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As the cobwebs start to clear, Longarm gradually recalls the name of the gal who hit his head. Now, if he can just remember where he put his Winchester…. Longarm and the Pleasant Valley War. It began when a powerful ranch fenced in its smaller neighbors--and now the entire valley is about to explode like a powder keg. But in a land where old feuds never die and new feuds come alive by the minute, Longarm will have to slap leather and sling lead before he can lay down the law….
Longarm and the Ambush at Holy Defiance. After some Arizona Rangers and U. The Pinkertons always get their man—and Haven is no exception. As they tangle with banditos, Apaches, and a wealthy ranch owner and his wild wife, Longarm and Haven are in for a hell of a ride…. Saddled with the sassy lass, the Trailsman must carve a bloody trail through danger and deception if either of them is going to come back alive…. The Gunman and the Greenhorn. Slocum's about to learn that sometimes, the best man for the job is a boy.
And Jack Mitcham is as cheap as they come. Saving on ammo, as Mitcham would say. The choice of therapy in each patient should be based on the individual hemodynamics of the ectopic varices. Total Ossicular Replacement Prosthesis: A New Fat Interposition Technique. To compare audiometric results between the standard total ossicular replacement prosthesis TORP-S and a new fat interposition total ossicular replacement prosthesis TORP-F in pediatric and adult patients and to assess the complication and the undesirable outcome.
This is a retrospective study. This study included patients who had undergone titanium implants with TORP-F and 54 patients who had undergone the procedure with TORP-S between and in our tertiary care centers. Normally, this prosthesis is designed to fit on the stapes' head as a partial ossicular replacement prosthesis. By stratifying data, the pediatric cohort shows However, the adult cohort shows These improvements in hearing were statistically significant.
There were no statistically significant differences in the speech discrimination scores. The only undesirable outcome that was statistically different between the 2 groups was the prosthesis displacement: The interposition of a fat graft between the legs of the titanium implants TORP-F provides superior hearing results compared with a standard procedure TORP-S in pediatric and adult populations because of its better stability in the oval window niche. Weight loss after gastric banding is associated with pouch pressure and not pouch emptying rate.
It is primarily treated with diet, lifestyle changes, and medicine. However, at present, surgery remains the only effective option for the management. Seventeen patients were studied 2 months after laparoscopic gastric banding. The aims were to evaluate the association between 1 the extent of pouch filling and satiety, 2 gastric emptying and weight loss, and 3 the pouch pressure during a meal and the sensation of satiety and weight loss.
The preoperative weight was kg range kg. The average weight loss was 21 kg between the banding and the examination. The sensation of satiety lasted 75 min No association was found between the sensory data and the pressure decline. The satiety sensation lasted much longer than the pouch emptying and the pressure increase.
The pressure load correlated to the weight loss. This indicates that neuroendocrine mechanisms caused by the accumulated mechanical load are most important for maintaining satiety. Primary jejunal adenocarcinoma constitutes a minute portion of small intestine adenocarcinomas.
Clinically, this cancer presents at latter stages of its progression, mainly due to vague and non-specific symptoms, and the difficulty encountered in accessing the jejunum on upper endoscopy. Diagnosis of jejunal adenocarcinoma is usually inconclusive with the use of computed tomography CT scan, small bowel series, or upper endoscopy.
Laparoscopy followed by frozen section biopsy provides a definitive diagnosis. In the past decade, balloon-assisted enteroscopy BAE and capsule endoscopy have become popular as useful modalities for diagnosing small bowel diseases. Physicians are advised to suspect jejunal adenocarcinoma as a differential diagnosis in patients who present with non-specific symptoms of abdominal pain, nausea, vomiting, weight loss, anemia, gastrointestinal bleeding or signs of small bowel obstruction. We present a rare case of a year-old woman with suspected bilateral ovarian masses, which was immunohistochemically confirmed as primary jejunal adenocarcinoma with bilateral ovarian metastasis.
Jejunal perforation due to porcupine quill ingestion in a horse. An 8-month-old Andalusian filly was treated for jejunal perforations due to ingestion of a porcupine quill. During exploratory laparotomy, 2 separate stapled side-to-side jejunojejunal resection and anastomoses were performed. Post-operative complications after 2 years follow-up included mild incisional herniation following incisional infection and chronic intermittent colic. We conducted a study to investigate current trends in carpometacarpal CMC interposition arthroplasty across time, sex, age, and region of the United States; per-patient charges and reimbursements; and the association between this procedure and concomitantly performed carpal tunnel syndrome CTS and carpal tunnel release CTR.
Between and , the number of patients who had CMC interposition arthroplasty increased Females had the procedure more frequently than males at all time points, though the percentage of patients who were male increased throughout the study period. Of the patients who had CMC interposition arthroplasty, Despite a lack of evidence that thumb CMC interposition arthroplasty is superior to other surgical treatment options, the number of patients who are having this procedure has increased significantly.
The impetus for these trends requires additional investigation. This operation may lead to loss of mobility and strength in the wrist. This study reports the short-term outcomes of a new technique for treating pisotriquetral arthritis using a pisotriquetral interposition arthroplasty with a pyrocarbon implant. We also studied the mobility of the implant and did assessed articular instability using dynamic radiology and fluoroscopy. All patients were satisfied or very satisfied with their operation and had an average functional recovery period of 1. The functional radiologic and fluoroscopic study reported good adaptive mobility of the implant in all the patients, without any indication of pisotriquetral joint instability.
This new surgical solution appears to be a valid alternative to pisiformectomy or pisotriquetral arthrodesis. Long-term studies are required to confirm these preliminary findings. Original treatment for ischaemic stenosis of colon interposition: Report of two cases. The treatment of ischaemic stenosis of colon interposition for oesophageal replacement remains poorly defined.
We report two cases of patients operated for ischaemic stenosis of the cervical extremity of the colon interposition for caustic stenosis of the oesophagus. Treatment consisted of resection of the stenosis with creation of a new cervical anastomosis after complete release of the colon graft via a neck and upper midline incision in one patient and a new ileocolic graft exclusively replacing the stenotic segment of the oesophagoplasty in the second patient.
These two cases illustrate the complex treatment modalities required for this complication. The treatment of choice of ischaemic stenosis of colon interposition is resection with creation of a new anastomosis, but repeat graft may sometimes be the only available treatment option. Causes and consequences of anterior pharyngeal pouch after total laryngectomy. To assess the frequency of anterior pharyngeal pouch formation after total laryngectomy, and to discuss the causes and consequences of anterior pharyngeal pouch formation.
A prospective, observational study of 43 patients undergoing total laryngectomy. Data collected included laryngeal defect closure type, tumour staging and demographic information. A barium swallow was performed on day after surgery to assess for anterior pharyngeal pouch formation and fistula formation. The incidence of anterior pharyngeal pouch formation was 47 per cent.
Patients who did not have an anterior pharyngeal pouch on swallow imaging assessment were less likely to develop a pharyngo-cutaneous fistula. There was no statistically significant association between laryngeal defect closure type and anterior pharyngeal pouch formation. The anterior pharyngeal pouch is a dynamic phenomenon best investigated with a fluoroscopic swallow imaging study. Its causes are multi-factorial. Absence of an anterior pharyngeal pouch appears to confer protection against pharyngo-cutaneous fistula formation, hastening commencement of adjuvant therapy and an oral diet.
Kinematic and fatigue biomechanics of an interpositional facet arthroplasty device. Interpositional facet arthroplasty IFA is a novel treatment for lumbar facetogenic pain designed to provide patients who gain insufficient relief from medical interventional treatment options with long-term relief, filling a void in the facet pain treatment continuum. This study aimed to quantify the effect of IFA on segmental range of motion ROM compared with the intact state, and to observe device position and condition after 10, cycles of worst-case loading.
In situ biomechanical analysis of the lumbar spine following implantation of a novel IFA device was carried out.
Twelve cadaveric functional spinal units L2-L3 and L5-S1 were tested in 7. Additionally, specimens underwent 10, cycles of worst-case complex loading and were testing in ROM again. Load-displacement and fluoroscopic data were analyzed to determine ROM and to evaluate device position during cyclic testing. Devices and facets were evaluated post testing.
Institutional support for implant evaluation was received by Zyga Technology.
Range of motion post implantation decreased versus intact, and then was restored post cyclic-testing. Of the tested devices, 6. No damage was observed on the devices, and wear patterns were primarily linear. The results from this in situ cadaveric biomechanics and cyclic fatigue study demonstrate that a low-profile, conformable IFA device can maintain position and facet functionality post implantation and through 10, complex loading cycles. In vivo conditions were not accounted for in this model, which may affect implant behavior not predictable via a biomechanical study.
However, these data along with.
Morbid obesity is a multifactorial disease that increasingly is being treated by surgery. To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative.
In the preoperative group, The postoperative group had a significant reduction in H. A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection.
The jejunal mucosa was considered normal in an absolute majority of patients. Ileal J- pouch vaginoplasty: Vaginal reconstruction has been performed for more than a century. Main complications are vaginal stenosis requiring dilatation, dyspareunia, excessive mucus secretion, and poor aesthetic and functional outcome. Here we report a new operation method modified after Baldwin for intestinal vaginoplasty in a patient with pelvic exenteration after spinal cell carcinoma of the vagina.
Because of balanced liquid resorption and mucus secretion with sufficient vessel length in the terminal ileum, this intestinal segment was chosen. A J- pouch of distal ileum was constructed pedicled on the ileocolic artery and accompanying nervous plexus, transferred into the lower pelvis and sutured to the vaginal stump. One year follow-up showed a highly satisfied, sexually active patient, with adequate vaginal size, optimal lubrication and no molesting fecal odor. Terminal ileum J- pouch vaginoplasty is an optimal method for vaginal reconstruction providing a sufficient vaginal lumen and lubrication and thereby restoring patients' sexual life and increasing life quality.
Pouch dilatation following laparoscopic adjustable gastric banding: Laparoscopic adjustable gastric banding is increasingly being performed in morbidly obese individuals for weight loss. Some patients develop pouch dilatation as a postoperative complication that limits the utility of the procedure. Surgical variables are poor predictors of this complication.
Psychiatric and surgical case-notes were analyzed retrospectively for the presence of operationally defined psychiatric disorders and compared to 10 controls from the same population. Cases were significantly more likely to have past or current binge eating, emotionally triggered eating with reduced awareness of the link, a history of affective disorder, reduced sexual functioning and successful preoperative weight loss. No difference between groups was observed for compliance with orlistat, childhood sexual abuse, relationships with parents, history of bulimia nervosa, rate of band inflation or preoperative BMI.
Psychological factors may be better predictors of pouch dilatation than biomedical variables. Disordered eating can be an attempt to modulate negative emotions. Pouch dilatation may be a consequence of this eating behavior. Selection for growth does not affect apparent energetic efficiency of jejunal glucose uptake in mice. Five-wk-old male mice from high growth M16 and randomly bred control ICR lines, plus their reciprocal crosses, ICR x M16 and M16 x ICR, were used to investigate whether whole-body O2 consumption, jejunal respiration, jejunal glucose absorption and the apparent energetic efficiency of jejunal active glucose uptake in mice are altered by genetic selection for growth as well as by heterosis and maternal effects.
Whole-body O2 consumption was measured in 12 mice from each line or cross. The mice were later killed for measurement of jejunal O2, using tissue respiration chambers and jejunal glucose transport determined by 3HO-methylglucose accumulation. No heterosis or maternal effects were detected in jejunal glucose active transport and active glucose uptake.
One option is capsular interpositional arthroplasty. We present a case of an extravesical, robotic-assisted VVF repair, without placement of an interposition graft performed in a Canadian teaching center. Selective arteriography of the superior mesenteric artery revealed a ruptured aneurysm in the first branch of the jejunal artery. This modified technique of the hypoglossal-facial reanimation is a valid method with good clinical results, especially in cases of a preserved intramastoidal facial nerve. Longarm and the Shotgun Man.
Selection for growth M16 vs. ICR increased daily gain 1. The apparent energetic efficiency of jejunal active glucose uptake among lines was not different Selection for growth in mice did not result in more energetically efficient jejunal glucose absorption. Colon pouch Mainz III for continent urinary diversion. To evaluate the use of a continent cutaneous pouch made exclusively of colon Mainz pouch III , as excellent results with the Mainz pouch III in irradiated patients suggested that the indication for this type of urinary diversion could be extended.
The outcome of 24 patients with continent cutaneous urinary diversions using colon segments Mainz pouch III was investigated retrospectively. Overall, 22 of the patients had a malignant disease and two a benign disease; 16 had a hysterectomy and pelvic exenteration for gynaecological tumours; two men with a rhabdomyosarcoma of the prostate had a radical cystoprostatectomy; one woman had pelvic exenteration for bladder cancer; one man had a simultaneous rectum resection due to infiltrating rectal cancer, and another a left nephrectomy with cystectomy for concomitant kidney and bladder tumour.
Benign indications were hyper-reflexive bladder after polytrauma and two cases of neurogenic bladder dysfunction. Eighteen patients had radiotherapy Gy before the urinary diversion. The mean range follow-up was 35 months. The mean pouch capacity was Three patients died during the follow-up two from disease progression and one suicide ; 20 patients were fully continent, four with reduced pouch capacity pouch were one outlet stenosis that required revision.
Postoperative pouchograms showed asymptomatic reflux in four patients. None of the patients developed metabolic acidosis or diarrhoea. The Mainz pouch III is an alternative to other types of continent urinary diversion. Occurrence and structure of epipharyngeal pouches in bears Ursidae. The infrequent mention of epipharyngeal pouches occurring in some species of bears indicates the scarcity of morphological and functional knowledge about these structures.
In order to provide precise morphological data on the structure of these remarkable formations and to verify their taxonomic utility, the pharyngeal regions of 1 spectacled bear and 3 brown bears were examined. All these individuals possessed epipharyngeal pouches , which are tubular, blind-ending outpouchings of the caudodorsal pharyngeal wall equipped with respiratory epithelium and a thick layer of elastic fibres.
While the spectacled bear and Ursus arctos syriacus possessed a single pouch on the caudodorsal wall of the nasopharynx, in Ursus arctos and Ursus arctos beringianus 2 unequally sized pouches were present. Two additional sacs of smaller size, representing outpouchings of the lateral pharyngeal wall, occurred in the spectacled bear. These findings prove epipharyngeal pouches to be constant and unique morphological features of the family Ursidae, the anatomical features suggesting involvement in the respiratory system most probably in important aspects of ursid phonation.
This is the first description of epipharyngeal pouches in the spectacled bear. Psychological impact of colostomy pouch change and disposal. This article presents some of the findings from a multicentre cross-sectional correlational study to evaluate the relationship between colostomy pouch change and disposal practices and the patient's psychological wellbeing.
Five questionnaires were used in a one-off interview with 86 patients. Patients were assessed at between one and four months postoperatively. Patients cited several factors, such as minimizing odour and having an appliance that could flush away, as factors which would help them to stop avoiding these activities. Stoma care nurses have a unique opportunity to improve the psychological wellbeing of their patients by considering the aspects of pouch change and disposal that pose the greatest challenge to individuals. Use of a modified version of the Pouch Change and Disposal questionnaire may be a useful tool in identifying those at risk of impaired quality of life.
Jejunal diverticulitis in a healthy year-old man. A year-old African American man was admitted with sudden onset diffuse abdominal pain which radiated to the right flank. CT of the abdomen with contrast showed diverticula in the jejunum with adjacent inflammation and microperforation that was contained.
Conservative therapy similar to colonic diverticulitis was effective. Although rare, our case highlights the importance of having an early and high suspicion for jejunal diverticulitis when patients present with non-specific abdominal symptoms in order to avoid perforation. No commercial use is permitted unless otherwise expressly granted. Jejunal obstruction caused by metastasis from an undiagnosed breast cancer: Solitary metastasis from breast carcinoma to the gastrointestinal tract is an uncommon finding.
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We describe a female patient with a solitary jejunal metastasis from an undiagnosed breast cancer who presented to the emergency department with a bowel obstruction. Abdominal surgery was performed, revealing a jejunal stenosis from a metastatic lobular carcinoma. The primary tumor in the left breast was subsequently diagnosed and surgically removed. Temporomandibular Joint TMJ ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue.
The management of TMJ ankylosis has a complicated chore and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of re-ankylosis. Interpositional gap arthroplasty is one of the modalities for its management. A range of inter-positional materials have been used to avert recurrence after gap arthroplasty in TMJ ankylosis.
The aim of this series was to evaluate the effectiveness of the temporomyofacial flap in the treatment of TMJ ankylosis as an interpositional gap arthroplasty. A total of 10 cases with unilateral TMJ ankylosis were treated by interpositional gap arthroplasty by pedicled temporalis myofacial flap and evaluated with a follow-up of 6 months to 5 years Mean 3. All the patients were successfully treated.
There were no signs of recurrence in any patients up to last follow up visit. The result showed that temporalis myofascial flap is a preferable choice for inter-positional gap arthroplasty which proves its versatility as an inter-positional material. Jejunal and ileal absorption of oxprenolol in man: Around 80 mg of drug were delivered as a saline solution directly in the small bowel. The AUC and Cmax values of free and conjugated oxprenolol for the jejunal perfusion were significantly lower than those of ileum. They showed large but consistent intersubject variations in the two treatments.
A saline in treatments A and B or a nutrient in treatment C solution containing oxprenolol was perfused into the jejunum below a balloon either inflated A or deflated B and C. Robotic-assisted vesicovaginal fistula repair using an extravesical approach without interposition grafting. Post-hysterectomy vesicovaginal fistula VVF is rare. In addition to conventional abdominal and vaginal approaches, robotic-assisted VVF repairs have recently been described.
We present a case of an extravesical, robotic-assisted VVF repair, without placement of an interposition graft performed in a Canadian teaching center. Computed tomography cystogram, cystoscopy, and methylene blue dye test, confirmed a VVF above the bladder trigone. An abdominal, extravesical approach was used. The realization of free flaps with lack of reliable vessels nearby the loss of substance is a difficult problem for plastic surgeons. We report 10 cases of free tissue transfers with a one-stage technique lengthening the vascular pedicle of the free flap with interpositional vein grafts.
Taking into consideration the good results and the low rate of morbidity, the authors emphasize the use of this technique rather than a two-stage procedure. Arthroscopically assisted elbow interposition arthroplasty without hinged external fixation: Total elbow arthroplasty is successful in older, lower demand patients but not in the younger, more active individual with severe elbow arthritis. Interposition arthroplasty is an alternative for younger patients who hope to minimize the degree to which arm use is restricted.
Interposition arthroplasty traditionally involves release of all ligaments and capsule. As a result, the postoperative care included the use of a hinged external fixator of the elbow to apply distraction and to permit motion during the early phases of healing. We describe a novel surgical technique without a hinged external fixator that allows secure fixation of the interposition graft through arthroscopic assistance and maintains the integrity of the medial collateral ligament with only a takedown and repair of the lateral collateral ligament complex.
A retrospective chart review was performed to analyze 4 patients with an average age of 57 years who underwent surgery between and The average follow-up was 3. The remaining 3 patients have done well with regard to pain control, stability, and functional use of the operative extremity. There were no postoperative complications. On the basis of our small series of patients, an arthroscopically assisted elbow interposition arthroplasty without hinged external fixation can provide satisfactory medium-term outcomes as a salvage procedure for a difficult condition with limited options.
Hallux rigidus is a common osteoarthritic disease of the first metatarsophalangeal joint MTPJ. Few salvage treatment options exist that preserve motion for patients who have failed an initial procedure and who are not amenable to fusion, typically patients who are active or who would like to wear high heels. Allograft tendon interpositional arthroplasty is an unconventional salvage treatment option that may preserve motion and prevent bone loss.
A retrospective chart review is reported of 19 patients who failed previous procedures and refused fusion who underwent allograft tendon interpositional arthroplasty of the hallux MTPJ by a single surgeon between and Radiographically, patients had an increase in apparent joint space from pre- to postoperatively, most notable on the lateral view 0.
One patient underwent hallux MTPJ fusion after the interpositional arthroplasty. Rolled allograft tendon interposition arthroplasty performed poorly as a salvage strategy for failed previous hallux MTPJ surgery for hallux rigidus because of a high rate of complication and minimal benefits. The senior author has abandoned the technique.
Jejunal enteropathy associated with human immunodeficiency virus infection: Jejunal biopsy specimens from 20 human immunodeficiency virus HIV positive male homosexual patients were analysed and compared with those of a control group to determine whether the abnormalities were caused by the virus or by opportunistic infection. The degree of villous atrophy was estimated with a Weibel eyepiece graticule, and this correlated strongly with the degree of crypt hyperplasia, which was assessed by deriving the mean number of enterocytes in the crypts.
The density of villous intraepithelial lymphocytes fell largely within the normal range, either when expressed in relation to the number of villous enterocytes or in relation to the length of muscularis mucosae. Villous enterocytes showed mild non-specific abnormalities.
Pathogens were sought in biopsy sections and in faeces. Crypt hyperplastic villous atrophy occurred at all clinical stages of HIV disease and in the absence of detectable enteropathogens. An analogy was drawn between HIV enteropathy and the small bowel changes seen in experimental graft-versus-host disease. It is suggested that the pathogenesis of villous atrophy is similar in the two states, the damage to the jejunal mucosa in HIV enteropathy being inflicted by an immune reaction mounted in the lamina propria against cells infected with HIV.
Effects of spaceflight on the proliferation of jejunal mucosal cells. The purpose of this project was to test the hypothesis that the generalized, whole body decrease in synthetic activity due to microgravity conditions encountered during spaceflight would be demonstrable in cells and tissues characterized by a rapid rate of turnover. Jejunal mucosal cells were chosen as a model since these cells are among the most rapidly proliferating in the body. Accordingly, the percentage of mitotic cells present in the crypts of Lieberkuhn in each of 5 rats flown on the COSMOS mission were compared to the percentage of mitotic cells present in the crypts in rats included in each of 3 ground control groups i.
No significant difference p greater than. Although the ability of jejunal mucosal cells to divide by mitosis was not impaired in flight group, there was, however, a reduction in the length of villi and depth of crypts. The concommitant reduction in villus length and crypth depth in the flight group probably reflects changes in connective tissue components within the core of villi.
Microbiology of third and fourth branchial pouch cysts. To identify the most common pathogens involved in infections of third and fourth branchial pouch cysts. Third and fourth branchial pouch cyst infections are an uncommon cause of anterior neck abscesses often confused with other entities, such as thyroglossal duct cysts and thyroid abscesses leading to misdiagnosis, recurrence, and increased morbidity related to a delay in diagnosis and appropriate treatment.
Retrospective chart and literature review. Retrospective chart review case series of patients presenting to the Bobby R. Alford Department of Otolaryngology at Texas Children's Hospital from July to July with third and fourth branchial pouch cysts. A total of 11 patients were identified. All patients had left-sided lesions. All organisms with the exception of Staphylococcus aureus were identified as oral cavity flora. Third and fourth branchial pouch cysts provide a communication between the neck and the oral cavity through pyriform sinus tracts.
The presence of oral cavity flora in a left anterior neck abscess should raise the suspicion of a branchial pouch anomaly, and subsequently alter therapeutic management. Microfluidic cassettes "chips" for processing and analysis of clinical specimens and other sample types facilitate point-of-care POC immunoassays and nucleic acid based amplification tests. These single-use test chips can be self-contained and made amenable to autonomous operation-reducing or eliminating supporting instrumentation-by incorporating laminated, pliable " pouch " and membrane structures for fluid storage, pumping, mixing, and flow control.
Materials and methods for integrating flexible pouch compartments and diaphragm valves into hard plastic e. We review several versions of these pouch chips for immunoassay and nucleic acid amplification tests, and describe related fabrication techniques. These protocols thus offer a "toolbox" of methods for storage, pumping, and flow control functions in microfluidic devices. Ileal pouch -anal anastomosis: The aim of this project was to establish and maintain an internet-based database of all ileal pouch procedures performed in major centres in Australasia.
A web-based database was designed. The data collection method was tested on a subgroup of 20 patients to ensure functionality.
Data were collected in five main categories: There were two deaths within 30 days 0. Functional data were available for patients. A national web-based database has been developed for access by all Australasian colorectal units. Initial Australasian data compare favourably with other international studies. Pouchitis continues to be a long-term problem.
The leak rate and rate of late anal stricture requiring a procedure are higher if the anastomosis is handsewn rather than stapled. Functional results are better with the W pouch than with the J pouch. Small bowel volvulus with jejunal diverticulum: Small bowel volvulus, which is torsion of the small bowel and its mesentery, is a medical emergency, and is categorized as primary or secondary type.
Here, we report a rare case of a year-old man diagnosed with small bowel volvulus using multidetector computed tomography MDCT angiography. Further discovery by laparotomy showed one jejunal diverticulum, longer corresponding mesentery with a narrower insertion, and a lack of mesenteric fat.
This case report includes several etiological factors of small bowel volvulus, and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease. Jejuno- jejunal intussusception in a guinea pig Cavia porcellus.
An approximately four-year-old male castrated guinea pig Cavia porcellus was presented for painful defecation with a hour history of hyporexia and intermittent episodes of rolling behavior. Upon presentation the patient was quiet, alert, and responsive, and mildly hypothermic.
Abdominal palpation revealed an approximately 2-cm long oblong mass within the caudal abdomen. Abdominal radiographs revealed gastric dilation without volvulus and a peritoneal mass effect. The patient was euthanized following gastric reflux of brown malodorous fluid from his nares and oral cavity. A necropsy was performed and revealed a jejuno- jejunal intussusception causing mechanical gastrointestinal ileus, and gastric dilatation without volvulus.
While non-obstructive gastrointestinal stasis is common and obstructive ileus is uncommon in guinea pigs, this report shows that intestinal intussusception is a differential in guinea pigs with ileus and gastric dilatation. The most common location for DL is the stomach, followed by duodenum. There is little information about duodenal and jejunal DLs.
For these reasons, there is no universal consensus about the diagnosis and treatment approach. There are few published case reports and case series recently published. Most duodenal DLs are not evaluated seperately in the studies, which makes it difficult to determine the optimal model. In this study, we summarize the general aspects and recent approaches used to treat duodenal DL. Pouching a draining duodenal cutaneous fistula: Blockage of the mesenteric artery typically causes necrosis to the colon, requiring extensive surgical resection.
In severe cases, the necrosis requires removal of the entire colon, creating numerous problems for the WOC nurse when pouching the opening created for effluent. This article describes the management of a draining duodenal fistula in a middle-aged woman, who survived surgery for a blocked mesenteric artery that necessitated the removal of the majority of the small and large intestine. Nutrition, skin management, and pouch options are described over a number of months as the fistula evolved and a stoma was created. Stability of double-row rotator cuff repair is not adversely affected by scaffold interposition between tendon and bone.
Rotator cuff reconstructions may be improved by adding growth factors, cells, or other biologic factors into the repair zone. This usually requires a biological carrier scaffold to be integrated into the construct and placed in the area of tendon-to-bone healing. This needs to be done without affecting the constructs mechanics. The purpose of this study was to examine the effect of scaffold interposition on the initial strength of rotator cuff repairs. Twenty-five fresh-frozen shoulders mean age: Groups were chosen to represent a broad spectrum of commonly used scaffold types: Cyclic loading to measure displacement was performed to cycles at 1 Hz with an applied to N load.
Ultimate load to failure of repairs that used the collagen patch as an interposition No significant differences were found for repairs with the fibrin clot as an interposition Buy the eBook Price: Available in Russia Shop from Russia to buy this item. In this series View all Book Ratings and Reviews 0 0 star ratings 0 reviews. Overall rating No ratings yet 0. How to write a great review Do Say what you liked best and least Describe the author's style Explain the rating you gave Don't Use rude and profane language Include any personal information Mention spoilers or the book's price Recap the plot.
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