Site Of Perforation Research Articles

Prediction of hospital mortality after colorectal perforation surgery from inflammation-based prognostic scores

BackgroundInflammation-based prognostic scores have prognostic value in cancer or cardiovascular disease patients. This study evaluated the prognostic value of inflammation-based prognostic scores in colorectal perforation patients. MethodsData of 97 patients who underwent surgery for colorectal perforation were reviewed. We calculated various inflammation-based prognostic scores and analyzed the relationship between inflammation-based prognostic score and hospital mortality due to colorectal perforation. ResultsMultivariate analyses of hospital mortality revealed neutrophil–lymphocyte ratio (P = .0021), C-reactive protein/albumin ratio (P = .0224), and prognostic nutritional index (P = .0078) as independent predictive factors. The Kaplan–Meier analysis showed that patients who met all of the following parameters avoided hospital death: neutrophil–lymphocyte ratio < 30, prognostic nutritional index ≥ 27.2, age < 75 years, and perforation of the left colon. ConclusionNeutrophil–lymphocyte ratio, C-reactive protein/albumin ratio, and prognostic nutritional index were superior to other inflammation-based prognostic scores in predicting mortality of colorectal perforation. Neutrophil–lymphocyte ratio, prognostic nutritional index, patient's age, and sidedness of the perforation site may be useful parameters to identify subgroups in which a favorable prognosis can be expected.

An Audit on Gastrointestinal Perforation in a Tertiary Care Teaching Hospital Based in Northern Part of India: A Study of 100 Cases

Background: A prospective study was conducted on 100 patients of perforation peritonitis: To find out the incidence of gastro intestinal perforation in various age groups, sex, riral or urban, socio economic status, To find out the various causes and sites of gastra intestinal perforartions, To determine various types of procedures being done to treat gastro intestinal perforations.Methods:The study population consisted of 100 patients of perforation peritonitis admitted at surgical wards of Rajindra Hospital, Patiala. Patients underwent necessary investigations such as Blood counts, biochemical analysis and urine analysis. X-ray Abdomen and chest / USG Abdomen/Pelvis CT-Abdomen (as and when required). All diagnosed patients were subjected to surgery. In all cases, operative findings and postoperative course were followed up for three months. Final outcome was evaluated on the basis of clinical, operative and radiological findings. In pre-pyloric and duodenal perforation, GRAHAM’S PATCH REPAIR carried out. In Ileal and Jejunal perforations, primary closure or exteriorization done depending upon the condition of the gut and duration of the symptoms. The patient outcome was assessed by duration of hospital stay, wound infection, wound dehiscence, leakage/entero-cutaneous fistula, intra-abdominal collection/abscess, ileostomy related complications and reoperation. Wound infection was graded as per SSI grading.Results:Most common age group for perforation was 21-40 years (50%) followed by 41-60 (33%) years in present study. Mean age of the patients is 37.91 + 13.15 years with male predominance (78%) in our study. 4% of the patients were of upper socio-economic status while 32% of the patients were of middle and 64% of the patients were of lower socio-economic status.Abdominal pain was seen in 100% of the patients while abdominal distension was present in 69% of the patients. Nausea/Vomiting was seen in 61% of the patients while Fever and Constipation was seen in 53% and 86% of the patients respectively. Diarrhoea was seen in 3% of the patients. Tenderness, guarding &amp; rigidity, distension, obliteration of liver dullness and evidence of free fluid were present in 100% of the patients. Bowel sounds were not detected in all the patients. Most common perforations were Duodena(37%), Ileal (25%), Gastric (25%) followed by Appendicular (9%), Jejunal (4%) and Colonic perforation (2%). The most common etiology of gastrointestinal perforations was Peptic ulcer followed by Typhoid, Appendicitis, Tuberculosis, Trauma, Malignancy and non-specific infection.In Gastric perforations, Peptic ulcer was the most common cause of perforation followed by Trauma. In Ileal perforations, Typhoid was the most common cause of perforation followed by Tuberculosis and non-specific infection. In Appendicular perforations, most common cause was Appendicitis. In Jejunal perforations, most common cause was Trauma. In Colonic perforations, most common cause was Malignancy.Conclusions:The incidence of gastrointestinal perforations was common in 21-40 years age group followed by 41-60 years age group with male preponderance in our study. The most common site of perforations was Gastro-duodenal followed by Ileal perforations and the most common cause for these perforations was peptic ulcer followed by typhoid. The most common procedure done to treat gastrointestinal perforations was primary closure, resection and anastomosis, appendectomy and stoma formation. However, small sample size and short follow up period were the limitations of the present study.

Comparative evaluation of mineral trioxide aggregate, endoseal, and biodentine in furcation perforation repair: A bacterial leakage study

Objectives: The aim of this study is a comparative evaluation of the sealing ability of mineral trioxide aggregate (MTA) Angelus, pozzolan-based Endoseal MTA, and Biodentine when used as sealing materials for furcation perforation. This was done with a bacterial leakage model. Materials and Method: Sixty-four permanent mandibular molars were selected and horizontally sectioned at middle third of the root. Cavities of 2 mm depth were prepared at the root ends. Access cavities were prepared, and the canal orifices and the root end cavities were restored with light cured resin. Perforations of diameter 1.6 mm were created in the center of the pulpal floor using a round bur in a low-speed handpiece. The teeth were randomly assigned to three experimental groups (n = 20). The perforation sites in Groups 1, 2, and 3 were repaired with MTA Angelus, EndoSeal MTA, and Biodentine, respectively. The teeth were inserted individually in an Eppendorf vial which was then placed in a McCartney's bottle containing nutrient broth. The reservoirs were filled with 0.5 ml of Enterococcus faecalis. The system was incubated at 37°C and checked for appearance of turbidity in the nutrient broth for 30 days, and these findings were noted. Level of significance was fixed at P = 0.05, and statistical analysis was done with Chi-square analysis using IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA). Results: In the time interval of 30 days, all the materials showed contamination to varying degrees (MTA Angelus 8/20 samples, Endoseal MTA 10/20 samples, and Biodentine 7/20 samples). There was no significant difference between the three groups (P > 0.05). Conclusions: MTA Angelus, Endoseal MTA, and Biodentine showed contamination in a 30-day incubation period when used as furcation perforation seal materials.

Endoscopic tympanoplasty type I using interlay technique

BackgroundTympanoplasty using the interlay technique has rarely been reported in transcanal endoscopic ear surgery, unlike the underlay technique. This is because many surgeons find it challenging to detach the epithelial layer of the tympanic membrane using only one hand. However, the epithelial layer can be easily detached from the inferior part of the tympanic membrane. Another key point is to actively improve anteroinferior visibility even if the overhang is slight because most perforations and postoperative reperforations are found in the anteroinferior quadrant of the tympanic membrane. We report the application of the interlay technique in endoscopic tympanoplasty type I for tympanic perforations.MethodsWe retrospectively reviewed the medical records of 51 patients who had undergone tympanoplasty using the interlay technique without ossiculoplasty between 2017 and 2020. We then compared the data with those of patients who underwent microscopic surgery (MS) using the underlay technique between 1998 and 2009 (n = 104). No other technique was used in each group during this period. Repair of tympanic membrane perforation and hearing outcomes were assessed for > 1 year postoperatively.ResultsThe perforation sites were limited to the anterior, posterior, and anterior–posterior quadrants in 23, 1, and 27 ears, respectively. Perforations were closed in 50 of the 51 ears (98.0%), and the postoperative hearing was good (average air-bone [A-B] gap was 6.8 ± 5.8 dB). The surgical success rate for the repair of tympanic membrane perforation was not significantly different from the MS group (93.3%, P = 0.15). The average postoperative average A-B gap in the group that underwent the interlay technique was significantly different from that in the MS group (10.1 ± 6.6 dB, P < 0.01).ConclusionThe interlay technique should be considered as one of the treatment methods in endoscopic surgery for tympanic perforations. Further study of the postoperative outcomes of this procedure should be conducted to establish the optimal surgical procedure for tympanic perforations.Trial registration: This study was retrospectively approved by the Institutional Review Board of the Jikei University, Tokyo, Japan (approval number: 32-205 10286).Video abstractEHU69PToR4KkpCPbQtPHKeVideo abstract

Duodenal perforations in the era of PPI; Is Lower Socioeconomic Status risk factor for peptic ulcer perforation? A Case Series.

Peptic ulcer perforation is one of the most prevalent surgical emergencies worldwide, with mortality rates of up to 30%. The knowledge base for clinical decision making is limited due to a scarcity of high-quality studies on the disease, but there are a few published randomized trials. Despite the fact that Helicobacter pylori infection of the stomach and the use of nonsteroidal anti-inflammatory medicines are thought to be common causes, there are age, gender, perforation site, and underlying causes that differ by demographics. The mortality rates in different countries also differ. This case series includes five perforated peptic ulcers that were operated on and data collected during a four-month period between September and December 2021. There were no significant changes in other less frequent characteristics that could influence ulcer development in this cohort, including as dietary habits, alcohol usage, occupation, or any drugs they could be taking. However, among those with chronic H. pylori infection, the prevalence of low socioeconomic status, lack of vocational training or education, semiskilled and unskilled occupations, and high work-related energy expenditure may explain the previously reported link between low socioeconomic status, H. pylori infection, and perforated peptic ulcers.

A Case of Mesenteric Border Intestinal Perforation- An Unusual and Unnoticed Site of Perforation

Incisional hernia which if not repaired at the earliest might increase in size and eventually end up in complications like incarceration or strangulation. Perforation of the bowel loop in case of incarcerated or strangulated incisional hernia without any precipitating events like trauma is very rare. Intestinal perforation, if identified is a life-threatening condition that requires emergency surgical management. Perforation of the small bowel along its mesenteric border is a rare entity with only very few cases being reported. Authors hereby, present a case of a 55-year-old female with long standing incisional hernia who was diagnosed as an incarcerated incisional hernia after computed tomography and was proceeded with an exploratory laparotomy, which on further exploration revealed perforation of the incarcerated ileum along its mesenteric border for which resection and anastomosis was done.

Validation of Boey's scoring system in predicting short-term morbidity and mortality in peptic ulcer perforation peritonitis

Aim: This study aims to assess the validation of Boey's scoring system in predicting short-term morbidity and mortality amongst patients with peptic ulcer perforation (PULP) peritonitis. Methodology: 110 patients with PULP peritonitis were included in this study. Boey's score was calculated based on three parameters, pre-operative shock, concomitant medical illness and duration of perforation >24 h. All patients with PULP were treated with exploratory laparotomy with peritoneal lavage and omental patch repair and the patients were then followed up throughout the data collection period to look for clinical outcomes. The main outcomes assessed were mortality and short-term morbidity (1 month). Data were analysed using SPSS (IBM, Delhi, India). Chi-square test was used to check for the association between the outcome variables and the categorised Boey's score. The level of statistical significance was assigned as a P < 0.05. Results: Amongst the 110 patients, half belonged to the age group of 31–50 years, and 90% were male. The most common site of perforation was the first part of duodenum (78%). The rate of mortality was 10%. With respect to the distribution of the Boey's score, the percentage of patients with Boey's score 0, 1, 2 and 3 was found to be 12.75%, 58.2%, 24.5% and 5%, respectively, and their corresponding mortality was found to be 0%, 4.7%, 25.9% and 40%, respectively. Their morbidity at 1 week was found to be 21.4%, 42.6%, 80% and 100%, respectively, and morbidity at 1 month was found to be 0%, 39.3%, 75% and 100%, respectively. Conclusion: There was a significant association between mortality and morbidity at 1 week and at 1 month with the distribution of Boey's score. This highlights the importance of Boey's score in determining the outcome amongst perforated peptic ulcer patients. Boey's score being an easily applicable score for day-to-day clinical practice can aid clinicians in predicting the outcome amongst perforated ulcer patients. Several studies have also shown better accuracy with Boey's scoring system when compared to the other scoring systems.

Management of iatrogenic root perforation with grade II furcation involvement through guided tissue regeneration technique: A case with comprehensive review of clinical literature

The aim of this case report was to describe a successful repair of a long-standing furcal and coronal root perforation with grade II furcation involvement in the mesiolingual canal of a lower first molar. A 41-year-old male patient reported with the chief complaint of mild intermittent pain and pus discharge from mandibular left first molar for 1 year. Upon clinical and radiographic examination, a pulpal diagnosis of previously initiated therapy with root perforation was made. In addition, the tooth had a periapical diagnosis of chronic apical abscess, as well as a primary endodontic and secondary periodontal lesion with grade II furcation involvement. Root canal treatment and surgical repair of the perforation and furcation involvement with Mineral Trioxide Aggregate and bone graft was done. Recall examination after 2 years showed no evidence of periodontal breakdown. The patient was asymptomatic, and favorable bone regeneration and periodontal healing were seen on the radiograph. A literature review was also conducted to assess the factors affecting the prognosis of perforation repair in molars. Long-standing cervical root and furcal perforations readily lead to persistent endo-perio lesions and have been found to have the worst prognosis. A biocompatible sealing of the perforation site along with periodontal regeneration effectively enhances the longevity of such teeth. Though there are very few case reports that advocated the use of guided tissue regeneration for periodontal regeneration, nevertheless it has proven to be a reliable technique to improve the prognosis for crestal level and furcal root perforations.

Double small incision lenticule extraction lenticular graft in impending corneal perforation

Purpose The aim of this study was to evaluate the safety and efficacy of double stromal lenticules, extracted by femtolaser small incision lenticule extraction (SMILE) surgery, as a surgical adjuvant for sealing of impending corneal perforation. Patients and methods The study included 20 eyes of 20 patients with impending corneal perforation. Double corneal stromal lenticules obtained through SMILE surgery, with a central thickness of 65 μm for each lenticule, were fixed over the corneal impending perforation site by 10-0 nylon interrupted stitches. The patients were monitored for a minimum of 6 months and were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity measurements. Postoperative complications were recorded throughout the follow-up period. Results The mean age of the patients was 51.25±1.49 years. The mean thickness of the used double SMILE lenticules was 108.85±10.77 μm (range, 90–120 μm). The preoperative best spectacle-corrected visual acuity was counting fingers at 30 cm in four patients, whereas the other 16 patients had a visual acuity of hand movement. Postoperatively, the corneal perforations were successfully sealed in 16 (80%) patients, and 15 (75%) patients exhibited a statistically significant improvement in visual acuity (P=0.02). During the follow-up period of 6 months, there was evidence of one case of infection and two cases of sliding graft. There was no significant association between the patients’ data and the reported complications except the association between complications and hand movement visual acuity. Conclusion The use of double corneal lenticules was a safe and effective surgical adjuvant for corneal perforation closure. It is a simple and inexpensive temporary measure to improve the corneal condition for further definitive interventions.

The management of complex perforation in a maxillary central incisor

Root perforations severely affect the prognosis of the teeth. This case report presents the successful management of a complex perforation with mineral trioxide aggregate (MTA) and fiber post. MTA was used to seal the perforation site since it is regarded as one of the ideal materials for perforation repair. Following retreatment and perforation repair, the root canal was rehabilitated using fiber post and composite resin. The elimination of the clinical signs and symptoms is the primary goal of successful treatment. One-year follow-up showed healthy periodontium with no clinical signs and symptoms.

Gastric Tumor Perforation Repair with Falciform Ligament

The rate of perforation in gastric tumors has been reported to be between 0.5 and 3.9%. Because the tumor is not diagnosed at the moment, or the tumor's stage is unknown, repairing the perforation site is recommended rather than resection. The first thing that comes to mind as a repair method is omentoplasty, but other alternatives can be applied in cases where this is not possible. In our case report, we aimed to present gastric tumor perforation repair with a falciform ligament in a case of linitis plastica under chemotherapy accompanied by peritoneal carcinomatosis.

Middle Ear Packing and External Ear Packing With Fibrin Glue Enhance the Success of Fat Myringoplasty Without Hyaluronic Acid Disc.

Recently, hyaluronic acid disc has been known to enhance the success rate of fat myringoplasty. However, hyaluronic acid disc (Epidisc) is not covered by south Korean medical insurance. To date, fat myringoplasty using middle ear packing has rarely been reported. In this study, we studied whether middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of tympanic membrane perforation (TMP) closure without hyaluronic acid disc, regardless of perforation size. Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at a tertiary referral center were enrolled, and the success rate and audiologic outcomes were analyzed. The mean successful tympanic membrane (TM) closure rate was 88.0%. The success rate by different age groups showed no significant difference. Further, the size of perforation showed no significant difference, and the perforation site (anterior or posterior) was not significant. The preoperative mean thresholds of air conduction (AC), bone conduction (BC), and air-bone gap (ABG) were 55.71, 12.98, and 42.73 dB respectively. The postoperative mean thresholds of AC, BC, and ABG were 23.67, 12.98, and 10.69 dB, respectively. Change in preoperative and postoperative hearing showed was statistically significant. Middle ear packing by gelfoam combined with external ear canal packing using fibrin glue enabled stable adhesion between the remnant TM and the fat graft. Regardless of the size of the TMP, the success rate of the fat myringoplasty by our technique can be enhanced without use of hyaluronic acid disc.

Perforation of the right atrial appendage during implantation of a leadless pacemaker.

We report a case of perforation of the right atrial appendage during implantation of a leadless pacemaker in a 94years old woman. We performed emergency surgery to repair the perforation site. To our konwledge, there are few reports of right atrial perforation during a leadless pacemaker indwelling.

Difficult to treat esophageal perforation after endoscopic balloon dilation for stenosis due to endoscopic submucosal dissection followed by chemoradiotherapy: A case report.

Introduction and importanceThere is no clear consensus on a specific treatment for esophageal perforation. The surgical approach is deemed necessary for local severe infection and pleural contamination requiring debridement.Presentations of caseWe have reported herein the case of a patient with esophageal perforation with severe mediastinal and thoracic abscess after endoscopic balloon dilation for stenosis due to endoscopic submucosal dissection and chemoradiotherapy. A surgical approach with primary closure was performed, but not found effective; while conservative treatment with mediastinal drainage via posterior neck and recovery of nutritional status was found to be effective. For the recovery of nutritional status, enteral nutrition was assessed using a polymeric formula through a percutaneous endoscopic gastrojejunostomy tube.DiscussionEsophageal perforation is a life-threatening condition. Iatrogenic injuries are the frequent cause of esophageal perforation. For esophageal perforation, not only surgical interventions but also conservative treatments including various endoscopic approaches have been performed. If the inflammation is not localized, surgical intervention is often needed; however, if the patient's general condition is stable, conservative treatment with drainage, antibiotics, and nutritional management may be considered, even in cases of esophageal perforation.ConclusionsEsophageal perforation with a large perforation site with widespread inflammation can be improved with proper thoracic and mediastinal drainage and adequate nutrition support if the patient's condition is mild.

P-L05 Enterohepatic migration of ingested fishbone resulting in hepatic abscess- Case report and review of literature

Abstract Background Ingestion of foreign bodies is common, particularly in children. In adults, most foreign body ingestions are related to food bolus or bone. The majority present with pharyngeal symptoms. Most foreign bodies exit the gastrointestinal tract without complication. However, around 1% result in perforation. Patients may have a delayed presentation with nonspecific symptoms and pose a diagnostic dilemma. We report a rare case of silent migration of a fishbone into the liver and a review of the literature. Methods We present the case of a 56 year old man who presented with a liver abscess second to an ingested fishbone. We conducted a PUBMED search and reviewed the published data over a period of thirty years. We identified 52 similar cases and compared the presentation, site of perforation and location of the fish bone. We observed the different approaches in presentation and management of such patients. Results A 56-year-old man presented to his local hospital with dull epigastric pain and raised inflammatory markers. CT scan revealed a 4 cm abscess in the left lobe of the liver, with a linear radio-dense body within. The patient was given antibiotics and the abscess was aspirated. The patient was transferred to our Hepatopancreaticobiliary unit for further management. Laparoscopy was performed. The left lateral segment of the liver was adherent to the gastric antrum. The hepato-gastric fistula was disconnected. The fishbone was retrieved from the liver. The abscess was drained and wash out performed. The patient was discharged the following day. Conclusions Left lobe liver abscess should raise suspicion of foreign body. Although antibiotic treatment may be effective in the short term, there is no long-term data regarding recurrence. We believe that laparoscopic drainage of the abscess and extraction of the foreign body offer control of the source of sepsis and reduces the risk of recurrence.

Dual-network hydrogel based on ionic nano-reservoir for gastric perforation sealing

In recent years, remarkable progress has been made in the research of injectable hydrogel for internal tissue healing. However, the therapeutic outcome is usually limited when the hydrogel is used for the treatment of gastric perforation due to the high acidic gastric juice and violent deformation of the gastric wall. Regarding these challenges, we proposed an ionic nano-reservoir (INR)-based dual-network hydrogel, which has excellent adhesion and mechanical properties, and can be easily applied to the perforation site to block the perforation while promoting tissue repairing. The results showed that the first network made of polyacrylamide had cross-linked on the stomach tissue within 5 s under blue light, and enhanced the adhesion performance through mechanical interlock. The nano-hydroxyapatite acted as ionic INR, which can gradually release Ca2+ under acid environments to form the second network with sodium alginate and inhibit the swelling of hydrogel in gastric juice. Meanwhile, the adhesion was further enhanced through amide covalent bonds at the hydrogel-tissue interface with the presence of 1- ethyl-3-(3-dimethylaminopropyl)carbodiimide/N-hydroxysuccinimide (EDC/NHS). The dual network hydrogels obtained by the INR strategy could be employed as a potential therapeutic option for gastric perforation and other similar biomedical prolems.

Prevention of Septal Perforation Using a Combination of Crushed Cartilage and Thin Silastic Sheet During Septoplasty

Background and Objectives: The aim of the present study was to investigate the effects of a combination of crushed cartilage and thin silastic sheet for patients with a risk of septal perforation during septoplasty.Materials and Methods: A total of 195 people who underwent septoplasty surgery at Dong-A University Hospital from January 2019 to December 2020 were enrolled retrospectively. Among 195 people, our surgical method was provided for those with damage to both septal mucosa. The cartilage was collected, crushed with the cartilage crusher, and inserted between perforated mucosa. After the cartilage insertion, a 0.254-mm-thin silastic sheet was designed to cover both sides of the perforated septal mucosa. Next, a penetrating suture was placed. After thin silastic was applied on both mucosa, a 1-mm-thick silastic sheet was inserted on both sides of the nasal cavity and penetrating sutures were placed on the anterior and inferior septum. The operation concluded after packing both sides of the nasal cavity using non-absorbable packing material. The packing was removed on the second day after the operation, and the nasal cavity condition was checked every week. Thick silastic sheets were removed 5 days after surgery, and thin silastic sheets were maintained until both septal mucosa healed.Results: Of nine total cases, only one 78-year-old male experienced septal perforation at the cartilage portion two months after surgery. In this case, no other action was taken to cover the perforation site because he reported no symptoms or discomfort during the 9 months after surgery. In the other eight cases, both septal mucosa healed completely, and there were no complications.Conclusion: This method with crushed cartilage and silastic sheets to fill the defect after septal surgery is thought to help prevent postoperative perforation at no additional cost, and further research is needed.

Surgical Strategies for Cardiac Perforation After Catheter Ablation or Electrophysiology Study.

Catheter ablation is a treatment modality which has been increasingly used for cardiac arrhythmias. However, it is not complication-free, and cardiac perforation is one of its most life-threatening complications. As surgery is usually not the first-line treatment for this emergent episode, there were only very few sporadic surgical reports in the literature. This systemic review primarily aims to collect different surgical approaches for catheter-induced cardiac perforation to help surgeons manage this kind of uncommon and critical patients. Of the 452 initially screened articles, 22 studies (38 patients) were included in the systemic review. Of all the included patients, 84% (32/38) were found to have pericardial effusion acutely following catheter-related procedures, and 16% (6/38) experienced delayed-onset episodes. Regarding the surgical procedures, four patients underwent removal of clots only, eight patients underwent suture repair of the left ventricle (LV), nine patients underwent suture repair of the right ventricle (RV), five patients underwent suture repair of the LA, and four patients underwent sutureless repair of the LV and pulmonary vein (LV 1, RV 1, pulmonary vein 1). In addition to repair of perforation sites, the concomitant combined procedures included repair of intercostal vessels (complication of pericardiocentesis) for one patient, cryoablation for two patients, and maze procedure for one patient. For cardiac perforation following catheter ablation or electrophysiology study, although the majority of the patients are treated with pericardiocentesis and medical management at first, cardiovascular surgeons have to prepare to take over if the bleeding is persistent or if the cardiac tamponade is not relieved.

Risk factors for sinus membrane perforation during lateral window maxillary sinus floor elevation surgery: A retrospective study.

To analyze the sinus membrane perforation (SMP) rate and its potential risk factors during lateral window maxillary sinus floor elevation (LSFE). For patients with LSFEs at Department of Implantology, Stomatology Hospital, School of Medicine, Zhejiang Universitiy during January 2014 to December 2020, patient-related risk factors (age/sex/smoking habit), surgery-related risk factors (operator experiment/number of tooth units/technique of osteotomy/surgical approach), and maxillary sinus-related risk factors (residual bone height/sinus membrane thickness/lateral wall thickness/maxillary sinus contours/presence of septa/blood vessels at the lateral maxillary sinus wall) were compared between perforated and nonperforated sites and were evaluated for their influence affecting SMP. The study sample comprised 278 LSFE procedures in 278 patients; a total of 47 LSFE procedures (16.91%) presented SMP. Four significant factors were identified: smoking habit (p < 0.001), thin (≤1.5 mm) sinus membrane (p=0.027), maxillary sinus contours (p < 0.001), and presence of septa (p=0.001). The SMP rate of irregular, narrow tapered, and tapering sinus contours was significantly higher than that of ovoid and square one (p < 0.05). In general, smoking habit, thin sinus membrane, irregular, narrow tapered, and tapering sinus contours, and presence of septa may increase the risk of SMP during LSFE.

Development and Validation of a Nomogram for Preoperative Prediction of Localization of Neonatal Gastrointestinal Perforation.

Background: Information regarding the localization of gastrointestinal perforation is crucial for the following surgical procedure. This study was to determine the key indicators and develop a prediction model for the localization in neonates with gastrointestinal perforation.Methods: A nomogram to predict the location of neonatal gastrointestinal perforation was developed using a cohort of patients who underwent surgery between July 2009 and May 2021. Baseline variables were analyzed using logistics regression and nomogram developed using significant predictors. The predictive performance of the nomogram was assessed by the concordance index (C-index), calibration curve, and area under the receiver operating characteristic (ROC) curve (AUC). The nomogram was further validated in an integrated external cohort.Results: We investigated the data of 201 patients, of which 65 (32.3%) were confirmed with upper gastrointestinal perforation by surgery. Multivariate logistic regression analysis identified the following as independent predictors: preterm [OR: 5.014 (1.492–18.922)], time of onset [OR: 0.705 (0.582–0.829)], preoperative hemoglobin [OR:1.017 (1.001–1.033)], bloody stool: No [OR: 4.860 (1.270–23.588)], shock [OR: 5.790 (1.683–22.455)] and sepsis: No [OR 3.044 (1.124–8.581)]. Furthermore, the nomogram was effective in predicting the perforation site, with an AUC of 0.876 [95% confidence interval (CI): 0.830–0.923]. Internal validation showed that the average AUC was 0.861. Additionally, the model achieved satisfactory discrimination (AUC, 0.900; 95% CI, 0.826–0.974) and calibration (Hosmer-Lemeshow test, P = 0.4802) in external validation.Conclusions: The nomogram based on the six factors revealed good discrimination and calibration, suggesting good clinical utility. The nomogram could help surgeons predict the location of gastrointestinal perforation before surgery to make a surgical plan.