complications. In 6 cases the recording was interrupted prematurely. Valuable data on the patterns of pressure variation could be attained and the occurrence of B-waves showed a good correlation with the clinical outcome of shunt operation. No sign of external or internal leakage of CSF was observed during the first 24 hours of monitoring. This technique could prove to be a less invasive method for evaluation of CSF-pressure in patients with CH or other diseases where CSF-pressure in the spinal canal can have some clinical significance.

Double Valve Replacement and Coronary Artery Bypass in a Patient with Chronic Osteomyelitis

Implantation of a prosthetic heart valve is generally contra-indicated in the presence of infection. A 68-year-old man with chronic osteomyelitis underwent successful double valve replacement, combined with coronary artery bypass, after his draining osteomyelitic fistula was controlled with antibiotics. During the 39 months since surgery, he has shown no sign of paravalvular leakage or infectious complications.

Release of carnitine from the perfused rat liver.

Perfused rat liver was shown to be the proper model for studies on hepatic cellular transport of carnitine. During recirculating perfusion the livers kept equilibrium with 45 nmol/ml total carnitine in perfusate, exhibited concentrative uptake and there was no sign of artificial leakage. The release side of the carnitine transport was characterized by utilizing outflow perfusions. The livers from fed rats exported daily 9.93 mumol per 100 g body weight total carnitine. This release rate is 4- or 10-fold higher than the estimated daily turnover in vivo or the measured urinary excretion. Therefore, the major part of the released carnitine has to re-enter the liver. The outward carnitine transport does not depend on energy or the Na+-K+ pump, since it did not respond to metabolic poisons and ouabain. However, the release rate was strongly inhibited by mersalyl and showed saturability in function of tissue carnitine levels. The Vmax of the saturable outward transport system was 2.47 nmol . min-1 . g-1 liver, the apparent Km was 0.27 mM tissue level (both as compared to total carnitine). These data showed the outward transport of carnitine from the liver to be protein mediated. The contribution of a diffusion (nonsaturable) component was estimated to be 20-25% in the range of tissue levels occurring in vivo. The rate of carnitine release from the liver decreased as an effect of 24 h starvation from the daily 9.92 mumol release to 6.55 mumol on 100 g body weight basis. This decrease is more pronounced when the release rates are expressed on the basis of tissue carnitine levels. The resulting value can be called rate constant (at the linear part of the saturation curve, Fig. 5) and it decreased to 5.00 min-1 from 8.41 min-1 as an effect of starvation. We have concluded that the altered parameters of carnitine transport across the liver cell is decisive in developing the higher hepatic carnitine concentration in the fasted state.