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PubMed1994

Perforating eye injuries in a western part of Sweden.

We performed a prospective study of all perforating eye injuries in a western part of Sweden during 1989-1991. We registered 140 cases (141 eyes) in a population of 1.4 million. Annual incidence was 3.3 per 100,000 inhabitants. Follow-up time was 6 months or more in 91 (64%) of the cases. Perforating eye injuries were 5.6 times more common in men than in women. Occupational injuries accounted for 37% of perforating eye injuries. Twenty-nine per cent of perforating eye injuries were injuries that occurred during domestic and leisure time. In addition to metal fragments, a whole nail was a common perforating object in these groups. Playing activity accounted for 11% of the perforating eye injuries, traffic accidents for 3% and assault for 9%. In a group of elderly patients (9%) perforating eye injuries were caused by falls. Visual acuity was 0.5 or better in 57 (63%) of the eyes with a follow-up period of at least 6 months. Only 2 of the 141 eyes were enucleated.

Adolescent↗

PubMed2000

Morphology of perforated atrial septal aneurysm suitable for closure by transcatheter device placement.

OBJECTIVE: To define the morphological criteria of perforated atrial septal aneurysms suitable for closure by a transcatheter device. METHODS: A retrospective analysis of all consecutive patients with atrial septal aneurysm and one or more perforations presenting between May 1997 and June 1999. The aneurysms were classified as: aneurysm with persistent foramen ovale (type A); aneurysm with single atrial septal defect (type B); aneurysm with two perforations requiring more than one device for closure (type C); and aneurysm with multiple perforations (type D). PATIENTS: Data from 50 patients aged 5-78 years (mean 43 years) were analysed; 32 had systemic thromboembolism or transient ischaemic attacks, eight presented with dyspnoea on exercise, and 10 were discovered incidentally but had significant left to right shunt and right ventricular volume overload. RESULTS: In all 18 patients with aneurysm and persistent foramen ovale (type A), transcatheter closure was possible. In nine with aneurysm and atrial septal defect (type B), five defects were closed and four required surgery. Device closure was achieved in all 10 patients with aneurysms and two perforations (type C), but four had a residual shunt. Thirteen patients with multiple perforated aneurysms (type D) underwent surgery. CONCLUSIONS: This classification of morphology of perforations of aneurysm is clinically useful for selecting patients for treatment by transcatheter devices.

Adolescent↗

PubMed2002

Coronary artery perforation during percutaneous intervention: incidence and outcome.

OBJECTIVE: To examine the clinical outcome of percutaneous coronary intervention where the procedure was complicated by vessel perforation. SETTING: Tertiary referral centre. METHODS: The procedural records of 6245 patients undergoing coronary intervention were reviewed. In 52 patients (0.8%) the procedure was complicated by vessel perforation, ranging from wire exit to free flow of contrast into the pericardial space. The majority of lesions treated were complex (37% type B, 59% type C) and 9 of 52 (17%) were chronic occlusions. Ten patients (19%) received abciximab. Four underwent rotational atherectomy (8%). RESULTS: In 28 of 52 patients (54%) the perforation was benign and managed conservatively without the development of haemodynamically significant sequelae. In 24 of 52 (46%) a significant pericardial effusion ensued requiring drainage. Of these 24 procedures 6 had involved the treatment of a chronic occlusion (25%). Eight of the 24 patients were referred for emergency bypass surgery (33%), 3 of whom died. Of the remaining 16 not referred for surgery, 3 died. Of the 10 procedures complicated by vessel perforation where abciximab had been administered, 9 (90%) led to pericardial tamponade. Latterly 2 vessel perforations were successfully treated by the deployment of a covered stent. CONCLUSIONS: Coronary artery perforation with sequelae during intervention is rare--26 of 6245 (0.4%). This complication was seen in the treatment of chronic occlusions, which are therefore not risk-free procedures. The development of pericardial tamponade carries a high mortality. While prompt surgical intervention may be life saving, expertise in the use of covered stents may provide a valuable rescue option for this serious complication. Caution should be exercised where coronary perforation occurs and abciximab has been used.

Abciximab↗

PubMed1999

Perforating branches from offending arteries in hemifacial spasm: anatomical correlation with vertebrobasilar configuration.

OBJECTIVE: In microvascular decompression for hemifacial spasm, the perforating branches around the facial nerve root exit zone occasionally complicate facial nerve decompression. In this context, the vertebrobasilar configuration was retrospectively correlated with the perforating branches. METHODS: Based on vertebral angiography, magnetic resonance angiography, and three dimensional computed tomographic angiography, 69 patients were divided into three groups, according to the anatomy of the vertebrobasilar system. In patients with the type I configuration, the vertebral artery on the affected side was dominant and had a sigmoidal course. The type II patients had the basilar artery curving mainly towards the affected side. The type III patients showed the basilar artery either running straight or curving toward the unaffected side. The relation of the anatomical configuration of these vessels with the perforating branches around the facial nerve exit zone was investigated. RESULTS: The posterior inferior cerebellar artery in type I patients (n=33) and the anterior inferior cerebellar artery in type II (n=5) and type III (n=31) patients were the most common offending arteries. More than half of the type I patients (n=20) showed no perforating branches around the facial nerve exit zone. However, the type II (n=3) and III patients (n=23) often showed one or more perforating branches around that region. CONCLUSIONS: The configuration of the vertebrobasilar system has a significant correlation with the presence of perforating branches near the site of microvascular decompression. These perforating vessels are often responsible for the difficulty encountered in mobilising the offending artery during the procedure.

Adult↗

PubMed2002

Epidemiology of perforated colonic diverticular disease.

Perforated colonic diverticular disease results in considerable mortality and morbidity. This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. Computerised searches were used to identify published articles relating to the epidemiology, pathophysiology, and clinical features of perforated colonic diverticular disease. Several drug and dietary exposures have potential biological mechanisms for causing perforation. Of these only non-steroidal anti-inflammatory drugs have been consistently identified as risk factors in aetiological studies. The causes of perforated colonic diverticular disease remain largely unknown. Further aetiological studies, looking specifically at perforation, are required to investigate whether cause-effect relationships exist for both drug and dietary exposures. The identification of risk factors for perforation would allow primary public health prevention, secondary risk factor modification, and early prophylactic surgery to be aimed at people at high risk.

Alcohol Drinking↗

PubMed1980

Influence of raphe nuclei on neuronal transmission from perforant pathway through dentate gyrus.

1. In chronically prepared, freely moving rats, electrical stimulation was applied to the perforant pathway and monosynaptic responses were recorded extracellularly in the ipsilateral dentate gyrus. In some tests a stimulus was also applied to the median raphe nucleus (mr) prior to activating the perforant pathway. Experiments were performed during two behavioral conditions: slow-wave sleep (SWS) and the still, alert state (SAL). Two varieties of evoked responses were recorded: those due to synchronous firing of neuronal action potentials (evoked action potentials or EAPs) and those produced by excitatory synaptic activity (evoked synaptic potentials or ESPs). 2. As reported previously (38), perforant path stimulation elicited EAPs of greater magnitude during SWS than during SAL. The application of a prior stimulus to mr (prestimulation) markedly increased the already elevated EAPs observed during SWS. The EAPs during SAL were unaffected by prestimulation. 3. The minimum delay time (time between mr and perforant path stimuli) at which the augmentation of the EAPs appeared during SWS was approximately 5 ms. The augmentation reached a maximum at delay times of 25-40 ms and was present up to a delay time of 150 ms. 4. As in former experiments (38), ESPs recorded in the molecular layer of the dentate gyrus after perforant path stimulation were found to be greater during SAL than during SWS. Prestimulation of mr had no significant effect on the ESPs at any level of the molecular layer during either SWS or SAL. 5. The perforant path afferent volley was recorded at high gain in the dentate gyrus. Its amplitude was found to be solely dependent on perforant path stimulus intensity and not on behavioral state or the prestimulation of mr. 6. In preparations anesthetized with Chloropent (82% chloral hydrate, 18% pentobarbital; Fort Dodge Laboratories, Fort Dodge, IA), prestimulation was applied at each of a number of loci within the pons and medulla, including mr, As in SWS, prestimulating mr resulted in augmented EAPs with a minimum delay time of 5 ms. Similar augmented responses were observed when stimulation was applied at other raphe nuclei (dorsal raphe, pontis, magnus, and pallidus), but there was no augmentation when stimulation was applied at other brain stem sites. Threshold stimulus intensities for producing augmented EAPs in the raphe nuclei were less than 30 microA. 7. In freely moving animals it was first established that the EAP responses during SWS were markedly greater than during SAL. Midline lesions were then made at the rostrocaudal level of mr. Following the lesions, there was no longer any significant difference in the magnitude of the EAPs recorded during the two behaviors. 8. These findings suggest that tonic influences arising from raphe nuclei during SWS may be involved in the facilitation of neuronal transmission through the dentate gyrus observed during this behavioral state.

Animals↗

PubMed1992

Electrophysiological and pharmacological characterization of perforant path synapses in CA1: mediation by glutamate receptors.

1. With the use of hippocampal slices from adult rats, we studied monosynaptic potentials in CA1 evoked by stimulating either the perforant pathway or the Schaffer collaterals. Excision of region CA3 and the dentate gyrus prevented polysynaptic excitation of CA1 and facilitated interpretation of the extracellular potentials. 2. Laminar profiles distinguished the population excitatory postsynaptic potentials (pEPSPs) in CA1 evoked by stimulating the Schaffer collaterals and the perforant path. Stimulating the perforant path evoked short-latency negative-going pEPSPs in s. lacunosum-moleculare of CA1 and positive-going pEPSPs in s. radiatum. Stimulating the Schaffer collaterals evoked negative-going pEPSPs in s. radiatum. 3. A pharmacological manipulation also distinguished the two pathways in CA1. The selective GABAB agonist baclofen greatly decreased the slope of pEPSPs evoked by stimulating the Schaffer collaterals but did not decrease the slope of pEPSPs evoked by stimulating the perforant path. 4. Combined bath application of the glutamate receptor antagonists 6,7-dinitroquinoxaline-2,3-dione (DNQX) and 2-amino-5-phosphonopentanoic acid (APV) abolished the negative-going pEPSPs in s. lacunosum-moleculare evoked by stimulating the perforant pathway. This application of DNQX and APV revealed a positive-going field potential that was blocked by bath application of the gamma-aminobutyric acid (GABA) receptor antagonists picrotoxin or bicuculline. 5. Although the glutamate-mediated component of the response evoked by stimulating the perforant path was apparently excitatory, we never observed a population spike in s. pyramidal evoked by stimulating the perforant path.(ABSTRACT TRUNCATED AT 250 WORDS)

2-Amino-5-phosphonovalerate↗

PubMedDate not supplied

Dye injection method for the demonstration of territories supplied by individual perforating arteries of the posterior communicating artery in the dog.

Various reported methods to demonstrate the territory supplied by an intracranial artery are designed to deal with major cerebral arteries or a group of perforating arteries. We have devised a technique to demonstrate the area supplied by individual small perforating arteries using different dyes with gelatin. A temporal craniectomy was made in the dog and the posterior circle of Willis was exposed via a subtemporal route under the operating microscope. After a portion of the posterior communicating artery including one perforating artery was trapped with clips, dye was injected through the cannule. The animals were immediately sacrificed and studied. The area supplied by an individual perforating artery occupied a relatively large and distinct area, and when two dyes for two different perforators were used, no significant overlapping of the stained territories was seen. This method is useful for the study of focal cerebral ischemia caused by occlusion of a fine perforating artery and in particular it will serve to clarify the importance of preserving each perforating artery in surgery in the region of the base of the brain such as that for basilar artery aneurysm.

Animals↗

PubMed2003

Diagnosis of perforated enterocystoplasty.

In the operation of enterocystoplasty, now widely practised, segments of bowel are used to augment or replace the urinary bladder. An occasional complication is perforation, and this may present in non-specialist settings. We investigated the management of spontaneous perforations among 264 patients with enterocystoplasty followed by one surgeon for 2-18 years. Patients' charts were examined for data on presentation, diagnosis and treatment. 10 patients had thirteen perforations; data were available for nine perforations in 9 patients. Mean time from enterocystoplasty to perforation was 45 months. Presentation was shoulder pain in 1 and abdominal pain (with or without fever) in 8. Perforation was diagnosed without delay in 3, but the initial diagnosis was urinary tract infection in 4 and small-bowel obstruction in 2. Ultrasound was the most useful investigation being diagnostic in 6 of 7 cases; contrast cystography showed a leak in only 2 of the 6 patients in whom it was performed. Treatment was successful in 8 cases (surgery 6; percutaneous drainage 2); 1 patient, who remained undiagnosed, was treated medically and died. Patients with enterocystoplasty need to be educated about this potentially lethal complication, so that they can alert non-specialist clinicians to what may have happened. In any patient with enterocystoplasty who reports abdominal pain or shoulder pain, perforation has to be ruled out.

Abdominal Pain↗

PubMed2003

Irreversible perforations in vertebral trabeculae?

UNLABELLED: In human cancellous bone, osteoclastic perforations resulting from normal remodeling were generally considered irreversible. In human vertebral samples, examined by backscatter electron microscopy, there was clear evidence of bridging of perforation defects by new bone formation. Hence trabecular perforations may not be irreversible. INTRODUCTION: Preservation of the trabecular bone microarchitecture is essential to maintain its load-bearing capacity and prevent fractures. However, during bone remodeling, the osteoclasts may perforate the platelike trabeculae and disconnect the structure. Large perforations (>100 microm) are generally considered irreversible because there is no surface on which new bone can be laid down. In this work, we investigated the outcome of these perforations on human vertebral cancellous bone. MATERIALS AND METHODS: Using backscatter electron microscopy, we analyzed 264 vertebral bone samples from the thoracic and lumbar spine of nine subjects (44-88 years old). Nine fields (2 x 1.5 mm) were observed on each block. Several bone structural units (BSUs) were visible on a single trabecula, illustrating a dynamic, historical aspect of bone remodeling. A bridge was defined as a single and recent BSU connecting two segments of trabeculae previously separated by osteoclastic resorption. They were counted and measured (length and breadth, microm). RESULTS AND CONCLUSION: We observed 396 bridges over 2376 images. By comparison, we found only 15 microcalluses on the same material. The median length of the bridge was 165 microm (range, 29-869 microm); 86% being longer than 100 microm and 35% longer than 200 microm. Their breadth was 56 microm (range, 6-255 microm), but the thinnest were still in construction. Bridges were found in all nine subjects included in the study, suggesting that it is a common feature of normal vertebral bone remodeling. These observations support the hypothesis that perforation could be repaired by new bone formation, and hence, might not be systematically irreversible.

Adult↗

PubMed1991

Perforation of the augmented urinary bladder in nine children and adolescents: importance of cystography.

Augmentation of the urinary bladder is a popular surgical procedure for increasing the capacity and lowering the intraluminal pressure in patients whose bladder is small, noncompliant, or has high pressure. Among 250 augmentations performed at our hospital, nine patients have had 16 episodes of postoperative extravasation of urine from their augmented bladder. Thirteen episodes were studied by fluoroscopically monitored contrast cystography, which was diagnostic in 12. One patient's perforation was noted during an unrelated operation and the other two died of peritonitis before cystography could be performed. Four episodes occurred early, within 3 weeks of surgery. All were at a surgical anastomosis and presumably represented incomplete healing. Each patient with an early episode of extravasation had a perforation later. Nine perforations occurred from 1.0 to 6.5 months after the augmentation. Of these, three occurred at an anastomosis and four occurred in the augmenting segment. The locations of two were never fully documented. Three perforations occurred late, from 2.5 to 6.0 years after surgery, and all were in the augmenting segment. Three of the nine patients died of complications associated with perforation. Perforation of the bladder is not rare and is a potentially fatal complication of augmentation. Whenever a patient who has undergone augmentation has signs or symptoms suggesting perforation, cystography can play a crucial role in diagnosis and should be performed without delay.

Adolescent↗

PubMed1987

Hyaluronan and healing of tympanic membrane perforations. An experimental study.

Hyaluronan, an extracellular high molecular weight polysaccharide, was applied onto experimentally performed tympanic membrane (TM) perforations in the rat. The hyaluronan-treated perforations closed faster than the untreated controls and showed less scar tissue. Initially the perforation became covered by a sheet of keratin and hyaluronan, which appeared to relax and orientate the retracted collagen fibres at the margin of the perforation. The hypertrophic stratified keratinizing squamous epithelium advanced within the hyaluronan-keratin cover and closed the perforation ahead of an approaching connective tissue. Three months after the closure, the hyaluronan-treated TMs appeared transparent in comparison to the opaque untreated controls. In histological sections the hyaluronan-treated TM was comparably thin and an organized collagen fibre layer was discernible. Hyaluronan of various concentrations (0.75, 1.0, 1.75 and 1.9%) and molecular weights (4 x 10(6) and 6 x 10(6)) were tested. The healing rate and degree of scar tissue was dependent on the concentration, but not on the molecular weight of the hyaluronan. Hyaluronan, at the higher concentration, healed the perforations faster and produced a less opaque TM than hyaluronan at low concentration. The number of applications of hyaluronan also influenced the healing rate; fewer applications resulted in a reduced rate. However, the quality of the healed TM was influenced to a lesser extent by the number of hyaluronan applications. Even single applications caused less scar tissue in comparison with untreated TMs. It is inferred from the study that hyaluronan, exogenously applied, might be valuable also in the clinical situation to enhance the healing of different types of TM perforation.

Animals↗

PubMed2006

Diagnosis and treatment of gallbladder perforation.

AIM: To present our clinical experience with gallbladder perforation cases. METHODS: Records of 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis in our clinic between 1997 and 2006 were reviewed retrospectively. Sixteen (4.8%) of those patients had gallbladder perforation. The parameters including age, gender, time from the onset of symptoms to the time of surgery, diagnostic procedures, surgical treatment, morbidity, and mortality were evaluated. RESULTS: Seven patients had type I gallbladder perforation, 7 type II gallbladder perforation, and 2 type III gallbladder perforation according to Niemeier's classification. The patients underwent surgery after administration of intravenous electrolyte solutions, and were treated with analgesics and antibiotics within the first 36 h (mean 9 h) after admission. Two patients died of sepsis and multiple organ failure in the early postoperative period. Subhepatic abscess, pelvic abscess, pneumonia, pancreatitis, and acute renal failure were found in 6 patients. CONCLUSION: Early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance. Upper abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation.

Aged↗

PubMed1999

[A clinical treatise upon the nasal septal perforation].

Thirty nine cases of septal perforation of various origins were presented using clinical such as backgrounds age, gender, possible causes, and size of septal perforation evaluated by diameter. The cases included 26 males and 13 females with a mean age of 35 years range: 8 to 85 years. Possible causative factors were as follows: septal surgeries (9), other nasal and paranasal surgeries (17), nasal cautery or tamponade (2), occupational (2), collagen disease (2), inflammatory (1) and idiopathic (5). Signs and symptoms related to perforations were minor, such as stuffy nose (3), running nose (3), nosebleed (5), dry sensation (4), nasal pain (1), and asymptomatic (23). Sizes of perforations by largest diameter were small (less than 10 mm) in 7, moderate (11-20 mm) in 13, and large (more than 21 mm) in 6. The size of perforations tended to be variable, but two cases with collagen disease showed large perforations 35 mm. Although iatrogenic and idiopathic cases comprised the majority of cases (80%), such a few cases of grave significases as collagen and hematological diseases showed unusually large perforations.

Adolescent↗

PubMed2000

Assessment of perioperative predictive factors influencing survival in patients with postinfarction ventricular septal perforation. Classified by the site of myocardial infarction.

BACKGROUND: The present study was designed to identify the perioperative factors and to consider a counterplan for the improvement of surgical results, based on the site of myocardial infarction. METHODS: Sixteen patients with postinfarction ventricular septal perforation underwent surgical repair. The operation was performed 5+/-3 days after the onset of ventricular septal perforation using the same method, an infarctectomy and reconstruction of the septum and right and left ventricular walls with a single Dacron patch. The ventricular septal perforation was anterior in 11 patients and posterior in 5. Preoperative hemodynamics between survivors and non-survivors were compared. Left ventricular wall motion was estimated using echocardiography by wall motion score (divided into 17 segments and each segment was graded on a fourpoint scale: normal, 0; hypokinetic, 1; severe hypokinetic, 2; a- or dyskinetic, 3) and summed up. RESULTS: The operative mortality was 36% in 11 patients with anterior ventricular septal perforation. In non-survivors compared to survivors, wall motion score was greater (25+/-4 vs 18+/-4, p<0.01) and all values were over 20. The value of the cardiac index divided by Qp/Qs was lower (0.98+/-0.09 vs 1.44+/-0.31, p<0.02) and all were under 1.1. In 5 patients with inferior ventricular septal perforation, the operative mortality was 40%. In non-survivors compared to survivors, wall motion score was greater (18, 18 vs 7, 2, 12) and the right atrial pressure was greater (18, 19 vs 10, 9, 9 mmHg) due to a right ventricular infarction. CONCLUSIONS: The patients with poor left ventricular wall motion were lost for reasons unrelated to the site of myocardial infarction. Moreover, a cardiac index over Qp/Qs in anterior ventricular septal perforation and the existence of a right ventricular infarction in inferior ventricular septal perforation was predictive of operative mortality.

Aged↗

PubMed1991

[Retinal detachment after perforating eye injuries. IV. Anatomic and functional results of cryosurgical procedures].

In the course of ten years the authors operated 69 patients with detachment of the retina (DR) after perforating eye injuries, using cryosurgical methods with silicone episcleral implants. In 37 patients DR developed after simple perforation (group A) and in 32 patients after perforation of the eye with an intraocular foreign body (group B). In all patients the perforation affected the vitreous space. From the total number of patients anatomical apposition of the retina was achieved in 62.3%. A significant difference is the poorer anatomical result of the operation in the group with simple perforations without a foreign body 54.0%, as compared with the group after perforation with a foreign body, 71.9%. The anatomical results were evaluated with regard to the period of DR, aphakia, the characteristic of the retinal defect, the type of LR and the extent of the operation. From the total number of successfully operated patients we recorded the same or better vision in 44.2% and in 51.2% poorer vision, as compared with that after the perforating injury of the eye. Deterioration was caused by the duration of DR, detachment of the macular region, an extensive operation and complications.

Adolescent↗

PubMed1992

The incidence of surgical glove perforation during obstetric and gynaecological surgical procedures.

The increasing prevalence of diseases such as AIDS and hepatitis B makes safe surgical techniques more important than ever before. Intact surgical gloves act as a barrier against these infections and a study was therefore done to determine the incidence of surgical glove perforation during obstetric and gynaecological surgical procedures. Surgical gloves were collected and tested for perforations following 353 consecutive obstetric and gynaecological operations. Forty pairs of new unused surgical gloves were tested for perforations in the same way. Whereas none of the 40 control pairs of gloves was found to be perforated, 22%-24% of used gloves were perforated. The experience of the surgeon had no influence on the incidence of glove perforation (P = 0.997; chi 2-test). Left-hand gloves were more frequently perforated than right-hand gloves, but this difference was not statistically significant (P = 0.075: chi 2-test). These findings must be a source of concern to all those practising obstetrics and gynaecology and measures are therefore suggested to decrease the risk of HIV or hepatitis B transmission during operations.

Equipment Failure↗

PubMed2003

[Histological evaluation on repair of furcation perforation in dogs using mineral trioxide aggregate].

OBJECTIVE: To investigate histological response to immediate repair of different sizes of furcation perforation using MTA, Dycal and GIC. METHODS: Forty-two posterior teeth in three adult beagle dogs were randomly divided into two groups, small perforation group and large perforation group. Each group was then divided into three sub-groups which were repaired with MTA, Dycal and GIC respectively. The dogs were sacrificed 4 months later, and the specimens processed and examined under the light microscope. Inflammation, epithelial proliferation, and formation of hard tissue over the material were evaluated. RESULTS: In teeth repaired with MTA, five cases were free of inflammation, and the other nine cases were associated with slight or moderate inflammation. There was formation of cementum with cementoblast cells around it in four cases. In the group of Dycal, all specimens had moderate or severe inflammation. The deposition of irregular calcified tissues as well as a large quantity of inflamed cells were found in two cases of small perforation. Six cases presented epithelial proliferation. In the group of GIC, moderate or severe inflammation was seen in all cases except for one case of large perforation with fibrous tissues and sparse inflammatory cells around the material. Four cases presented epithelial proliferation. There was some relation between epithelial proliferation and size of perforation. CONCLUSION: MTA is superior to GIC and Dycal for immediate repairing furcation perforation in dogs owing to its less irritation to surrounding tissues and its ability to induce the formation of hard tissues.

Aluminum Compounds↗