China
Africa
Explore chapters and articles related to this topic
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The incidence of duodenal atresia is 1 in 5000 births in the UK. The ‘double bubble’ sign indicates gas in the stomach and proximal duodenum. If not treated it becomes fatal as a result of fluid shifts and electrolyte imbalances. Fullness in the epigastric region is a result of the stomach being full of gas. In oesophageal atresia the baby typically presents with choking rather than vomiting. In gastric outlet obstruction there is no bile in the vomit and, most importantly, it presents later at about 4 weeks whereas duodenal atresia presents at birth. In congenital intestinal obstruction a plain film will show more pathognomonic features of obstruction. There is an association of duodenal atresia with Down’s syndrome.
Breast
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Double bubble A – can happen with the (total) submuscular placement when the implant is held high on the chest wall whilst the parenchyma slides downwards over it – sometimes called ‘waterfall deformity’ or Snoopy appearance.
Principles of paediatric surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Duodenal atresia may take the form of a membrane or the proximal and distal duodenum may be completely separated. Prenatal ultrasound finds a ‘double bubble' in the fetal abdomen with polyhydramnios. There is an association with Down syndrome. Postnatally, there is bilious vomiting if the atresia is distal to the ampulla. A plain abdominal x-ray also shows the double-bubble (Figure9.24). Repair is by open duodeno- duodenostomy (Figure9.25). Occasionally, there is a duodenal membrane with a modest central perforation, which may delay symptoms until later childhood.
Pneumatic retinopexy: a review of an essential technique in vitreoretinal surgical care
Published in Expert Review of Ophthalmology, 2022
Ian Shao, Arjan S. Dhoot, Marko M. Popovic, Paola L. Oquendo, Hesham Hamli, Peter J. Kertes, Rajeev H Muni
The double-bubble approach (i.e. sequential PnR) is a strategy that has been employed as an alternative technique for the management of inferior RRDs[22]. The double bubble technique, as described by Alali et al., is similar to the standard PnR approach in terms of visualization, sterile preparation, and anterior chamber paracentesis. However, in contrast to the standard PnR approach, 0.6cc of SF6 gas is first injected and then the patient receives another gas injection with a similar size on a subsequent day to achieve a gas bubble of sufficient size to tamponade the retinal breaks. Laser retinopexy may be subsequently applied to the breaks[22]. Overall, the study by Alali et al. demonstrated that in patients with inferior breaks (with no giant retinal tears), the primary reattachment rate with the double bubble approach is approximately 70%, which is comparable to the reattachment rates following PPV and/or SB for this subset of patients [22,23]. Given the relative simplicity of the double-bubble approach, as well as the functional post-procedural benefits, sequential PnR may be a cost-effective and viable option. At the same time, well-designed randomized trials should be conducted to further assess the viability of this approach.
In search for the ‘perfect’ breast implant: are textured implants still indicated in today’s breast augmentation practice?
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Paolo Montemurro, Mubashir Cheema, Per Hedén
In total, 113 patients (11.0%) developed a complication postoperatively (Table 1). These represented 15.1% (n = 29) of patients with round implants and 10.0% (n = 84) of those with anatomical implants (not statistically significant, p-value = .07). Among all patients, in 27 cases (2.6%) the implants ‘bottomed out’ at a mean 10.7 months after augmentation (range, 5 to 39 months). Six patients (0.6%) developed a ‘double bubble’ deformity at a mean 14.0 months of follow up (range, 6 to 58 months). 33 patients (3.2%) developed capsular contracture (CC) at an average 35.6 months (range, 3 to 112 months). Ten patients (1.0%) developed postoperative hematomas that were managed surgically. There were 12 (1.2%) small volume uncomplicated seromas that were aspirated with ultrasound guidance and managed according to existing protocol. In 29 patients (3.4% of) the anatomical implants mal-rotated at a mean 13.4 months after surgery (range 3 to 48 months). Tables 1 and 2 give the breakdown of complications for implant with respect to their shapes and surfaces.
Clinical outcome of pregnancies with the prenatal double bubble sign – a five-year experience from one single centre in mainland China
Published in Journal of Obstetrics and Gynaecology, 2018
A double bubble detected on antenatal ultrasound is a serious finding that usually implies an obstruction proximal Treitz’s ligament. However, there are other anomalies that mimic a double bubble sign, so aetiologies in addition to duodenal obstruction should always be considered. It can be associated with proximal jejunal atresia or oesophageal atresia, a jejunal duplication cyst, duodenal duplication or even non- bowel anomaly, as demonstrated in this study and other reports (Malone et al. 1997; Schwartzberg and Burjonrappa 2013; Kucińska-Chahwan et al. 2015). Careful sonographic examination can sometimes result in the identification of the anatomic cause of double bubble. For example, annular pancreas can be diagnosed by visualising a hyperechogenic band around the duodenum (Dankovcik et al. 2008). In proximal jejunal atresia, three instead of two bubbles are present (Tongsong and Chanprapaph 2000). Duodenal duplication is suspected with detection of double bubble together with the following triad: (1) lack of polyhydramnios, (2) failure to demonstrate the double bubble sign consistently on a transverse abdominal image and (3) presence of normal, or dilated, distal bowel pattern (Malone et al. 1997).