A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Co...A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately,her family refused surgery because of her worsening condition.On the third evening after admission,the patient developed peritonitis and sepsis. Perforation of small bowel due to the incarceration was noted during laparotomy.Bowel resection and an endileostomy were performed.She recovered well despite of the complication of multiple organ dysfunction syndrome.Literature is reviewed,and the pathogenesis,clinical manifestation,imaging features and treatment are discussed.展开更多
Objective To assess stresses produced by different obturator prostheses. Methods Three-dimensional finite clement models of unilateral maxillary defects rehabilitated with different obturators were constructed. The di...Objective To assess stresses produced by different obturator prostheses. Methods Three-dimensional finite clement models of unilateral maxillary defects rehabilitated with different obturators were constructed. The different stresses were analyzed by three-dimensional finite element method under different load angle. Results The Von Mises stress values obtained for the remaining tissues adjacent to defect cavity were higher when rehabilitated by inferior hollow obturator in comparison with by superior hollow obturator. The maximum of Von Mises were higher when rehabilitated by resilient hollow obturator than by rigid hollow obturator. It was also observed that in the rigid type stress distribution contours formed in the remaining tissues adjacent to defect cavity, while in resilient hollow obturator prostheses the stress distributed mainly in the prosthesis itself. The oblique load shows the most maximum of Von Mises among all types of obturator prostheses. Conclusions A high lateral wall of an obturator may be more better in preserving the remaining structures than a shorter prosthesis lateral wall. A soft liner may be incorporated to reduce the pain of the residual maxillary structures and mucosa. When load on defect, higher stress would be generated to the residual maxillary structures. The adjustment of occlusual relationship is very important.展开更多
The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital deformation poses a challenge to prosthodontists, particularly when the use of an implant cannot ...The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital deformation poses a challenge to prosthodontists, particularly when the use of an implant cannot be considered. This case report described the use of an air valve in a hollow silicone obturator to manufacture an inflatable obturator that could be extended further into undercut area to retain itself. The inflatable obturator exhibited adequate retention, stability and border sealing, thereby improving the masticatory, pronunciation and swallowing functions of patients. It may be a suitable alternative treatment option to an implant-retained obturator.展开更多
BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in wh...BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARY A 65-year-old Asian man presented with severe pain and numbness in his left lower limb,which became aggravated during walking and showed intermittent claudication.The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive.Computed tomography(CT)and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint.The results of electrophysiological examination showed peripheral neuropathy.A CT-guided obturator nerve block significantly reduced the severity of pain in this patient.According to the above findings,ONI caused by the osteophyte in the sacroiliac joint was diagnosed.This patient underwent an operation to remove the bone spur and symptomatic treatment.After therapy,the patient's pain and numbness were significantly relieved.The last follow-up was performed 6 mo after the operation,and the patient recovered well without other complications,returned to work,and resumed his normal lifestyle.CONCLUSION Osteophytes of the sacroiliac joint can cause ONI,which leads to symptoms including severe radiative pain in the lower limb in patients.The diagnosis and differentiation of this disease should attract the attention of clinicians.Surgical excision of osteophytes should be considered when conservative treatment is not effective.展开更多
The developmental morphology of the obturator and micropyle and the pathway of the pollen tubes in the ovarian locule in Phellodendron amurense Rupr.have been investigated by scanning electronmicroscopy and light micr...The developmental morphology of the obturator and micropyle and the pathway of the pollen tubes in the ovarian locule in Phellodendron amurense Rupr.have been investigated by scanning electronmicroscopy and light microscopy.The obturator of the ovule is of funicular origin.As the ovule is fully developed,the obturator becomes considerably large and closely covers the micropyle.When the pistillate flower reaches the receptive phase,the morphology of the obturator is greatly modified,and its cells on the surface are radially expanded and appear to be columnar,semi-papillar or papillar.Following fertilization the obturator reduces in size and degenerates.The pollen tubes need not necessarily traverse the obturator.Whether the pollen tubes pass the obturator or not depends on the sites at which they enter the ovarian locule.This observation does not support the idea that the obturator mainly serves the function of mechanical guidance for the growth of pollen tubes.Our investigations indicate that the structure of themicropyle changes with the different stages of the reproductive process,and becomes asymmetrical during pollination.The development of the obturator and the micropyle correlates with that of the female gametophyte in P.amurense.展开更多
We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, an...We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.展开更多
In order to investigate the mechanical response behavior of the gas obturator of the breech mechanism,made of polychloroprene rubber(PCR), uniaxial compression experiments were carried out by using a universal testing...In order to investigate the mechanical response behavior of the gas obturator of the breech mechanism,made of polychloroprene rubber(PCR), uniaxial compression experiments were carried out by using a universal testing machine and a split Hopkinson pressure bar(SHPB), obtaining stress-strain responses at different temperatures and strain rates. The results revealed that, in comparison to other polymers, the gas obturator material exhibited inconspicuous strain softening and hardening effects;meanwhile, the mechanical response was more affected by the strain rate than by temperature. Subsequently, a succinct viscoelastic damage constitutive model was developed based on the ZWT model, including ten undetermined parameters, formulated with incorporating three parallel components to capture the viscoelastic response at high strain rate and further enhanced by integrating a three-parameter Weibull function to describe the damage. Compared to the ZWT model, the modified model could effectively describe the mechanical response behavior of the gas obturator material at high strain rates. This research laid a theoretical foundation for further investigation into the influence of chamber sealing issues on artillery firing.展开更多
BACKGROUND Lateral thigh pain is a common complaint in patients visiting a pain clinic.Herein,we describe the case of a patient with lateral thigh pain caused by an obturator hernia.CASE SUMMARY An 83-year-old woman v...BACKGROUND Lateral thigh pain is a common complaint in patients visiting a pain clinic.Herein,we describe the case of a patient with lateral thigh pain caused by an obturator hernia.CASE SUMMARY An 83-year-old woman visited the emergency room with suddenly aggravated right lateral thigh pain.Magnetic resonance imaging of the thigh revealed no abnormal findings in the lateral thigh area.However,an obturator hernia between the pectineus and obturator externus muscles was observed by chance.Retroperitoneal computed tomography revealed a herniated small bowel with an incarceration point at the right obturator canal and a dilated loop of the small bowel upstream.Ultrasonography of the right inguinal region revealed a distended bowel loop in the right pectineus muscle.CONCLUSION Our report provides clinicians with information that an obturator hernia can cause lateral thigh pain.展开更多
Obturator dislocation is a rare type of hip dislocation,accounting for about 2%-5%of all hip dislocations.The occurrence of old unreduced obturator dislocation is even more infrequent,with only 17 cases reported in ni...Obturator dislocation is a rare type of hip dislocation,accounting for about 2%-5%of all hip dislocations.The occurrence of old unreduced obturator dislocation is even more infrequent,with only 17 cases reported in nine studies,most of which were from the 1950s to 1980s in developing countries.CASE SUMMARY A 38-year-old woman from Hunan Province,China presented with stiffness of the left hip in abduction,flexion,and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior.Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture.Open reduction was performed,resulting in restoration of the concentric alignment of the left hip.After surgery,6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk.At 3 mo after surgery,the patient reported experiencing some pain,which did not affect the function of the affected limb,and some movement restriction but no abduction deformity or claudication was present.An X-ray showed that the left hip was homocentric,and there was no sign of posttraumatic arthritis or avascular necrosis.CONCLUSION Open reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.展开更多
Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving r...Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.展开更多
AIM: To study the anatomy(formation, course, relationships and branching pattern) of the obturator nerve in detail.METHODS: The study was based on 500 adult human formalin-embalmed cadavers, 342 males and 158 females....AIM: To study the anatomy(formation, course, relationships and branching pattern) of the obturator nerve in detail.METHODS: The study was based on 500 adult human formalin-embalmed cadavers, 342 males and 158 females. We studied the anatomical formation, course and relationships of the obturator nerve within the lesser pelvis before the obturator canal. Finally, the whole course of the obturator nerve was examined.RESULTS: We found numerous anatomical variations about the formation of the obturator nerve, its division into two main branches, its articular branches, its intrapelvic branches for the periosteum of the pubic bone, and also the number of its muscular divisions and its anatomical relationship to the obturator externus muscle and obturator artery. We found that fibers from the L3 and L4 spinal nerves are standard components of the obturator nerve. The main trunk of the obturator nerve divides into anterior and posterior branches, within the pelvis in 23.30%, within the obturator canal in 52.30% and extrapelvic in 24.35% of cases. The anterior branch of the obturator nerve supplies three muscular branches in 67.10%, two muscular branches in 28.94% and four muscular branches in 3.94% of the cases. The posterior branch of the obturator nerve supplies two muscular branches in 60.52%, three muscularbranches in 19.07%, one muscular branch in 14.47% and four muscular branches in 5.92% of cases.CONCLUSION: We present a gross anatomical study of the human obturator nerve based on a remarkably large number of cases as well as potential clinical applications of our findings.展开更多
Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necr...Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated fragment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.展开更多
Oral cancer treatment primarily focused on the surgical removal of cancer tissues followed by surgical/prosthetic reconstruction.Restoration of the missing structures immediately after surgery shortens recovery time a...Oral cancer treatment primarily focused on the surgical removal of cancer tissues followed by surgical/prosthetic reconstruction.Restoration of the missing structures immediately after surgery shortens recovery time and allows patient to return to community as a functioning member.The most practiced surgical obturators are simple resin prosthetic bases without incorporation of the teeth.This article highlights a technique to fabricate a surgical obturator that duplicates patient’s original tissue form including teeth,alveolus and palatal tissues.The obturator is placed immediately after surgery and make patient feel unaware of surgical deformity.The obturator prosthesis fabricated with this technique supports soft tissues and minimizes the scar contracture.We have clinically tried this technique in 11 patients.Patients’satisfaction level was recorded on visual analogue scale(VAS)and it ranges between 74%and 94%(with average of 87%).Four different prosthodontists have visually evaluated facial asymmetry of patients at6 mo recall and their average perception on VAS varies between 71%and 93%(with average of 84%).展开更多
Open oro-nasal defects resulting after oral tumor resection need structural and functional rehabilitation using dental prostheses. Conventional removable prostheses have usually been indicated and performed for prosth...Open oro-nasal defects resulting after oral tumor resection need structural and functional rehabilitation using dental prostheses. Conventional removable prostheses have usually been indicated and performed for prosthodontics. When the patient has an edentulous maxilla, the unfavorable stability of the prosthesis will cause dysfunction of mastication and pronunciation. To achieve improvement of the impaired functional situation, implant-supported full fixed prostheses (IPSPs) for the edentulous maxilla with a removable obturator offer a reasonable solution. We present herein the case of a 70-year-old Japanese man who has presented with oro-nasal defect due to surgical procedures for oral cancer. He was treated with implant-supported full fixed prostheses in a conventional two-step procedure. After prosthesis treatment, a palatal obturator was set. The patient has shown no clinical or radiological evidence of failure as of 24 months after the end of treatment. Functional evaluation of mastication and pronunciation showed dramatic improvements. For a patient with an edentulous maxilla and palatal fistula, full-arch fixed prostheses supported by a combination of axially and non-axially positioned implants and a removable oro-nasal obturator, using the anterior alveolar bone, without bone transplantation or maxillary sinus elevation, could offer an effective, minimally invasive treatment alternative.展开更多
OBJECTIVE: To evaluate the effect of a system of velopharyngeal incompetence (VPI) management after the application of obturator. METHODS: Using nasopharyngofiberoscope (NPF) and a computer analysis system, we quantit...OBJECTIVE: To evaluate the effect of a system of velopharyngeal incompetence (VPI) management after the application of obturator. METHODS: Using nasopharyngofiberoscope (NPF) and a computer analysis system, we quantitatively analyzed the improved state of velopharyngeal incompetence in 100 patients with unilateral and/or bilateral cleft palate. RESULTS: The velopharyngeal closure (VPC) can be greatly improved by using a temporary oral prosthesis (obturator) and speech training. An objective quantitative standard was established to evaluate the change of velopharyngeal closure of cleft palate patients after surgery and conservative treatment. CONCLUSIONS: The method used is more succinct, accurate and practical than previous methods. In order to reflect the state of velopharyngeal incompetence, the concept of improvement rate of velopharyngeal incompetence (IRVPI) is put forward.展开更多
Ectopic pregnancy, in which the fertilized ovum implants on any tissue other than the endometrium, is the most common life-threatening emergency in the first trimester of pregnancy. The incidence of ectopic pregnancy ...Ectopic pregnancy, in which the fertilized ovum implants on any tissue other than the endometrium, is the most common life-threatening emergency in the first trimester of pregnancy. The incidence of ectopic pregnancy is 0.25%-1.0% of all pregnancies, and has increased greatly in the last few decades, from 4.5 per 1000 pregnancies in 1970 to an estimated 19.7 per 1000 pregnancies in 1992.^1展开更多
Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women.Because symptoms are nonspecific in most cases, diagnosis is often delayed until laparotomy is performed for t...Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women.Because symptoms are nonspecific in most cases, diagnosis is often delayed until laparotomy is performed for treatment of bowel obstruction or peritonitis. Delay in diagnosis and surgical intervention directly contribute to high morbidity and mortality rates,Here we report a case of obturator hernia where the diagnosis was made by emergency preoperative abdominal CT scan.展开更多
Schwannomas are usually benign tumors that arise from a nerve supporting the Schwann cells, those are mostly associated with the cranial or main peripheral nerves. The occurrence of retroperitoneal schwannoma is quit...Schwannomas are usually benign tumors that arise from a nerve supporting the Schwann cells, those are mostly associated with the cranial or main peripheral nerves. The occurrence of retroperitoneal schwannoma is quite rare, and in such a case, surgical excision is the first option for treatment. In 1996, Melvin confirmed the feasibility of the complete resection of a retroperitoneal schwannoma using laparoscopy for the first time. Until recently, only few cases of laparoscopic resection of retroperitoneal schwannoma have been reported.展开更多
What could be better than improving the comfort and quality of life of a patient with a life-threatening disease?Maxillectomy,the partial or total removal of the maxilla in patients suffering from benign or malignant ...What could be better than improving the comfort and quality of life of a patient with a life-threatening disease?Maxillectomy,the partial or total removal of the maxilla in patients suffering from benign or malignant neoplasms,creates a challenging defect for the maxillofacial prosthodontist when attempting to provide an effective obturator.Although previous methods have been described for rehabilitation of such patients,our goal should be to devise one stage techniques that will allow the patient an improved quality of life as soon as possible.The present report describes the aesthetic rehabilitation of a maxillectomy patient by use of a hollow obturator.The obturator is fabricated through a processing technique which is a variation of other well-known techniques,consisting of the use of a single-step flasking procedure to fabricate a single-unit hollow obturator using the lost salt technique.As our aim is to aesthetically and functionally rehabilitate the patient as soon as possible,the present method of restoring the maxillectomy defect is cost-effective,time-saving and beneficial for the patient.展开更多
基金Supported by The Grant of Education Department of Liaoning Province,2009A719
文摘A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately,her family refused surgery because of her worsening condition.On the third evening after admission,the patient developed peritonitis and sepsis. Perforation of small bowel due to the incarceration was noted during laparotomy.Bowel resection and an endileostomy were performed.She recovered well despite of the complication of multiple organ dysfunction syndrome.Literature is reviewed,and the pathogenesis,clinical manifestation,imaging features and treatment are discussed.
文摘Objective To assess stresses produced by different obturator prostheses. Methods Three-dimensional finite clement models of unilateral maxillary defects rehabilitated with different obturators were constructed. The different stresses were analyzed by three-dimensional finite element method under different load angle. Results The Von Mises stress values obtained for the remaining tissues adjacent to defect cavity were higher when rehabilitated by inferior hollow obturator in comparison with by superior hollow obturator. The maximum of Von Mises were higher when rehabilitated by resilient hollow obturator than by rigid hollow obturator. It was also observed that in the rigid type stress distribution contours formed in the remaining tissues adjacent to defect cavity, while in resilient hollow obturator prostheses the stress distributed mainly in the prosthesis itself. The oblique load shows the most maximum of Von Mises among all types of obturator prostheses. Conclusions A high lateral wall of an obturator may be more better in preserving the remaining structures than a shorter prosthesis lateral wall. A soft liner may be incorporated to reduce the pain of the residual maxillary structures and mucosa. When load on defect, higher stress would be generated to the residual maxillary structures. The adjustment of occlusual relationship is very important.
文摘The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital deformation poses a challenge to prosthodontists, particularly when the use of an implant cannot be considered. This case report described the use of an air valve in a hollow silicone obturator to manufacture an inflatable obturator that could be extended further into undercut area to retain itself. The inflatable obturator exhibited adequate retention, stability and border sealing, thereby improving the masticatory, pronunciation and swallowing functions of patients. It may be a suitable alternative treatment option to an implant-retained obturator.
文摘BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARY A 65-year-old Asian man presented with severe pain and numbness in his left lower limb,which became aggravated during walking and showed intermittent claudication.The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive.Computed tomography(CT)and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint.The results of electrophysiological examination showed peripheral neuropathy.A CT-guided obturator nerve block significantly reduced the severity of pain in this patient.According to the above findings,ONI caused by the osteophyte in the sacroiliac joint was diagnosed.This patient underwent an operation to remove the bone spur and symptomatic treatment.After therapy,the patient's pain and numbness were significantly relieved.The last follow-up was performed 6 mo after the operation,and the patient recovered well without other complications,returned to work,and resumed his normal lifestyle.CONCLUSION Osteophytes of the sacroiliac joint can cause ONI,which leads to symptoms including severe radiative pain in the lower limb in patients.The diagnosis and differentiation of this disease should attract the attention of clinicians.Surgical excision of osteophytes should be considered when conservative treatment is not effective.
文摘The developmental morphology of the obturator and micropyle and the pathway of the pollen tubes in the ovarian locule in Phellodendron amurense Rupr.have been investigated by scanning electronmicroscopy and light microscopy.The obturator of the ovule is of funicular origin.As the ovule is fully developed,the obturator becomes considerably large and closely covers the micropyle.When the pistillate flower reaches the receptive phase,the morphology of the obturator is greatly modified,and its cells on the surface are radially expanded and appear to be columnar,semi-papillar or papillar.Following fertilization the obturator reduces in size and degenerates.The pollen tubes need not necessarily traverse the obturator.Whether the pollen tubes pass the obturator or not depends on the sites at which they enter the ovarian locule.This observation does not support the idea that the obturator mainly serves the function of mechanical guidance for the growth of pollen tubes.Our investigations indicate that the structure of themicropyle changes with the different stages of the reproductive process,and becomes asymmetrical during pollination.The development of the obturator and the micropyle correlates with that of the female gametophyte in P.amurense.
文摘We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.
基金National Natural Science Foundation of China (Grant No. U2141246)。
文摘In order to investigate the mechanical response behavior of the gas obturator of the breech mechanism,made of polychloroprene rubber(PCR), uniaxial compression experiments were carried out by using a universal testing machine and a split Hopkinson pressure bar(SHPB), obtaining stress-strain responses at different temperatures and strain rates. The results revealed that, in comparison to other polymers, the gas obturator material exhibited inconspicuous strain softening and hardening effects;meanwhile, the mechanical response was more affected by the strain rate than by temperature. Subsequently, a succinct viscoelastic damage constitutive model was developed based on the ZWT model, including ten undetermined parameters, formulated with incorporating three parallel components to capture the viscoelastic response at high strain rate and further enhanced by integrating a three-parameter Weibull function to describe the damage. Compared to the ZWT model, the modified model could effectively describe the mechanical response behavior of the gas obturator material at high strain rates. This research laid a theoretical foundation for further investigation into the influence of chamber sealing issues on artillery firing.
基金the National Research Foundation of Korea Grant funded by the Korean Government,No.NRF-2021R1A2C1013073.
文摘BACKGROUND Lateral thigh pain is a common complaint in patients visiting a pain clinic.Herein,we describe the case of a patient with lateral thigh pain caused by an obturator hernia.CASE SUMMARY An 83-year-old woman visited the emergency room with suddenly aggravated right lateral thigh pain.Magnetic resonance imaging of the thigh revealed no abnormal findings in the lateral thigh area.However,an obturator hernia between the pectineus and obturator externus muscles was observed by chance.Retroperitoneal computed tomography revealed a herniated small bowel with an incarceration point at the right obturator canal and a dilated loop of the small bowel upstream.Ultrasonography of the right inguinal region revealed a distended bowel loop in the right pectineus muscle.CONCLUSION Our report provides clinicians with information that an obturator hernia can cause lateral thigh pain.
基金The Grant of Xiangya Famous Doctors of Central South University,No.201468.
文摘Obturator dislocation is a rare type of hip dislocation,accounting for about 2%-5%of all hip dislocations.The occurrence of old unreduced obturator dislocation is even more infrequent,with only 17 cases reported in nine studies,most of which were from the 1950s to 1980s in developing countries.CASE SUMMARY A 38-year-old woman from Hunan Province,China presented with stiffness of the left hip in abduction,flexion,and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior.Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture.Open reduction was performed,resulting in restoration of the concentric alignment of the left hip.After surgery,6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk.At 3 mo after surgery,the patient reported experiencing some pain,which did not affect the function of the affected limb,and some movement restriction but no abduction deformity or claudication was present.An X-ray showed that the left hip was homocentric,and there was no sign of posttraumatic arthritis or avascular necrosis.CONCLUSION Open reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.
文摘Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.
文摘AIM: To study the anatomy(formation, course, relationships and branching pattern) of the obturator nerve in detail.METHODS: The study was based on 500 adult human formalin-embalmed cadavers, 342 males and 158 females. We studied the anatomical formation, course and relationships of the obturator nerve within the lesser pelvis before the obturator canal. Finally, the whole course of the obturator nerve was examined.RESULTS: We found numerous anatomical variations about the formation of the obturator nerve, its division into two main branches, its articular branches, its intrapelvic branches for the periosteum of the pubic bone, and also the number of its muscular divisions and its anatomical relationship to the obturator externus muscle and obturator artery. We found that fibers from the L3 and L4 spinal nerves are standard components of the obturator nerve. The main trunk of the obturator nerve divides into anterior and posterior branches, within the pelvis in 23.30%, within the obturator canal in 52.30% and extrapelvic in 24.35% of cases. The anterior branch of the obturator nerve supplies three muscular branches in 67.10%, two muscular branches in 28.94% and four muscular branches in 3.94% of the cases. The posterior branch of the obturator nerve supplies two muscular branches in 60.52%, three muscularbranches in 19.07%, one muscular branch in 14.47% and four muscular branches in 5.92% of cases.CONCLUSION: We present a gross anatomical study of the human obturator nerve based on a remarkably large number of cases as well as potential clinical applications of our findings.
文摘Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated fragment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.
文摘Oral cancer treatment primarily focused on the surgical removal of cancer tissues followed by surgical/prosthetic reconstruction.Restoration of the missing structures immediately after surgery shortens recovery time and allows patient to return to community as a functioning member.The most practiced surgical obturators are simple resin prosthetic bases without incorporation of the teeth.This article highlights a technique to fabricate a surgical obturator that duplicates patient’s original tissue form including teeth,alveolus and palatal tissues.The obturator is placed immediately after surgery and make patient feel unaware of surgical deformity.The obturator prosthesis fabricated with this technique supports soft tissues and minimizes the scar contracture.We have clinically tried this technique in 11 patients.Patients’satisfaction level was recorded on visual analogue scale(VAS)and it ranges between 74%and 94%(with average of 87%).Four different prosthodontists have visually evaluated facial asymmetry of patients at6 mo recall and their average perception on VAS varies between 71%and 93%(with average of 84%).
文摘Open oro-nasal defects resulting after oral tumor resection need structural and functional rehabilitation using dental prostheses. Conventional removable prostheses have usually been indicated and performed for prosthodontics. When the patient has an edentulous maxilla, the unfavorable stability of the prosthesis will cause dysfunction of mastication and pronunciation. To achieve improvement of the impaired functional situation, implant-supported full fixed prostheses (IPSPs) for the edentulous maxilla with a removable obturator offer a reasonable solution. We present herein the case of a 70-year-old Japanese man who has presented with oro-nasal defect due to surgical procedures for oral cancer. He was treated with implant-supported full fixed prostheses in a conventional two-step procedure. After prosthesis treatment, a palatal obturator was set. The patient has shown no clinical or radiological evidence of failure as of 24 months after the end of treatment. Functional evaluation of mastication and pronunciation showed dramatic improvements. For a patient with an edentulous maxilla and palatal fistula, full-arch fixed prostheses supported by a combination of axially and non-axially positioned implants and a removable oro-nasal obturator, using the anterior alveolar bone, without bone transplantation or maxillary sinus elevation, could offer an effective, minimally invasive treatment alternative.
文摘OBJECTIVE: To evaluate the effect of a system of velopharyngeal incompetence (VPI) management after the application of obturator. METHODS: Using nasopharyngofiberoscope (NPF) and a computer analysis system, we quantitatively analyzed the improved state of velopharyngeal incompetence in 100 patients with unilateral and/or bilateral cleft palate. RESULTS: The velopharyngeal closure (VPC) can be greatly improved by using a temporary oral prosthesis (obturator) and speech training. An objective quantitative standard was established to evaluate the change of velopharyngeal closure of cleft palate patients after surgery and conservative treatment. CONCLUSIONS: The method used is more succinct, accurate and practical than previous methods. In order to reflect the state of velopharyngeal incompetence, the concept of improvement rate of velopharyngeal incompetence (IRVPI) is put forward.
文摘Ectopic pregnancy, in which the fertilized ovum implants on any tissue other than the endometrium, is the most common life-threatening emergency in the first trimester of pregnancy. The incidence of ectopic pregnancy is 0.25%-1.0% of all pregnancies, and has increased greatly in the last few decades, from 4.5 per 1000 pregnancies in 1970 to an estimated 19.7 per 1000 pregnancies in 1992.^1
文摘Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women.Because symptoms are nonspecific in most cases, diagnosis is often delayed until laparotomy is performed for treatment of bowel obstruction or peritonitis. Delay in diagnosis and surgical intervention directly contribute to high morbidity and mortality rates,Here we report a case of obturator hernia where the diagnosis was made by emergency preoperative abdominal CT scan.
文摘Schwannomas are usually benign tumors that arise from a nerve supporting the Schwann cells, those are mostly associated with the cranial or main peripheral nerves. The occurrence of retroperitoneal schwannoma is quite rare, and in such a case, surgical excision is the first option for treatment. In 1996, Melvin confirmed the feasibility of the complete resection of a retroperitoneal schwannoma using laparoscopy for the first time. Until recently, only few cases of laparoscopic resection of retroperitoneal schwannoma have been reported.
文摘What could be better than improving the comfort and quality of life of a patient with a life-threatening disease?Maxillectomy,the partial or total removal of the maxilla in patients suffering from benign or malignant neoplasms,creates a challenging defect for the maxillofacial prosthodontist when attempting to provide an effective obturator.Although previous methods have been described for rehabilitation of such patients,our goal should be to devise one stage techniques that will allow the patient an improved quality of life as soon as possible.The present report describes the aesthetic rehabilitation of a maxillectomy patient by use of a hollow obturator.The obturator is fabricated through a processing technique which is a variation of other well-known techniques,consisting of the use of a single-step flasking procedure to fabricate a single-unit hollow obturator using the lost salt technique.As our aim is to aesthetically and functionally rehabilitate the patient as soon as possible,the present method of restoring the maxillectomy defect is cost-effective,time-saving and beneficial for the patient.
