A case of transanal barotrauma by high-pressure compressed air leading to transverse colon perforation with extensive colon serosal tear.

INTRODUCTION AND IMPORTANCE: Compressed air is used to apply paint, wash vehicles or machines, and remove water droplets after washing the precision instrument. Barotrauma due to high-pressure compressed air is extremely rare. CASE PRESENTATION: We report a case of transverse colon perforation caused by a compressed air gun in a 20-year-old male. He used a compressed air machine to dust after work, and a coworker inserted compressed air transanally as a joke. Although he returned home once, he consulted a former hospital with worsening abdominal pain. Radiography and computed tomography (CT) revealed a massive amount of free air. The patient was admitted to our hospital. The patient underwent emergency surgery. Transverse colon perforation with extensive serosal tears and massive air bubbles inside the omental bursa were observed. Double-barrel colostomy using transverse colon perforation point for decompression and diverting the stoma at the ileum end was performed with serosal tear repair and abdominal cleaning drainage. Four months after the surgery, the patient underwent colostomy and diverting stoma closure. CLINICAL DISCUSSION: The management of colon injury due to compressed air has two aspects: tension pneumoperitoneum and colon injury. The initial management of tension pneumoperitoneum is converted to open pneumoperitoneum and early emergency operation for colon injury is recommended as soon as full-thickness perforation is diagnosed. CONCLUSION: Transanal high-pressure compressed air can cause lethal situations, and we encountered a similar case that required surgical intervention.

Anatomical analyses for maxillary sinus floor augmentation with a lateral approach: A cone beam computed tomography study.

BACKGROUND: Various anatomical references and structures should be analyzed prior approaching a surgery in the maxillary sinus. The objective of the present study was to evaluate the anatomical structures and references involved in sinus floor elevation with a lateral approach. MATERIALS AND METHODS: Seventy-five patients planned for sinus floor elevation were included in the study. Eighty-eight maxillary sinuses were evaluated using cone beam computed tomographies (CBCTs). The nasal floor was used as main reference (X) and sinus mucosa width, bone crest height, palatal-nasal recess angle (PNR), sinus width at the level of the nasal floor, distance from the nasal floor to the base of the sinus (X-F), position of the posterior superior alveolar artery (PSAA height) and diameter (PSAA diameter), lateral bone wall width at 3mm (LW 3mm) and 9mm (LW 9mm) from the base of the sinus (F), patency of the ostium (OP), and presence and position of septa have been evaluated. RESULTS: The mean dimensions and standard deviations were the following: mucosa thickness was 2.0±1.4mm, bone crest height 2.8±1.4mm, distance X-F 8.3±1.9mm, PNR angle 135.5±23.1, sinus width 12.6±4.2mm, X-F 8.3±1.9mm, PSAA height 14.4±2.9mm, PSAA diameter 1.1±0.4mm, LW 3mm 1.5±1.2, LW 9mm 1.3±0.6mm, OP 1.9±0.4mm. Septa were present in 19.3% of the sinuses evaluated and were located mostly in the molar region. CONCLUSIONS: In conclusion, the analysis of the CBCT before sinus floor elevation allows the identification of anatomical structures and references that might be used for the planning of the surgical approach, aiming to improve the outcome of the treatment and to avoid possible complications.

Horizontal Bone Augmentation in the Anterior Esthetic Area of the Maxilla Using a Flap Design Adapted from Mucogingival Surgery in Association with PLA Membrane and ß-TCP.

Systematic reviews showed possible esthetic complications with the use of traditional flap designs after guided bone regeneration (GBR) procedures in the esthetic zone and the aim of this case series was to analyze hard and soft tissue changes over 18 months after these procedures. Healthy subjects requiring tooth extraction and single-implant placement in the anterior maxilla were enrolled in the study. Three months after tooth extraction and ridge preservation, a prosthetic-driven implant was placed. The horizontal bone deficiency was treated with a resorbable bone graft substitute (beta tricalcium phosphate [ß-TCP]) and a bioresorbable polylactic acid (PLA) membrane. Primary closure was obtained by a novel coronally advanced flap adapted from mucogingival techniques. Final metal-free implant restorations were delivered 4 months after placement. Clinical measurements, pictures, and radiographs were acquired after delivery of the final restoration (T1) and at the 18-month follow-up (T2). Digital impressions were taken at the time of tooth extraction (T-1) and implant insertion (baseline; T0) and at T2. Marginal bone level changes were assessed by radiographic analysis, while soft tissue changes were evaluated with ExoCad software. Student t test for paired data was used to detect differences between the different time points. Twelve subjects (7 men and 5 women; mean age: 63.7 ± 14 years) completed the study and received 15 implants. All implants healed uneventfully and were clinically osseointegrated and stable, showing no sign of infection. No GBR complications were noted. Statistically significant ridge-width changes were observed after extraction (T-1 vs T0 = -1.72 ± 0.30 mm; P = .00001) and after horizontal GBR (T0 vs T2 = 1.41 ± 0.64 mm; P = .00001). Radiographic bone levels after implant placement remained stable T0 to T2 (0.09 ± 0.08 mm). Periodontal parameters never exceeded physiologic levels. It can be concluded that GBR using a bioresorbable PLA membrane and resorbable ß-TCP bone graft in conjunction with a coronally advanced flap is a predictable procedure for horizontal bone augmentation with simultaneous implant placement in the esthetic area.

Influence of the height of the antrostomy in sinus floor elevation assessed by cone beam computed tomography- a randomized clinical trial.

PURPOSE: To evaluate the influence of the height of the antrostomy on dimensional variations of the elevated space after sinus floor elevation. MATERIALS AND METHODS: Twenty-four healthy volunteers planned for sinus floor elevation were included in the study. An antrostomy of either 4 mm (Group A) or 8 mm (Group B) in height was prepared in the lateral wall of the sinus. Cone beam computed tomography (CBCT) scans were taken before surgery (T0) and after 1 week (T1) and 9 months (T2). Dimensional variation analyses were performed. RESULTS: The CBCT scans of 10 patients per group were evaluated. After 1 week (T1), the sinus floor was found elevated in the middle region by 12.0 ± 2.3 mm in Group A, while in Group B, the height was 11.8 ± 2.1 mm. After 9 months (T2), the respective heights were 9.9 ± 2.4 mm and 8.9 ± 2.7 mm, with a reduction of -2.1 ± 2.2 mm in Group A and -3.0 ± 2.6 mm in Group B. The area in a central position was reduced by 25.5% to 34.2%, showing a slightly higher shrinkage in Group B compared with Group A. However, no statistically significant differences were found between the two groups. DISCUSSION: In maxillary sinus floor elevations performed by the lateral approach, the size of the antrostomy did not affect the clinical and radiographic outcomes.

Influence of the position of the antrostomy in sinus floor elevation assessed with cone-beam computed tomography: A randomized clinical trial.

AIM: The aim of the present study was to evaluate dimensional variations of augmented sinus volumes after sinus floor elevation using a lateral approach placing the antrostomy close to the sinus floor or more cranially to it. METHODS: Twenty-four healthy volunteers in need of sinus floor elevation were included in the study. The lateral approach was adopted placing the antrostomy randomly either close to the level of the sinus floor (group A) or approximately 3-4 mm cranially (group B). Cone-beam computed tomography (CBCT) was done before surgery (T0) and after 1 week (T1) and 9 months (T2), and analyses on dimensional variations were performed. RESULTS: CBCT of 10 patients per group were analyzed. At T1, the sinus floor was found to be elevated by 9.8 ± 2.1 mm in group A and 10.9 ± 1.9 mm in group B. At T2, shrinkage of 2.0 ± 1.7 mm in group A and 1.4 ± 2.5 mm in group B was observed. The area was reduced approximately 18-24% between T1 and T2. The sinus mucosa width increased by 4.3-5 mm between T0 and T1, and regained the original dimensions at T2. CONCLUSIONS: The more cranial the antrostomy, the greater the augmentation height after 9 months.

Bilateral inguinal hernia after axillary-femoral artery bypass effectively treated with laparoscopic repair: A case report.

We report herein our experience with bilateral inguinal hernia surgery for a patient who had previously undergone a Y-shaped vascular graft for an abdominal aortic aneurysm and then right axillary-bilateral femoral artery bypass surgery. Preoperative physical examination and imaging revealed a subcutaneous vascular graft passing from the right axilla through the right flank region and branching at the lower abdomen to reach the femoral areas on both sides. As repair surgery by inguinal incision was considered difficult, we performed laparoscopic surgery. Bilateral direct hernia was observed on intraperitoneal observation. Essentially no intraperitoneal organ adhesion to the abdominal wall was present, and the previous surgery was also confirmed not to have reached the inguinal preperitoneal space. Transabdominal preperitoneal repair was therefore performed, yielding favorable results.

Pancreatic carcinogenesis: apoptosis and angiogenesis.

Apoptosis and angiogenesis are critical biologic processes that are altered during carcinogenesis. Both apoptosis and angiogenesis may play an important role in pancreatic carcinogenesis. Despite numerous advances in the diagnosis and treatment of pancreatic cancer, its prognosis remains dismal and a new therapeutic approach is much needed. Recent research has revealed that apoptosis and angiogenesis are closely interrelated. Several reports show that a tumor suppresser gene that is expressed in pancreatic carcinoma and related to malignant potential can induce apoptosis and also inhibit angiogenesis. At present, it is generally accepted that tumor growth in cancers, including pancreatic cancer, depends on angiogenesis. We have identified 2 new angiogenesis inhibitors from a conditioned medium of human pancreatic carcinoma cell line (BxPC-3): antiangiogenic antithrombin III (aaAT-III) and vitamin D binding protein-macrophage activating factor (DBP-maf). These molecules were able to regress tumors in severe combined immunodeficiency disease (SCID) mice, demonstrating potent inhibition of endothelial cell proliferation. Moreover, the angiogenesis inhibitors induced tumor dormancy in the animal model. These results suggest that antiangiogenic therapy using angiogenesis inhibitors may become a new strategy for treatment of pancreatic cancer in the near future.

Characterization of GABA(B) receptors involved in inhibition of motility associated with acetylcholine release in the dog small intestine: possible existence of a heterodimer of GABA(B1) and GABA(B2) subunits.

Characterization of the gamma-aminobutyric acid (GABA)(B) receptor involved in the motility of dog small intestine was analyzed by application of the microdialysis method to the small intestine of the whole body of the dog. The reverse transcription-polymerase chain reaction (RT-PCR) was used. Intraarterial administration of muscimol induced acceleration of motility associated with acetylcholine (ACh) release, these responses being antagonized by bicuculline. Intraarterial administration of baclofen induced inhibition of motility associated with ACh release, these responses being antagonized by CGP62349. GABA induced inhibition of motility associated with decrease in ACh release. CGP62349 alone induced acceleration of motility associated with increase in ACh release. RT-PCR revealed the presence of mRNAs for both subunits of GABA(B) receptor, GABA(B1) and GABA(B2), in the dog small intestine, although GABA(B1) subunits were 6 isoforms of GABA(B1) (GABA(B1(a)) - GABA(B1(g))), except GABA(B1(d)). Thus, the GABA(B) receptor located at cholinergic neurons as a heterodimer with subunits of GABA(B1) and GABA(B2) in the dog small intestine operates predominantly relative to the GABA(A) receptor in physiological motility.

Characterization of GABAB receptor in the human colon.

Characterization of the GABA(B) receptor in the human colon was performed by the reverse transcription-polymerase chain reaction (RT-PCR). mRNAs for both subunits of the GABA(B) receptor, GABA(B1) and GABA(B2), were detected in the human colon. The GABA(B1(e)) isoform was detected in the human colon, but not in the brain, and the other isoforms, except GABA(B1(d)), were detected in both tissues. Thus, the GABA(B) receptor may be present as a heterodimer with subunits of GABA(B1) and GABA(B2) in the human colon.

In vivo assessment of acceleration of motor activity associated with acetylcholine release via 5-hydroxytryptamine4 receptor in dog intestine.

Effect of mosapride, a benzamide, on the motor activity associated with the release of endogenous acetylcholine (ACh) from enteric neurons was examined in the ileum of anesthetized dogs using an in vivo microdialysis method and compared with the effect of 5-hydroxytryptamine (5-HT). Intraarterial administration of 5-HT accelerated intestinal motor activity and increased the concentration of dialysate ACh, and the responses were inhibited by SB204070, a specific 5-HT4-receptor antagonist, but were apparently not affected by methiothepin, ketanserin and granisetron. Intraarterial administration of mosapride, a prokinetic benzamide, accelerated intestinal motor activity and the concentration of dialysate ACh increased. The effects of mosapride were antagonized by SB204070. Specific [125I]SB207710 binding was observed in the myenteric and submucosal plexuses and muscle layers of dog ileum by in vitro receptor autoradiography. High densities of [125I]SB207710 binding sites were detected in the myenteric and submucosal plexuses. Mosapride as well as SB204070 inhibited [125I]SB207710 binding. Thus, in the whole body of dogs, 5-HT and mosapride accelerated the intestinal motor activity due to the increases in ACh release mediated by stimulation of the 5-HT4 receptor.