Colonoscopy-associated perforation: a 7-year survey of in-hospital frequency, treatment and outcome in a German university hospital.

AIM: Perforation occurs rarely after colonoscopy, but is associated with high morbidity and mortality. In this study, we assessed the perforation rate in our hospital, its clinical diagnosis and the long-term outcome. METHOD: During the study period, 7535 examinations were performed, of which 4830 were diagnostic and 2705 therapeutic. The latter included polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), dilatation and argon plasma coagulation (APC). RESULTS: Overall, 25 (0.33%) perforations occurred with two (0.026%) procedure-related deaths. Seven (0.14%) perforations occurred during a diagnostic procedure and 18 (0.67%) occurred during a therapeutic procedure. Dilation, submusous resection (SMR) and APC accounted for more perforations than polypectomy or diagnostic colonoscopy. Pre-existing gastrointestinal disease was present in 24 (96%) perforations. Three (12%) patients were treated conservatively and 22 (88%) underwent surgery. The site of perforation was closed by suture in four (18%) patients and resected with colonic anastomosis in five (23%) patients. Two patients underwent endoscopic clipping. A stoma was created after resection in 13 (59%) patients. CONCLUSION: Death from perforation after colonoscopy is rare, occurring in 1/3500 examinations. The risk is increased in therapeutic colonoscopy and in the presence of previous gastrointestinal disease. Dilatation, SMR and APC appeared to confer a higher risk of perforation than polypectomy or diagnostic colonoscopy.

Minimally invasive neck surgery. Surgical feasibility and physiological effects of carbon dioxide insufflation in a unilateral subplatysmal approach.

Endoscopically assisted, minimally invasive techniques to regions without a natural cavity require insufflation with carbon dioxide (CO2). In the neck region this may impair hemodynamics, blood gas homoeostasis, cerebral blood circulation and increase the intracranial pressure. An exclusively endoscopic unilateral subplatysmal approach to the submandibular region was investigated in nine mini-pigs randomized to three groups. On both neck sides, within a 14 day interval, the subplatysmal space was inflated with CO2 at 10 mmHg, 20 mmHg (1.33/2.66 x 10 (3)Pa) or 20 mmHg (2.66 x 10 (3)Pa) combined with mechanical suspension. Data for hemodynamic and blood gas parameters, gas volumes, and intracranial pressure were obtained preoperatively, 30 min after onset and 10 min postopeatively. In a pocket created by insufflation of 20 mmHg (2.66 x 10 (3)Pa), exposition and resection of the submandibular gland were accomplished easily. The elevation procedure had technical disadvantages. The mean operation time was 48.9 min. Unilateral subplatysmal carbon dioxide insufflation of the submandibular neck region up to 20 mmHg (2.66 x 10 (3)Pa) did not affect physiological parameters. As an exclusive endoscopical approach for unilateral surgery of the submandibular region, the use of inflation pressures of up to 20 mmHg (2.66 x 10 (3)Pa) might be considered.

P53 and cyclin D1 staining patterns of malignant and premalignant oral lesions in age-dependent populations.

OBJECTIVE: Recent epidemiologic studies have identified a trend of increasing cancer incidence in younger patients. The purpose of this study was to determine whether this might be reflected by different molecular mechanisms for tumor development. STUDY DESIGN: Dysplastic and malignant oral lesions from age-distinct patient populations were immunohistochemically analyzed for expression of p53 and cyclin D1. Chi-square analysis was used to determine statistical significance. RESULTS: Eighty-two percent of "older" and 75% of "younger" carcinomas stained positively with p53; 63% of carcinomas in the older population and 55% of carcinomas in the younger population showed cyclin D1 positivity. Dysplasias showed similar cyclin D1 staining in both groups. Interestingly, 100% of "younger" dysplasias stained positively for p53, whereas 35.3% of "older" dysplastic lesions showed immunoreactivity. Staining of carcinomas was not statistically significant, whereas p53 staining of dysplasias proved highly significant (P < .025). CONCLUSIONS: p53 immunoreactivity is detectable at an earlier stage of carcinogenesis in younger patients than in the traditional risk population for oral cancer.

Polymorphous low grade adenocarcinoma: a clinicopathologic study of 164 cases.

BACKGROUND: Polymorphous low grade adenocarcinomas (PLGA) are minor salivary gland neoplasms with a predilection for intraoral sites. METHODS: One hundred sixty-four cases of PLGA diagnosed between 1970-1994 were retrieved from the files of the Armed Forces Institute of Pathology, Washington, DC. Histologic features were reviewed, immunohistochemical studies and prognostic markers were performed, and patient follow-up was obtained. The data were analyzed statistically. RESULTS: The patients included 109 women and 55 men, ages 23-94 years (average, 57.6 years). The patients usually presented clinically with a palatal mass that ranged in size from 0.4-6 cm (average, 2.2 cm). The tumors were infiltrative and characterized by a polymorphous growth pattern, with individual tumors demonstrating multiple patterns, including solid, ductotubular, cribriform, trabecular, and single file growth. Neurotropism was identified frequently. The neoplastic cells were isomorphic with vesicular nuclei. Mitotic activity was inconspicuous. At an average of 115.4 months after presentation, approximately 97.6% of all patients were either alive or had died without evidence of recurrent disease after treatment with surgical excision only. Four patients had evidence of disease at last follow-up; three had died with evidence of tumor, and one patient was alive with tumor. CONCLUSIONS: PLGA is a neoplasm of minor salivary gland origin that must be separated from adenoid cystic carcinoma and benign mixed tumor for therapeutic and prognostic considerations. Conservative but complete surgical excision is the treatment of choice for these slow-growing tumors with a low proliferation index; adjuvant therapy does not appear to alter the prognosis.

Problems in mass-disaster dental identification: a retrospective review.

A wide variety of problems may prevent or hinder a dental-identification (ID) team in its efforts to identify mass casualties. Since these problems have been infrequently reported in a comprehensive manner, the authors identified and summarized these problems to increase the awareness of dental-ID team members and to prepare them for future mass-disaster missions. The authors analyzed 50 mass disasters--ten in which the authors as members of military dental ID teams played a major role and 40 from the literature--and summarized problems that they confronted.

Age estimation using dental periapical radiographic parameters. A review and comparative study of clinically based and regression models with the Operation Desert Storm victims.

A brief discussion of teeth and aging is followed by a review of the first four studies by our group at Temple University. In the present study, periapical, postmortem radiographs taken with the bisecting-angle technique from U.S. armed forces personnel killed during Operation Desert Storm were analyzed for age estimation. A total of 74 sets of dental radiographs (52 complete and 22 incomplete) with documented age of the individual at the time of death recorded were examined by investigators (D.R.M. and J.V.E.), who were blind to age range and specific ages of the victims. Comparisons were made between the same clinically based and multiple regression models used in a previous study of age estimation from private dental practice patients in which the long-cone radiographic technique had been used. Age estimation for both models was based on the same radiographic parameters used in that previous study (13 for the clinical model and eight for the regression model). Results showed that, in contrast to that previous study, the clinical model was superior to the regression model. Mean difference between estimated and actual age was +/- 4.4 years (clinical) and +/- 6.3 years (regression). Median difference between estimated and actual age was +/- 2.0 years (clinical) and +/- 6.0 years (regression). Mode difference between estimated and actual age was +/- 2.0 years (clinical) and +/- 6 and 7 years (regression). The results from the present study show that the clinical and regression models developed from full-mouth series of periapical radiographs taken of living patients by the long-cone radiographic technique can be used with decedents' radiographs taken with the bisecting-angle technique.

Forensic dental identification of casualties during Operation Desert Storm.

Forensic dental identification of casualties during Operation Desert Storm was performed at the Dover Port Mortuary, Dover Air Force Base, under the auspices of the Office of the Armed Forces Medical Examiner. A total of 251 dental identifications were attempted and 244 individuals were positively identified by dental comparison. The panoramic radiographs on file at the Central Panograph Storage Facility were the primary antemortem records utilized in establishing the dental identification. The inability to establish a positive dental identification was most often the result of a lack of available antemortem dental records.

Quantification of bone in dental implant sites after composite grafting of the mandible: report of a case.

The amount of viable bone in a composite graft that consisted of autogenous iliac bone marrow, allogenic rib, and porous hydroxyapatite was quantified using standard histologic techniques and an optical insert disk prior to placement of endosteal implants in an augmented mandible. It is suggested that this technique could be used in such cases before deciding whether to proceed with implant insertion.

The glandular odontogenic cyst: an apparent entity.

This article reports 8 examples of a rare cyst of the jaws that appears to be a distinct entity and which we have named glandular odontogenic cyst because of its unusual histopathological features. This lesion occurs over a wide age range in both sexes, tends to recur, and may become very large. However, one example in this series remained small over a period of 9 years; another, somewhat atypical example, was associated with an ameloblastoma.