Wall Defects Research Articles

Cancer mortality among patients admitted to gynecological wards at Lagos University Teaching Hospital, Nigeria

to break her hymen using a candle, but the object could not be removed. The woman consulted a gynecologist the next day complaining of acute onset of urinary retention and intense pelvic pain; no lacerations or defects of the vaginal wall were found on examination. However, pelvic ultrasound showed the foreign body, which was thought to be in the bladder. Thepatientwas referred to theurologic emergencydepartment where urine was drained by suprapubic catheter. Cystoscopy under general anesthesia showed a normal bladder. Vaginoscopy was also performed, but did not show any foreign body. The patient returned home without treatment and experienced normal voiding. Sexual function was normal except for intermittent pelvic pain. During 3 years of infertility she consulted a gynecologist; hysterography revealed an obstruction in the left fallopian tube (Fig. 2) suggesting endosalpingitis. Pelvic ultrasound revealed a left ovarian cyst and the patient was referred to our department for further investigation. Uterine transmigration appears to be the most likely explanation for the presence of the foreign body in the fallopian tube, since there were no vaginal lacerations and no evidence of bladder transmigraFig. 2. Hysterogram suggesting endosalpingitis.

Comment je contrôle une aorte thoracique après traitement en scanner ou en IRM ?

Follow-up after thoracic aortic repair relies on CT and MR imaging in order to detect complications from the treatment or underlying pathology. Following prosthetic repair of the ascending aorta, peri-prosthetic hematoma and anastomotic complications (leak, false aneurysm, peri-prosthetic circulation) should be excluded. Following treatment with a covered stent, the location of the prosthesis and its skeleton should be evaluated and endo-leaks and wall defects should be excluded. Following treatment of a dissection, there often is persistent flow in the false lumen. The entry points into the false lumen should be identified. The caliber of the aorta at different levels should be assessed. Signs of ischemia (static and dynamic) and acute complications should be excluded in patients with acute chest pain. Atherosclerosis and dysplastic conditions may affect other segments of the aorta (aneurysm, dissection, hematoma). Follow-up is performed with CT, if possible, when high-resolution evaluation is required, of with MRI in other cases. Follow-up is obtained on a yearly basis or twice a year when an evolutive process is identified. It is performed every two to five years when the risk is low. Follow-up should be suggested by the radiologist.

Mannose trimming reactions in the early stages of the N-glycan processing pathway

In all eukaryotes, asparagine-linked glycosylation is one of the most common co- and posttranslational modifications of secretory and membrane proteins. In mammals, N-glycosylation is involved in several cellular processes including protein folding, protein stability, intracellular trafficking and interactions with other proteins. Until recently, the functional importance of protein N-glycosylation in plants has been widely elusive. We have now identified class I α-mannosidase mutants (mns) impaired in de-mannosylation of N-glycans.1 The mns mutants accumulate high amounts of oligo-mannosidic N-glycans and display striking cell wall alterations and defects in root development. Especially the mns1 mns2 mns3 triple mutant forms short roots with radially swollen cortical cells and displays alterations in development of aerial plant parts. Our data indicate that the N-glycan processing defects in mns mutants affect one or several glycoproteins involved in cell wall formation, which could be linked to the potential impact of mannose trimming on glycoprotein quality control in the endoplasmic reticulum (ER) and ER-associated degradation of misfolded glycoproteins.

Ceramic capillary electrophoresis chip for the measurement of inorganic ions in water samples

We present a microchip capillary electrophoresis (CE) device build-up in low temperature co-fired ceramics (LTCC) multilayer technology for the analysis of major inorganic ions in water samples in less than 80 s. Contactless conductivity measurement is employed as a robust alternative to direct-contact conductivity detection schemes. The measurement electrodes are placed in a planar way at the top side of the CE chip and are realized by screen printing. Laser-cutting of channel and double-T injector structures is used to minimize irregularities and wall defects, elevating plate numbers per meter up to values of 110,000. Lowest limit of detection is 6 microM. The cost efficient LTCC module is attractive particularly for portable instruments in environmental applications because of its chemical inertness, hermeticity and easy three-dimensional integration capabilities of fluidic, electrical and mechanical components.

A Case of Invasive Paranasal Aspergillosis with Opthalmopathy

Invasive paranasal aspergillosis has been considered to have a poor prognosis. We report a case of orbital apex syndrome due to left ethmoid-sphenoid aspergillosis. A 76-year-old woman with untreated diabetes mellitus, presented with left visual disturbance, oculomotor nerve palsy, ptosis and orbital pain. CT and MRI showed cloudy images with defects of the bone wall in the left posterior ethmoidal sinus. The serological examination revealed aspergillus antigen (+) and high levels of β-D glucan. Therefore, we diagnosed paranasal aspergillosis, and administrated voriconazol preoperatively as an antifungal agent. The patient underwent left ethmoid-sphenoidectomy and biopsy via the endonasal approach. In the histopathologic examination, aspergillus was found around the optic nerve canal. At the present, continucus administration of voriconazol has improved the patient's ptosis and orbital pain, but not her visual disturbance. This case suggests that invasive paranasal aspergillosis has the possibility of visual loss and high mortality rate so that he needs early diagnosis and treatment.

特発性外耳道骨欠損症が原因と考えられた耳鳴例

I report on a case of an idiopathic bone defect of the external auditory canal. A 62-year-old female patient presented with tinnitus and aural fullness in her right ear during biting. I confirmed the projection of the anterior wall of the external auditory canal during biting, and the projection was retracted when she opened her mouth. Computed tomography examination revealed a partial defect of the anterior wall of the bony external ear canal. I thought that this defect was caused by the failure of the foramen of Huschke to close during development.

Enxerto homólogo congelado de diafragma na correção dos defeitos da parede abdominal de ratos

To analyse the morphology and biomechanics of diaphragma frozen homografts used for rats' abdominal wall defects repair. Thirty wistar rats with abdominal wall resection and reconstruction using frozen diaphragma homografts were compared to twenty other rats submitted to abdominal wall incision and closure (control). Animals were euthanized after 3 and 6 months and abdominal walls were avaliated histologically with H/E and Picrosiriud Red staining and tensiometric evaluation. The tensiometric parameters were greater in the experimental group at 3 months after surgery. The percentage of mature collagen was significantly greater at 6 months after surgery in control and experimental groups. Tensiometric parameters and type I collagen as well maturation collagen index and rupture maximal strength were statistically correlated after 3 and 6 months. Frozen diaphragma homograft can be an alternative to repair the defects of abdominal wall.

Severe Disease Activity and Complications of Immunosuppressive Therapy: A Challenge for Acute Hospital-based Rehabilitation in Rheumatology

Acute rehabilitation refers to the multidisciplinary rehabilitative treatment of patients in continuing need of integrated acute and rehabilitative longterm care. As a result of the advances in acute rheumatology and improved emergency services, an increasing number of patients survive episodes of severe disease and complications of immunosuppressive therapy. These patients require not only treatment of their acute medical problems but also specialized multidisciplinary acute rehabilitation starting as early as possible during their hospital stay. We describe 4 typical cases from the major fields of rheumatology. (1) Acute rehabilitation of a 63-year-old woman with rheumatoid arthritis after replacement of both preexisting knee endoprostheses in one session and removal of the left hip endoprosthesis due to infection and sepsis. (2) Rehabilitation of a 29-year-old man with a 7-year history of ankylosing spondylitis who lived in an adjustable easy chair for 2 years due to severe pain prior to admission. (3) A 61-year-old woman with active refractory Wegener's granulomatosis who developed respiratory insufficiency due to aspergillus and pseudomonas pneumonia. (4) The acute rehabilitation of a 21-year-old woman with systemic lupus erythematosus and a history of 14 laparotomies due to severe acute pancreatitis and multiple gut perforations. Acute rehabilitation was complicated by a large defect of the abdominal wall and significant critical illness polyneuropathy. Our report points out differences between acute, postacute, and longterm rehabilitation, describes the mobilization of patients in acute rheumatology units, and defines specific problems encountered in acute hospital-based rehabilitation of rheumatological patients.

Vakuumtherapie einer Anastomoseninsuffizienz am Ösophagus – ein Fallbericht

Esophageal anastomotic leakage is a major complication. In rectal surgery, anastomotic dehiscence is successfully treated by endoscopically placed intracavitary vacuum sponge systems. We used this technique in a case of anastomotic dehiscence following transhiatal gastrectomy. In an 80-year-old female patient esophageal anastomotic leakage was diagnosed endoscopically six days following transhiatal gastrectomy. Endocavitary treatment by endoscopic implantation of a vacuum sponge system was performed. After 14 days of treatment with 4 system changes and a change interval of 2-4 days complete healing was observed. A week later, a second wall defect was diagnosed and treated in the same way. The total hospital stay after operation was sixty days. Esophageal anastomotic leakage can be successfully treated by means of an endoscopically placed intracavitary vacuum sponge system. This paper describes the therapeutic technique.

The hidden mortality of congenital diaphragmatic hernia: a 20-year review

Aims The true mortality associated with congenital diaphragmatic hernia (CDH) is hidden because survival analyses do not include fetuses with CDH. A retrospective review of all postmortems (PMs) with a diagnosis of CDH over a 20-year period was carried out to highlight this hidden mortality and also measure the nature and number of associated anomalies. Methods Postmortem case record details were reviewed for the period January 1986 to December 2005. Data were collected on live birth, stillbirth, therapeutic abortion, and spontaneous abortion. Results There was a decline in the annual number of PMs during the period of the study. The median for the four 5-year intervals being 609 (570-657), 528 (488-565), 515 (413-537), and 373 (357-388). A total of 130 PMs were identified, which included a diagnosis of CDH; 97 (75%) were left sided, 22 (17%) were right sided, and 11 (8%) were bilateral. There were 69 live births, 46 therapeutic abortions, 10 stillbirths, and 5 intrauterine deaths; 22% were right sided/bilateral in the live and therapeutic abortion groups, whereas 53% were right sided/bilateral in the latter 2 groups. Of 130, 82 (63%) had major associated anomalies, and 50% of these had at least 1 further major anomaly. The commonest categories of anomalies were cardiac (30), gastrointestinal/abdominal wall defect (28), and neural tube defects (25). Conclusions The true incidence of CDH is considerably higher than that seen in neonatal surgical practice. The decline in number of PMs in our region will exacerbate the underestimation of the true incidence. There is a higher incidence of right-sided/bilateral hernias and more than one major anomaly in those who die in utero.

Delayed repair for traumatic abdominal wall hernia: is it safe?

Abdominal wall hernias after trauma have been recognized for more than a century, with the first case reported as occurring after a fall. Traumatic abdominal wall hernias (TAWHs) after blunt trauma are uncommon. The timing of definitive repair, early or delayed, is not clear. We report a case on TAWH and mesenteric avulsion, highlighting the reasons for immediate or delayed repair. A single case study can hardly be considered as a basis for profound changes in the management of post traumatic hernias. However, damage to all layers of the abdominal wall indicates high-energy trauma. In such cases, the damage is not, in all probability, limited to the integumentary system. For the moment, the timing of surgery in any TAWH should be considered differently according to the trauma, the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient.

Biomechanical and dinical studies of anatomical reconstruction of posterior wall of the acetabulum with self ilium

Objective To design a new method of posterior wall reconstruction for severely corn-minuted and obsolete fracture of the posterior wall of the aeetabulum. Methods (1) Biomechanical study (from two perspectives: the stability and the stress distribution on the femoral head and the acetabu-lure) : six fresh adult' s pelvis and femur specimens were collected and divided into experimental group ( consisted of the left sides) and control group ( consisted of the right sides). After the defects of the pos-terior wall were made, the defects were anatomically reconstructed with the harvested ilium by acetabular tridimentional memory fixation system (ATMFS) in the experimental group, whereas the acetabular frag-ments were repositioned to the defect sites and fixated by the plates and screws in the control group. Lon-gitudinal and latitudinal displacement, stability of the anatomically reconstructed posterior wall of the ace-tabulum, the fitness of femoral head to the acetabulum after anatomical reconstruction and mean and maxi-mum pressure of anterior wall, posterior and cupuh of the acetabuhm were analysed and compared. (2) Cinical study: The posterior wall defect on the harvested ilium piece was repaired with 3-directional loc-king of ATMFS in 10 male patients (at age of 16-50 years, mean 36.4 years) from January 2000 to June 2002. There were seven patients with flesh acetabular fractures and three with old acetabular fractures.The period from fracture to reconstruction for the patients with old fractures was 58-251 days ( 137.7 days an average). The patients were foUowed up for 5.8 years (average 5.2-7.1 years). Results (1) Biomechanical study showed no statistical difference upon stability and fitness of femoral head to acetabu-lum after reconstruction in experimental and control groups. (2) Clinical study: postoperative X-ray film showed no repeated displacement of the fracture and the patients began out-of-bed movement with weight bearing after 1.6 months (1.2-2.1 months). Heterotopic ossification was found in two patients, with no influence on the joint function. According to the elinieal ranking standard of Modified d' Aubigne and Postal, the excellence rate was 93%. Conclusions Anatomical reconstruction of posterior wall of the acetabulum by using serf ilium with ATMS has good stability and stress distribution of the femoral head and the reconstructed acetabulum in clinical application and offers a new method for treatment of severely comminuted and obsolete fracture of posterior wall of acetabulum. Key words: Aeetabulum; Fracture fixation, internal; Biomechanics; Anatomical recon-straction

Mammary myocutaneous-glandular flap for reconstruction of oncological defects of the anterior midline chest wall

We describe a mammary myocutaneous-glandular flap, which is a simple, convenient, reliable, and speedy reconstructive technique applicable for women that combines little or no morbidity with excellent cosmetic outcome and provides a simple solution to an extremely difficult problem.

Laparoscopic Repair of a Ureter Damaged During Inguinal Herniorrhaphy

Laparotomy has been used generally to deal with ureteral injury. Recently, a few papers have reported the repair of gynecologic ureteral injuries by laparoscopy, with encouraging results; however, successful repair of a ureter damaged during an open inguinal herniorrhaphy fully performed by laparoscopy has not been reported yet. A 49-year-old obese man (body mass index=35) in the 10 years before surgery began to note a protrusion in the scrotal region. The protrusion evolved asymptomatically for 8 years, and began to cause pain in the lumbar spine to the right and paresthesia of the right leg. An open right inguinal herniorrhaphy was performed. When the exeresis of the fatty tissue around the spermatic cord was being carried out, resection of a 12-cm tubular structure, supposedly the appendix, was performed. Wall defect was closed by a polypropylene mesh. Acute abdominal pain developed immediately in the postoperative period and investigation using laparoscopy was undertaken. After confirmation of ureteral injury, laparoscopic repair was performed, and the ureter was anastomosed without tension over a double-J catheter. A suction drain was left near the anastomosis. Postoperative period was uneventful. The vesical catheter was withdrawn on the eighth postoperative day and the drain on the twelfth postoperative day. The histopathologic report confirmed that the resected structure was the ureter. The patient has remained asymptomatic for 2 years since the surgery.

Incarcerated massive incisional hernia: extensive necrosis of the colon in a very obese patient. Surgical treatment and vacuum-assisted closure therapy: a case report

We discuss a diabetic obese patient with an extensive necrosis of the ascending and transverse colon plus segmental necrosis of the small bowel incarcerated in a massive median incisional hernia below the umbilicus. After a blood test and an abdominal CT scan (without contrast dial), the patient underwent an urgent operation. We performed an extended right hemicolectomy, multiple segmental small bowel resections and a terminal ileostomy. The defect of the abdominal wall was treated with vacuum-assisted closure (VAC) therapy with good results.

A rare case of primary actinomycosis of the anterior abdominal wall: diagnosis and treatment

We present the case of a 60-year-old man who presented with a left hypochondrial swelling first noticed 4 weeks prior to admission to our clinic. Based on the findings of the ultrasound and magnetic resonance imaging investigation, a tumour of uncertain origin of the abdominal wall was suspected, also involving the small bowel. The swelling, including the affected lateral and transverse oblique muscles as well as the subcutaneous tissue and the adjacent omentum majus, was completely excised. The resulting myoaponeurotic defect of the left lateral abdominal wall was closed with interrupted Vicryl sutures and stabilised with a PTFE prosthesis (20 x 10 cm) that was placed intraabdominally and secured by spiral tackers and interrupted transfascial monofilament Prolene sutures. Microscopic examination of the excised specimen revealed an actinomycosis of the anterior abdominal wall, which is extremely rare. The surgical treatment was followed by antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications.

Pedicled superior epigastric perforator flap for reconstruction of a soft tissue defect at the ventral thoracic wall

The purpose of this paper is to present a new method of ventral chest wall reconstruction utilizing skin and fat from the abdominal wall pedicled on the superior epigastric artery and its comitant veins without sacrificing the rectus abdominis muscle. In a patient with a 13 × 15 cm left parasternal soft tissue defect of the thoracic wall, a paraumbilical perforator flap of skin and subcutaneous tissue was elevated with meticulous preparation of the perforators to the right superior epigastric vessels without sacrificing any muscle. The skin and fat island with its vascular pedicle was drawn through an epigastric subcutaneous tunnel to the ventral thorax and placed into the defect. Postoperative flap perfusion measured by laser Doppler flowmetry was excellent, abdominal wall reconstruction was easy, and 3 months after operation, the ability to perform sit-ups was as good as before the operation. In two further patients, we found the vascular anatomy to be unsuitable for this flap. The pedicled superior epigastric perforator (SEP) flap is suitable in certain cases but unreliable for reconstruction of soft tissue defects at the chest wall. Further investigations and operating experience may provide additional knowledge to allow wider and more secure use of the SEP flap.

Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy

Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (kappa) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo.

Natural Orifice Translumenal Endoscopic Surgery (NOTES): What are We Getting Into?

1Division of Gastroenterology; 2School of Computing, Department of Mechanical and Materials Engineering, Department of Surgery, Hotel Dieu Hospital, Kingston, Ontario Correspondence: Dr Lawrence C Hookey, Queen's University, Division of Gastroenterology, Hotel Dieu Hospital, 166 Brock Street, Kingston, Ontario K7L 5G2. Telephone 613-544-3310, fax 613-544-3114, e-mail hookeyl@hdh.kari.net WHAT IS NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY? For most gastroenterologists, one of the first rules of endoscopy is to diligently avoid perforation of the gastrointestinal lumen. While this principle remains true in the majority of cases, therapeutic crossing of the gastric or duodenal lumen is now accepted for pancreatic pseudocyst drainage and percutaneous gastrostomy tube placement. Endoscopic ultrasound-guided fine needle aspiration of abnormalities in the abdomen and mediastinum has further pushed this barrier. Natural orifice translumenal endoscopic surgery (NOTES), first described in 2004 (1), extends the concept of extraluminal endoscopic intervention to another level. The technique begins with the creation of an opening in a natural lumen (most often gastric, although colonic, vesical, vaginal and uterine approaches have been described) using either electrosurgical incision or needle puncture followed by balloon dilation. An endoscope is then passed through the opening, with pneumoperitoneum provided through the endoscope. Procedures such as cholecystectomy and oophorectomy are performed using traditional (snares, biopsy forceps, endo-loops) and nontraditional (endoscopic suturing devices) endoscopic equipment. Upon withdrawal of the endoscope back into the lumen, the wall defect is closed using clips or sutures. Although most work has been limited to animal experiments (most commonly pigs), Drs Reddy and Rao, from the Asian Institute of Gastroenterology in Hyderabad, India, have performed a limited number of transgastric appendectomies in humans (personal communication). The main potential advantages of NOTES are related to the lack of transabdominal incisions. This could possibly reduce anesthetic requirements and postoperative pain, leading to faster recovery. The lack of restricted inspiration secondary to abdominal wall pain could potentially lead to a lower rate of postoperative atelectasis and pneumonia. In addition, patients who traditionally have poorer outcomes with open surgery (those with chronic obstructive pulmonary disease, the morbidly obese, corticosteroid users) may be particularly suited to NOTES, with its potential for easier access to the peritoneum and decreased postoperative recovery. The cosmetic advantage of NOTES, or ‘scarless surgery’, is obvious. However, the importance of this is still debated (2) and the significance that patients would place on this remains to be determined.

Change of Paternity: A New Environmental Risk?

An increase in the rate of gastroschisis (a congenital defect of the abdominal wall) has been noted in several population-based studies. Gastroschisis usually is a sporadic event and is thought to be related to vascular compromise in the developing fetus. In a case-control study, researchers examined whether change of paternity might …