Ectopic intra-abdominal fascioliasis

OpenAIRE

ÖNGÖREN, Ali Ulvi

2009-01-01

Human fascioliasis, caused by Fasciola hepatica, is emerging as an important chronic zoonotic disease in many areas of the world, including Turkey. It primarily involves the liver and may also cause severe damage in the tissue. Herein we report on a patient with ectopic intra-abdominal fascioliasis that presented to our clinic with abdominal pain and distention. Physical and radiological examination as well as an exploratory laparotomy revealed a 10 × 10-cm mass in the splenic flexura of the ...

Interaction between intra-abdominal pressure and positive-end expiratory pressure

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Jamili Anbar Torquato

2009-02-01

Full Text Available OBJECTIVE: The aim of this study was to quantify the interaction between increased intra-abdominal pressure and Positive-End Expiratory Pressure. METHODS: In 30 mechanically ventilated ICU patients with a fixed tidal volume, respiratory system plateau and abdominal pressure were measured at a Positive-End Expiratory Pressure level of zero and 10 cm H2O. The measurements were repeated after placing a 5 kg weight on the patients' belly. RESULTS: After the addition of 5 kg to the patients' belly at zero Positive-End Expiratory Pressure, both intra-abdominal pressure (p<0.001 and plateau pressures (p=0.005 increased significantly. Increasing the Positive-End Expiratory Pressure levels from zero to 10 cm H2O without weight on the belly did not result in any increase in intra-abdominal pressure (p=0.165. However, plateau pressures increased significantly (p< 0.001. Increasing Positive-End Expiratory Pressure from zero to 10 cm H2O and adding 5 kg to the belly increased intra-abdominal pressure from 8.7 to 16.8 (p<0.001 and plateau pressure from 18.26 to 27.2 (p<0.001. Maintaining Positive-End Expiratory Pressure at 10 cm H2O and placing 5 kg on the belly increased intra-abdominal pressure from 12.3 +/- 1.7 to 16.8 +/- 1.7 (p<0.001 but did not increase plateau pressure (26.6+/-1.2 to 27.2 +/-1.1 -p=0.83. CONCLUSIONS: The addition of a 5kg weight onto the abdomen significantly increased both IAP and the airway plateau pressure, confirming that intra-abdominal hypertension elevates the plateau pressure. However, plateau pressure alone cannot be considered a good indicator for the detection of elevated intra-abdominal pressure in patients under mechanical ventilation using PEEP. In these patients, the intra-abdominal pressure must also be measured.

Evaluation of the Diagnostic Value of Peritoneal Lavage Test in Intra Abdominal Injuries Due to Abdominal Trauma and Comparison with Laparotomy and Conservative Treatment

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AH Amoie

2004-04-01

Full Text Available Introduction: Prevalence of abdominal trauma is increasing during recent years. Abdomen is the third most affected part of body by trauma. Early diagnosis can help us select better methods for managing abdominal trauma. Even though newer imaging techniques such as CT scan are available, abdominal trauma is still a complex matter, which every doctor in the emergency department has to deal with. Physical examination for the evaluation of intra abdominal organ damage though impotant, is not enough. Material and Methods: This observational (cross-sectional study was done over a period of 24 months (1999-2001. 135 patients (99male and 36 female with abdominal trauma and no urgent laparotomy indication were included in this study. We calculated the sensitivity, specificity, positive&negative predictive values of DPL test in our cases using SPSS software. Results: Mean age of patients was 28.6 years. All of the patients were evaluated with peritoneal lavage which resulted in 70 positive and 65 negative cases. All of the 70 cases with positive results were further evaluated with laparotomy of which 63 cases have intra peritoneal injuries that needed surgical treatment, while 7 cases didn’t have any intra peritoneal injuries (False positive results. All cases with negative results of peritoneal lavage test were treated conservatively for 3-5 days and during this period of time, 3 cases needed laparotomy and surgical treatment (False negative results. Conclusion : According to the results of this study, sensitivity of peritoneal lavage test in diagnosis of abdominal trauma was 95.5% and specificity was 90%. Negative predictive value of this test was 95.4% and positive predictive value of this test was 90%. Thus, peritoneal lavage test in abdominal trauma is sensitive, specific and has high specificity. It is therefore advisable that after initial evaluation of all penetrating and blunt abdominal traumas, peritoneal lavage test should be performed.

Does intra-abdominal fluid increase the resting energy expenditure?

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Zarling, E J; Grande, A; Hano, J

1997-10-01

In patients with intra-abdominal fluid collection, caloric needs are based on an estimated dry weight. This is done because intra-abdominal fluid has been assumed to be metabolically inactive. One recent study of patients with slowly resolving ascites suggested otherwise. In our study, the effect of intra-abdominal fluid on the resting energy expenditure (REE) and apparent lean body mass was determined in 10 stable patients requiring peritoneal dialysis. For each subject, in both the empty and full state, we measured REE by indirect calorimetry, and body composition by the bioelectric impedance method. In the full state, the VCO2 was significantly increased (210 +/- 11 versus 197 +/- 9 mL/min, P empty state. This caused an increase in the calculated resting energy expenditure (1531 +/- 88 kcal/d empty versus 1593 +/- 94 kcal/d full, P calories derived from glucose absorbed out of the dialysate. Estimates of body fat, lean body mass, and total water also were not affected by the intra-abdominal fluid. We conclude that intra-abdominal fluid will not affect the measured REE and hence may be considered to be metabolically inactive.

Experience with Extra Hepatic Intra Abdominal Hydatid Cyst

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Altaf Ahmed Talpur

2016-10-01

showed hydatid cyst spleen in 02 (18.1% patients, epigastrium in 04 (36.3% patients, beneath left crus of diaphragm in 02 (18.1% patients & right iliac fossa & pelvis in 1 (9.09% patient. In 02 (18.1% patients multiple Hydatid cysts were noted. Hydatid cysts liver found in 07 (63.6% patients. C.T scan Abdomen was performed in 09 (81.8% patients. Surgical procedures performed include Saucerization & omental packing in liver Hydatid cysts; Splenectomy for Splenic disease & complete excision of remaining intra-abdominal Hydatid cysts. Postoperative complications noted in 05 (45.4% patients. Conclusion: Extra hepatic intra abdominal is an infrequent disease presents signicant diagnostic & therapeutic challenge for surgeons.  Keywords: extra hepatic; hydatid disease; intra abdominal.

The value of intra-abdominal pressure monitoring through ...

African Journals Online (AJOL)

hypertension after abdominal closure (8%) and only one of ... Ann Pediatr. Surg 13:69–73 c 2017 Annals of Pediatric Surgery. Annals of ... intra-abdominal hypertension ..... measurements as a guide in the closure of abdominal wall defects.

Fatal intra-abdominal hemorrhage as a result of avulsion of the gallbladder: a postmortem case report

International Nuclear Information System (INIS)

Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Saito, Haruo; Igari, Yui; Funayama, Masato

2013-01-01

Gallbladder injuries are extremely rare in blunt trauma, with a reported incidence of <2%. We report an autopsy case of fatal hemorrhagic shock due to intra-abdominal bleeding resulting from complete avulsion of the gallbladder associated with liver cirrhosis. Multiplanar images derived from multislice computed tomography (MSCT) performed as part of pre-autopsy screening showed complete avulsion of the gallbladder without any other associated intra-abdominal injuries, facilitating forensic autopsy planning. In this report, we discuss the role of MSCT in cases of fatal intra-abdominal bleeding caused by avulsion of the gallbladder and discuss the mechanism of this injury

When and how should we measure intra- abdominal pressure?

African Journals Online (AJOL)

2008-11-11

Nov 11, 2008 ... developing intra-abdominal hypertension (IAH) and. ACS. This may be ... the development of systemic inflammatory response syndrome (SIRS) ... of this technique are that it places the patient at increased risk for .... 9. Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a.

Orchiopexy for intra-abdominal testes: factors predicting success.

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Stec, Andrew A; Tanaka, Stacy T; Adams, Mark C; Pope, John C; Thomas, John C; Brock, John W

2009-10-01

Intra-abdominal testes can be treated with several surgical procedures. We evaluated factors influencing the outcome of orchiopexy for intra-abdominal testis. We retrospectively reviewed 156 consecutive orchiopexies performed for intra-abdominal testis, defined as a nonpalpable testis on examination and located in the abdomen at surgery. All surgical approaches were included in the study. Primary outcome was the overall success rate and secondary outcomes were success based on surgical approach, age and a patent processus vaginalis. Success was considered a testis with normal texture and size compared to the contralateral testis at followup. Multivariate analysis was performed to determine factors predictive of success. The overall success rate of all orchiopexies was 79.5%. Median patient age at orchiopexy was 12 months and mean followup was 16 months. Of the patients 117 had a patent processus vaginalis at surgery. One-stage abdominal orchiopexy was performed in 92 testes with 89.1% success. Of these cases 32 were performed laparoscopically with 96.9% success. One-stage Fowler-Stephens orchiopexy was performed in 27 testes and 2-stage Fowler-Stephens orchiopexy was performed in 37 with success in 63.0% and 67.6%, respectively. Multivariate analysis revealed that 1-stage orchiopexy without vessel division had more successful outcomes than 1 and 2-stage Fowler-Stephens orchiopexy (OR 0.24, p = 0.007 and 0.29, p = 0.19, respectively). Neither age at surgery nor an open internal ring was significant (p = 0.49 and 0.12, respectively). The overall success of orchiopexy for intra-abdominal testis is 79.5%. While patient selection remains a critical factor, 1-stage orchiopexy without vessel division was significantly more successful and a laparoscopic approach was associated with the fewest failures for intra-abdominal testes.

Intra-abdominal fungal pseudomycetoma in two cats.

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Bianchi, Matheus V; Laisse, Cláudio J M; Vargas, Thainã P; Wouters, Flademir; Boabaid, Fabiana M; Pavarini, Saulo P; Ferreiro, Laerte; Driemeier, David

Pseudomycetomas are deep cutaneous to subcutaneous lesions caused by Microsporum canis mainly described in Persian cats, with few reports of intra-abdominal location. This report describes the clinical signs and lesions of intra-abdominal pseudomycetomas caused by M. canis in two Persian cats. Two Persian cats with a history of previous laparotomy (ovariohysterectomy and nephrostomy) and fecal impaction were examined. Cat #1 was euthanized and subjected to necropsy, histopathology and mycological evaluation. Cat #2 presented with chronic dermatophytosis, and an intra-abdominal mass, that was subjected to histopathology evaluation. Cat #1 presented at necropsy a white-grayish, firm mass (6cm×3.5cm×2.8cm) in the uterine cervix. Cat #2 presented a firm whitish mass (6.5cm×1.5cm×0.5cm) located close to the left kidney. Histologically, both masses contained multifocal granules with hyphae and spores surrounded by Splendore-Hoeppli reaction, with a pyogranulomatous inflammatory infiltrate and fibrous connective tissue proliferation in the periphery. Hyphae and spores exhibited marked Grocott and periodic acid-Schiff staining. M. canis was identified by fungal isolation in cat #1. Pseudomycetoma should be considered as a differential diagnosis in cats, especially in Persian cats presenting with an intra-abdominal mass. Entrance of the agent into the cavity can occur during laparotomy. Copyright © 2016 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

Morphology-Independent Virulence of Candida Species during Polymicrobial Intra-abdominal Infections with Staphylococcus aureus.

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Nash, Evelyn E; Peters, Brian M; Fidel, Paul L; Noverr, Mairi C

2016-01-01

Intra-abdominal polymicrobial infections cause significant morbidity and mortality. An experimental mouse model of Candida albicans-Staphylococcus aureus intra-abdominal infection (IAI) results in 100% mortality by 48 to 72 h postinoculation, while monomicrobial infections are avirulent. Mortality is associated with robust local and systemic inflammation without a requirement for C. albicans morphogenesis. However, the contribution of virulence factors coregulated during the yeast-to-hypha transition is unknown. This also raised the question of whether other Candida species that are unable to form hyphae are as virulent as C. albicans during polymicrobial IAI. Therefore, the purpose of this study was to evaluate the ability of non-albicans Candida (NAC) species with various morphologies and C. albicans transcription factor mutants (efg1/efg1 and cph1/cph1) to induce synergistic mortality and the accompanying inflammation. Results showed that S. aureus coinoculated with C. krusei or C. tropicalis was highly lethal, similar to C. albicans, while S. aureus-C. dubliniensis, S. aureus-C. parapsilosis, and S. aureus-C. glabrata coinoculations resulted in little to no mortality. Local and systemic interleukin-6 (IL-6) and prostaglandin E2 (PGE2) levels were significantly elevated during symptomatic and/or lethal coinfections, and hypothermia strongly correlated with mortality. Coinoculation with C. albicans strains deficient in the transcription factor Efg1 but not Cph1 reversed the lethal outcome. These results support previous findings and demonstrate that select Candida species, without reference to any morphological requirement, induce synergistic mortality, with IL-6 and PGE2 acting as key inflammatory factors. Mechanistically, signaling pathways controlled by Efg1 are critical for the ability of C. albicans to induce mortality from an intra-abdominal polymicrobial infection. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Diagnosis of intra-abdominal infections and management of catastrophic outcomes

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Atema, J.J.

2015-01-01

Intra-abdominal infections are a diverse group of frequently encountered conditions of varying severity with various underlying pathologies. The first part of this thesis focused on the diagnostic work-up of suspected intra-abdominal infections. The diagnosticvalue of commonly used inflammatory

Complicated Intra-Abdominal Infections Observational European study (CIAO Study

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Sartelli Massimo

2011-12-01

Full Text Available Abstract Complicated intra-abdominal infections are frequently associated with poor prognoses and high morbidity and mortality rates. Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. In order to describe the clinical, microbiological, and management-related profiles of both community-acquired and healthcare-acquired complicated intra-abdominal infections (IAIs, the World Society of Emergency Surgery (WSES, in collaboration with the Surgical Infections Society of Europe (SIS-E and other prominent European surgical societies, has designed the CIAO study. The CIAO study is a multicenter, observational study and will be carried out in various surgical departments throughout Europe. The study will include patients undergoing surgery or interventional drainage for complicated IAI.

Diagnosis of intra abdominal inflammatory processes with 111In-labelled leucocytes

International Nuclear Information System (INIS)

Roevekamp, M.H.; Brummelkamp, W.H.; Schoot, J.B. van der; Reinders Folmer, S.Chr.C.; Royen, E.A. van

1982-01-01

Over a two and a half year period, 225 scintigrams with indium-111 oxinate labelled leukocytes were performed in 184 patients suspected of an intra-abdominal, retroperitoneal or pelvic inflammatory process. In patients suspected of an upper abdominal process, an indium-111 leukocyte-99Tc-Sn colloid subtraction was performed, in order to eliminate the normal liver and spleen uptake. 123 Scintigrams were considered true positive and 73 true negative. A diagnostic accuracy of 87% was calculated. With 18 false-positive scans an 80%-specificity and with 11 false-negative a 92%-sensitivity were obtained. False-positive results in the majority of the scintigrams were based on leukocyte accumulations, due to aspecific cellular inflammatory reactions. False-negative results were mainly related to intra-hepatic, intra-splenic or older lesions. In 150 patients, ultrasonography and/or computed tomography was also performed. A higher diagnostic accuracy was observed with leukocyte scintigraphy compared to ultrasonography. (Auth.)

Effect of exercise training on in vivo lipolysis in intra-abdominal adipose tissue in rats

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Enevoldsen, L H; Stallknecht, B; Fluckey, J D

2000-01-01

Intra-abdominal obesity is associated with cardiovascular disease and non-insulin-dependent diabetes mellitus, and physical training has been suggested to alleviate these conditions. We compared epinephrine-stimulated lipolysis in vivo in three intra-abdominal adipose tissues (ATs: retroperitonea...... be beneficial in alleviating intra-abdominal obesity by enhancing lipolysis in intra-abdominal fat depots.......Intra-abdominal obesity is associated with cardiovascular disease and non-insulin-dependent diabetes mellitus, and physical training has been suggested to alleviate these conditions. We compared epinephrine-stimulated lipolysis in vivo in three intra-abdominal adipose tissues (ATs: retroperitoneal......: 73 +/- 12 (trained) vs. 14 +/- 4 (sedentary) ml. 100 g(-1). min(-1), P abdominal than in subcutaneous AT in both trained...

Intra-abdominal fat: Comparison of computed tomography fat segmentation and bioimpedance spectroscopy.

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Finch, Peter

2017-06-01

Intra-abdominal fat is an important factor in determining the metabolic syndrome/insulin resistance, and thus the risk of diabetes and ischaemic heart disease. Computed Tomography (CT) fat segmentation represents a defined method of quantifying intra-abdominal fat, with attendant radiation risks. Bioimpedance spectroscopy may offer a method of assessment without any risks to the patients. A comparison is made of these two methods. This was a preliminary study of the utility of multifrequency bioimpedance spectroscopy of the mid abdomen as a measure of intra-abdominal fat, by comparison with fat segmentation of an abdominal CT scan in the -30 to -190 HU range. There was a significant (P abdominal fat and mid-upper arm circumference, as well as the bioimpedance parameter, the R/S ratio. Multivariate analysis showed that these were the only independant variables and allowed the derivation of a formula to estimate intra-abdominal fat: IAF = 0.02 × MAC - 0.757 × R/S + 0.036. Circumabdominal bioimpedance spectroscopy may prove a useful method of assessing intra-abdominal fat, and may be suitable for use in studies to enhance other measures of body composition, such as mid-upper arm circumference.

A case study in intra-abdominal sepsis.

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Paul, Jasmeet S; Ridolfi, Timothy J

2012-12-01

Intra-abdominal infections are a common problem for the general surgeon and major sources of morbidity and mortality in the intensive care unit. Some of these patients present with peritonitis that can rapidly progress to septic shock. The basic principles of care include prompt resuscitation, antibiotics, and source control. This article will use a detailed case study to outline the management of a patient with severe intra-abdominal infection from diverticulitis from initial resuscitation to reconstruction. Components of the Surviving Sepsis Campaign as they pertain to surgical patients are discussed and updated, and the concept of damage control general surgery is applied. Copyright © 2012. Published by Elsevier Inc.

Predictors of "occult" intra-abdominal injuries in blunt trauma patients

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José Gustavo Parreira

Full Text Available Objective: to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. Methods: We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries or Group 2 (without intra-abdominal injuries. Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting p<0.05 as significant. Subsequently, the variables with p<0.20 on bivariate analysis were selected to create a logistic regression model using the forward stepwise method. Results: A total of 268 cases met the inclusion criteria. Patients in Group I were characterized as having significantly (p<0.05 lower mean AIS score for the head segment (1.0±1.4 vs. 1.8±1.9, as well as higher mean AIS thorax score (1.6±1.7 vs. 0.9±1.5 and ISS (25.7±14.5 vs. 17,1±13,1. The rate of abdominal injuries was significantly higher in run-over pedestrians (37.3% and in motorcyclists (36.0% (p<0.001. The resultant logistic regression model provided 73.5% accuracy for identifying abdominal injuries. The variables included were: motorcyclist accident as trauma mechanism (p<0.001 - OR 5.51; 95%CI 2.40-12.64, presence of rib fractures (p<0.003 - OR 3.00; 95%CI 1.47-6.14, run-over pedestrian as trauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22 and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85. Conclusion Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

Acute intestinal distress syndrome: the importance of intra-abdominal pressure.

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Malbrain, M L N G; Vidts, W; Ravyts, M; De Laet, I; De Waele, J

2008-11-01

This review article will focus primarily on the recent literature on abdominal compartment syndrome (ACS) as well as the definitions and recommendations published by the World Society for the Abdominal Compartment Syndrome (WSACS, www.wsacs.org). The risk factors for intra-abdominal hypertension (IAH) and the definitions regarding increased intra-abdominal pressure (IAP) will be listed, followed by a brief but comprehensive overview of the different mechanisms of end-organ dysfunction associated with IAH. Measurement techniques for IAP will be discussed, as well as recommendations for organ function support in patients with IAH. Finally, noninvasive medical management options for IAH, surgical treatment for ACS and management of the open abdomen will be briefly discussed.

Nodular intra-abdominal panniculitis: an accompaniment of colorectal carcinoma and diverticular disease

DEFF Research Database (Denmark)

Bak, Martin

1996-01-01

should not be regarded as a specific nosological entity but merely a result of injury to the fat cells. Intra-abdominal panniculitis is seen more often as a secondary local phenomenon than as a primary condition, and in both cases it is associated with considerable differential diagnostic problems......Intra-abdominal panniculitis is a tumour-like inflammatory condition of adipose tissue. The aetiology and pathogenesis of the disease is unknown, but a number of associated diseases have been recorded. It has been customary to deal with only primary cases in the literature. This study...... was undertaken in order to describe the entire spectrum of the disease including primary as well as secondary cases. Eleven patients are reported, nine of which had an associated colorectal disease in direct continuity with areas of intra-abdominal panniculitis. It is concluded that intra-abdominal panniculitis...

The Increase of Intra-Abdominal Pressure Can Affect Intraocular Pressure

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Ilhan Ece

2015-01-01

Full Text Available Objective. This study aims to explore the usage of intraocular pressure measurements as the early indicator of the increase in intra-abdominal pressure. Methods. In this prospective study, 40 patients undergoing elective surgery were included. Patients were divided into four groups of 10 patients. The control group (Group C was not subjected to laparoscopic intervention. Laparoscopic surgery was, respectively, performed with an intra-abdominal pressure of 9, 12, and 15 mmHg in Groups L (low, M (medium, and H (high pressure. Intraocular pressure was measured binocularly in each patient at three different times (before, during, and end of surgery using a contact tonometer. Results. Patients’ gender, age, body mass index (BMI, American Society of Anesthesiology (ASA class, and operative times were not different among the groups. No complications occurred with either the surgery or measurement of intraocular pressure. Intubation was associated with a severe rise in IOP (P<0.05. An increase in intraocular pressure was seen in groups M and H (P<0.05. Conclusion. Intraocular pressure was increased in the groups with an intra-abdominal pressure of 12 mmHg or more. Measuring the intraocular pressure might be a useful method to estimate the intra-abdominal pressure. This trial is registered with NCT02319213.

Effect of intra-abdominal volume increment technique for the treatment of intra-abdominal hypertension on the liver after resuscitation of hemorrhagic shock in pig

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Zheng-gang WANG

2012-02-01

Full Text Available Objective  To observe the effect of vacuum sealing drainage (VSD assisted intra-abdominal volume increment (IAVI technique on the liver in the treatment of intra-abdominal hypertension (IAH following hemorrhagic shock resuscitation in pigs. Methods  Twelve healthy mini-pigs (Bama, Guangxi were selected for bloodletting from the femoral artery to reproduce hemorrhagic shock model (mean arterial blood pressure, 50mmHg, 1h, and IAH model was successfully reproduced in eight pigs by partial occlusion of portal vein. The eight pigs were randomly divided into the intra-abdominal volume increment treatment (IT group (n=4 and sham operation control (SC group (n=4. Vesical pressure (VP and inferior vena cava pressure (IVCP were observed before shock, 2h after IAH, and 22h after IAVI treatment. Aspartate aminotransferase (AST and alanine aminotransferase (ALT were measured. In addition, the ratio of the abdominal anteroposterior diameter to the transverse diameter was assessed, and the liver CT values were measured after enhanced CT scanning. The pigs were sacrificed 26h after operation. Liver specimens were collected to measure the ratio of wet weight to dry weight and pathological examination. Results  The VP in 8 IAH pigs was 21.16±4.63mmHg. The ratio of abdominal anteroposterior diameter to the transverse diameter increased remarkably 2h after IAH compared with that before shock (1.22±1.41 vs 0.96±0.08, PPvs 42.73±4.92HU, PPPvs 5.14±0.71, PConclusions  The established model could better reproduce the symptoms of IAH after hemorrhagic shock and fluid resuscitation, accompanied by liver damage. IAVI helps to relieve liver functional disturbance after IAH, which is related to decreased intra-abdominal pressure and hypoxia-ischemia of the liver.

Intra-abdominal fat accumulation is a hypertension risk factor in young adulthood: A cross-sectional study.

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Takeoka, Atsushi; Tayama, Jun; Yamasaki, Hironori; Kobayashi, Masakazu; Ogawa, Sayaka; Saigo, Tatsuo; Kawano, Hiroaki; Abiru, Norio; Hayashida, Masaki; Maeda, Takahiro; Shirabe, Susumu

2016-11-01

Accumulation of intra-abdominal fat is related to hypertension. Despite this, a relationship between hypertension and intra-abdominal fat in young adulthood is not clear. In this study, we verify whether intra-abdominal fat accumulation increases a hypertension risk in young adult subjects.In a cross-sectional study, intra-abdominal fat area was measured using a dual bioelectrical impedance analysis instrument in 697 university students (20.3 ± 0.7 years, 425 men). Blood pressure and anthropometric factors were measured. Lifestyle variables including smoking, drinking, physical activity, and eating behavior were assessed with questionnaire. High blood pressure risk (systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥85 mm Hg) with increasing intra-abdominal fat area was evaluated.Participants were divided into 5 groups according to their intra-abdominal fat area (≤24.9, 25-49.9, 50-74.9, 75-99.9, and ≥100 cm). As compared with the values of the smallest intra-abdominal fat area group, the crude and lifestyle-adjusted odds ratios (ORs) were elevated in larger intra-abdominal fat area groups [OR 1.31, 95% confidence interval (CI) 0.66-2.80; OR 3.38, 95% CI 1.60-7.57; OR 7.71, 95% CI 2.75-22.22; OR 18.74, 95% CI 3.93-105.64, respectively). The risk increase was observed only in men.Intra-abdominal fat accumulation is related to high blood pressure in men around 20 years of age. These results indicate the importance of evaluation and reduction of intra-abdominal fat to prevent hypertension.

An unusual case of intra-abdominal testicular torsion: Role of laparoscopy

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Alfonso Papparella

2013-01-01

Full Text Available The authors report a case of intra-abdominal testicular torsion, where laparoscopy has been useful for diagnosis and surgical management. A boy was presented with a left impalpable testis. Laparoscopy revealed a twisted spermatic cord at the inlet pelvis, which ended in a testicular remnant located in the sub-umbilical area. After orchiectomy, the pathologist confirmed testicular atrophy. Diagnosis of intra-abdominal testicular torsion should be considered in patients with impalpable testis and abdominal pain, but could not be excluded in those with no symptoms.

Intra-abdominal cryptococcosis in two dogs.

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Malik, R; Hunt, G B; Bellenger, C R; Allan, G S; Martin, P; Canfield, P J; Love, D N

1999-08-01

Intra-abdominal cryptococcosis was diagnosed in two young dogs. The first, an entire male border collie, was presented with vomiting. An abdominal mass detected during physical examination proved to be cryptococcal mesenteric lymphadenitis on exploratory laparotomy. The second dog, a female neutered giant schnauzer, was presented with neurological signs suggestive of encephalopathy. Intestinal cryptococcal granulomas were detected in an extensive diagnostic investigation which included abdominal ultrasonography. The gastrointestinal tract was considered the most likely portal of entry for cryptococcal organisms in both cases. Both dogs were treated using surgery and multiagent antifungal chemotherapy. The first case succumbed despite therapy, while the second dog was treated successfully as gauged by return to clinical normality and a substantial decline in the cryptococcal antigen titre which continued to fall after cessation of treatment.

Increased pressure within the abdominal compartment: intra-abdominal hypertension and the abdominal compartment syndrome.

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Roberts, Derek J; Ball, Chad G; Kirkpatrick, Andrew W

2016-04-01

This article reviews recent developments related to intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) and clinical practice guidelines published in 2013. IAH/ACS often develops because of the acute intestinal distress syndrome. Although the incidence of postinjury ACS is decreasing, IAH remains common and associated with significant morbidity and mortality among critically ill/injured patients. Many risk factors for IAH include those findings suggested to be indications for use of damage control surgery in trauma patients. Medical management strategies for IAH/ACS include sedation/analgesia, neuromuscular blocking and prokinetic agents, enteral decompression tubes, interventions that decrease fluid balance, and percutaneous catheter drainage. IAH/ACS may be prevented in patients undergoing laparotomy by leaving the abdomen open where appropriate. If ACS cannot be prevented with medical or surgical management strategies or treated with percutaneous catheter drainage, guidelines recommend urgent decompressive laparotomy. Use of negative pressure peritoneal therapy for temporary closure of the open abdomen may improve the systemic inflammatory response and patient-important outcomes. In the last 15 years, investigators have better clarified the pathogenesis, epidemiology, diagnosis, and appropriate prevention of IAH/ACS. Subsequent study should be aimed at understanding which treatments effectively lower intra-abdominal pressure and whether these treatments ultimately affect patient-important outcomes.

Immune Protection against Lethal Fungal-Bacterial Intra-Abdominal Infections.

Science.gov (United States)

Lilly, Elizabeth A; Ikeh, Melanie; Nash, Evelyn E; Fidel, Paul L; Noverr, Mairi C

2018-01-16

Polymicrobial intra-abdominal infections (IAIs) are clinically prevalent and cause significant morbidity and mortality, especially those involving fungi. Our laboratory developed a mouse model of IAI and demonstrated that intraperitoneal inoculation with Candida albicans or other virulent non- albicans Candida (NAC) species plus Staphylococcus aureus resulted in 70 to 80% mortality in 48 to 72 h due to robust local and systemic inflammation (sepsis). Surprisingly, inoculation with Candida dubliniensis or Candida glabrata with S. aureus resulted in minimal mortality, and rechallenge of these mice with lethal C. albicans / S. aureus (i.e., coninfection) resulted in >90% protection. The purpose of this study was to define requirements for C. dubliniensis / S. aureus -mediated protection and interrogate the mechanism of the protective response. Protection was conferred by C. dubliniensis alone or by killed C. dubliniensis plus live S. aureus S. aureus alone was not protective, and killed S. aureus compromised C. dubliniensis -induced protection. C. dubliniensis / S. aureus also protected against lethal challenge by NAC plus S. aureus and could protect for a long-term duration (60 days between primary challenge and C. albicans/S. aureus rechallenge). Unexpectedly, mice deficient in T and B cells (Rag-1 knockouts [KO]) survived both the initial C. dubliniensis/S. aureus challenge and the C. albicans/S. aureus rechallenge, indicating that adaptive immunity did not play a role. Similarly, mice depleted of macrophages prior to rechallenge were also protected. In contrast, protection was associated with high numbers of Gr-1 hi polymorphonuclear leukocytes (PMNLs) in peritoneal lavage fluid within 4 h of rechallenge, and in vivo depletion of Gr-1 + cells prior to rechallenge abrogated protection. These results suggest that Candida species can induce protection against a lethal C. albicans / S. aureus IAI that is mediated by PMNLs and postulated to be a unique form of

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

NARCIS (Netherlands)

Sartelli, M.; Chichom-Mefire, A.; Labricciosa, F.M.; Hardcastle, T.; Abu-Zidan, F.M.; Adesunkanmi, A.K.; Ansaloni, L.; Bala, M.; Balogh, Z.J.; Beltran, M.A.; Ben-Ishay, O.; Biffl, W.L.; Birindelli, A.; Cainzos, M.A.; Catalini, G.; Ceresoli, M.; Che Jusoh, A.; Chiara, O.; Coccolini, F.; Coimbra, R.; Cortese, F.; Demetrashvili, Z.; Saverio, S. Di; Diaz, J.J.; Egiev, V.N.; Ferrada, P.; Fraga, G.P.; Ghnnam, W.M.; Lee, J.G.; Gomes, C.A.; Hecker, A.; Herzog, T.; Kim, J.I.; Inaba, K.; Isik, A.; Karamarkovic, A.; Kashuk, J.; Khokha, V.; Kirkpatrick, A.W.; Kluger, Y.; Koike, K.; Kong, V.Y.; Leppaniemi, A.; Machain, G.M.; Maier, R.V.; Marwah, S.; McFarlane, M.E.; Montori, G.; Moore, E.E.; Negoi, I.; Olaoye, I.; Omari, A.H.; Ordonez, C.A.; Pereira, B.M.; Junior, G.A.; Pupelis, G.; Reis, T.; Sakakhushev, B.; Sato, N.; Segovia Lohse, H.A.; Shelat, V.G.; Soreide, K.; Uhl, W.; Ulrych, J.; Goor, H. van; Velmahos, G.C.; Yuan, K.C.; Wani, I.; Weber, D.G.; Zachariah, S.K.; Catena, F.

2017-01-01

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial

Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Association with Ruptured Abdominal Aortic Aneurysm in the Endovascular Era: Vigilance Remains Critical

Directory of Open Access Journals (Sweden)

Matthew C. Bozeman

2012-01-01

In this review, we describe published experience with IAH and ACS complicating abdominal vascular catastrophes, experience with ACS complicating endovascular repair of rAAAs, and techniques for management of the abdominal wound. Vigilance and appropriate management of IAH and ACS remains critically important in decreasing morbidity and optimizing survival following catastrophic intra-abdominal vascular events.

Change in Intra-Abdominal Fat Predicts the Risk of Hypertension in Japanese Americans.

Science.gov (United States)

Sullivan, Catherine A; Kahn, Steven E; Fujimoto, Wilfred Y; Hayashi, Tomoshige; Leonetti, Donna L; Boyko, Edward J

2015-07-01

In Japanese Americans, intra-abdominal fat area measured by computed tomography is positively associated with the prevalence and incidence of hypertension. Evidence in other populations suggests that other fat areas may be protective. We sought to determine whether a change in specific fat depots predicts the development of hypertension. We prospectively followed up 286 subjects (mean age, 49.5 years; 50.4% men) from the Japanese American Community Diabetes Study for 10 years. At baseline, subjects did not have hypertension (defined as blood pressure ≥140/90 mm Hg) and were not taking blood pressure or glucose-lowering medications. Mid-thigh subcutaneous fat area, abdominal subcutaneous fat area, and intra-abdominal fat area were directly measured by computed tomography at baseline and 5 years. Logistic regression was used to estimate odds of incident hypertension over 10 years in relation to a 5-year change in fat area. The relative odds of developing hypertension for a 5-year increase in intra-abdominal fat was 1.74 (95% confidence interval, 1.28-2.37), after adjusting for age, sex, body mass index, baseline intra-abdominal fat, alcohol use, smoking status, and weekly exercise energy expenditure. This relationship remained significant when adjusted for baseline fasting insulin and 2-hour glucose levels or for diabetes mellitus and pre-diabetes mellitus classification. There were no significant associations between baseline and change in thigh or abdominal subcutaneous fat areas and incident hypertension. In conclusion, in this cohort of Japanese Americans, the risk of developing hypertension is related to the accumulation of intra-abdominal fat rather than the accrual of subcutaneous fat in either the thigh or the abdominal areas. © 2015 American Heart Association, Inc.

Original Research Intra-abdominal fat: Comparison of computed ...

African Journals Online (AJOL)

advantage for composition measurement of no radiation exposure ... Computed Tomography (CT) fat segmentation represents a defined method of quantifying intra-abdominal fat, with .... spiral CT scan with 3-mm slices covering the abdomen,.

A user's guide to intra-abdominal pressure measurement.

LENUS (Irish Health Repository)

Sugrue, Michael

2015-01-01

The intra-abdominal pressure (IAP) measurement is a key to diagnosing and managing critically ill medical and surgical patients. There are an increasing number of techniques that allow us to measure the IAP at the bedside. This paper reviews these techniques. IAP should be measured at end-expiration, with the patient in the supine position and ensuring that there is no abdominal muscle activity. The intravesicular IAP measurement is convenient and considered the gold standard. The level where the mid-axillary line crosses the iliac crest is the recommended zero reference for the transvesicular IAP measurement; moreover, marking this level on the patient increases reproducibility. Protocols for IAP measurement should be developed for each ICU based on the locally available tools and equipment. IAP measurement techniques are safe, reproducible and accurate and do not increase the risk of urinary tract infection. Continuous IAP measurement may offer benefits in specific situations in the future. In conclusion, the IAP measurement is a reliable and essential adjunct to the management of patients at risk of intra-abdominal hypertension.

WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

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Leppaniemi Ari

2011-01-01

Full Text Available Abstract Intra-abdominal infections are still associated with high rate of morbidity and mortality. A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care. A World Society of Emergency Surgery (WSES Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections. This document represents the executive summary of the final guidelines approved by the consensus conference.

Dynamics of albumin synthetic response to intra-abdominal abscess in patients with gastrointestinal fistula.

Science.gov (United States)

Zhou, Bo; Ren, Jianan; Han, Gang; Chen, Yu; A, Jiye; Gu, Guosheng; Chen, Jun; Wang, Gefei; Li, Jieshou

2014-04-01

Low serum albumin concentration is a predictor of failure of source control for intra-abdominal infection. However, data on dynamics of albumin synthesis in these patients and to what extent these changes contribute to hypoalbuminemia are relatively scarce. We investigated in a group of patients with gastrointestinal fistula the dynamic response of liver albumin synthesis to intra-abdominal abscess and how these related to hypoalbuminemia and circulating endocrine hormone profiles. Eight gastrointestinal fistula patients scheduled to undergo percutaneous abscess sump drainage were enrolled prospectively to measure albumin synthesis rates at different stages of the inflammatory response (immediately after diagnosis and 7 d following sump drainage when clinical signs of intra-abdominal sepsis had been eradicated). Eight age-, sex-, and body mass index-matched intestinal fistula patients were studied as control patients. Consecutive arterial blood samples were drawn during a primed-constant infusion (priming dose: 4 micromol·kg(-1), infusion rate: 6 micromol·kg(-1)·min(-1)) to determine the incorporation rate of L-[ring-(2)H5]-phenylalanine directly into plasma albumin using gas chromatography/mass spectrometry analysis. Patients suffering from intra-abdominal infection had reduced plasma albumin and total plasma protein concentrations, compared with control patients. Albumin fractional synthesis rates in patients with intra-abdominal abscess were decreased, compared with those in the control group. When the source of infection was removed, albumin synthesis rates returned to control values, whereas albumin concentrations did not differ significantly from the corresponding concentrations in control subjects and patients with intra-abdominal abscess. Despite nutritional intervention, albumin synthesis rate is decreased in intestinal fistula patients with intra-abdominal abscess; albumin synthesis returns to control values during convalescence.

Case Study: Intra-abdominal hypertension | Veldsman | South ...

African Journals Online (AJOL)

South African Journal of Clinical Nutrition. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 27, No 2 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Case Study: Intra-abdominal hypertension.

Intra-abdominal solid organ injuries: an enhanced management algorithm.

Science.gov (United States)

Kokabi, Nima; Shuaib, Waqas; Xing, Minzhi; Harmouche, Elie; Wilson, Kenneth; Johnson, Jamlik-Omari; Khosa, Faisal

2014-11-01

The organ injury scale grading system proposed by the American Association for the Surgery of Trauma provides guidelines for operative versus nonoperative management in solid organ injuries; however, major shortcomings of the American Association for the Surgery of Trauma injury scale may become apparent with low-grade injuries, in which conservative management may fail. Nonoperative management of common intra-abdominal solid organ injuries relies increasingly on computed tomographic findings and other clinical factors, including patient age, presence of concurrent injuries, and serial clinical assessments. Familiarity with characteristic imaging features is essential for the prompt diagnosis and appropriate treatment of blunt abdominal trauma. In this pictorial essay, the spectrum of the American Association for the Surgery of Trauma organ injury scale grading system is illustrated, and a multidisciplinary management algorithm for common intra-abdominal solid organ injuries is proposed. Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Effect of exercise training on in vivo insulin-stimulated glucose uptake in intra-abdominal adipose tissue in rats

DEFF Research Database (Denmark)

Enevoldsen, L H; Stallknecht, B; Fluckey, J D

2000-01-01

Intra-abdominal obesity may be crucial in the pathogenesis of the insulin-resistance syndrome, and training may alleviate this condition. We compared insulin-mediated glucose uptake in vivo in three intra-abdominal adipose tissues (ATs; retroperitoneal, parametrial, and mesenteric) and in subcuta......Intra-abdominal obesity may be crucial in the pathogenesis of the insulin-resistance syndrome, and training may alleviate this condition. We compared insulin-mediated glucose uptake in vivo in three intra-abdominal adipose tissues (ATs; retroperitoneal, parametrial, and mesenteric...

Intra-abdominal fat measurement by ultrasonography: association with anthropometry and metabolic syndrome in adolescents.

Science.gov (United States)

Novais, Rommel L R; Café, Ana Carolina C; Morais, Aisha A; Bila, Wendell C; Santos, Gilson D da S; Lopes, Carlos Alexandre de O; Belo, Vinícius S; Romano, Márcia Christina C; Lamounier, Joel A

2018-04-27

To associate intra-abdominal fat thickness measured by ultrasonography to the factors related to metabolic syndrome and to determine cutoff points of intra-abdominal fat measurement associated with a greater chance of metabolic syndrome in adolescents. This was a cross-sectional study, with 423 adolescents from public schools. Intra-abdominal fat was measured by ultrasonography. Anthropometric data were collected, and biochemical analyses were performed. Intra-abdominal fat was measured by ultrasonography, showing a statistically significant association with the diagnosis of metabolic syndrome (p=0.037), body mass index (p<0.001), elevated triglyceride levels (p=0.012), decreased plasma HDL levels (p=0.034), and increased systemic blood pressure values (p=0.023). Cutoff values of intra-abdominal fat thickness measurements were calculated by ultrasound to estimate the individuals most likely to develop metabolic syndrome. In the logistic regression models, the cutoff values that showed the highest association with metabolic syndrome in males were 4.50, 5.35, 5.46, 6.24, and 6.50cm for the ages of 14, 15, 16, 17, and 18/19 years, respectively. In the female gender, the cutoff values defined for the same age groups were 4.46, 4.55, 4.45, 4.90, and 6.46cm. In an overall analysis using the ROC curve, without gender and age stratification, the cut-off of 3.67cm showed good sensitivity, but low specificity. Ultrasonography is a useful method to estimate intra-abdominal adipose tissue in adolescents, which is associated with the main factors related to obesity and metabolic syndrome. Copyright © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

[Prediction of intra-abdominal hypertension risk in patients with acute colonic obstruction under epidural analgesia].

Science.gov (United States)

Stakanov, A V; Potseluev, E A; Musaeva, T S

2013-01-01

Purpose of the study was to identify prediction possibility of direct current potential level for intra-abdominal hypertension risk in patients with acute colonic obstruction under preoperative epidural analgesia. Prospective analysis of the preoperative period was carried out in 140 patients with acute colonic obstruction caused by colon cancer. Relations between preoperative level of permanent capacity and risk of intra-abdominal hypertension was identified Direct current potential level is an independent predictor of intra-abdominal hypertension. Diagnostic significance increases from first to fifth hour of preoperative period according to AUROC data from 0.821 to 0.905 and calibration 6.9 (p > 0.37) and 4.7 (p > 0.54) by Hosmer-Lemeshou criteria. The use of epidural analgesia in the complex intensive preoperative preparation is pathogenically justified. It reduces intra-abdominal hypertension in patients with acute colonic obstruction.

Low fitness is associated with abdominal adiposity and low-grade inflammation independent of BMI

DEFF Research Database (Denmark)

Wedell-Neergaard, Anne-Sophie; Eriksen, Louise; Grønbæk, Morten

2018-01-01

OBJECTIVE: Up to 30% of obese individuals are metabolically healthy. Metabolically healthy obese (MHO) individuals are characterized by having low abdominal adiposity, low inflammation level and low risk of developing metabolic comorbidity. In this study, we hypothesize that cardiorespiratory fit...... to be inversely associated with both abdominal adiposity and low-grade inflammation independent of BMI. These data suggest that, in spite of BMI, high fitness levels lead to a reduction in abdominal fat mass and low-grade inflammation.......OBJECTIVE: Up to 30% of obese individuals are metabolically healthy. Metabolically healthy obese (MHO) individuals are characterized by having low abdominal adiposity, low inflammation level and low risk of developing metabolic comorbidity. In this study, we hypothesize that cardiorespiratory...... fitness (fitness) is a determinant factor for the MHO individuals and aim to investigate the associations between fitness, abdominal adiposity and low-grade inflammation within different BMI categories. METHOD: Data from 10,976 individuals from the general population, DANHES 2007-2008, on waist...

Regression of sporadic intra-abdominal desmoid tumour following administration of non-steroidal anti-inflammatory drug

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Fujiwara Yoshinori

2008-02-01

Full Text Available Abstract Background Desmoid tumours or fibromatoses are rare entities characterized by the benign proliferation of fibroblasts, which can be life-threatening due to their locally aggressive properties. Surgery is widely accepted as the first line of treatment for extra-abdominal desmoids; however, it is not recommended for intra-abdominal desmoids because of the high-risk of recurrence and difficulties with the operation. Here, we report on a patient with sporadic intra-abdominal desmoid tumours, who showed partial response following the intake of non-steroidal anti-inflammatory drugs. Case presentation A 73-year-old man presented with swelling and pain of the right leg. Computed tomography showed an abnormal multilocular soft-tissue mass (95 × 70 mm in the right pelvis, which was revealed by biopsy to be a desmoid tumour. Immunohistochemical analysis showed that the tumour cells expressed vimentin, but not smooth-muscle actin, CD34, or desmin. Very few Ki-67-positive cells were found. Non-cytotoxic treatment with etodolac (200 mg/day was chosen because of the patient's age, lack of bowel obstruction, and the likelihood of prostate cancer. Two years after the commencement of non-steroidal anti-inflammatory drug administration, computed tomography showed a decrease in tumour size (63 × 49 mm, and the disappearance of intratumoural septa. Conclusion Our case report suggests that non-steroidal anti-inflammatory drug treatment should be taken into consideration for use as first-line treatment in patients with sporadic intra-abdominal desmoid tumours.

Regression of sporadic intra-abdominal desmoid tumour following administration of non-steroidal anti-inflammatory drug

Science.gov (United States)

Tanaka, Keita; Yoshikawa, Reigetsu; Yanagi, Hidenori; Gega, Makoto; Fujiwara, Yoshinori; Hashimoto-Tamaoki, Tomoko; Hirota, Syozo; Tsujimura, Tohru; Tomita, Naohiro

2008-01-01

Background Desmoid tumours or fibromatoses are rare entities characterized by the benign proliferation of fibroblasts, which can be life-threatening due to their locally aggressive properties. Surgery is widely accepted as the first line of treatment for extra-abdominal desmoids; however, it is not recommended for intra-abdominal desmoids because of the high-risk of recurrence and difficulties with the operation. Here, we report on a patient with sporadic intra-abdominal desmoid tumours, who showed partial response following the intake of non-steroidal anti-inflammatory drugs. Case presentation A 73-year-old man presented with swelling and pain of the right leg. Computed tomography showed an abnormal multilocular soft-tissue mass (95 × 70 mm) in the right pelvis, which was revealed by biopsy to be a desmoid tumour. Immunohistochemical analysis showed that the tumour cells expressed vimentin, but not smooth-muscle actin, CD34, or desmin. Very few Ki-67-positive cells were found. Non-cytotoxic treatment with etodolac (200 mg/day) was chosen because of the patient's age, lack of bowel obstruction, and the likelihood of prostate cancer. Two years after the commencement of non-steroidal anti-inflammatory drug administration, computed tomography showed a decrease in tumour size (63 × 49 mm), and the disappearance of intratumoural septa. Conclusion Our case report suggests that non-steroidal anti-inflammatory drug treatment should be taken into consideration for use as first-line treatment in patients with sporadic intra-abdominal desmoid tumours. PMID:18257933

Pylephlebitis: An Uncommon Complication of Intra-Abdominal Infection

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Salim R Surani

2011-05-01

Full Text Available We herein present a case of pylephlebitis, which is an infective suppurative thrombosis of the portal vein. Pylephlebitis is an uncommon complication of intra-abdominal infections and carries with it significant morbidity and mortality. [West J Emerg Med. 2011;12(4:575–576.

Intra-abdominal gout mimicking pelvic abscess

International Nuclear Information System (INIS)

Chen, Chia-Hui; Chen, Clement Kuen-Huang; Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang

2005-01-01

Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

Intra-abdominal gout mimicking pelvic abscess

Energy Technology Data Exchange (ETDEWEB)

Chen, Chia-Hui; Chen, Clement Kuen-Huang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan); National Yang-Ming University, School of Medicine, Taipei (Taiwan); Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan)

2005-04-01

Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

The Accuracy of Urinalysis in Predicting Intra-Abdominal Injury Following Blunt Traumas.

Science.gov (United States)

Sabzghabaei, Anita; Shojaee, Majid; Safari, Saeed; Hatamabadi, Hamid Reza; Shirvani, Reza

2016-01-01

In cases of blunt abdominal traumas, predicting the possible intra-abdominal injuries is still a challenge for the physicians involved with these patients. Therefore, this study was designed, to evaluate the accuracy of urinalysis in predicting intra-abdominal injuries. Patients aged 15 to 65 years with blunt abdominal trauma who were admitted to emergency departments were enrolled. Abdominopelvic computed tomography (CT) scan with intravenous contrast and urinalysis were requested for all the included patients. Demographic data, trauma mechanism, the results of urinalysis, and the results of abdominopelvic CT scan were gathered. Finally, the correlation between the results of abdominopelvic CT scan, and urinalysis was determined. Urinalysis was considered positive in case of at least one positive value in gross appearance, blood in dipstick, or red blood cell count. 325 patients with blunt abdominal trauma were admitted to the emergency departments (83% male with the mean age of 32.63±17.48 years). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of urinalysis, were 77.9% (95% CI: 69.6-84.4), 58.5% (95% CI: 51.2-65.5), 56% (95% CI: 48.5-63.3), 79.6% (95% CI: 71.8-85.7), 1.27% (95% CI: 1.30-1.57), and 0.25% (95% CI: 0.18-0.36), respectively. The diagnostic value of urinalysis in prediction of blunt traumatic intra-abdominal injuries is low and it seems that it should be considered as an adjuvant diagnostic tool, in conjunction with other sources such as clinical findings and imaging.

The comparative study of CT guided and ultrasound guided percutaneous ethanol injection in the treatment of intra-abdominal cyst

International Nuclear Information System (INIS)

Li Heping; Yang Jianyong; Chen Wei; Zhuang Wenquan; Huang Yulian; Chen Jianye

2005-01-01

Objective: An comparative study of the interventional approach of CT guided and ultiasound guided percutaneous ethanol injection(PEI) in the treatment of intra-abdominal cyst. Methods: CT guided PEI was performed in the treatment of intra-abdominal cyst in 38 patients while ultrasound guided PEI was performed in 45 cases. Results: The puncture procedure of CT guided PEI was totally performed 83 times in treating 56 intra-abdominal cysts in 38 patients and CT guided PEI was unsuccessful in 6 patients. The puncture procedure of ultrasound guided PEI were performed 87 times in treating 71 intra-abdominal cysts in 55 patients and ultrasound guided PEI only failed only in 1 patient. Conclusion: Ultrasound guided PEI is superior to CT guided PEI in the treatment of intra-abdominal cyst. (authors)

The effect of increased intra-abdominal pressure on orbital subarachnoid space width and intraocular pressure.

Science.gov (United States)

Liu, Su-Meng; Wang, Ning-Li; Zuo, Zhen-Tao; Chen, Wei-Wei; Yang, Di-Ya; Li, Zhen; Cao, Yi-Wen

2018-02-01

In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can relieve glaucomatous optic neuropathy. Increased intracranial pressure can also reduce optic nerve damage in glaucoma patients, and a safe, effective and noninvasive way to achieve this is by increasing the intra-abdominal pressure. The purpose of this study was to observe the changes in orbital subarachnoid space width and intraocular pressure at elevated intra-abdominal pressure. An inflatable abdominal belt was tied to each of 15 healthy volunteers, aged 22-30 years (12 females and 3 males), at the navel level, without applying pressure to the abdomen, before they laid in the magnetic resonance imaging machine. The baseline orbital subarachnoid space width around the optic nerve was measured by magnetic resonance imaging at 1, 3, 9, and 15 mm behind the globe. The abdominal belt was inflated to increase the pressure to 40 mmHg (1 mmHg = 0.133 kPa), then the orbital subarachnoid space width was measured every 10 minutes for 2 hours. After removal of the pressure, the measurement was repeated 10 and 20 minutes later. In a separate trial, the intraocular pressure was measured for all the subjects at the same time points, before, during and after elevated intra-abdominal pressure. Results showed that the baseline mean orbital subarachnoid space width was 0.88 ± 0.1 mm (range: 0.77-1.05 mm), 0.77 ± 0.11 mm (range: 0.60-0.94 mm), 0.70 ± 0.08 mm (range: 0.62-0.80 mm), and 0.68 ± 0.08 mm (range: 0.57-0.77 mm) at 1, 3, 9, and 15 mm behind the globe, respectively. During the elevated intra-abdominal pressure, the orbital subarachnoid space width increased from the baseline and dilation of the optic nerve sheath was significant at 1, 3 and 9 mm behind the globe. After decompression of the abdominal pressure, the orbital subarachnoid space width normalized and returned to the baseline value. There was no significant difference in the

Successful Management of Perforated Duodenal Diverticulitis With Intra-abdominal Drainage and Feeding Jejunostomy: A Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Chin-Fan Chen

2008-08-01

Full Text Available We report the clinical experience of one patient with perforated duodenal diverticulitis who was successfully treated by intra-abdominal drainage and feeding jejunostomy. A 53-year-old male patient visited our hospital due to acute onset of abdominal pain and distension. Physical examination revealed tenderness over the epigastric area and right-lower quadrant of the abdomen without obvious rebound tenderness or muscle guarding. Duodenal diverticulitis with a retroperitoneal abscess was identified by abdominal computed tomography scan. Surgical intervention was performed after the failure of conservative treatment. The operative findings were compatible with perforated duodenal diverticulitis, and intra-abdominal drainage of retroperitoneal abscess with simultaneous feeding jejunostomy was undertaken. The patient was doing well at the 4-month postoperative follow-up visit. We suggest the use of a conservative operative method, as opposed to conventional diverticulectomy and duodenorrhaphy, as an alternative approach for the management of this disorder, especially when conservative treatment has failed.

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

OpenAIRE

Sartelli, Massimo; Chichom-Mefire, Alain; Labricciosa, Francesco M.; Hardcastle, Timothy; Abu-Zidan, Fikri M.; Adesunkanmi, Abdulrashid K.; Ansaloni, Luca; Bala, Miklosh; Balogh, Zsolt J.; Beltr?n, Marcelo A.; Ben-Ishay, Offir; Biffl, Walter L.; Birindelli, Arianna; Cainzos, Miguel A.; Catalini, Gianbattista

2017-01-01

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelin...

The Accuracy of Urinalysis in Predicting Intra-Abdominal Injury Following Blunt Traumas

Directory of Open Access Journals (Sweden)

Anita Sabzghabaei

2016-01-01

Full Text Available Introduction: In cases of blunt abdominal traumas, predicting the possible intra-abdominal injuries is still a challenge for the physicians involved with these patients. Therefore, this study was designed, to evaluate the accuracy of urinalysis in predicting intra-abdominal injuries. Methods: Patients aged 15 to 65 years with blunt abdominal trauma who were admitted to emergency departments were enrolled. Abdominopelvic computed tomography (CT scan with intravenous contrast and urinalysis were requested for all the included patients. Demographic data, trauma mechanism, the results of urinalysis, and the results of abdominopelvic CT scan were gathered. Finally, the correlation between the results of abdominopelvic CT scan, and urinalysis was determined. Urinalysis was considered positive in case of at least one positive value in gross appearance, blood in dipstick, or red blood cell count. Results: 325 patients with blunt abdominal trauma were admitted to the emergency departments (83% male with the mean age of 32.63±17.48 years. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of urinalysis, were 77.9% (95% CI: 69.6-84.4, 58.5% (95% CI: 51.2-65.5, 56% (95% CI: 48.5-63.3, 79.6% (95% CI: 71.8-85.7, 1.27% (95% CI: 1.30-1.57, and 0.25% (95% CI: 0.18-0.36, respectively. Conclusion: The diagnostic value of urinalysis in prediction of blunt traumatic intra-abdominal injuries is low and it seems that it should be considered as an adjuvant diagnostic tool, in conjunction with other sources such as clinical findings and imaging.

Clinics in diagnostic imaging (133). Retained placenta from an intra-abdominal pregnancy.

Science.gov (United States)

Win, T; Tang, P H; Lim, T Y

2011-01-01

A 29-year-old Indonesian woman presented with abdominal pain seven months after an intra-abdominal pregnancy. Ultrasonography revealed a cystic mass in the pelvis and magnetic resonance imaging showed an umbilical stump within it, indicating a retained placenta. This was removed surgically, and on histology, an infarcted placenta was confirmed.

Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries.

Science.gov (United States)

Adelgais, Kathleen M; Kuppermann, Nathan; Kooistra, Joshua; Garcia, Madelyn; Monroe, David J; Mahajan, Prashant; Menaker, Jay; Ehrlich, Peter; Atabaki, Shireen; Page, Kent; Kwok, Maria; Holmes, James F

2014-12-01

To determine the accuracy of complaints of abdominal pain and findings of abdominal tenderness for identifying children with intra-abdominal injury (IAI) stratified by Glasgow Coma Scale (GCS) score. This was a prospective, multicenter observational study of children with blunt torso trauma and a GCS score ≥13. We calculated the sensitivity of abdominal findings for IAI with 95% CI stratified by GCS score. We examined the association of isolated abdominal pain or tenderness with IAI and that undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion, or ≥2 nights of intravenous fluid therapy). Among the 12 044 patients evaluated, 11 277 (94%) had a GCS score of ≥13 and were included in this analysis. Sensitivity of abdominal pain for IAI was 79% (95% CI, 76%-83%) for patients with a GCS score of 15, 51% (95% CI, 37%-65%) for patients with a GCS score of 14, and 32% (95% CI, 14%-55%) for patients with a GCS score of 13. Sensitivity of abdominal tenderness for IAI also decreased with decreasing GCS score: 79% (95% CI, 75%-82%) for a GCS score of 15, 57% (95% CI, 42%-70%) for a GCS score of 14, and 37% (95% CI, 19%-58%) for a GCS score of 13. Among patients with isolated abdominal pain and/or tenderness, the rate of IAI was 8% (95% CI, 6%-9%) and the rate of IAI undergoing acute intervention was 1% (95% CI, 1%-2%). The sensitivity of abdominal findings for IAI decreases as GCS score decreases. Although abdominal computed tomography is not mandatory, the risk of IAI is sufficiently high that diagnostic evaluation is warranted in children with isolated abdominal pain or tenderness. Copyright © 2014 Elsevier Inc. All rights reserved.

[Pylephlebitis: a rare but possible complication of intra-abdominal infections].

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Pérez-Bru, Susana; Nofuentes-Riera, Carmen; García-Marín, Andrés; Luri-Prieto, Paloma; Morales-Calderón, Miguel; García-García, Salvador

2015-01-01

Pylephlebitis or septic thrombophlebitis of the portal venous system is a rare but serious complication of intra-abdominal infections which drain into the portal venous system. Its diagnosis is based on clinical suspicion and imaging tests, mainly a computed tomography scan, given the lack of specificity of the signs and symptoms. Spread of septic emboli is the major cause of morbidity and mortality. The aim of the study was to analyse patients diagnosed in our hospital. Retrospective descriptive study of patients diagnosed with pylephlebitis in our hospital. Four patients were included, 3 men and one woman. In 3 cases it was acute cholecystitis that led to the diagnosis of pylephlebitis at the same time as the intra-abdominal infection. Emergency surgery was performed in one case, whilst the other 2 were treated conservatively. Blood cultures were performed in all cases, and empirical antibiotic treatment was used. In the only case of acute appendicitis, diagnosis of pylephlebitis was achieved during the study of postoperative fever, with empirical antibiotic treatment also being started. The haematologist was requested to start the required anticoagulation therapy in all cases. Pylephlebitis is a rare complication of intra-abdominal infections that may make lead to a worse outcome. A high level of suspicion is required as well as imaging tests to make an early diagnosis and appropriate treatment. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Keratinocyte Growth Factor Combined with a Sodium Hyaluronate Gel Inhibits Postoperative Intra-Abdominal Adhesions

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Guangbing Wei

2016-09-01

Full Text Available Postoperative intra-abdominal adhesion is a very common complication after abdominal surgery. One clinical problem that remains to be solved is to identify an ideal strategy to prevent abdominal adhesions. Keratinocyte growth factor (KGF has been proven to improve the proliferation of mesothelial cells, which may enhance fibrinolytic activity to suppress postoperative adhesions. This study investigated whether the combined administration of KGF and a sodium hyaluronate (HA gel can prevent intra-abdominal adhesions by improving the orderly repair of the peritoneal mesothelial cells. The possible prevention mechanism was also explored. The cecum wall and its opposite parietal peritoneum were abraded after laparotomy to induce intra-abdominal adhesion formation. Animals were randomly allocated to receive topical application of HA, KGF, KGF + HA, or normal saline (Control. On postoperative day 7, the adhesion score was assessed with a visual scoring system. Masson’s trichrome staining, picrosirius red staining and hydroxyproline assays were used to assess the magnitude of adhesion and tissue fibrosis. Cytokeratin, a marker of the mesothelial cells, was detected by immunohistochemistry. The levels of tissue plasminogen activator (tPA, interleukin-6 (IL-6, and transforming growth factor β1 (TGF-β1 in the abdominal fluid were determined using enzyme-linked immunosorbent assays (ELISAs. Western blotting was performed to examine the expression of the TGF-β1, fibrinogen and α-smooth muscle actin (α-SMA proteins in the rat peritoneal adhesion tissue. The combined administration of KGF and HA significantly reduced intra-abdominal adhesion formation and fibrin deposition and improved the orderly repair of the peritoneal mesothelial cells in the rat model. Furthermore, the combined administration of KGF and HA significantly increased the tPA levels but reduced the levels of IL-6, tumor necrosis factor α (TNF-α and TGF-β1 in the abdominal fluid. The

Intra-abdominal hypertension in fulminant Clostridium difficile infection--an under-recognized treatable complication.

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Oud, Lavi

2010-09-01

Clostridium difficile is the most common cause of nosocomial infectious diarrhea in adults, with recent reports of increased severity and case fatality. Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized and treatable complications of severe illness in medical patients, and are independent predictors of mortality. Patients with severe Clostridium difficile infection (CDI) are at increased risk for IAH and ACS. However, ACS has been only rarely described in this population. We report a case of a 61 year-old morbidly obese, chronically ill, ventilator dependent patient, who developed fulminant CDI, including progressive colonic distension, acute renal failure and intra-abdominal fluid sequestration. Her clinical course worsened abruptly, with new shock, worsening hypoxic respiratory failure, increased peak airway pressures and reduced tidal volumes. Intra-abdominal pressure was 30 mm Hg. The patient was not considered a surgical candidate, was refractory to escalating non-surgical support, and died following withdrawal of life support. Although patients with fulminant CDI share many risk factors for IAH and ACS, these conditions were rarely reported in this population and are likely under recognized, as was the case with the present patient. Increased vigilance for IAH is needed in this at-risk population.

Analysis of Urobilinogen and Urine Bilirubin for Intra-Abdominal Injury in Blunt Trauma Patients

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Gorchynski, Julie

2009-05-01

Full Text Available OBJECTIVE: To determine the point prevalence of urine bilirubin, urine hemoglobin and urobilinogen in blunt trauma patients, and to evaluate its utility as a screening tool for intra-abdominal injury.METHODS: Data analysis of 986 consecutive trauma patients of which 698 were adult blunt trauma patients. Five-hundred sixteen subjects had a urinalysis and a CT scan of the abdomen/pelvis or exploratory laparotomy. We reviewed initial urinalysis results from trauma patients in the emergency department (ED for the presence of urine hemoglobin, uroblinogen and urine bilirubin. Computed tomography (CT scan results and operative reports were reviewed from the trauma registry for evidence of liver laceration, spleen laceration, bowel or mesenteric injuries.RESULTS: There were 73 injuries and 57/516 patients (11% with intra-abdominal injury. Urinalysis was positive for urobilinogen in 28/516 (5.4% patients, urine bilirubin in 15/516 (2.9% patients and urine hemoglobin in 313/516 (61% patients. Nineteen/forty-seven (4% subjects had liver lacerations, 28/56 (5% splenic lacerations, and 15/5 (3% bowel or mesenteric injury. Comparing the proportion of patients that had urobilinogen detected in the group with and without intra-abdominal injury, 8/28 (29% subjects with urobilinogen, 5/15 (33% subjects with bilirubin and 47/313 (15% subjects with urine hemoglobin were found to have liver lacerations, spleen lacerations, or bowel/mesenteric injuries. Preexisting liver or biliary conditions were not statistically associated with elevation of urine bilirubin, urine hemoglobin or urobilinogen on initial urinalysis after blunt abdominal trauma. Point prevalence for urobilinogen, urine bilirubin and urine hemoglobin are 5.43% (28/516, 2.91% (15/516 and 60.7% (313/516 respectively.CONCLUSIONS: The utility of the initial routine urinalysis in the ED for adult blunt abdominal trauma patients should not be used as a screening tool for the evaluation of intra-abdominal

Analysis of urobilinogen and urine bilirubin for intra-abdominal injury in blunt trauma patients.

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Gorchynski, Julie; Dean, Kevin; Anderson, Craig L

2009-05-01

To determine the point prevalence of urine bilirubin, urine hemoglobin and urobilinogen in blunt trauma patients, and to evaluate its utility as a screening tool for intra-abdominal injury. Data analysis of 986 consecutive trauma patients of which 698 were adult blunt trauma patients. Five-hundred sixteen subjects had a urinalysis and a CT scan of the abdomen/pelvis or exploratory laparotomy. We reviewed initial urinalysis results from trauma patients in the emergency department (ED) for the presence of urine hemoglobin, uroblinogen and urine bilirubin. Computed tomography (CT) scan results and operative reports were reviewed from the trauma registry for evidence of liver laceration, spleen laceration, bowel or mesenteric injuries. There were 73 injuries and 57/516 patients (11%) with intra-abdominal injury. Urinalysis was positive for urobilinogen in 28/516 (5.4%) patients, urine bilirubin in 15/516 (2.9%) patients and urine hemoglobin in 313/516 (61%) patients. Nineteen/forty-seven (4%) subjects had liver lacerations, 28/56 (5%) splenic lacerations, and 15/5 (3%) bowel or mesenteric injury. Comparing the proportion of patients that had urobilinogen detected in the group with and without intra-abdominal injury, 8/28 (29%) subjects with urobilinogen, 5/15 (33%) subjects with bilirubin and 47/313 (15%) subjects with urine hemoglobin were found to have liver lacerations, spleen lacerations, or bowel/mesenteric injuries. Preexisting liver or biliary conditions were not statistically associated with elevation of urine bilirubin, urine hemoglobin or urobilinogen on initial urinalysis after blunt abdominal trauma. Point prevalence for urobilinogen, urine bilirubin and urine hemoglobin are 5.43% (28/516), 2.91% (15/516) and 60.7% (313/516) respectively. The utility of the initial routine urinalysis in the ED for adult blunt abdominal trauma patients should not be used as a screening tool for the evaluation of intra-abdominal injury.

Leisure-time physical activity and intra-abdominal fat in young adulthood: A monozygotic co-twin control study.

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Rottensteiner, Mirva; Leskinen, Tuija; Järvelä-Reijonen, Elina; Väisänen, Karoliina; Aaltonen, Sari; Kaprio, Jaakko; Kujala, Urho M

2016-05-01

To investigate differences in abdominal fat compartments between young adult monozygotic twin pairs discordant for leisure-time physical activity. Ten young adult male monozygotic twin pairs (age range 32-36 years) discordant for leisure-time physical activity during the past 3 years were systematically selected from a population-based Finnish twin cohort. Magnetic resonance image at the level of the L2-L3 intervertebral disc was used to predict intra-abdominal and subcutaneous abdominal fat masses. Dietary intake was assessed with a 4-day food diary. Inactive twins had 31% more intra-abdominal fat than their active co-twins (mean difference 0.52 kg, 95% CI 0.12 to 0.91, P = 0.016), whereas the difference in subcutaneous abdominal fat was only 13% (P = 0.21) and 3% in body mass index (P = 0.28). Intraperitoneal fat mass was 41% higher among inactive twins compared to their active co-twins (mean difference 0.41 kg, 95% CI 0.11 to 0.70, P = 0.012). Dietary intake did not differ between co-twins. A lower level of physical activity is related to greater accumulation of intra-abdominal fat among healthy adult males in their mid-30s. The findings highlight the importance of leisure-time physical activity independent of genes and diet in the prevention of intra-abdominal fat accumulation from early adulthood onward. © 2016 The Obesity Society.

Intraoperative ultrasonography in nine dogs with intra-abdominal neoplasm suspect

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Daniella Matos da Silva

Full Text Available ABSTRACT: Intraoperative ultrasonography (IOUS is used in medicine for diagnosis and guidance during oncologic surgery. The aims of this study were to assess the performance, feasibility, advantages and difficulties of the IOUS technique in dogs with suspected intra-abdominal tumors. The study included nine client-owed dogs that had suspected intra-abdominal tumors (spleen, liver or bowel based on transabdominal ultrasound examination and that were subsequently referred for exploratory laparotomy surgery. During surgery, IOUS was performed; results of preoperative transabdominal ultrasonography, inspection by the surgeon and IOUS were compared on a case-by-case basis. IOUS was helpful in determining lesion resection in all cases. Lesions detected solely by the use of IOUS were observed in seven out of nine cases. Analysis of these cases demonstrated that IOUS can be a tool to assist during oncology surgery on the liver, spleen or bowel. Dogs with hepatic tumors can have small non-palpable intraparenchymal nodules, which may be visible by IOUS.

Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity.

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Nazare, Julie-Anne; Smith, Jessica D; Borel, Anne-Laure; Haffner, Steven M; Balkau, Beverley; Ross, Robert; Massien, Christine; Alméras, Natalie; Després, Jean-Pierre

2012-10-01

Ethnic differences in cardiometabolic risk (CMR) may be related to patterns of ethnic-specific body fat distribution. We aimed to identify differences across ethnic groups in interrelations between BMI, abdominal adiposity, liver fat, and CMR profile. In the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity, 297 physicians recruited 4504 patients (from 29 countries). In the current cross-sectional analyses, 2011 whites, 166 African Caribbean blacks, 381 Hispanics, 1192 East Asians, and 347 Southeast Asians were included. Computed tomography was used to assess abdominal fat distribution and to estimate liver fat content. Anthropometric variables and CMR profile were measured. Higher ranges of BMI were associated with higher levels of visceral [visceral adipose tissue (VAT)] and deep subcutaneous [deep subcutaneous adipose tissue (DSAT)] adiposity, with significant ethnic differences regarding the slope of these relations. Despite lower absolute BMI values, East Asians presented the largest accumulation of VAT but the lowest accumulation of DSAT with increasing adiposity. The association of BMI with liver fat did not differ between ethnic groups. Liver fat and DSAT were positively correlated with VAT with no ethnic variation. All ethnic groups had a similar association between a 1-SD increase in VAT, DSAT, or liver fat with hypertension, type 2 diabetes, hypertriglyceridemia, low HDL-cholesterol concentration, or high C-reactive protein concentration. Ethnicity significantly affects abdominal adiposity and liver fat partitioning, and East Asians have the most deleterious abdominal fat distribution. Irrespective of ethnicity, abdominal and hepatic fat depots are strongly interrelated and increased with obesity. Higher amounts of VAT or liver fat are associated with a more deteriorated CMR profile in all ethnic groups.

An Intra-Abdominal Desmoid Tumor, Embedded in the Pancreas, Preoperatively Diagnosed as an Extragastric Growing Gastrointestinal Stromal Tumor

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Mari Mizuno

2017-04-01

Full Text Available A 45-year-old woman was found to have a pancreatic tumor by abdominal ultrasound performed for a medical check-up. Abdominal contrast-enhanced computed tomography showed a hypovascular tumor measuring 30 mm in diameter in the pancreatic tail. Endoscopic ultrasound-guided fine needle aspiration was performed. An extragastric growing gastrointestinal stromal tumor was thereby diagnosed preoperatively, and surgical resection was planned. Laparoscopic surgery was attempted but conversion to open surgery was necessitated by extensive adhesions, and distal pancreatectomy, splenectomy, and partial gastrectomy were performed. The histological diagnosis was an intra-abdominal desmoid tumor. A desmoid tumor is a fibrous soft tissue tumor arising in the fascia and musculoaponeurotic tissues. It usually occurs in the extremities and abdominal wall, and only rarely in the abdominal cavity. We experienced a case with an intra-abdominal desmoid tumor that was histologically diagnosed after laparotomy, which had been preoperatively diagnosed as an extragastric growing gastrointestinal stromal tumor. Although rare, desmoid tumors should be considered in the differential diagnosis of intra-abdominal tumors. Herein, we report this case with a literature review.

Immune Protection against Lethal Fungal-Bacterial Intra-Abdominal Infections

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Lilly, Elizabeth A.; Ikeh, Melanie; Nash, Evelyn E.; Fidel, Paul L.

2018-01-01

ABSTRACT Polymicrobial intra-abdominal infections (IAIs) are clinically prevalent and cause significant morbidity and mortality, especially those involving fungi. Our laboratory developed a mouse model of IAI and demonstrated that intraperitoneal inoculation with Candida albicans or other virulent non-albicans Candida (NAC) species plus Staphylococcus aureus resulted in 70 to 80% mortality in 48 to 72 h due to robust local and systemic inflammation (sepsis). Surprisingly, inoculation with Candida dubliniensis or Candida glabrata with S. aureus resulted in minimal mortality, and rechallenge of these mice with lethal C. albicans/S. aureus (i.e., coninfection) resulted in >90% protection. The purpose of this study was to define requirements for C. dubliniensis/S. aureus-mediated protection and interrogate the mechanism of the protective response. Protection was conferred by C. dubliniensis alone or by killed C. dubliniensis plus live S. aureus. S. aureus alone was not protective, and killed S. aureus compromised C. dubliniensis-induced protection. C. dubliniensis/S. aureus also protected against lethal challenge by NAC plus S. aureus and could protect for a long-term duration (60 days between primary challenge and C. albicans/S. aureus rechallenge). Unexpectedly, mice deficient in T and B cells (Rag-1 knockouts [KO]) survived both the initial C. dubliniensis/S. aureus challenge and the C. albicans/S. aureus rechallenge, indicating that adaptive immunity did not play a role. Similarly, mice depleted of macrophages prior to rechallenge were also protected. In contrast, protection was associated with high numbers of Gr-1hi polymorphonuclear leukocytes (PMNLs) in peritoneal lavage fluid within 4 h of rechallenge, and in vivo depletion of Gr-1+ cells prior to rechallenge abrogated protection. These results suggest that Candida species can induce protection against a lethal C. albicans/S. aureus IAI that is mediated by PMNLs and postulated to be a unique form of

Immune Protection against Lethal Fungal-Bacterial Intra-Abdominal Infections

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Elizabeth A. Lilly

2018-01-01

Full Text Available Polymicrobial intra-abdominal infections (IAIs are clinically prevalent and cause significant morbidity and mortality, especially those involving fungi. Our laboratory developed a mouse model of IAI and demonstrated that intraperitoneal inoculation with Candida albicans or other virulent non-albicans Candida (NAC species plus Staphylococcus aureus resulted in 70 to 80% mortality in 48 to 72 h due to robust local and systemic inflammation (sepsis. Surprisingly, inoculation with Candida dubliniensis or Candida glabrata with S. aureus resulted in minimal mortality, and rechallenge of these mice with lethal C. albicans/S. aureus (i.e., coninfection resulted in >90% protection. The purpose of this study was to define requirements for C. dubliniensis/S. aureus-mediated protection and interrogate the mechanism of the protective response. Protection was conferred by C. dubliniensis alone or by killed C. dubliniensis plus live S. aureus. S. aureus alone was not protective, and killed S. aureus compromised C. dubliniensis-induced protection. C. dubliniensis/S. aureus also protected against lethal challenge by NAC plus S. aureus and could protect for a long-term duration (60 days between primary challenge and C. albicans/S. aureus rechallenge. Unexpectedly, mice deficient in T and B cells (Rag-1 knockouts [KO] survived both the initial C. dubliniensis/S. aureus challenge and the C. albicans/S. aureus rechallenge, indicating that adaptive immunity did not play a role. Similarly, mice depleted of macrophages prior to rechallenge were also protected. In contrast, protection was associated with high numbers of Gr-1hi polymorphonuclear leukocytes (PMNLs in peritoneal lavage fluid within 4 h of rechallenge, and in vivo depletion of Gr-1+ cells prior to rechallenge abrogated protection. These results suggest that Candida species can induce protection against a lethal C. albicans/S. aureus IAI that is mediated by PMNLs and postulated to be a unique form of

Endoscopic Ultrasound-Guided Drainage of Intra-Abdominal Abscess after Gastric Perforation in a Patient Receiving Ramucirumab and Paclitaxel for Advanced Gastric Cancer

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Koichiro Mandai

2017-01-01

Full Text Available Gastrointestinal perforation is a serious adverse event that occurs in approximately 1% of patients receiving ramucirumab and paclitaxel. A 67-year-old man with unresectable advanced gastric cancer was admitted to our hospital and treated with ramucirumab and paclitaxel. Gastric perforation occurred during the second cycle of chemotherapy. Although the patient’s condition improved without surgery, an abscess developed in the intra-abdominal fluid collection resulting from the perforation. We performed endoscopic ultrasound-guided abscess drainage. The patient improved and was discharged in satisfactory condition. Endoscopic ultrasound-guided drainage is a treatment option for patients with intra-abdominal abscess following gastric perforation due to ramucirumab.

Diagnostic yield of EUS-guided FNA and cytology in suspected tubercular intra-abdominal lymphadenopathy

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Puri, Rajesh; Mangla, Rakhee; Eloubeidi, Mohamad

2012-01-01

Intra-abdominal lymphadenopathy is a common diagnostic challenge faced by clinicians. In the absence of palpable peripheral nodes, tissue is usually obtained from the abdominal nodes by image-guided biopsy or surgery. We speculate that EUS-guided FNA (EUS-FNA) avoids the morbidity of a laparotomy...

Intra-Abdominal Testicular Seminoma in a Woman with Testicular Feminization Syndrome

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Darshana D. Rasalkar

2011-01-01

Full Text Available We report a case of intra-abdominal testicular tumor in a 36-year-old married lady presenting with chief complaints of primary amenorrhea. The patient was later diagnosed with testicular feminization syndrome, a form of male pseudohermaphroditism. This testicular tumor was histologically proven as seminoma. Due to rarity, imaging findings in patients with testicular feminization syndrome and intraabdominal testicular tumor have been poorly documented. So far, only one case report had described the combined role of CT and MR imaging in intraabdominal testicular sex-cord stromal tumor. To our knowledge, this case is first to document USG and MR imaging in addition to MR spectroscopy features in intraabdominal testicular seminoma.

Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture

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Park, Seongsik

2012-01-01

Background Although it is rare for the fracture itself to become a life threatening injury in patients suffering from rib fracture, the lives of these patients are occasionally threatened by other associated injuries. Especially, early discovery of patients with rib fracture and intra-abdominal organ injury is extremely important to the prognosis. This study analyzed the link between rib fracture and intra-abdominal injury to achieve improved treatment. Materials and Methods Among trauma pati...

Waist circumference adjusted for body mass index and intra-abdominal fat mass

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Berentzen, Tina Landsvig; Ängquist, Lars; Kotronen, Anna

2012-01-01

The association between waist circumference (WC) and mortality is particularly strong and direct when adjusted for body mass index (BMI). One conceivable explanation for this association is that WC adjusted for BMI is a better predictor of the presumably most harmful intra-abdominal fat mass (IAFM......) than WC alone. We studied the prediction of abdominal subcutaneous fat mass (ASFM) and IAFM by WC alone and by addition of BMI as an explanatory factor....

Predicting intra-abdominal fatness from anthropometric measures : the influence of stature

NARCIS (Netherlands)

Han, T.S.; McNeill, G; Seidell, J C; Lean, M.E.J.

OBJECTIVE: To investigate the influence of height on the relationships between the intra-abdominal fat and anthropometric measures. SUBJECTS: Twenty healthy female volunteers aged 20-51 y from Aberdeen, and 71 men and 34 women aged 19-85 y from Nijmegen, The Netherlands. OUTCOME MEASURES:

Selective parasympathetic innervation of subcutaneous and intra-abdominal fat - functional implications

NARCIS (Netherlands)

Kreier, Felix; Fliers, Eric; Voshol, Peter J.; van Eden, Corbert G.; Havekes, Louis M.; Kalsbeek, Andries; van Heijningen, Caroline L.; Sluiter, Arja A.; Mettenleiter, Thomas C.; Romijn, Johannes A.; Sauerwein, Hans P.; Buijs, Ruud M.

2002-01-01

The wealth of clinical epidemiological data on the association between intra-abdominal fat accumulation and morbidity sharply contrasts with the paucity of knowledge about the determinants of fat distribution, which cannot be explained merely in terms of humoral factors. If it comes to neuronal

IMAGING DIAGNOSIS-ECTOPIC SPLEEN MIMICKING HEPATIC TUMOR WITH INTRA-ABDOMINAL METASTASES INVESTIGATED VIA TRIPLE-PHASE HELICAL COMPUTED TOMOGRAPHY IN A DOG.

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Kutara, Kenji; Konno, Toshiaki; Kondo, Hirotaka; Aoki, Kotoyo; Yamazoe, Hinako; Matsunaga, Satoru

2017-05-01

A 10-year-old castrated male miniature dachshund was presented with an abdominal mass. The dog had a history of splenectomy. Triple-phase helical computed tomography was utilized, revealing a hepatic mass and multiple intra-abdominal solid masses. In triple-phase helical computed tomography the images, hepatic mass and two of four intra-abdominal masses were heterogenous in all phases. Therefore, we diagnosed a malignant hepatic tumor and presumed intra-abdominal metastases. The masses were surgically removed and were histologically composed of normal spleen tissues, findings which were consistent with ectopic spleen. © 2016 American College of Veterinary Radiology.

The Effect of Ethanol Extract of Rose (Rosa damascena) on Intra-abdominal Adhesions After Laparotomy in Rats.

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Karimi, Mehrdad; Yazdan Asadi, Sayyed; Parsaei, Pouya; Rafieian-Kopaei, Mahmoud; Ghaheri, Hafez; Ezzati, Sareh

2016-05-01

Abdominal adhesions are pathological connections in peritoneal surfaces that are created after abdominal surgery. The aim of this study was to evaluate the inhibitory effect of Rosa damascena extract on adhesions, considering the antioxidant properties of rose. Thirty healthy rats were divided into 3 groups: rats treated by 1% (A) and 5% (B) of R. damascena extract and the con- trol group (C). After administering anesthesia, the abdominal wall was opened and 3 shallow incisions (2 cm) were made on the right wall, and a 2 × 2 piece of peritoneal surface was removed on the left side of the abdominal wall. Then 3 mL of 1% (A) and 5% (B) R. damascena extract was administered into the abdominal cavity. The control group (C) received 3 mL of distilled water. The abdominal cavity was sutured, and a second laparotomy was carried out 14 days later to the created adhesions according to the Canbaz scale, and a histopathologic examination was also performed. All data was analyzed by SPSS volume 16 (Chicago, IL); P less than 0.05 was considered statistically significant. The amount of adhesion in group A was significantly lower than that of group C, 1.4 ± 1.265 versus 3 ± 0.816, (P = 0.007). The histological investigation also showed significant differences in the se- verity of fibrosis (P = 0.029) and inflammation (P = 0.009) between groups A and C; all rats in group B (5%) were found dead. This study indicated the use of R. damascena at a 1% level resulted in a remarkable decrease of intra-abdominal adhesions after laparotomy in rats. Further studies are necessary on this extract and its derivatives for treatment of such diseases in the human model.

Confusion and abdominal symptoms following a rugby tackle.

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Ioannides, Demetris; Davies, Madeleine; Kluzek, Stefan

2017-09-23

A 19-year-old man was sent to the emergency department following a pitch-side assessment for suspected concussion, unexplained upper abdominal tenderness and vomiting, following a high-impact tackle during a rugby match. A Focussed Assessment with Sonography for Trauma (FAST) scan performed in the emergency department suggested intra-abdominal free fluid, and subsequent head and abdominal CT imaging showed no intracranial lesion but confirmed a significant haemoperitoneum due to large splenic tear and bleeding. An emergency splenectomy was performed, which confirmed the rupture of an enlarged spleen with blood loss of almost 2 L into the peritoneal cavity. The patient made a full recovery following surgery. A subsequent histological examination revealed granulomatous inflammation characteristic of infectious mononucleosis. This unique case illustrates that physically fit patients with early hypovolaemic shock can present with symptoms mimicking concussion. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Radiological Signs of Intra-abdominal Gossypiboma

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Ferhat Çengel

2014-03-01

Full Text Available Gossypiboma is a mass lesion at the site of surgery due to a forgotten surgical sponge. Forgotten foreign bodies are mostly retained in the abdominal cavity but there are some cases in the thorax, cranium, breast, and an extremity. Gossypiboma should be considered, especially by radiologists, in patients with a history of surgery, who present with non-specific symptoms and abdominal mass. In this report, we describe the case of a female patient who presented with non-specific abdominal discomfort and fever about six months after open cholecystectomy. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 47-9

Hyperandrogenism Accompanies Increased Intra-Abdominal Fat Storage in Normal Weight Polycystic Ovary Syndrome Women.

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Dumesic, Daniel A; Akopians, Alin L; Madrigal, Vanessa K; Ramirez, Emmanuel; Margolis, Daniel J; Sarma, Manoj K; Thomas, Albert M; Grogan, Tristan R; Haykal, Rasha; Schooler, Tery A; Okeya, Bette L; Abbott, David H; Chazenbalk, Gregorio D

2016-11-01

Normal weight polycystic ovary syndrome (PCOS) women may have altered adipose structure-function underlying metabolic dysfunction. This study examines whether adipose structure-functional changes exist in normal weight PCOS women and correlate with hyperandrogenism and/or hyperinsulinemia. This is a prospective cohort study. The setting was an academic medical center. Six normal weight PCOS women and 14 age- and body mass index-matched normoandrogenic ovulatory (NL) women were included. All women underwent circulating hormone and metabolic measurements; frequently sampled intravenous glucose tolerance testing; total body dual-energy x-ray absorptiometry; abdominal magnetic resonance imaging; and SC abdominal fat biopsy. Circulating hormones and metabolites, body fat and its distribution, and adipocyte size were compared between PCOS and NL women, and were correlated with each other in all women. Circulating LH and androgen levels were significantly greater in PCOS than NL women, as were fasting insulin levels, pancreatic β-cell responsiveness to glucose, and total abdominal fat mass. Intra-abdominal fat mass also was significantly increased in PCOS women and was positively correlated with circulating androgen, fasting insulin, triglyceride, and non-high-density lipoprotein cholesterol levels in all women. SC abdominal fat mass was not significantly increased in PCOS women, but contained a greater proportion of small SC abdominal adipocytes that positively correlated with serum androgen levels in all women. Hyperandrogenism in normal weight PCOS women is associated with preferential intra-abdominal fat deposition and an increased population of small SC abdominal adipocytes that could constrain SC adipose storage and promote metabolic dysfunction.

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

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Sartelli Massimo

2012-11-01

Full Text Available Abstract The CIAO Study (“Complicated Intra-Abdominal infection Observational” Study is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012. Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4–98 years were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5% (163/2.152. According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation, a delayed initial intervention (a delay exceeding 24 hours, sepsis and septic shock in the immediate post-operative period, and ICU admission. Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs throughout Europe.

Profiling of Candida albicans Gene Expression During Intra-abdominal Candidiasis Identifies Biologic Processes Involved in Pathogenesis

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Cheng, Shaoji; Clancy, Cornelius J.; Xu, Wenjie; Schneider, Frank; Hao, Binghua; Mitchell, Aaron P.; Nguyen, M. Hong

2013-01-01

Background. The pathogenesis of intra-abdominal candidiasis is poorly understood. Methods. Mice were intraperitoneally infected with Candida albicans (1 × 106 colony-forming units) and sterile stool. nanoString assays were used to quantitate messenger RNA for 145 C. albicans genes within the peritoneal cavity at 48 hours. Results. Within 6 hours after infection, mice developed peritonitis, characterized by high yeast burdens, neutrophil influx, and a pH of 7.9 within peritoneal fluid. Organ invasion by hyphae and early abscess formation were evident 6 and 24 hours after infection, respectively; abscesses resolved by day 14. nanoString assays revealed adhesion and responses to alkaline pH, osmolarity, and stress as biologic processes activated in the peritoneal cavity. Disruption of the highly-expressed gene RIM101, which encodes an alkaline-regulated transcription factor, did not impact cellular morphology but reduced both C. albicans burden during early peritonitis and C. albicans persistence within abscesses. RIM101 influenced expression of 49 genes during intra-abdominal candidiasis, including previously unidentified Rim101 targets. Overexpression of the RIM101-dependent gene SAP5, which encodes a secreted protease, restored the ability of a rim101 mutant to persist within abscesses. Conclusions. A mouse model of intra-abdominal candidiasis is valuable for studying pathogenesis and C. albicans gene expression. RIM101 contributes to persistence within intra-abdominal abscesses, at least in part through activation of SAP5. PMID:24006479

"EFFECTIVENESS OF ABDOMINAL WALL ELEVATOR IN REDUCING INTRA-ABDOMINAL PRESSURE AND CO2 VOLUME DURING LAPAROSCOPIC CHOLECYSTECTOMY"

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A. Yaghoobi Notash

2004-06-01

Full Text Available Since CO2 pneumoperitoneum is the dominant method of laparoscopic exposure due to facility and good view, its physiologic effects are most relevant to the surgeons. CO2 pneumoperitoneum may affects hemodynamics by increased intra-abdominal pressure (IAP and the physiologic effects of absorbed CO2. The adverse effects of both mechanisms relate directly to the duration of the pneumoperitoneum and the elevation of IAP. Gasless laparoscopy involves obtaining exposure for laparoscopy by placing an internal retracting device through a small incision and lifting the anterior abdominal wall. We designed and made a mechanical wall elevator and used it in 24 patients, compared with a control group (52 cases using a conventional laparoscopic cholecystectomy. A prospective trial was undertaken in Sina Hospital, Tehran University of Medical Sciences from 1998 to 2000. The patients were assigned randomly to two groups. There was a significant decrease in IAP and CO2 consumption in the group using mechanical wall elevator as compared to conventional laparoscopic cholecystectomy, (mean IAP of 3.5 mmHg compared to 11.4 mmHg in the control group, mean CO2 volume 17 liters compared to 73 liters in the control group. We recommend this semigasless method in laparoscopy due to safety in performance and significant reduction in IAP through the surgery. This method provides a satisfactory view and easy performance without any increase in time or complications. The hospital stay and costs did not increase.

Hyperandrogenism Accompanies Increased Intra-Abdominal Fat Storage in Normal Weight Polycystic Ovary Syndrome Women

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Akopians, Alin L.; Madrigal, Vanessa K.; Ramirez, Emmanuel; Margolis, Daniel J.; Sarma, Manoj K.; Thomas, Albert M.; Grogan, Tristan R.; Haykal, Rasha; Schooler, Tery A.; Okeya, Bette L.; Abbott, David H.; Chazenbalk, Gregorio D.

2016-01-01

Context: Normal weight polycystic ovary syndrome (PCOS) women may have altered adipose structure-function underlying metabolic dysfunction. Objective: This study examines whether adipose structure-functional changes exist in normal weight PCOS women and correlate with hyperandrogenism and/or hyperinsulinemia. Design: This is a prospective cohort study. Setting: The setting was an academic medical center. Patients: Six normal weight PCOS women and 14 age- and body mass index-matched normoandrogenic ovulatory (NL) women were included. Intervention(s): All women underwent circulating hormone and metabolic measurements; frequently sampled intravenous glucose tolerance testing; total body dual-energy x-ray absorptiometry; abdominal magnetic resonance imaging; and SC abdominal fat biopsy. Main Outcome Measure(s): Circulating hormones and metabolites, body fat and its distribution, and adipocyte size were compared between PCOS and NL women, and were correlated with each other in all women. Results: Circulating LH and androgen levels were significantly greater in PCOS than NL women, as were fasting insulin levels, pancreatic β-cell responsiveness to glucose, and total abdominal fat mass. Intra-abdominal fat mass also was significantly increased in PCOS women and was positively correlated with circulating androgen, fasting insulin, triglyceride, and non-high-density lipoprotein cholesterol levels in all women. SC abdominal fat mass was not significantly increased in PCOS women, but contained a greater proportion of small SC abdominal adipocytes that positively correlated with serum androgen levels in all women. Conclusion: Hyperandrogenism in normal weight PCOS women is associated with preferential intra-abdominal fat deposition and an increased population of small SC abdominal adipocytes that could constrain SC adipose storage and promote metabolic dysfunction. PMID:27571186

Effects of intra-abdominal sepsis on atherosclerosis in mice.

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Kaynar, Ata Murat; Yende, Sachin; Zhu, Lin; Frederick, Daniel R; Chambers, Robin; Burton, Christine L; Carter, Melinda; Stolz, Donna Beer; Agostini, Brittani; Gregory, Alyssa D; Nagarajan, Shanmugam; Shapiro, Steven D; Angus, Derek C

2014-09-03

and vascular cell adhesion molecule 1) and the adhesion assay, a functional measure of endothelial activation, were elevated at 72 hours and 120 hours in mice that underwent CLP versus sham-operations (all at P <0.05). Using a combination of existing murine models for atherosclerosis and sepsis, we found that CLP, a model of intra-abdominal sepsis, accelerates atheroma development. Accelerated atheroma burden was associated with prolonged systemic, endothelial and intimal inflammation and was not explained by ongoing infection. These findings support observations in humans and demonstrate the feasibility of a long-term follow-up murine model of sepsis.

INTRA-ABDOMINAL INFECTION AND ACUTE ABDOMEN-EPIDEMIOLOGY, DIAGNOSIS AND GENERAL PRINCIPLES OF SURGICAL MANAGEMENT

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Jovanović Dušan

2015-03-01

Full Text Available Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.

Postoperative intra-abdominal collections using a sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier at the time of laparotomy for uterine or cervical cancers.

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Leitao, Mario M; Byrum, Graham V; Abu-Rustum, Nadeem R; Brown, Carol L; Chi, Dennis S; Sonoda, Yukio; Levine, Douglas A; Gardner, Ginger J; Barakat, Richard R

2010-11-01

A prior analysis of patients undergoing laparotomy for ovarian malignancies at our institution revealed an increased rate of intra-abdominal collections using HA-CMC film during debulking surgery. The primary objective of the current study was to determine whether the use of HA-CMC is associated with the development of postoperative intra-abdominal collections in patients undergoing laparotomy for uterine or cervical malignancies. We retrospectively identified all laparotomies performed for these malignancies from 3/1/05 to 12/31/07. We identified cases involving the use of HA-CMC via billing records and operative reports. Intra-abdominal collections were defined as localized intraperitoneal fluid accumulations in the absence of re-accumulating ascites. We noted incidences of intra-abdominal collections, as well as other complications. Appropriate statistical tests were applied using SPSS 15.0. We identified 169 laparotomies in which HA-CMC was used and 347 in which HA-CMC was not used. The following were statistically similar in both cohorts: age, body mass index (BMI), primary site, surgery for recurrent disease, prior intraperitoneal surgery, and extent of current surgery. Intra-abdominal collections were seen in 6 (3.6%) of 169 HA-CMC cases compared to 10 (2.9%) of 347 non-HA-CMC cases (p=0.7). The rate of infected collections was similar in both groups (1.2% vs. 1.4%). In the subgroup that underwent tumor debulking, intra-abdominal collections were seen in 3 (11.5%) of 26 HA-CMC cases compared to 2 (5.4%) of 37 non-HA-CMC cases (p=0.6). HA-CMC use does not appear to be associated with postoperative intra-abdominal collections in patients undergoing laparotomy for uterine or cervical cancer. Copyright © 2010 Elsevier Inc. All rights reserved.

Hemodynamic and metabolic changes as a result of application of different degrees of non-pneumatic intra-abdominal compression in rats

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Bin LIANG

2012-05-01

Full Text Available Objective 　To assess effects of different degrees of non-pneumatic intra-abdominal high pressure on metabolism and hemodynamics for the purpose of selecting the safe range of intra-abdominal pressure in anesthetized rats. Methods 　Twenty four male Wistar rats were anesthetized and randomly distributed into four groups (IAP0, IAP5, IAP10, IAP15 (n=6. All the rats underwent 30 minutes of intra-abdominal distension resulting in 0, 5, 10 or 15mmHg of intra-abdominal pressure with a non-pneumatic device. Arterial blood were collected at following 4 time points: baseline, end of insufflation, 20 and 40min after desufflation respectively for assaying arterial blood pH, PaO2, PaCO2, HCO3－, base excess (BE, lactic acid (LAC. At the end of experiment, serum alanine aminotransferase (ALT and creatinine (Cr were determined. Mean artery pressure (MAP and heart rate (HR were monitored via right carotid catheter throughout the experiment. Results 　No death occurred in each group. MAP in IAP15 group decreased by 42 percent when compared with that in IAP0 group (P 0.05. The pH values at the period of insufflation and at 20min after desufflation in IAP15 group were significantly lower than those in other groups (P 0.05. Significantly higher LAC level and significantly lower HCO3－ and BE level were seen in IAP15 group compared with those of IAP0, IAP5, IAP10 groups at the end of the insufflation and at 20 and 40min after desufflation (P 0.05. Conclusion　Safe limit of intra-abdominal pressures is less than 10mmHg, and intra-abdominal pressure of 15mmHg should be avoided in spontaneously breathing anesthetized rats.

Removal of an intra-abdominal desmoplastic small round cell tumor by repetitive debulking surgery: A case report and literature review.

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Shimazaki, Jiro; Motohashi, Gyo; Nishida, Kiyotaka; Tabuchi, Takanobu; Ubukata, Hideyuki; Tabuchi, Takafumi

2014-05-01

In the current study, a case of recurrent desmoplastic small round cell tumor (DSRCT) is presented, which was successfully treated by repetitive debulking surgery. In May 2010, a 39-year-old male, with a history of surgical resection of intra-abdominal DSRCT, visited the Ibaraki Medical Center, Tokyo Medical University Hospital (Ami, Japan) with severe lower abdominal discomfort. Abdominal computed tomography revealed a large tumor in the pouch of Douglas with a small number of nodules in the abdominal cavity. The recurrent DSRCT was diagnosed and removed via lower anterior resection; however, complete resection was impossible due to multiple peritoneal metastases. One year later, the patient developed pain in the right groin due to the growth of metastasized tumor cells in the groin lymph nodes. The affected lymph nodes were removed utilizing an extra-peritoneal approach. At the time of writing, the patient continues to survive without any symptoms 60 months since the initial surgery. In conclusion, surgical debulking is a significant procedure for relieving patient symptoms as well as improving the survival time of patients with metastatic and recurrent DSRCT.

Laparoscopic Stephen-Fowler stage procedure: appropriate management for high intra-abdominal testes.

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Agrawal, Amit; Joshi, Milind; Mishra, Pankaj; Gupta, Rahul; Sanghvi, Beejal; Parelkar, Sandesh

2010-03-01

The length of testicular vessels is the main length-limiting factor to bring down the testes in the scrotum. Fowler and Stephen proposed the division of testicular vessels, high and as far from the testes as possible to maintain collateral blood supply, to treat high intra-abdominal testes. Cortesi introduced the diagnostic laparoscopy and Jorden first did the laparoscopic orchiopexy for nonpalpable testes. We had done Fowler-Stephen staged orchiopexy for high intra-abdominal testes, in which both stages were done laparoscopically. In total, 17 testes of 13 patients had undergone laparoscopic staged Fowler-Stephen orchiopexy. The decision to perform a staged Fowler-Stephen orchiopexy was based on the distance of the testis from the deep inguinal ring on laparoscopy. If distance was more than 2.5 cm, then we proceeded to a laparoscopic staged Fowler-Stephen orchiopexy. In the first stage, testicular vessels were cauterized by bipolar diathermy. Laparoscopic second-stage Fowler-Stephen procedure was done 6 months after the first stage. Patients were regularly followed, and the success of the procedure was assessed by the size of the testes and the position in the scrotum. Testicular vascularity was assessed by color Doppler ultrasonography. There was no testicular atrophy on second stage and on follow-up. All testes were in the scrotum with good size on follow-up. There was no complication related to laparoscopy. In cases of high intra-abdominal testes, the staged Fowler-Stephen procedure should be the procedure of choice. This procedure yields a high success rate. Transaction of vessels by bipolar diathermy is a very safe, cost-effective method.

Gastric fluid versus amniotic fluid analysis for the identification of intra-amniotic infection due to Ureaplasma species.

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Kim, Sun Min; Romero, Roberto; Lee, JoonHo; Chaemsaithong, Piya; Docheva, Nikolina; Yoon, Bo Hyun

2016-01-01

Early neonatal sepsis is often due to intra-amniotic infection. The stomach of the neonate contains fluid swallowed before and during delivery. The presence of bacteria as well as neutrophils detected by culture or Gram stain of the gastric fluid during the first day of life is suggestive of exposure to bacteria or inflammation. We undertook this study to determine the relationship between gastric fluid analysis and amniotic fluid obtained by transabdominal amniocentesis in the detection of Ureaplasma species, the most frequent microorganisms responsible for intra-amniotic infection. The study population consisted of 100 singleton pregnant women who delivered preterm neonates (Ureaplasma species was performed. Intra-amniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration (>23 ng/mL). (1) Ureaplasma species were detected by culture or PCR in 18% (18/100) of amniotic fluid samples and in 5% (5/100) of gastric fluid samples; (2) among the amniotic fluid cases positive for Ureaplasma species, these microorganisms were identified in 27.8% (5/18) of gastric fluid samples; (3) none of the cases negative for Ureaplasma species in the amniotic fluid were found to be positive for these microorganisms in the gastric fluid; (4) patients with amniotic fluid positive for Ureaplasma species but with gastric fluid negative for these microorganisms had a significantly higher rate of intra-amniotic inflammation, acute histologic chorioamnionitis, and neonatal death than those with both amniotic fluid and gastric fluid negative for Ureaplasma species; and (5) no significant differences were observed in the rate of intra-amniotic inflammation, acute histologic chorioamnionitis, and neonatal death between patients with amniotic fluid positive for Ureaplasma species but with gastric fluid negative for these microorganisms and those with both amniotic fluid and gastric fluid positive for Ureaplasma species. Gastric fluid analysis has 100

Sonographic evaluation of intra-abdominal adhesions during the third trimester of pregnancy: a novel technique in women undergoing repeated cesarean section.

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Baron, Joel; Tirosh, Dan; Mastrolia, Salvatore Andrea; Ben-Haroush, Yigal; Schwartz, Shoshana; Kerner, Yoav; Hershkovitz, Reli

2018-03-25

Intra-abdominal adhesions may result in an increased risk of major complications in case of a repeated cesarean section, such as bladder and bowel injury, hemorrhage, infection, and hysterectomy. In an attempt to predict intra-abdominal adhesions before a repeated cesarean delivery, we suggest the use of a novel technique employing a simple and feasible ultrasound imaging technique. The study included pregnant women who underwent one or more cesarean deliveries in their obstetric history and were evaluated during the third trimester of the ongoing pregnancy. In order to diagnose intra-abdominal adhesions, we used a sonographic sliding sign of the uterus under the inner part of the fascia of the abdominal muscles, and considered women 1) at high risk for severe adhesions in the absence of sonographic uterine sliding; or 2) at a low risk for severe adhesions in the presence of an obvious or moderate uterine sliding. A comparison between sonographic findings and intra-abdominal adhesions as evaluated by the surgeons during surgery was performed. We examined 63 patients with one or more previous cesarean delivery. Out of these 63 patients, 59 had completed the study and underwent repeated cesarean section at our Institution. In 16 out of the19 cases assigned to the high risk for severe adhesions group, the suspicion was confirmed at surgery, with a sensitivity of 76.2%. In addition, the suspicion for low risk for adhesions was confirmed in 35 out of 40 patients, with a specificity of 92.1%. The inter and intra-observer correlation using Cohen's Kappa (k) coefficient were 0.52 and 0.77 respectively. Our data show that a simple sonographic sign might predict both high and low risk for intra-abdominal adhesions in patients who underwent previous cesarean delivery. This technique may aid clinical decisions regarding repeated cesarean section approach. This article is protected by copyright. All rights reserved.

Intra-abdominal hypertension in acute pancreatitis.

Science.gov (United States)

De Waele, Jan J; Leppäniemi, Ari K

2009-06-01

The incidence of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP) is approximately 60-80%. It is usually an early phenomenon, partly related to the effects of the inflammatory process, causing retroperitoneal edema, fluid collections, ascites, and ileus, and partly iatrogenic, resulting from aggressive fluid resuscitation. It also can manifest at a later stage, often associated with local pancreatic complications. IAH is associated with impaired organ dysfunction, especially of the cardiovascular, respiratory, and renal systems. Using current definitions, the incidence of the clinical manifestation, abdominal compartment syndrome (ACS), has been reported as 27% in the largest study so far. Despite several intervention options, the mortality in patients developing ACS remains high: 50-75%. Prevention with judicious use of crystalloids is important, and nonsurgical interventions, such as nasogastric decompression, short-term use of neuromuscular blockers, removal of fluid by extracorporeal techniques, and percutaneous drainage of ascites should be instituted early. The indications for surgical decompression are still not clearly defined, but undoubtedly some patients benefit from it. It can be achieved with full-thickness laparostomy (midline or transverse subcostal) or through a subcutaneous linea alba fasciotomy. Despite the improvement in physiological variables and significant decrease in IAP, the effects of surgical decompression on organ function and outcome are less clear. Because of the significant morbidity associated with surgical decompression and the management of the ensuing open abdomen, more research is needed to define better the appropriate indications and techniques for surgical intervention.

Efficacy of tigecycline versus ceftriaxone plus metronidazole for the treatment of complicated intra-abdominal infections

DEFF Research Database (Denmark)

Qvist, Niels; Warren, Brian; Leister-Tebbe, Heidi

2012-01-01

This randomized, open-label, multi-center trial compared tigecycline (TGC), a broad-spectrum glycylcycline, with ceftriaxone-metronidazole (CTX/MET) for the treatment of complicated intra-abdominal infections (cIAI)....

Allergic Lung Inflammation Aggravates Angiotensin II-Induced Abdominal Aortic Aneurysms in Mice

DEFF Research Database (Denmark)

Liu, Cong-Lin; Wang, Yi; Liao, Mengyang

2016-01-01

sensitization and challenge in mice led to the development of allergic lung inflammation (ALI). Subcutaneous infusion of angiotensin II into mice produced AAA. Simultaneous production of ALI in AAA mice doubled abdominal aortic diameter and increased macrophage and mast cell content, arterial media smooth...... and reduced lesion inflammation, plasma IgE, and bronchioalveolar inflammation. Pre-establishment of ALI also increased AAA lesion size, lesion accumulation of macrophages and mast cells, media smooth muscle cell loss, and plasma IgE, reduced plasma interleukin-5, interleukin-13, and transforming growth...... factor-β, and increased bronchioalveolar inflammation. Consequent production of ALI also doubled lesion size of pre-established AAA and increased lesion mast cell and T-cell accumulation, media smooth muscle cell loss, lesion cell proliferation and apoptosis, plasma IgE, and bronchioalveolar inflammation...

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

NARCIS (Netherlands)

Sartelli, Massimo; Weber, Dieter G.; Ruppé, Etienne; Bassetti, Matteo; Wright, Brian J.; Ansaloni, Luca; Catena, Fausto; Coccolini, Federico; Abu-Zidan, Fikri M.; Coimbra, Raul; Moore, Ernest E.; Moore, Frederick A.; Maier, Ronald V.; de Waele, Jan J.; Kirkpatrick, Andrew W.; Griffiths, Ewen A.; Eckmann, Christian; Brink, Adrian J.; Mazuski, John E.; May, Addison K.; Sawyer, Rob G.; Mertz, Dominik; Montravers, Philippe; Kumar, Anand; Roberts, Jason A.; Vincent, Jean-Louis; Watkins, Richard R.; Lowman, Warren; Spellberg, Brad; Abbott, Iain J.; Adesunkanmi, Abdulrashid Kayode; Al-Dahir, Sara; Al-Hasan, Majdi N.; Agresta, Ferdinando; Althani, Asma A.; Ansari, Shamshul; Ansumana, Rashid; Augustin, Goran; Bala, Miklosh; Balogh, Zsolt J.; Baraket, Oussama; Bhangu, Aneel; Beltrán, Marcelo A.; Bernhard, Michael; Biffl, Walter L.; Boermeester, Marja A.; Brecher, Stephen M.; Cherry-Bukowiec, Jill R.; Buyne, Otmar R.; Cainzos, Miguel A.; Cairns, Kelly A.; Camacho-Ortiz, Adrian; Chandy, Sujith J.; Che Jusoh, Asri; Chichom-Mefire, Alain; Colijn, Caroline; Corcione, Francesco; Cui, Yunfeng; Curcio, Daniel; Delibegovic, Samir; Demetrashvili, Zaza; de Simone, Belinda; Dhingra, Sameer; Diaz, José J.; Di Carlo, Isidoro; Dillip, Angel; Di Saverio, Salomone; Doyle, Michael P.; Dorj, Gereltuya; Dogjani, Agron; Dupont, Hervé; Eachempati, Soumitra R.; Enani, Mushira Abdulaziz; Egiev, Valery N.; Elmangory, Mutasim M.; Ferrada, Paula; Fitchett, Joseph R.; Fraga, Gustavo P.; Guessennd, Nathalie; Giamarellou, Helen; Ghnnam, Wagih; Gkiokas, George; Goldberg, Staphanie R.; Gomes, Carlos Augusto; Gomi, Harumi; Guzmán-Blanco, Manuel; Haque, Mainul; Hansen, Sonja; Hecker, Andreas; Heizmann, Wolfgang R.; Herzog, Torsten; Hodonou, Adrien Montcho; Hong, Suk-Kyung; Kafka-Ritsch, Reinhold; Kaplan, Lewis J.; Kapoor, Garima; Karamarkovic, Aleksandar; Kees, Martin G.; Kenig, Jakub; Kiguba, Ronald; Kim, Peter K.; Kluger, Yoram; Khokha, Vladimir; Koike, Kaoru; Kok, Kenneth Y. Y.; Kong, Victory; Knox, Matthew C.; Inaba, Kenji; Isik, Arda; Iskandar, Katia; Ivatury, Rao R.; Labbate, Maurizio; Labricciosa, Francesco M.; Laterre, Pierre-François; Latifi, Rifat; Lee, Jae Gil; Lee, Young Ran; Leone, Marc; Leppaniemi, Ari; Li, Yousheng; Liang, Stephen Y.; Loho, Tonny; Maegele, Marc; Malama, Sydney; Marei, Hany E.; Martin-Loeches, Ignacio; Marwah, Sanjay; Massele, Amos; McFarlane, Michael; Melo, Renato Bessa; Negoi, Ionut; Nicolau, David P.; Nord, Carl Erik; Ofori-Asenso, Richard; Omari, AbdelKarim H.; Ordonez, Carlos A.; Ouadii, Mouaqit; Pereira Júnior, Gerson Alves; Piazza, Diego; Pupelis, Guntars; Rawson, Timothy Miles; Rems, Miran; Rizoli, Sandro; Rocha, Claudio; Sakakhushev, Boris; Sanchez-Garcia, Miguel; Sato, Norio; Segovia Lohse, Helmut A.; Sganga, Gabriele; Siribumrungwong, Boonying; Shelat, Vishal G.; Soreide, Kjetil; Soto, Rodolfo; Talving, Peep; Tilsed, Jonathan V.; Timsit, Jean-Francois; Trueba, Gabriel; Trung, Ngo Tat; Ulrych, Jan; van Goor, Harry; Vereczkei, Andras; Vohra, Ravinder S.; Wani, Imtiaz; Uhl, Waldemar; Xiao, Yonghong; Yuan, Kuo-Ching; Zachariah, Sanoop K.; Zahar, Jean-Ralph; Zakrison, Tanya L.; Corcione, Antonio; Melotti, Rita M.; Viscoli, Claudio; Viale, Perluigi

2016-01-01

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric

Intra-abdominal desmoplastic small cell tumor in a girl : a case report

International Nuclear Information System (INIS)

Lee, Young Seok

1998-01-01

Desmoplastic small cell tumor is a rare primary intra-abdominal disease with a predilection for the adolescent boy. This aggressive tumor involved multiple intraperitoneal organs, peritoneal, mesentery and omental seedings, and sometimes retroperitoneal extension. The author reports a case of this rare tumor, demonstrated by CT, MRI and US, in a 14-year-old girl. (author). 9 refs., 2 figs

Urethral pressure reflectometry during intra-abdominal pressure increase—an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women

DEFF Research Database (Denmark)

Saaby, Marie-Louise; Klarskov, Niels; Lose, Gunnar

2013-01-01

to assess the urethral closure function by urethral pressure reflectometry (UPR) during intra-abdominal pressure-increase in SUI and continent women.......to assess the urethral closure function by urethral pressure reflectometry (UPR) during intra-abdominal pressure-increase in SUI and continent women....

Antimicrobial susceptibility of intra-abdominal infection isolates from a tertiary care hospital in karachi

International Nuclear Information System (INIS)

Saad, U.; Anwar, S.; Kahara, U.Z.; Saeed, H.

2016-01-01

Intra-abdominal infections are associated with significant morbidity and mortality. The most frequent pathogens involved are the gastrointestinal flora which can cause poly-microbial infections. Microbiological diagnosis is required to determine the aetiology and antimicrobial susceptibility of the organisms involved. Prompt initiation of antimicrobials is essential for improving patient's outcome. Knowledge of local trends of antimicrobial resistance in nosocomial isolates is essential for empiric therapy. Methods: A total of 190 clinical isolates collected from intra-abdominal infections during July 2013 to July 2014 were included in the study. Organism identification and Antimicrobial sensitivity testing using standard biochemical tests and CLSI recommended criteria was carried out. Result: Of the total 190 isolates from abdominal infection sources 52% were from fluid sources (peritoneal and ascitic fluid), 41% were from gall bladder and 6.5% were from other abdominal sources. E. coli (46.8%) was the most frequently isolated gram negative and Enterococcus (13.1%) was the most frequently isolated gram positive organism. Carbapenem (imipenem) was the most active agent against enterobacteraceae exhibiting, 94.4% and 91.3% sensitivity against E. coli and Klebsiella respectively. While vancomycin was the most active agent against gram positive organisms. Eighty-four percent of the Enterococci isolated were sensitive to vancomycin. Most isolates exhibited resistance to one or more antibiotics. Conclusion: Continuous evolution of antimicrobial resistance patterns in bacteria necessitates updating of local data on antimicrobial susceptibility profiles to ensure the safety and efficacy of pathogen specific antimicrobial therapies. (author)

Effects of norepinephrine on tissue perfusion in a sheep model of intra-abdominal hypertension

NARCIS (Netherlands)

Ferrara, Gonzalo; Kanoore Edul, Vanina S.; Caminos Eguillor, Juan F.; Martins, Enrique; Canullán, Carlos; Canales, Héctor S.; Ince, Can; Estenssoro, Elisa; Dubin, Arnaldo

2015-01-01

The aim of the study was to describe the effects of intra-abdominal hypertension (IAH) on regional and microcirculatory intestinal blood flow, renal blood flow, and urine output, as well as their response to increases in blood pressure induced by norepinephrine. This was a pilot, controlled study,

Intra-abdominal Migration of a Lag Screw in Gamma Nailing: Report of a Case

NARCIS (Netherlands)

Heineman, D.J.; van Buijtenen, J.M.; Heuff, G.; Derksen, E.J.; Pöll, R.G.

2010-01-01

An 83-year-old female patient was referred to the emergency room with progressive pain on mobilization. Three weeks before presentation, she had been treated with a gamma nail for an unstable right intertrochanteric fracture. Pelvic X-ray showed an intra-abdominally migrated lag screw. No evidence

Fetal uptake of intra-amniotically delivered dendrimers in a mouse model of intrauterine inflammation and preterm birth.

Science.gov (United States)

Burd, Irina; Zhang, Fan; Dada, Tahani; Mishra, Manoj K; Borbiev, Talaibek; Lesniak, Wojciech G; Baghlaf, Haitham; Kannan, Sujatha; Kannan, Rangaramanujam M

2014-08-01

Intrauterine inflammation is associated with preterm birth and can lead to fetal neuroinflammation and neurobehavioral disorders in newborns. Dendrimers can intrinsically target and deliver drugs for the treatment of neuroinflammation. We explore whether hydroxyl polyamidoamine (PAMAM) dendrimer (G4-OH)-based nanomedicines can be delivered to the fetus by intra-amniotic administration, in a mouse model of intrauterine inflammation. The time-dependent accumulation of G4-OH-fluorophore conjugate was quantified by fluorescence. These studies suggest that, after intra-amniotic administration, there is significant accumulation of dendrimer in the fetus gut and brain. In addition, there is some fetal-maternal transport of the dendrimer. Confocal microscopy confirmed the presence of G4-OH in the fetal brain, with a large accumulation in the brain blood vessels and the brain parenchyma, and some microglial uptake. We believe that intra-amniotic administration of G4-OH-drug nanomedicines may enable the treatment of diseases related to intrauterine inflammation and fetal neuroinflammation. Using a mouse model of intrauterin inflammation leading to neuroinflammation in the fetus, these investigators demonstrate that intra-amniotic delivery of hydroxyl polyamidoamine (PAMAM) dendrimer (G4-OH)-based nanomedicines may provide an effective method in preventing this complication. Copyright © 2014 Elsevier Inc. All rights reserved.

Untargeted antifungal therapy in adult patients with complicated intra-abdominal infection

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Petersen, Marie Warrer; Perner, Anders; Sjövall, Fredrik

2017-01-01

who are critically ill have provided conflicting results, and clinical equipoise exists. Accordingly, we aim to assess patient-important benefits and harms of untargeted antifungal therapy versus placebo or no treatment in adult patients with complicated intra-abdominal infection. Methods and analysis......-cause mortality, and secondary outcomes include adverse events, duration of mechanical ventilation and inotropic support, need for renal replacement therapy, emergence of antibiotic resistance and intensive care unit and hospital length-of-stay. Conventional meta-analysis, including sensitivity and subgroup...

INTRA-ABDOMINAL HYPERTENSION AS A RISK FACTOR FOR ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS

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Sreelatha

2016-05-01

Full Text Available BACKGROUND AND AIMS Increased intra-abdominal pressure (IAP, also referred to as intra-abdominal hypertension (IAH, affects organ function in critically ill patients. The prevalence of IAH is between 32% - 65% in intensive care units. Normal IAP is ≈ 5–7 mmHg. According to WSACS definition, IAH = IAP ≥12 mmHg and is divided into 4 grades. They are Grade I (12-15 mmHg, Grade II (16-20 mmHg, Grade III (21-25 mmHg, Grade IV (>25 mmHg. Transvesical measurement of IAP currently is the most popular technique. Several systems with or without the need for electronic equipment are available that allow IAP measurement. The aim is to study the incidence of IAH in critically ill patients, to assess the risk factors for development of IAH, to study the role of IAH as a risk factor for Acute Kidney Injury (AKI, to assess the role of IAH as a risk factor for increased (Intensive Care Unit ICU mortality. SUBJECTS AND METHODS This is a prospective observational study. Study period was six months. The study included 52 patients admitted to Medical ICU in Government Medical College, Kozhikode, Kerala. RESULTS AND CONCLUSION There was a very high incidence of intra-abdominal hypertension in critically ill patients. IAH was significantly associated with risk factors like sepsis, mechanical ventilation, pancreatitis, capillary leak, ascites, cumulative fluid balance and cirrhosis. IAH is an independent risk factor for development of acute kidney injury. IAH is an independent predictor of mortality in critically ill patients.

A Large Intra-Abdominal Hiatal Hernia as a Rare Cause of Dyspnea

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Cem Sahin

2015-01-01

Full Text Available Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the left atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea.

Ratos isogênicos F344 como modelo biológico de sepsis intra-abdominal

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Sueli Blanes Damy

2002-01-01

Full Text Available Com o objetivo de estudar um modelo biológico de sepsis intra-abdominal aguda para estudos experimentais, foram infectados ratos isogênicos F344, convencionais, com a bactéria Escherichia coli (E.coli, cepa ATCC 11775, sorotipo H7:O1:K1. Os animais inoculados, machos e fêmeas, apresentaram 6 horas após a inoculação por E.coli os seguintes sintomas: arqueamento do dorso, piloereção, hiperpnéia e diminuição das atividades motoras. A dose que produziu 50% de mortalidade (DL50 após 7 dias, determinada pelo método Reed & Muench, foi de 6 x 10(5 CFU/ml (analisado em 32 machos e 32 fêmeas. A maior concentração de mortalidade foi observada nas primeiras 24 horas. A disfunção hepática, comum em sepsis intra-abdominal, foi avaliada por provas enzimáticas, em 0, 24, 48 e 168 horas após a inoculação. O estudo da migração de células polimorfonucleares-neutrófilos (PMN e mononucleares-macrófagos (MN apontou um aumento significante de PMN entre o grupos de machos (z ³ 4,7; p < 0,003 e de fêmeas (z ³ 6,2; p < 0,0003 inoculados E.coli, quando comparados ao grupos controles. Quanto às células MN, não houve diferença entre os grupos inoculados e os controles, tanto para os machos (z=2,3; p = 0,0107, como para as fêmeas (z=1,8; p =0,0359. Em conclusão, estes resultados demonstram que os ratos isogênicos F344 são modelos biológicos adequados para estudos de sepsis intra-abdominal aguda.

Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis – a case report

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Oke V

2015-09-01

Full Text Available Vikram Oke, Frances Schmidt, Bikash Bhattarai, Md Basunia, Chidozie Agu, Amrit Kaur, Danilo Enriquez, Joseph Quist, Divya Salhan, Vijay Gayam, Prajakta Mungikar Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA Abstract: Clozapine is the preferred antipsychotic used for the treatment of resistant schizophrenia with suicidal ideation. The drug is started at a low dose and gradually increased to a target dose of 300–450 mg/day. It is well known to cause agranulocytosis and neutropenia. Several cases of fatal sepsis have been reported in neutropenic patients and emphasis is placed on monitoring for agranulocytosis; however, clozapine also causes intestinal hypomotility and constipation, which if unrecognized can lead to intestinal obstruction, bowel necrosis, and intra-abdominal sepsis. Reduced behavioral pain reactivity in schizophrenics may alter the ability to express pain, potentially leading to a delay in the presentation for medical attention. We report a case of fatal intra-abdominal sepsis secondary to an unrecognized case of clozapine-related constipation. Keywords: antipsychotics, clozapine, schizophrenia, syncope, constipation, sepsis

A comparative study to validate the use of ultrasonography and computed tomography in patients with post-operative intra-abdominal sepsis

International Nuclear Information System (INIS)

Go, H.L.S.; Baarslag, H.J.; Vermeulen, H.; Lameris, J.S.; Legemate, D.A.

2005-01-01

Purpose: To validate abdominal ultrasonography and helical computed tomography in detecting causes for sepsis in patients after abdominal surgery and to determine improved criteria for its use. Materials and methods: Eighty-five consecutive surgical patients primarily operated for non-infectious disease were included in this prospective study. Forty-one patients were admitted to the intensive care unit. All patients were suspected of an intra-abdominal sepsis after abdominal surgery. Both ultrasonography (US) and helical abdominal computed tomography (CT) were performed to investigate the origin of an intra-abdominal sepsis. The images of both US and CT were interpreted on a four-point scale by different radiologists or residents in radiology, the investigators were blinded of each other's test. Interpretations of US and CT were compared with a reference standard which was defined by the result of diagnostic aspiration of suspected fluid collections (re)laparotomy, clinical course or the opinion of an independent panel. Likelihood ratios and post-test probabilities were calculated and interobserver agreement was determined using κ statistics. Results: The overall prevalence of an abdominal infection was 0.49. The likelihood ratio (LR) of a positive test-result for US was 1.33 (95% CI: 0.8-2.5) and for CT scan 2.53 (95% CI: 1.4-5.0); corresponding post-test probabilities for US 0.57 (95% CI: 0.42-0.70) and for CT 0.71 (95% CI: 0.57-0.83). The LR of a negative test-result was, respectively, 0.60 (95% CI: 0.3-1.3) and 0.18 (95% CI: 0.06-0.5); corresponding post-test probabilities for US 0.37 (95% CI: 0.20-0.57) and for CT 0.15 (95% CI: 0.06-0.32) were calculated. Conclusion: Computed tomography can be used as the imaging modality of choice in patients suspected of intra-abdominal sepsis after abdominal surgery. Because of the low discriminatory power ultrasonography should not be performed as initial diagnostic test

[The influnence of dachengqi tang on acute lung injury and intra abdominal hypertension in rats with acute pancreatitis].

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Wan, Mei-Hua; Li, Juan; Tang, Wen-Fu; Gong, Han-Lin; Chen, Guang-Yuan; Xue, Ping; Zhao, Xian-Lin; Xia, Qing

2011-09-01

To test the hypothesis "lung and large intestine are interior exteriorly related" through investgating into the effect of Dacheng qi tang (DCQT) on intra abdominal hypertension (IAH) and acute lung injury (ALI) in rats with acute pancreatitis. Male SD rats were randomly divided into three groups with ten rats for each group: rats with sham-operations (SO); rats with acute necrosis pancreatitis (ANP); rats with ANP plus DCQT treatment. ANP was induced by retrograde infusion of 5% taurocholic acid into pancreatic duct. Two hours after operations, 10 mL/kg of normal saline was orally adminstered to the rats in both SO and ANP groups, whereas 10 mL/kg DCQT was adminstered to the rats in the treatment group. Aterial blood, pancreas and lung tissues were collected for biomarkers and histopathology 24 hours after operations. Intra-abdominal pressure and intestinal propulsion rate were also measured. RESULTS; DCQT treatment reduced intra-abdominal pressure and improved intestinal propulsion rate compared with those treated with saline (P 0.05). Only two rats in the ANP group died. DCQT can effectively relieve IAH and cure ALI at the same time in rats with acute pancreatitis. The result provides evidence to support the hypothesis "lung and large intestine are interior exteriorly related".

Nodo-colonic fistula caused by intra-abdominal tuberculous lymphadenitis during treatment with anti-tuberculous medication: A case report

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Nam, Kyung Sun; Bae, Kyung Eun; Jeong, Myeong Ja; Lee, Ji Hae; Kang, Mi Jin; Kim, Jae Hyung; Kim, Soo Hyun [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

2016-08-15

Recently, the overall incidence of tuberculosis has decreased, but the incidence of an extrapulmonary manifestation in patients with tuberculosis has increased in the Republic of Korea. Although intestinal tuberculosis is not infrequent, a fistula caused by tuberculosis is a rare condition. A 23-year-old man presented with fever, diarrhea and right lower quadrant pain. A computed tomography (CT) scan revealed a lobulated, peripherally enhancing, low density mass in the mesentery. The patient underwent laparoscopic biopsy for necrotic lymph node, and intra-abdominal tuberculous lymphadenitis was diagnosed. Four months after initiating treatment with anti-tuberculous medication, the patient developed fever together with lower abdominal pain. A follow-up CT scan revealed a fistulous tract that had developed between the initially noted lymphadenopathy and the proximal ascending colon. Laparoscopic right hemicolectomy was performed as a curative treatment. This case suggests that a nodo-colonic fistula may occur as a paradoxical response in patients with intra-abdominal tuberculous lymphadenitis during treatment with anti-tuberculous medication.

Increased intra-abdominal fat may lower HDL levels by increasing the fractional catabolic rate of Lp A-I in postmenopausal women.

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Vajo, Zoltan; Terry, James G; Brinton, Eliot A

2002-02-01

High-density lipoprotein (HDL) particles without apolipoprotein A-II (Lp A-I) may be more anti-atherogenic than HDL with apo A-II (Lp A-I/AII) and Lp A-I is reported selectively to be reduced in cases of intra-abdominal obesity. We explored the mechanisms of this reduction by studying the turnover of Lp A-I and Lp A-I/A-II in postmenopausal women well characterized for total body, regional and sub-regional adiposity by body mass index (BMI), truncal girth ratio, and abdominal magnetic resonance imaging (MRI), respectively. We tested for possible cause-effect relationships by measuring inter-correlations among these variables. Intra-abdominal fat area correlated strongly and positively with the fractional catabolic rate (FCR) of Lp A-I (r=0.98, P=0.003). Intra-abdominal fat only showed a non-significant trend toward correlation with the FCR of Lp A-I/A-II (r=0.84, P=0.07), and had no correlation with the production or transport rate (TR) of either Lp A-I or Lp A-I/A-II (r=0.48 and 0.02, respectively, P>0.1). Subjects were studied both with and without estrogen replacement, allowing exploration of a possible interaction of adiposity with estrogen effects on HDL turnover. Response of HDL turnover to estrogen did not correlate with adiposity, except for a parameter of waist to hip ratio (WHR), which predicted the increase in LP A-I TR with estrogen (r=0.84, P=0.04). We conclude that intra-abdominal fat may lower HDL levels by increasing the FCR of Lp A-I, suggesting a mechanism by which central adiposity may be proatherogenic.

Evaluation of intra-abdominal vasectomy in llamas and alpacas.

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Bravo, P W; Sumar, J

1991-11-01

A method of intra-abdominal vasectomy (deferentectomy), using a laparoscopic technique in llamas and alpacas, was evaluated. Food was withheld from 14 animals for 24 hours before sedation and laparoscopy. The ductus deferens was located close to the bladder, and a 2- to 3-cm section of ductus deferens was resected with the aid of a pair of hook scissors. The procedure was completed in 5 to 8 minutes, and animals did not have any adverse effects. Forty-five days after vasectomy, animals were used for detecting sexually receptive females or inducing ovulation during reproductive physiologic studies. The procedure did not impair libido and had no effect on male sexual behavior for many years. The technique is simpler, safer, and faster than the traditional external approach.

Intra-Abdominal Cooling System Limits Ischemia-Reperfusion Injury During Robot-Assisted Renal Transplantation.

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Meier, R P H; Piller, V; Hagen, M E; Joliat, C; Buchs, J-B; Nastasi, A; Ruttimann, R; Buchs, N C; Moll, S; Vallée, J-P; Lazeyras, F; Morel, P; Bühler, L

2018-01-01

Robot-assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra-abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra-abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p-values system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia-reperfusion injuries. © 2017 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of American Society of Transplant Surgeons.

Adrenal gland volume, intra-abdominal and pericardial adipose tissue in major depressive disorder.

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Kahl, Kai G; Schweiger, Ulrich; Pars, Kaweh; Kunikowska, Alicja; Deuschle, Michael; Gutberlet, Marcel; Lichtinghagen, Ralf; Bleich, Stefan; Hüper, Katja; Hartung, Dagmar

2015-08-01

Major depressive disorder (MDD) is associated with an increased risk for the development of cardio-metabolic diseases. Increased intra-abdominal (IAT) and pericardial adipose tissue (PAT) have been found in depression, and are discussed as potential mediating factors. IAT and PAT are thought to be the result of a dysregulation of the hypothalamus-pituitary-adrenal axis (HPAA) with subsequent hypercortisolism. Therefore we examined adrenal gland volume as proxy marker for HPAA activation, and IAT and PAT in depressed patients. Twenty-seven depressed patients and 19 comparison subjects were included in this case-control study. Adrenal gland volume, pericardial, intraabdominal and subcutaneous adipose tissue were measured by magnetic resonance imaging. Further parameters included factors of the metabolic syndrome, fasting cortisol, fasting insulin, and proinflammatory cytokines. Adrenal gland and pericardial adipose tissue volumes, serum concentrations of cortisol and insulin, and serum concentrations tumor-necrosis factor-α were increased in depressed patients. Adrenal gland volume was positively correlated with intra-abdominal and pericardial adipose tissue, but not with subcutaneous adipose tissue. Our findings point to the role of HPAA dysregulation and hypercortisolism as potential mediators of IAT and PAT enlargement. Further studies are warranted to examine whether certain subtypes of depression are more prone to cardio-metabolic diseases. Copyright © 2015 Elsevier Ltd. All rights reserved.

Intra-abdominal vacuum-assisted closure (VAC) after necrosectomy for acute necrotising pancreatitis: preliminary experience.

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Sermoneta, D; Di Mugno, M; Spada, P L; Lodoli, C; Carvelli, M E; Magalini, S C; Cavicchioni, C; Bocci, M G; Martorelli, F; Brizi, M G; Gui, D

2010-12-01

Infection of pancreatic necrosis, although present in less than 10% of acute pancreatitis, carries a high risk of mortality; debridment and drainage of necrosis is the treatment of choice, followed by 'open' or 'close' abdomen management. We recently introduced the use of intra-abdominal vacuum sealing after a classic necrosectomy and laparostomy. Two patients admitted to ICU for respiratory insufficiency and a diagnosis of severe acute pancreatitis developed pancreatic necrosis and were treated by necrosectomy, lesser sac marsupialisation and posterior lumbotomic opening. Both of the patients recovered from pancreatitis and a good healing of laparostomic wounds was obtained with the use of the VAC system. Most relevant advantages of this technique seem to be: the prevention of abdominal compartment syndrome, the simplified nursing of patients and the reduction of time to definitive abdominal closure. © 2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Removal of an intra-abdominal desmoplastic small round cell tumor by repetitive debulking surgery: A case report and literature review

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SHIMAZAKI, JIRO; MOTOHASHI, GYO; NISHIDA, KIYOTAKA; TABUCHI, TAKANOBU; UBUKATA, HIDEYUKI; TABUCHI, TAKAFUMI

2014-01-01

In the current study, a case of recurrent desmoplastic small round cell tumor (DSRCT) is presented, which was successfully treated by repetitive debulking surgery. In May 2010, a 39-year-old male, with a history of surgical resection of intra-abdominal DSRCT, visited the Ibaraki Medical Center, Tokyo Medical University Hospital (Ami, Japan) with severe lower abdominal discomfort. Abdominal computed tomography revealed a large tumor in the pouch of Douglas with a small number of nodules in the...

The effect of intra-abdominal hypertension incorporating severe acute pancreatitis in a porcine model.

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Lu Ke

Full Text Available INTRODUCTION: Abdominal compartment syndrome (ACS and intra abdominal hypertension(IAH are common clinical findings in patients with severe acute pancreatitis(SAP. It is thought that an increased intra abdominal pressure(IAP is associated with poor prognosis in SAP patients. But the detailed effect of IAH/ACS on different organ system is not clear. The aim of this study was to assess the effect of SAP combined with IAH on hemodynamics, systemic oxygenation, and organ damage in a 12 h lasting porcine model. MEASUREMENTS AND METHODS: Following baseline registrations, a total of 30 animals were divided into 5 groups (6 animals in each group: SAP+IAP30 group, SAP+IAP20 group, SAP group, IAP30 group(sham-operated but without SAP and sham-operated group. We used a N(2 pneumoperitoneum to induce different levels of IAH and retrograde intra-ductal infusion of sodium taurocholate to induce SAP. The investigation period was 12 h. Hemodynamic parameters (CO, HR, MAP, CVP, urine output, oxygenation parameters(e.g., S(vO(2, PO(2, PaCO(2, peak inspiratory pressure, as well as serum parameters (e.g., ALT, amylase, lactate, creatinine were recorded. Histological examination of liver, intestine, pancreas, and lung was performed. MAIN RESULTS: Cardiac output significantly decreased in the SAP+IAH animals compared with other groups. Furthermore, AST, creatinine, SUN and lactate showed similar increasing tendency paralleled with profoundly decrease in S(vO(2. The histopathological analyses also revealed higher grade injury of liver, intestine, pancreas and lung in the SAP+IAH groups. However, few differences were found between the two SAP+IAH groups with different levels of IAP. CONCLUSIONS: Our newly developed porcine SAP+IAH model demonstrated that there were remarkable effects on global hemodynamics, oxygenation and organ function in response to sustained IAH of 12 h combined with SAP. Moreover, our model should be helpful to study the mechanisms of IAH

The effect of endoleak on intra-aneurysmal pressure after EVE for abdominal aortic aneurysm

International Nuclear Information System (INIS)

Huang Sheng; Jing Zaiping; Mei Zhijun; Lu Qingsheng; Zhao Jun; Zhang Suzhen; Zhao Xin; Cai Lili; Tang Jingdong; Xiong Jiang; Liao Mingfang

2003-01-01

Objective: To investigate the intra-aneurysmal pressure curve in the presence of endoleak after endovascular exclusion (EVE) for abdominal aortic aneurysm (AAA). Methods: Infrarenal aortic aneurysms were created with bovine jugular vein segments or patches. Then they were underwent incomplete endovascular exclusion of the aneurysm and formation of endoleaks. The pressures of blood flow outside the graft into the sac were measured. Results: The intrasac pressure was higher than systemic pressure in the presence of endoleak. After sealing the endoleak, pressure decreased significantly, and the pressure cure showed approximately linear. Conclusion: The change of intra-aneurysmal pressure curve reflected the load on aneurysmal wall after EVE, and can also help to determine the endoleak existence

Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes

DEFF Research Database (Denmark)

Thorup, J M; Cortes, D; Visfeldt, J

1999-01-01

PURPOSE: Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides...... studied 17 nonpalpable testes in 10 patients 1 year and 7 months to 13(1/2) years old. Results of testicular biopsies of 13 intra-abdominal testes taken at stages 1 and 2 of surgery were available for histological comparison. RESULTS: Median number of spermatogonia per tubular cross section...... of the biopsies taken at stage 2 was slightly lower (0.03) compared to the median number at stage 1 (0.06) of the operation but this difference was not significant (p = 0.2031). CONCLUSIONS: Our study shows that the spermatogonia may survive clipping and division of the spermatic vessels, although the number...

Effect of Gender on the Total Abdominal Fat, Intra-Abdominal Adipose Tissue and Abdominal Sub-Cutaneous Adipose Tissue among Indian Hypertensive Patients.

Science.gov (United States)

Sahoo, Jaya Prakash; Kumari, Savita; Jain, Sanjay

2016-04-01

Abdominal obesity is a better marker of adverse metabolic profile than generalized obesity in hypertensive subjects. Further, gender has effect on adiposity and its distribution. Effect of gender on obesity and the distribution of fat in different sub-compartments of abdomen among Indian hypertensive subjects. This observational study included 278 adult subjects (Males-149 & Females-129) with essential hypertension from a tertiary care centre in north India over one year. A detailed history taking and physical examination including anthropometry were performed in all patients. Total Abdominal Fat (TAF) and abdominal adipose tissue sub-compartments like Intra-Abdominal Adipose Tissue (IAAT) and Sub-Cutaneous Adipose Tissue (SCAT) were measured using the predictive equations developed for Asian Indians. Female hypertensive subjects had higher Body Mass Index (BMI) with more overweight (BMI ≥ 23kg/m(2)), and obesity (BMI≥ 25 kg/m(2)). Additionally, they had higher prevalence of central obesity based on both Waist Circumference (WC) criteria (WC≥ 90 cm in males and WC≥ 80 cm in females) and TAF criteria {≥245.6 cm(2) (males) and ≥203.46 cm(2) (females)} than male patients. But there was no difference in the prevalence of central obesity based on Waist Hip Ratio (WHR) criteria (WHR ≥0.90 in males and WHR ≥ 0.85 in females) between two genders. High TAF & IAAT were present in more females although there was no difference in the distribution of high SCAT between two genders. Female hypertensive subjects were more obese with higher abnormal TAF & IAAT compared to male patients. However, there was no difference in the distribution of high SCAT among them.

Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes

DEFF Research Database (Denmark)

Thorup, J M; Cortes, Dina; Visfeldt, J

1999-01-01

Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides adequate...

Pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications in refractory peritoneal dialysis-related peritonitis.

Science.gov (United States)

Hsu, Chih-Yang; Huang, Wei-Chieh; Huang, Chun-Kai; Huang, Chien-Wei; Chou, Nan-Hua; Lee, Po-Tsang; Fang, Hua-Chang; Chou, Kang-Ju; Chen, Chien-Liang

2015-11-01

Some patients with refractory peritoneal dialysis-related peritonitis continue to develop intra-abdominal complications despite removal of the peritoneal catheter. Repeated percutaneous drainage or open laparotomy is often required, and mortality is not uncommon. The benefits of pelvic drainage placement during catheter removal in decreasing these complications and interventions remain unproven. Forty-six patients with refractory peritonitis who underwent removal of a Tenckhoff catheter between 1991 and 2013 were reviewed retrospectively. Twelve patients had pelvic drainage using closed active suction devices during catheter removal (drainage group). The remaining 34 patients underwent catheter removal without drainage (non-drainage group). The outcomes measured were the development of intra-abdominal complications and the requirement for repeated percutaneous drainage or open laparotomy within 90 days after the catheter removal. Baseline characteristics were similar with the exception of a higher median number of previous peritonitis episodes in the drainage group compared with the non-drainage group (2 vs 0, P = 0.02). During the follow-up period, intra-abdominal complications occurred in 15 (44%) of 34 patients in the non-drainage group, compared with one (8%) of 12 patients in the drainage group (P = 0.03). Twelve (35%) patients in the non-drainage group required repeated percutaneous drainage or open laparotomy for management, compared with zero (0%) patients in the drainage group (P = 0.02). Drain tubes were removed at a median of 6 days (inter-quartile range: 5-10) without complications. In the management of refractory peritonitis, pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications and invasive interventions. © 2015 Asian Pacific Society of Nephrology.

Open abdomen management of intra-abdominal infections: analysis of a twenty-year experience.

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Rausei, Stefano; Dionigi, Gianlorenzo; Boni, Luigi; Rovera, Francesca; Minoja, Giulio; Cuffari, Salvatore; Dionigi, Renzo

2014-06-01

No conclusive results on the efficacy and timing of open abdomen (OA) are available, particularly in the setting of intra-abdominal infections. We analyzed outcomes and risk factors retrospectively in a large series of patients managed with an OA during the past 20 y in an effort to clarify this issue. We reviewed the records of 133 patients who underwent treatment with an OA, considering factors related to patient, disease, medical management, and surgical treatment. The end points of the bi-variable analysis were 1-y mortality, calculated from the time of an initial OA procedure, and definitive fascial closure. Most patients (112/133) managed with an OA had one of several types of peritonitis. Many patients had severe clinical conditions (mean Acute Physiology and Chronic Health Evaluation [APACHE] II score was almost 9 points for the study population). With regard to surgical management, the mean (+SD) number of abdominal revisions was 5.9+9.3 during a mean duration of treatment with an OA of 14.3+11.6 d. The overall mortality in the study was 26% (35/133). Bi-variable analysis revealed factors associated with overall mortality to be age, renal and respiratory co-morbidities, edema on an initial chest radiograph, blood pressure, blood glucose and creatinine concentrations; and APACHE II score. The rate of definitive fascial closure was 75% (100/133). Factors associated negatively with fascial closure were respiratory co-morbidity, edema on a first chest radiograph, post-operative mesenteric ischemia as an indication for OA, blood glucose and creatinine concentrations, and duration of an OA. Patients' pre-operative clinical status influences strongly their response to surgical treatment. The management of OA does not affect adversely the survival of patients with intra-abdominal infections, but factors related to the management of OA (duration of OA) seem to affect the possibility of definitive fascial closure.

New scoring system for intra-abdominal injury diagnosis after blunt trauma.

Science.gov (United States)

Shojaee, Majid; Faridaalaee, Gholamreza; Yousefifard, Mahmoud; Yaseri, Mehdi; Arhami Dolatabadi, Ali; Sabzghabaei, Anita; Malekirastekenari, Ali

2014-01-01

An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi-square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor. Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (scoretool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.

Intestinal fatty acid binding protein as a marker for intra-abdominal pressure-related complications in patients admitted to the intensive care unit; study protocol for a prospective cohort study (I-Fabulous study)

NARCIS (Netherlands)

K.D. Strang; O.J.F. van Waes (Oscar); B. van der Hoven (Ben); S. Ali (Samir); M.H.J. Verhofstad (Michiel); P. Pickkers (Peter); E.M.M. van Lieshout (Esther)

2015-01-01

textabstractBackground: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have detrimental effects on all organ systems and are associated with increased morbidity and mortality in critically ill patients admitted to an intensive care unit. Intra-bladder measurement of the

Intestinal fatty acid binding protein as a marker for intra-abdominal pressure-related complications in patients admitted to the intensive care unit; study protocol for a prospective cohort study (I-Fabulous study)

NARCIS (Netherlands)

Strang, S.G.; Waes, O.J. van; Hoven, B. van der; Ali, S.; Verhofstad, M.H.J.; Pickkers, P.; Lieshout, E.M. van

2015-01-01

BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have detrimental effects on all organ systems and are associated with increased morbidity and mortality in critically ill patients admitted to an intensive care unit. Intra-bladder measurement of the

Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

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Charles Hoffmann

2016-02-01

Full Text Available Antimicrobial stewardship programs (ASPs focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics.

Acute appendicitis after blunt abdominal trauma

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Marjan Joudi

2012-02-01

Full Text Available Appendecitis is one of the most frequent surgeries. Inflammation of appendix may be due to variable causes such as fecalit, hypertrophy of Peyer’s plaques, seeds of fruits and parasites. In this study we presented an uncommon type of appendicitis which occurred after abdominal blunt trauma. In this article three children present who involved acute appendicitis after blunt abdominal trauma. These patients were 2 boys (5 and 6-year-old and one girl (8-year-old who after blunt abdominal trauma admitted to the hospital with abdominal pain and symptoms of acute abdomen and appendectomy had been done for them.Trauma can induce intramural hematoma at appendix process and may cause appendicitis. Therefore, physicians should be aware of appendicitis after blunt abdominal trauma

CT findings of benign omental lesions following abdominal cancer surgery

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Lee, Sang Yun; Kim, Dong Won; Cho, Jin Han; Kwon, Hee Jin; Ha, Dong Ho; Oh, Jong Young [Diagnostic Radiology, Dong-A University College of Medicine, Busan (Korea, Republic of)

2016-07-15

The greater omentum is the largest peritoneal fold and can be the origin of primary pathologic conditions, as well as a boundary and conduit for disease processes. Most diseases involving the omentum manifest with nonspecific and overlapping features on computed tomography (CT). In particular, varying benign disease processes of traumatic, inflammatory, vascular, or systemic origin can occur in the omentum during the follow-up period after surgery for intra-abdominal malignancy. It can be challenging for radiologists due to various spectrum of CT findings. Thus, we reviewed the CT findings of various benign omental lesions after surgery for intra-abdominal malignancy.

Impact of Prolonged Periods Classroom Settings in Intra-abdominal fat area and its Consequence on Posture/Balance Control among Algerian Childhood College Preparatory School.

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Zerf Mohammed

2017-08-01

Full Text Available The play has been shown to help children adjust to the school setting and to enhance children's learning [1]. Since this theory, the current study was designed to examine the significance of mechanical effects of intra-abdominal on posture/balance control among the Algerian Childhood Primary Schools. Since our teachers emphasise the good classroom settings as a discipline pedagogical aspect of success learning. While High-quality educational programs for children in preschool and kindergarten have play at the centre of the curriculum [2]. Our interventions in this study aimed to examine Impact of Prolonged Periods Classroom Settings in Intra-abdominal fat area and its Consequence on Posture/Balance Control among Algerian Childhood Preparatory Schools. for the purpose, a total of 61 schoolboys of Slimane provinces Naama, Municipality Mecheria, Algeria male gender their average age 5±1.52 years distributed into two homogeneous groups, according to them, school attendance (kindergarten School (29 boys - preschool (32 boys. Tested by saving tests (Body Fat Percentage-Abdominal circumference - Modified Bass Test of Dynamic Balance and standing balance. Based on the analysis statistics, we confirm: • Prolonged periods classroom settings increase Intra-Abdominal Fat which represents big risk posture/balance control. • Primary schools posture needs an interactive play method Learning classroom to improve body imbalance as health benefits physical activities. Based on the differences acquired by the research team, we emphasise that prolonged periods classroom settings Primary Schools increase the intra-abdominal which owing to the weakness of skeletal muscle fatigue and abnormal pathological alignment. While as a recommendation pedagogy practised, we suggested to our teachers, who work with these children to know that the balanced posture requires more energy in the class, Considering that our student seat more than 6 hours a day, 30 per week, and

Experimental intra-abdominal hypertension influences airway pressure limits for lung protective mechanical ventilation.

Science.gov (United States)

Cortes-Puentes, Gustavo A; Cortes-Puentes, Luis A; Adams, Alexander B; Anderson, Christopher P; Marini, John J; Dries, David J

2013-06-01

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) may complicate monitoring of pulmonary mechanics owing to their impact on the respiratory system. However, recommendations for mechanical ventilation of patients with IAH/ACS and the interpretation of thoracoabdominal interactions remain unclear. Our study aimed to characterize the influence of elevated intra-abdominal pressure (IAP) and positive end-expiratory pressure (PEEP) on airway plateau pressure (PPLAT) and bladder pressure (PBLAD). Nine deeply anesthetized swine were mechanically ventilated via tracheostomy: volume-controlled mode at tidal volume (VT) of 10 mL/kg, frequency of 15, inspiratory-expiratory ratio of 1:2, and PEEP of 1 and 10 cm H2O (PEEP1 and PEEP10, respectively). A tracheostomy tube was placed in the peritoneal cavity, and IAP levels of 5, 10, 15, 20, and 25 mm Hg were applied, using a continuous positive airway pressure system. At each IAP level, PBLAD and airway pressure measurements were performed during both PEEP1 and PEEP10. PBLAD increased as experimental IAP rose (y = 0.83x + 0.5; R = 0.98; p < 0.001 at PEEP1). Minimal underestimation of IAP by PBLAD was observed (-2.5 ± 0.8 mm Hg at an IAP of 10-25 mm Hg). Applying PEEP10 did not significantly affect the correlation between experimental IAP and PBLAD. Approximately 50% of the PBLAD (in cm H2O) was reflected by changes in PPLAT, regardless of the PEEP level applied. Increasing IAP did not influence hemodynamics at any level of IAP generated. With minimal underestimation, PBLAD measurements closely correlated with experimentally regulated IAP, independent of the PEEP level applied. For each PEEP level applied, a constant proportion (approximately 50%) of measured PBLAD (in cm H2O) was reflected in PPLAT. A higher safety threshold for PPLAT should be considered in the setting of IAH/ACS as the clinician considers changes in VT. A strategy of reducing VT to cap PPLAT at widely recommended values may not be

Nódulo umbilical metastático (nódulo da Irmã Maria José: um sinal de alerta para tumoração maligna intra-abdominal - relato de caso Sister Mary Joseph's nodule: a warning sign for intra-abdominal malignant tumors. A case report

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Homero Soares Fogaça

2003-07-01

Full Text Available O nódulo da "Irmã Maria José" é tumor metastático que acomete a cicatriz umbilical e pode ser a primeira evidência de neoplasia intra-abdominal disseminada. Os autores relatam o caso de uma paciente com o nódulo da "Irmã Maria José" no qual o diagnóstico do tumor primário só foi possível por meio dos testes imuno-histoquímicos da lesão biopsiada da pele.The umbilical metastatic tumoral nodule, Sister Mary Joseph's nodule, is a rare clinical sign indicative of disseminated intra-abdominal tumor, and may be the first evidence of malignancy. The authors report a case of a patient with umbilical metastatic nodule in whom the diagnosis of the primary tumor was possible by immunohistochemistry of the lesion biopsy.

Pancreaticojejunal bridge-anastomosis: a novel option for surgeon to preserve pancreatic body and tail in urgent reoperation for intra-abdominal massive hemorrhage after pancreaticoduodenectomy.

Science.gov (United States)

Xu, Jin; Dai, Xianwei; Bu, Xianmin; Gao, Feng; Zhang, Xiaobo

2010-10-01

Postoperative intra-abdominal massive bleeding is a rare and life-threatening complication associated with pancreaticoduodenectomy. Completion pancreatectomy (CP) was usually performed during reexploration for the complication. The management could decrease the complications, such as the pancreatic leakage or intraluminal infection after reexploration, but could increase mortality during the perioperative period. It also could result in loss of pancreatic function forever. This study evaluated an alternative surgical management for intra-abdominal massive hemorrhage to prevent pancreas function, simplify the surgical processes, and decrease the mortality of relaparotomy. Outcome after pancreaticojejunal bridge-anastomosis (PJBA) performed between January 2006 and June 2009 was compared with that after CP performed between February 1984 and December 2005. Between February 1984 and June 2009, 963 patients underwent the Whipple procedure (PD) or pylorus-preserving pancreaticoduodectomy (PPPD). Pancreatic leakage occurred in 103 patients (10.7%); 22 cases (21.4%) developed into intra-abdominal massive bleeding. Nonsurgical procedures of transarterial embolization (TAE) were performed in ten (45.45%) patients, of whom one died (10%). Twelve (54.55%) underwent reoperation. Five had CP with one death (20%). Pancreatic remnant was preserved by pancreaticojejunal bridge-anastomosis (PJBA) in seven patients with no deaths. The reexploration time was 340 +/- 48.2 min vs. 247.9 +/- 40.8 min (P endocrine insufficiency ("brittle" diabetes) and diarrhea (exocrine insufficiency). There were no evidences of exocrine and endocrine insufficiency in patients with PJBA. Pancreaticojejunal bridge-anastomosis is an easy, simple, and safe procedure for intra-abdominal massive hemorrhage associated with pancreaticoduodenectomy. It could decrease the mortality of reoperation and preserve the pancreatic function.

Inhibition of skeletal muscle protein synthesis in septic intra-abdominal abscess

International Nuclear Information System (INIS)

Vary, T.C.; Siegel, J.H.; Tall, B.D.; Morris, J.G.; Smith, J.A.

1988-01-01

Chronic sepsis is always associated with profound wasting leading to increased release of amino acids from skeletal muscle. Net protein catabolism may be due to decreased rate of synthesis, increased rate of degradation, or both. To determine whether protein synthesis is altered in chronic sepsis, the rate of protein synthesis in vivo was estimated by measuring the incorporation of [ 3 H]-phenylalanine in skeletal muscle protein in a chronic (5-day) septic rat model induced by creation of a stable intra-abdominal abscess using an E. coli + B. fragilis-infected sterile fecal-agar pellet as foreign body nidus. Septic rats failed to gain weight at rates similar to control animals, therefore control animals were weight matched to the septic animals. The skeletal muscle protein content in septic animals was significantly reduced relative to control animals (0.18 +/- 0.01 vs. 0.21 +/- 0.01 mg protein/gm wet wt; p less than 0.02). The rate of incorporation of [ 3 H]-phenylalanine into skeletal muscle protein from control animals was 39 +/- 4 nmole/gm wet wt/hr or a fractional synthetic rate of 5.2 +/- 0.5%/day. In contrast to control animals, the fractional synthetic rate in septic animals (2.6 +/- 0.2%/day) was reduced by 50% compared to control animals (p less than 0.005). The decreased rate of protein synthesis in sepsis was not due to an energy deficit, as high-energy phosphates and ATP/ADP ratio were not altered. This decrease in protein synthesis occurred even though septic animals consumed as much food as control animals

[Orbital inflammation].

Science.gov (United States)

Mouriaux, F; Coffin-Pichonnet, S; Robert, P-Y; Abad, S; Martin-Silva, N

2014-12-01

Orbital inflammation is a generic term encompassing inflammatory pathologies affecting all structures within the orbit : anterior (involvement up to the posterior aspect of the globe), diffuse (involvement of intra- and/or extraconal fat), apical (involvement of the posterior orbit), myositis (involvement of only the extraocular muscles), dacryoadenitis (involvement of the lacrimal gland). We distinguish between specific inflammation and non-specific inflammation, commonly referred to as idiopathic inflammation. Specific orbital inflammation corresponds to a secondary localization of a "generalized" disease (systemic or auto-immune). Idiopathic orbital inflammation corresponds to uniquely orbital inflammation without generalized disease, and thus an unknown etiology. At the top of the differential diagnosis for specific or idiopathic orbital inflammation are malignant tumors, represented most commonly in the adult by lympho-proliferative syndromes and metastases. Treatment of specific orbital inflammation begins with treatment of the underlying disease. For idiopathic orbital inflammation, treatment (most often corticosteroids) is indicated above all in cases of visual loss due to optic neuropathy, in the presence of pain or oculomotor palsy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Vegetarian diet reduces the risk of hypertension independent of abdominal obesity and inflammation: a prospective study.

Science.gov (United States)

Chuang, Shao-Yuan; Chiu, Tina H T; Lee, Chun-Yi; Liu, Ting-Ting; Tsao, Chwen Keng; Hsiung, Chao A; Chiu, Yen-Feng

2016-11-01

A vegetarian diet may prevent elevation of blood pressures and lower the risk for hypertension through lower degrees of obesity, inflammation, and insulin resistance. This study investigated the association between a vegetarian diet and hypertension incidence in a cohort of Taiwanese adult nonsmokers and examined whether this association was mediated through inflammation, abdominal obesity, or insulin resistance (using fasting glucose as a proxy). This matched cohort study was from the 1994-2008 MJ Health Screening Database. Each vegetarian was matched with five nonvegetarians by age, sex, and study site. The analysis included 4109 nonsmokers (3423 nonvegetarians and 686 vegetarians), followed for a median of 1.61 years. The outcome includes hypertension incidence, as well as SBP and DBP levels. Regression analysis was performed to assess the association between vegetarian diet and hypertension incidence or future blood pressure levels in the presence/absence of potential mediators. Vegetarians had a 34% lower risk for hypertension, adjusting for age and sex (odds ratio: 0.66, 95% confidence interval: 0.50-0.87; SBP: -3.3 mmHg, P vegetarian diet and hypertension appeared to be consistent across age groups. Taiwanese vegetarians had lower incidence of hypertension than nonvegetarians. Vegetarian diets may protect against hypertension beyond lower abdominal obesity, inflammation, and insulin resistance.

In women with polycystic ovary syndrome and obesity, loss of intra-abdominal fat is associated with resumption of ovulation

NARCIS (Netherlands)

Kuchenbecker, W.K.H.; Groen, H.; van Asselt, S.J.; Bolster, J.H.T.; Zwerver, J.; Slart, R.H.J.; van der Jagt, E.J.; Kobold, A.C.M.; Wolffenbuttel, B.H.R.; Land, J.A.; Hoek, A.

BACKGROUND: It is not clear why some anovulatory women with polycystic ovary syndrome (PCOS) and obesity resume ovulation and others remain anovulatory after weight loss. The objective of this study was to compare the changes in body fat distribution and specifically intra-abdominal fat (IAF) and

A Novel Diagnostic Aid for Detection of Intra-Abdominal Adhesions to the Anterior Abdominal Wall Using Dynamic Magnetic Resonance Imaging.

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Randall, David; Fenner, John; Gillott, Richard; Ten Broek, Richard; Strik, Chema; Spencer, Paul; Bardhan, Karna Dev

2016-01-01

Introduction. Abdominal adhesions can cause serious morbidity and complicate subsequent operations. Their diagnosis is often one of exclusion due to a lack of a reliable, non-invasive diagnostic technique. Development and testing of a candidate technique are described below. Method. During respiration, smooth visceral sliding motion occurs between the abdominal contents and the walls of the abdominal cavity. We describe a technique involving image segmentation and registration to calculate shear as an analogue for visceral slide based on the tracking of structures throughout the respiratory cycle. The presence of an adhesion is attributed to a resistance to visceral slide resulting in a discernible reduction in shear. The abdominal movement due to respiration is captured in sagittal dynamic MR images. Results. Clinical images were selected for analysis, including a patient with a surgically confirmed adhesion. Discernible reduction in shear was observed at the location of the adhesion while a consistent, gradually changing shear was observed in the healthy volunteers. Conclusion. The technique and its validation show encouraging results for adhesion detection but a larger study is now required to confirm its potential.

A Novel Diagnostic Aid for Detection of Intra-Abdominal Adhesions to the Anterior Abdominal Wall Using Dynamic Magnetic Resonance Imaging

Science.gov (United States)

Randall, David; Fenner, John; Gillott, Richard; ten Broek, Richard; Strik, Chema; Spencer, Paul; Bardhan, Karna Dev

2016-01-01

Introduction. Abdominal adhesions can cause serious morbidity and complicate subsequent operations. Their diagnosis is often one of exclusion due to a lack of a reliable, non-invasive diagnostic technique. Development and testing of a candidate technique are described below. Method. During respiration, smooth visceral sliding motion occurs between the abdominal contents and the walls of the abdominal cavity. We describe a technique involving image segmentation and registration to calculate shear as an analogue for visceral slide based on the tracking of structures throughout the respiratory cycle. The presence of an adhesion is attributed to a resistance to visceral slide resulting in a discernible reduction in shear. The abdominal movement due to respiration is captured in sagittal dynamic MR images. Results. Clinical images were selected for analysis, including a patient with a surgically confirmed adhesion. Discernible reduction in shear was observed at the location of the adhesion while a consistent, gradually changing shear was observed in the healthy volunteers. Conclusion. The technique and its validation show encouraging results for adhesion detection but a larger study is now required to confirm its potential. PMID:26880884

Delayed radiation-induced inflammation accompanying a marked carbohydrate antigen 19-9 elevation in a patient with resected pancreatic cancer

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Mattes, Malcolm D.; Cardinal, Jon S.; Jacobson, Geraldine M. [West Virginia University School of Medicine, Morgantown (United States)

2016-06-15

Although carbohydrate antigen (CA) 19-9 is a useful tumor marker for pancreatic cancer, it can also become elevated from a variety of benign and malignant conditions. Herein we describe an unusual presentation of elevated CA 19-9 in an asymptomatic patient who had previously undergone adjuvant chemotherapy and radiation therapy for resected early stage pancreatic cancer. The rise in CA 19-9 might be due to delayed radiation-induced inflammation related to previous intra-abdominal radiation therapy with or without radiation recall induced by gemcitabine. After treatment with corticosteroids the CA 19-9 level decreased to normal, and the patient has not developed any evidence of recurrent cancer to date.

Bladder distension as a cause of abdominal compartment syndrome

International Nuclear Information System (INIS)

Yasir, M.; Hoda, M.Q.

2018-01-01

Abdominal compartment syndrome (ACS) is increasingly identified in critically ill patient and its harmful effects are well documented. The disparity among the pressure, volume in abdominal cavity and its contents, results in ACS. The actual incidence of ACS is not known. However, it has been observed predominantly in patients with severe blunt and penetrating abdominal trauma, ruptured abdominal aortic aneurysms, retro- and intra-peritoneal hemorrhage, pneumoperitoneum, neoplasm, pancreatitis, ascites and multiple bone fracture. We present a case of 40-year female who underwent emergency cesarean section and developed abdominal compartment syndrome due to urinary bladder distension secondary to blockade of urinary catheter with blood clots. This is a very unusual cause of ACS. (author)

Surgical removal of intra-abdominal intrauterine devices at one center in a 20-year period.

Science.gov (United States)

Ertopcu, Kenan; Nayki, Cenk; Ulug, Pasa; Nayki, Umit; Gultekin, Emre; Donmez, Aysegul; Yildirim, Yusuf

2015-01-01

To review 20 years of experience of the removal of intra-abdominal intrauterine devices (IUDs) and to compare the surgical methods used. In a retrospective study, charts dating from between September 1, 1992, and August 31, 2012, were reviewed. Patients were eligible for inclusion when they had an IUD surgically removed by minilaparotomy or laparoscopy at a tertiary referral center in Izmir, Turkey. Among the 36 eligible women, 18 (50%) had undergone laparoscopy and 18 (50%) had undergone minilaparotomy. Mean operation length was 55.3±6.3 minutes in the laparoscopy group and 29.1±4.2 minutes in the minilaparotomy group (P=0.008). Conversion to full laparotomy was necessary in 4 (22%) women in the laparoscopy group and 1 (6%) in the minilaparotomy group (P=0.02). Perioperative complications were observed in 5 (14%) women, with no difference in frequency between groups (P=0.09). Total cost of medical/surgical procedures was US$436.4±35.4 for the laparoscopy group and $323.4±21.3 for the minilaparotomy group (P=0.04). Minilaparotomy seems to be an important alternative to laparoscopy for the removal of intra-abdominal IUDs. This procedure should be an integral part of gynecologic surgical training. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

SU-E-J-133: Evaluation of Inter- and Intra-Fractional Pancreas Tumor Residual Motions with Abdominal Compression

International Nuclear Information System (INIS)

Li, Y; Shi, F; Tian, Z; Jia, X; Meyer, J; Jiang, S; Mao, W

2014-01-01

Purpose: Abdominal compression (AC) has been widely used to reduce pancreas motion due to respiration for pancreatic cancer patients undergoing stereotactic body radiotherapy (SBRT). However, the inter-fractional and intra-fractional patient motions may degrade the treatment. The purpose of this work is to study daily CBCT projections and 4DCT to evaluate the inter-fractional and intra-fractional pancreatic motions. Methods: As a standard of care at our institution, 4D CT scan was performed for treatment planning. At least two CBCT scans were performed for daily treatment. Retrospective studies were performed on patients with implanted internal fiducial markers or surgical clips. The initial motion pattern was obtained by extracting marker positions on every phase of 4D CT images. Daily motions were presented by marker positions on CBCT scan projection images. An adaptive threshold segmentation algorithm was used to extract maker positions. Both marker average positions and motion ranges were compared among three sets of scans, 4D CT, positioning CBCT, and conformal CBCT, for inter-fractional and intra-fractional motion variations. Results: Data from four pancreatic cancer patients were analyzed. These patients had three fiducial markers implanted. All patients were treated by an Elekta Synergy with single fraction SBRT. CBCT projections were acquired by XVI. Markers were successfully detected on most of the projection images. The inter-fractional changes were determined by 4D CT and the first CBCT while the intra-fractional changes were determined by multiple CBCT scans. It is found that the average motion range variations are within 2 mm, however, the average marker positions may drift by 6.5 mm. Conclusion: The patients respiratory motion variation for pancreas SBRT with AC was evaluated by detecting markers from CBCT projections and 4DCT, both the inter-fraction and intra-fraction motion range change is small but the drift of marker positions may be comparable

Intra-abdominal sepsis following pancreatic resection: incidence, risk factors, diagnosis, microbiology, management, and outcome.

Science.gov (United States)

Behrman, Stephen W; Zarzaur, Ben L

2008-07-01

Intra-abdominal sepsis (IAS) following pancreatectomy is associated with the need for therapeutic intervention and may result in mortality. We retrospectively reviewed patients developing IAS following elective pancreatectomy. Risk factors for the development of sepsis were assessed. The microbiology of these infections was ascertained. The number and type of therapeutic interventions required and infectious-related mortality were recorded. One hundred ninety-six patients had a pancreatectomy performed, 32 (16.3%) of who developed IAS. Infected abdominal collections were diagnosed and therapeutically managed at a mean of 11.8 days after the index procedure (range, 4-33). Eleven of 32 (34%) of these infections were diagnosed on or before postoperative day 6, 10 of who had Whipple procedures. Statistically significant risk factors included an overt pancreatic fistula (18.8% vs 5.5%) and a soft pancreatic remnant (74.2% vs 42.3%), but not the lack of intra-abdominal drainage, an antecedent immunocompromised state, postoperative hemorrhage, or the preoperative placement of a biliary stent. Fifty-five per cent had polymicrobial infections and 26 per cent of isolates were resistant organisms. Nineteen per cent and 48 per cent of patients had an isolate positive for fungus and a Gram-positive organism, respectively. Forty-seven therapeutic interventions were used, including 10 reoperations. Length of stay was significantly prolonged in those with IAS (28.5 vs 15.2 days) and mortality was higher (15.6% vs 1.8%). We conclude: 1) septic morbidity after pancreatectomy is associated with a soft pancreatic remnant and an overt pancreatic fistula and in this series resulted in a prolonged length of stay and a significant increase in procedure-related mortality; 2) infected fluid collections may occur very early in the postoperative period before frank abscess formation, and an early threshold for diagnostic imaging and/or therapeutic intervention should be entertained in those

A Novel Diagnostic Aid for Detection of Intra-Abdominal Adhesions to the Anterior Abdominal Wall Using Dynamic Magnetic Resonance Imaging

Directory of Open Access Journals (Sweden)

David Randall

2016-01-01

Full Text Available Introduction. Abdominal adhesions can cause serious morbidity and complicate subsequent operations. Their diagnosis is often one of exclusion due to a lack of a reliable, non-invasive diagnostic technique. Development and testing of a candidate technique are described below. Method. During respiration, smooth visceral sliding motion occurs between the abdominal contents and the walls of the abdominal cavity. We describe a technique involving image segmentation and registration to calculate shear as an analogue for visceral slide based on the tracking of structures throughout the respiratory cycle. The presence of an adhesion is attributed to a resistance to visceral slide resulting in a discernible reduction in shear. The abdominal movement due to respiration is captured in sagittal dynamic MR images. Results. Clinical images were selected for analysis, including a patient with a surgically confirmed adhesion. Discernible reduction in shear was observed at the location of the adhesion while a consistent, gradually changing shear was observed in the healthy volunteers. Conclusion. The technique and its validation show encouraging results for adhesion detection but a larger study is now required to confirm its potential.

Intra-abdominal pressure alterations after large pancreatic pseudocyst transcutaneous drainage

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Papavramidis Theodossis S

2009-06-01

Full Text Available Abstract Background Acute pancreatitis leads to abdominal hypertension and compartment syndrome. Weeks after the episodes pancreatic fluids sometimes organize to pseudocysts, fluid collections by or in the gland. Aims of the present study were to evaluate the intra-abdominal pressure (IAP induced by large pancreatic pseudocysts and to examine the effect of their transcutaneous drainage on IAP. Methods Twenty seven patients with a pancreatic pseudocyst were included. Nine patients with pseudocysts greater than 1l (group A had CT drainage and eighteen (volume less than 1l were the control group. The measurements of group A were taken 6 hours before and every morning after the drainage, while for group B, two measurements were performed, one at the day of the initial CT and one 7 days after. Abdominal compliance (Cabd was calculated. Data were analyzed using student's t-test. Results Baseline IAP for group A was 9.3 mmHg (S.D. 1.7 mmHg, while the first post-drainage day (PDD IAP was 5.1 mmHg (S.D. 0.7 mmHg. The second PDD IAP was 5.6 mmHg (S.D. 0.8 mmHg, the third 6.4 mmH (S.D. 1.2 mmHgg, the fourth 6.9 mmHg (S.D. 1.6 mmHg, the fifth 7.9 mmHg (S.D. 1.5 mmHg, the sixth 8.2 mmHg (S.D. 1.4 mmHg, and the seventh 8.2 mmHg (S.D. 1.5 mmHg. Group B had baseline IAP 8.0 mmHg (S.D. 1.2 mmHg and final 8.2 mmHg (S.D. 1.4 mmHg. Cabd after drainage was 185.6 ml/mmHg (SD 47.5 ml/mmHg. IAP values were reduced between the baseline and all the post-drainage measurements in group A. IAPs seem to stabilize after the 5th post-drainage day. Baseline IAP was higher in group A than in group B, while the two values, at day 7, were equivalent. Conclusion The drainage of large pancreatic pseudocyst reduces IAP. Moreover, the IAP seems to rise shortly after the drainage again, but in a way that it remains inferior to the initial value. More chronic changes to the IAP are related to abdominal cavity's properties and have to be further studied.

Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review

DEFF Research Database (Denmark)

Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

2014-01-01

INTRODUCTION: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. METHODS: A systematic review was conducted...... formation and physical function. RESULTS: A total of 50 publications were identified; 42 publications were excluded leaving eight publications counting a total of 578 patients for analysis. Generally, the scientific quality of the studies was poor. Use of abdominal binder revealed a non-significant tendency...... to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases...

Abdominal Compartment Syndrome

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Pınar Zeyneloğlu

2015-04-01

Full Text Available Intraabdominal hypertension and Abdominal compartment syndrome are causes of morbidity and mortality in critical care patients. Timely diagnosis and treatment may improve organ functions. Intra-abdominal pressure monitoring is vital during evaluation of the patients and in the management algorithms. The incidence, definition and risk factors, clinical presentation, diagnosis and management of intraabdominal hypertension and Abdominal compartment syndrome were reviewed here.

Relación entre la presión intrabdominal en diálisis peritoneal con las hernias y fugas The link between intra-abdominal pressure in peritoneal dialysis and hernias and fugues

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Concepción Blasco Cabañas

2012-06-01

±253 ml/m². Un 23.5 % tenían una presión intrabdominal mayor a 20 cm. de H2O. En sedestación la media fue de 28±5.5 cm. de H2O y en bipedestación de 43.7±5.3 cm. de H2O. Los enfermos con presión intrabdominal > 20 cm. H2O tenían más porcentaje de hernias (50% vs 12 % y fugas pericatéter (37 % vs. 12 %. Como principales conclusiones, podemos destacar que los niveles de presión intrabdominal de nuestros pacientes son algo más elevados que en otras series. A mayor edad, mayor comorbilidad y mayor índice de masa corporal, la presión intrabdominal es más elevada. Los enfermos con presión intrabdominal elevada presentaron más episodios de hernias y fugas.Normal intra-abdominal pressure is equal to atmospheric pressure (zero. In peritoneal dialysis the introduction of intra-peritoneal liquid increases intra-abdominal pressure. In various studies it is recommended that this does not exceed 16-20cm H2O. In addition to possible abdominal discomfort, high intra-abdominal pressure can be linked to problems with the abdominal wall, such as hernias and fugues, and have implications for peritoneal transport and ultrafiltration deficit. The aims of this study were the following: to find out the intra-abdominal pressure levels in the prevalent type of patients in peritoneal dialysis, to assess the factors influencing the values for this pressure and to study the relationship between intra-abdominal pressure and the development of hernias and fugues, retrospectively. A transversal, observational and retrospective study was conducted to measure intra-abdominal pressure in the prevalent, stable patients who had been on peritoneal dialysis for more than three months. Intra-abdominal pressure was measured using the method described by Durand: patient in a supine position, with diurnal peritoneal volume. The final intra-abdominal pressure is the average of the measurements taken during inspiration and expiration, is expressed in cm H2O and the volume drained is

Unusual causes of abdominal pain: sickle cell anemia.

Science.gov (United States)

Ahmed, Shahid; Shahid, Rabia K; Russo, Linda A

2005-04-01

Sickle cell disease is characterized by chronic hemolytic anemia and vaso-occlusive painful crises. The vascular occlusion in sickle cell disease is a complex process and accounts for the majority of the clinical manifestation of the disease. Abdominal pain is an important component of vaso-occlusive painful crises. It often represents a substantial diagnostic challenge in this population of patients. These episodes are often attributed to micro-vessel occlusion and infarcts of mesentery and abdominal viscera. Abdominal pain due to sickle cell vaso-occlusive crisis is often indistinguishable from an acute intra-abdominal disease process such as acute cholecystitis, acute pancreatitis, hepatic infarction, ischemic colitis and acute appendicitis. In the majority of cases, however, no specific cause is identified and spontaneous resolution occurs. This chapter will focus on etiologies, pathophysiology and management of abdominal pain in patients with sickle cell disease.

Effects of anabolic steroids on acute phase responses in intra-abdominal sepsis

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K. Mealy

1997-01-01

Full Text Available The acute phase response is an important adaptive response to sepsis and injury. As anabolic steroids increase protein synthesis we postulated that these agents might also increase hepatic acute phase protein synthesis. Male Wistar rats were pretreated with testosterone or danazol for 48 h prior to caecal ligation and puncture (CLP. Thirty-six h following surgery the animals were killed and blood taken for full blood count, total protein, albumin, α, β and γ globulin fractions on serum electrophoresis, complement C3 and transferrin levels. Danazol increased the α1, α2 and β1 globulin serum protein fractions in comparison with no surgery and CLP alone groups. These results indicate that danazol increases plasma acute phase proteins, as measured by electrophoresis, in this model of intra-abdominal sepsis.

Ultrasonographic evaluation of masses of the abdominal walls in children

International Nuclear Information System (INIS)

Cairo, J.L.B.; Marins, J.L.C.; Prando, A.; Pereira, R.M.

1988-01-01

The sonographic features of seven cases of masses of the abdominal wall in children were reviewed. The sonographic manifestations of two cases of lipoma, two cases of abscess (one with intra-abdominal component), one case of lymph angioma, one case of capillary hemangioma and one due to a secondary involvement of a malignant retroperitoneal teratoma are presented. Ultrasound proved to be very useful modality in order to show the topography and the real extent of the disease. (author)

Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra-abdominal Infections: A Retrospective Analysis on 111 Cases.

Science.gov (United States)

Rausei, Stefano; Pappalardo, Vincenzo; Ruspi, Laura; Colella, Antonio; Giudici, Simone; Ardita, Vincenzo; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

2018-03-01

Time to source control plays a determinant prognostic role in patients having severe intra-abdominal infections (IAIs). Open abdomen (OA) management became an effective treatment option for peritonitis. Aim of this study was to analyze the correlation between time to source control and outcome in patients presenting with abdominal sepsis and treated by OA. We retrospectively analyzed 111 patients affected by abdominal sepsis and treated with OA from May 2007 to May 2015. Patients were classified according to time interval from first patient evaluation to source control. The end points were intra-hospital mortality and primary fascial closure rate. The in-hospital mortality rate was 21.6% (24/111), and the primary fascial closure rate was 90.9% (101/111). A time to source control ≥6 h resulted significantly associated with a poor prognosis and a lower fascial closure rate (mortality 27.0 vs 9.0%, p = 0.04; primary fascial closure 86 vs 100%, p = 0.02). We observed a direct increase in mortality (and a reduction in closure rate) for each 6-h delay in surgery to source control. Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm.

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Coleman, Tanner J; Nygaard, Ingrid E; Holder, Dannielle N; Egger, Marlene J; Hitchcock, Robert

2015-08-01

The objective was to describe the intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold. Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22-59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP. There were no statistically significant differences in the mean maximal IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean maximal IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand, but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking). Our results support recommending this series of introductory Pilates exercises, including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long-term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health.

Intra-abdominal Pressure during Pilates: Unlikely to Cause Pelvic Floor Harm

Science.gov (United States)

Coleman, Tanner J.; Holder, Dannielle N.; Egger, Marlene J.; Hitchcock, Robert

2015-01-01

Aims To describe intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold. Methods Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22 – 59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP. Results There were no statistically significant differences in mean max IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean max IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking). Conclusion Our results support recommending this series of introductory Pilates exercises including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health. PMID:25672647

Intra-abdominal and subcutaneous abdominal fat as predictors of cardiometabolic risk in a sample of Mexican children.

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González-Álvarez, C; Ramos-Ibáñez, N; Azprioz-Leehan, J; Ortiz-Hernández, L

2017-09-01

Few studies in Latin American paediatric populations have differentiated fat deposits in specific areas, such as intra-abdominal fat (IAF) and subcutaneous abdominal fat (SAF). Research in diverse populations is needed, as patterns of fat accumulation vary by ethnicity. The aim of this study was to determine whether IAF and/or SAF are related to cardiometabolic risk factors, independent of total body fat (TBF), in a group of Mexican schoolchildren. A cross-sectional study was conducted in Mexico City with 94 children aged between 5 and 11 years. IAF and SAF were assessed by magnetic resonance using two different estimation methods: (a) at the midpoint of lumbar vertebras 4 and 5 (L4-L5) and (b) the sum of the areas of four slices (L1-L2, L2-L3, L3-L4 and L4-L5, which will be referred to as 'total' IAF and SAF). TBF was measured by dual-energy X-ray absorptiometry. The following cardiometabolic risk factors were assessed: total cholesterol, low-density lipoprotein-cholesterol, triglycerides, glucose, insulin, high-density lipoprotein-cholesterol, blood pressure, insulin resistance, number of risk factors and metabolic syndrome score. After adjusting for sex, age and TBF, total SAF was related to the number of cardiometabolic risk factors and metabolic syndrome score. Although IAF at L4-L5 was also related to the number of cardiometabolic risk factors, there was evidence of collinearity with TBF. In this sample of Mexican schoolchildren, TBF and SAF, but not IAF, were associated with higher cardiometabolic risk.

Waist Circumference Adjusted for Body Mass Index and Intra-Abdominal Fat Mass

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Berentzen, Tina Landsvig; Ängquist, Lars; Kotronen, Anna; Borra, Ronald; Yki-Järvinen, Hannele; Iozzo, Patricia; Parkkola, Riitta; Nuutila, Pirjo; Ross, Robert; Allison, David B.; Heymsfield, Steven B.; Overvad, Kim; Sørensen, Thorkild I. A.; Jakobsen, Marianne Uhre

2012-01-01

Background The association between waist circumference (WC) and mortality is particularly strong and direct when adjusted for body mass index (BMI). One conceivable explanation for this association is that WC adjusted for BMI is a better predictor of the presumably most harmful intra-abdominal fat mass (IAFM) than WC alone. We studied the prediction of abdominal subcutaneous fat mass (ASFM) and IAFM by WC alone and by addition of BMI as an explanatory factor. Methodology/Principal Findings WC, BMI and magnetic resonance imaging data from 742 men and women who participated in clinical studies in Canada and Finland were pooled. Total adjusted squared multiple correlation coefficients (R2) of ASFM and IAFM were calculated from multiple linear regression models with WC and BMI as explanatory variables. Mean BMI and WC of the participants in the pooled sample were 30 kg/m2 and 102 cm, respectively. WC explained 29% of the variance in ASFM and 51% of the variance in IAFM. Addition of BMI to WC added 28% to the variance explained in ASFM, but only 1% to the variance explained in IAFM. Results in subgroups stratified by study center, sex, age, obesity level and type 2 diabetes status were not systematically different. Conclusion/Significance The prediction of IAFM by WC is not improved by addition of BMI. PMID:22384179

New scoring system for intra-abdominal injury diagnosis after blunt trauma

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Shojaee Majid

2014-02-01

Full Text Available 【Abstract】Objective: An accurate scoring system for intra-abdominal injury (IAI based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods: This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT admitted to the emergency department (ED of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β was given based on the contribution of each of them. Scoring system was developed based on the obtained total βof each factor. Results: Altogether 261 patients (80.1% male were enrolled (48 cases of IAI. A 24-point blunt abdominal trauma scoring system (BATSS was developed. Patients were divided into three groups including low (score<8, moderate (8≤score<12 and high risk (score≥12. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%. Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%. Conclusion: The present scoring system furnishes a

Recent advances in the management of abdominal compartment syndrome

International Nuclear Information System (INIS)

Saleem, T.B.; Ahmed, I.

2004-01-01

Abdominal compartment syndrome is a systemic syndrome involving derangement in cardiovascular hemodynamics, respiratory and renal function as a result of sustained increase in intra-abdominal pressure. This results in multi-organ failure requiring prompt action and treatment. Presentation can be acute, chronic and acute on chronic. Initial diagnosis is clinical, confirmed by measurement of urinary bladder pressure. Treatment is abdominal decompression by laparostomy and delayed abdominal closure. Awareness among the surgeons has increased because laparoscopy has resulted in determination of intra-abdominal pressure as a readily measurable quantity. They have been able to appreciate the benefit of abdominal decompression by performing repeated planned laparotomies for trauma. (author)

PCR-based detection of resistance genes in anaerobic bacteria isolated from intra-abdominal infections.

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Tran, Chau Minh; Tanaka, Kaori; Watanabe, Kunitomo

2013-04-01

Little information is available on the distribution of antimicrobial resistance genes in anaerobes in Japan. To understand the background of antimicrobial resistance in anaerobes involved in intra-abdominal infections, we investigated the distribution of eight antimicrobial resistance genes (cepA, cfiA, cfxA, ermF, ermB, mefA, tetQ, and nim) and a mutation in the gyrA gene in a total of 152 organisms (Bacteroides spp., Prevotella spp., Fusobacterium spp., Porphyromonas spp., Bilophila wadsworthia, Desulfovibrio desulfuricans, Veillonella spp., gram-positive cocci, and non-spore-forming gram-positive bacilli) isolated between 2003 and 2004 in Japan. The cepA gene was distributed primarily in Bacteroides fragilis. Gene cfxA was detected in about 9 % of the Bacteroides isolates and 75 % of the Prevotella spp. isolates and did not appear to contribute to cephamycin resistance. Two strains of B. fragilis contained the metallo-β-lactamase gene cfiA, but they did not produce the protein product. Gene tetQ was detected in about 81, 44, and 63 % of B. fragilis isolates, other Bacteroides spp., and Prevotella spp. isolates, respectively. The ermF gene was detected in 25, 13, 56, 64, and 16 % of Bacteroides spp., Prevotella spp., Fusobacterium spp., B. wadsworthia, and anaerobic cocci, respectively. Gene mefA was found in only 10 % of the B. fragilis strains and 3 % of the non-B. fragilis strains. Genes nim and ermB were not detected in any isolate. Substitution at position 82 (Ser to Phe) in gyrA was detected in B. fragilis isolates that were less susceptible or resistant to moxifloxacin. This study is the first report on the distribution of resistance genes in anaerobes isolated from intra-abdominal infections in Japan. We expect that the results might help in understanding the resistance mechanisms of specific anaerobes.

Fallopian Tube Herniation through Left Sided Abdominal Drain Site.

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Hussain, Khalid; Masood, Jovaria

2016-06-01

Intra-abdominal drains have been used since long to prevent intra-abdominal collection, and detect any anastomotic leaks. We report a case of left sided fallopian tube herniation from a left lower abdominal drain site in a 27-year female who underwent caesarian section for breach presentation. Several complications related to drain usage has been described but left sided fallopian tube prolapse through drain site has not been reported in literature.

Case Study: Intra-abdominal hypertension

African Journals Online (AJOL)

2014-05-05

May 5, 2014 ... his weight estimated to be 75 kg, with a body mass index (BMI) of 27.5kg/m2. ... critically ill adults).1 During the laparotomy, a diagnosis of intra- ... Peer reviewed. ..... Best practices for determining resting energy expenditure in.

Intra-amniotic Ureaplasma parvum-Induced Maternal and Fetal Inflammation and Immune Responses in Rhesus Macaques.

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Senthamaraikannan, Paranthaman; Presicce, Pietro; Rueda, Cesar M; Maneenil, Gunlawadee; Schmidt, Augusto F; Miller, Lisa A; Waites, Ken B; Jobe, Alan H; Kallapur, Suhas G; Chougnet, Claire A

2016-11-15

 Although Ureaplasma species are the most common organisms associated with prematurity, their effects on the maternal and fetal immune system remain poorly characterized.  Rhesus macaque dams at approximately 80% gestation were injected intra-amniotically with 10 7 colony-forming units of Ureaplasma parvum or saline (control). Fetuses were delivered surgically 3 or 7 days later. We performed comprehensive assessments of inflammation and immune effects in multiple fetal and maternal tissues.  Although U. parvum grew well in amniotic fluid, there was minimal chorioamnionitis. U. parvum colonized the fetal lung, but fetal systemic microbial invasion was limited. Fetal lung inflammation was mild, with elevations in CXCL8, tumor necrosis factor (TNF) α, and CCL2 levels in alveolar washes at day 7. Inflammation was not detected in the fetal brain. Significantly, U. parvum decreased regulatory T cells (Tregs) and activated interferon γ production in these Tregs in the fetus. It was detected in uterine tissue by day 7 and induced mild inflammation and increased expression of connexin 43, a gap junction protein involved with labor.  U. parvum colonized the amniotic fluid and caused uterine inflammation, but without overt chorioamnionitis. It caused mild fetal lung inflammation but had a more profound effect on the fetal immune system, decreasing Tregs and polarizing them toward a T-helper 1 phenotype. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Intra-abdominal pressure and procalcitonin are valid prognostic markers of acute pancreatitis severity (intra-abdominal pressure and procalcitonin

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Stojanović Maja

2017-01-01

Full Text Available Introduction. Early assessment of the severity and etiology of acute pancreatitis is very important for further treatment procedures. The aim of the study was to investigate the association between intra-abdominal pressure (IAP and procalcitonin as an indicator of severity of acute pancreatitis. Method. The IAP is measured every 12 hours through the urinary catheter placed in the bladder, in 65 patients with acute pancreatitis. Procalcitonin is measured within 24 hours of receipt of the patient, after 48 hours and after 78 hours. These values of procalcitonin and IAP were compared to each other and in relation to the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II scoring system. Patients with APACHE II score > 8 are defined with moderate and severe acute pancreatitis. Results. The values of IAP (18,1 ± 4,5 mmHg vs 8,9 ± 2,67 mmHg; p = 0,01 , procalcitonin (15,43 + 2,25 ng/ml vs 3,14 + 1,12 ng/ml; p =0,031 and APACHE II scoring system (17,3 ± 6,24 vs 6,5 ± 1,0; p = 0,013 were significantly higher in patients with moderate and severe acute pancreatitis. The increase in the value of IAP was accompanied by an increase in the value of procalcitonin (r = 0,581, p = 0,01. The sensitivity in the prediction of severe acute pancreatitis after 24 hours of receiving the patient is 91,7% for the IAP, 87,8% for procalcitonin and 84,9% for APACHE II scoring system. Conclusion. The increase in the value of the IAP is accompanied by an increase in the values of procalcitonin, also patients with higher values of APACHE II scoring sys­tem have higher values of IAP and procalcitonin. The values of IAP and procalcitonin can be used as markers of acute pancreatitis severity.

Whey and Casein Proteins and Medium-Chain Saturated Fatty Acids from Milk Do Not Increase Low-Grade Inflammation in Abdominally Obese Adults.

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Bohl, Mette; Bjørnshave, Ann; Gregersen, Søren; Hermansen, Kjeld

2016-01-01

Low-grade inflammation is involved in the development of diabetes and cardiovascular disease (CVD). Inflammation can be modulated by dietary factors. Dairy products are rich in saturated fatty acids (SFA), which are known to possess pro-inflammatory properties. However, different fatty acid compositions may exert different effects. Other components such as milk proteins may exert anti-inflammatory properties which may compensate for the potential negative effects of SFAs. Generally, the available data suggest a neutral role of dairy product consumption on inflammation. To investigate the effects of, and potential interaction between, a dietary supplementation with whey protein and milk fat, naturally enriched in medium-chain SFA (MC-SFA), on inflammatory markers in abdominal obese adults. The study was a 12-week, randomized, double-blinded, intervention study. Sixty-three adults were equally allocated to one of four groups which received a supplement of either 60 g/day whey or 60 g/day casein plus 63 g/day milk fat either high or low in MC-SFA content. Fifty-two subjects completed the study. Before and after the intervention, changes in plasma interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1RA), high-sensitive C-reactive protein (hsCRP), adiponectin, and monocyte chemoattractant protein-1 (MCP-1) were measured. Changes in inflammatory genes in the subcutaneous adipose tissue were also documented. There were no differences in circulating inflammatory markers between protein types or fatty acid compositions in abdominally obese subjects, with the exception of an increase in adiponectin in response to high compared to low MC-SFA consumption in women. We found that combined dairy proteins and MC-SFAs influenced inflammatory gene expression in adipose tissue, while no effect was detected by dairy proteins or MC-SFA per se. Whey protein compared with casein and MC-SFA-enriched milk fat did not alter circulating markers of low-grade inflammation in

The Cause of Unexpected Acute Abdomen and Intra-Abdominal Hemorrhage in 24-Week Pregnant Woman: Bochdalek Hernia

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Yavuz Savas Koca

2016-01-01

Full Text Available Bochdalek hernia (BH is the most common type of congenital diaphragm hernia and is rarely seen in adults. In adult patients, BH often remains asymptomatic or presents with nondiagnostic symptoms and may lead to complications, though rarely. The necrosis and perforations occurring in the hernia may lead to mortality. In this report, we present a 34-year-old pregnant woman at 24 gestational weeks who presented with Bochdalek hernia causing gastric volvulus associated with perforation and intra-abdominal hemorrhage associated with splenic rupture.

Safety and Efficacy of Tissue Plasminogen Activator and DNase for Complicated Pleural Effusions Secondary to Abdominal Pathology.

Science.gov (United States)

Majid, Adnan; Ochoa, Sebastian; Chatterji, Sumit; Fernandez-Bussy, Sebastian; Kheir, Fayez; Rivera, Estefania; Cheng, George; Folch, Erik

2017-03-01

Exudative pleural effusions may arise secondary to inflammation of intra-abdominal structures. Pleural space loculations can complicate these effusions, preventing adequate chest tube drainage and leading to consideration of surgical intervention. Previous studies have demonstrated that intrapleural administration of tissue plasminogen activator (tPA) combined with human recombinant DNase can improve fluid drainage and reduce surgery for patients with loculated parapneumonic effusions; however, the efficacy of this treatment has not been evaluated for complicated pleural effusions attributed to intra-abdominal inflammation. We assessed the safety and efficacy of tPA/DNase for 17 pleural effusions associated with nonmalignant intra-abdominal pathology that did not drain adequately after placement of one or more chest tubes. Efficacy was measured by comparing post- to pretreatment fluid drainage rates, volumetric assessment of pleural fluid on radiographic images before and after treatment, and clinical improvement, including the need for surgical intervention. Symptomatic relief was assessed using the Borg scale for breathlessness. After a median of two doses of tPA/DNase, 23.5% of patients had chest pain and none had pleural bleeding. The volume of pleural fluid drained increased from a median of 325 ml to 890 ml per 24 hours after therapy (P = 0.018). The area of pleural space opacity on chest radiographs decreased from a median of 42.8-17.8% of the hemithorax (P = 0.001). tPA/DNase reduced the pleural fluid volume on chest computed tomographic imaging from a median of 294.4 ml to 116.1 ml. Borg scores improved from a median of 3 (interquartile range = 1-6) to 0 (interquartile range = 0-2) after therapy (P = 0.001). The median duration of chest tube placement and hospital stay were 4 and 11 days, respectively. Two patients required surgical intervention for lung entrapment. Overall, treatment was considered successful for 88.2% of patients

ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSING INTRA-ABDOMINAL LESIONS- A 6-YEAR RETROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL IN MANIPUR

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Ratan Konjengbam

2017-07-01

Full Text Available BACKGROUND Fine-Needle Aspiration Cytology (FNAC is a widely used method, which is accurate and safe in a readily palpable masses. But, in those inaccessible lesions and deeper organs are safely aspirated using fine needle radiological procedure like ultrasound or computed tomography guided. The aim of the study is to assess the utility of FNAC in the diagnosis of intra-abdominal lesions and different pattern of lesions in particular to the sites. MATERIALS AND METHODS This retrospective study was done in the Department of Pathology, Regional Institute of Medical Sciences (RIMS, Imphal, between June 2010 and June 2016. The study included 128 intra-abdominal masses. Giemsa and Papanicolaou’s stains were used. The cytological diagnosis was correlated with clinical and radiological data to arrive at a final diagnosis. RESULTS Reports on FNAC smears were retrospectively analysed, which had been done in various anatomic sites- liver (70 cases, colon (19 cases, gallbladder (17 cases, mesenteric lymph nodes (12 cases, ovary (3 cases, adrenals (2 cases and 1 case each of pancreas, peritoneal wall, pelvic, suprapubic and flank masses. The mean age was 42.16 years with M:F of 1.3:1. The diagnostic yield was 85.2% in combination for Ultrasound Guided (USG and Computed Tomography (CT guided aspiration. The smears were classified as benign neoplastic, malignant neoplastic, non-neoplastic, inconclusive and unsatisfactory for interpretation. There were 79 (61.7% malignant neoplastic lesion, 5 (3.9% benign neoplastic lesion, 25 (19.5% non-neoplastic lesion, one (0.7% inconclusive lesions and 18 (14.1% unsatisfactory smears. The liver and the colon were the most common sites. Adenocarcinomas and Hepatocellular Carcinoma (HCC were the most common malignant lesions comprising of 35 (44.3% and 25 (31.6% of the total malignant lesions diagnosed. CONCLUSION Intra-abdominal FNA is a simple, economical and a safe procedure with high sensitivity, specificity and

A Novel Diagnostic Aid for Detection of Intra-Abdominal Adhesions to the Anterior Abdominal Wall Using Dynamic Magnetic Resonance Imaging

NARCIS (Netherlands)

Randall, D.; Fenner, J.; Gillott, R.; Broek, R.P.G ten; Strik, C.; Spencer, P.; Bardhan, K.D.

2016-01-01

Introduction. Abdominal adhesions can cause serious morbidity and complicate subsequent operations. Their diagnosis is often one of exclusion due to a lack of a reliable, non-invasive diagnostic technique. Development and testing of a candidate technique are described below. Method. During

Visualization of Abdominal Organs by Intra-Arterial Injection of {sup 131}I-Labelled Albumin Macroaggregates

Energy Technology Data Exchange (ETDEWEB)

Ogris, E.; Hofer, R.; Depisch, D.; Pokieser, H.; Grabner, G.; Brunner, H. [2nd Medical University Clinic and Surgical University Clinic, Vienna (Austria)

1969-05-15

Perfusion scintigrams of the abdominal organs were made after intra-arterial injection of {sup 131}I-MAA through the lying catheter immediately after angiographic examination of the coeliac and superior mesenteric artery vascular system. The anatomical architecture of the coeliac artery makes it impossible to visualize a single organ by scanning with this technique because several organs get their blood supply from the branches of this artery. Interpretation of a perfusion scintigram alone is therefore impossible. For better interpretation some simple methods have been developed: (1) Selective or even superselective,catheterization techniques; (2) Supplementation of the perfusion scintigram by a subsequent scintigram which delineates a single organ, like-liver, by means of colloidal radiogold; and (3) Photographic superposition of one scintigram over another to give a clear identification of the individual organs, especially the pancreatic head, by subtraction of the optic density. Mostly patients suspected of pancreatic carcinome were studied. The results correlated well with those of other methods, especially coeliac arteriography, and have been-partly confirmed by surgical intervention. Thus, perfusion scintigraphy of the abdominal organs seems to be a useful complement to coeliac arteriography in diagnosing pancreatic diseases. (author)

FEASIBILITY OF THE CONSERVATIVE TREATMENT OF SPLENIC INJURIES IN BLUNT ABDOMINAL TRAUMA

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M. M. Abakumov

2013-01-01

Full Text Available ABSTRACT. In blunt trauma, the structural features of the splenic parenchyma usually predispose to a significant intra-abdominal bleeding, so the excision of the damaged spleen is considered a main treatment technique in a majority of cases. However, a number of recent clinical studies have proved the necessity of a differentiated approach to making the treatment decisions and demonstrated the possibility of spleen salvage in certain cases.The most debatable issue is the management tactics in splenic injury associated with the formation of subcapsular hematoma. It is necessary to emphasize that the conservative treatment of such splenic injury implies a persisting risk of double-stage splenic rupture with following intra-abdominal bleeding.The Sklifosovsky Research Institute traditionally deals with injury management in all aspects and has gained a wide experience in splenic injury treatment that makes possible to demonstrate the choice of treatment tactics with regard to the splenic injury severity, and patient’s condition. A conservative management of spleen injury is reasonable only in stable patients and requires an additional use of instrumental diagnostic techniques. Morphological studies suggest that reparation processes around the splenic hematoma arise early enough and proceed, as a rule, with no signs of a purulent inflammation. 

Intra-Abdominal Hydatid Cyst: Sociodemographics, Clinical Profiles, and Outcomes of Patients Operated on at a Tertiary Hospital in Addis Ababa, Ethiopia

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Engida Abebe

2017-01-01

Full Text Available Background. Hydatid cyst is caused by the tapeworm Echinococcus granulosus. The abdomen, specifically the liver, is the most common site affected. Objective. Determine the presentation patterns, types of surgical management, and outcomes of patients operated for intra-abdominal hydatid cyst (IAHC. Methodology. A retrospective descriptive study of patients admitted and operated for IAHC from September 1, 2011, to August 31, 2015. Results. Forty-two patients whose age ranged from 10 to 65 (mean of 37 years were operated on. Females comprised 27 (64.3% of the patients. The commonest presenting complaint was abdominal pain (41, 97.6%. Abdominal mass was documented in 23 (54.7% cases. Abdominal ultrasound (AUS and CT were the main imaging studies done on 38 (90.5% and 24 (57.1% patients, respectively. Cysts measuring more than 10 cm in diameter were the most common finding in both studies. Liver was the primary site involved, 30 (71.4% cases, the right lobe being the main side, 73%. Thirty-eight (90.5% patients underwent deroofing, evacuation, marsupialization, and omentoplasty (DEMO. There was no perioperative death, but 4 (9.5% of the patients had post-op complications. Conclusion. Abdominal pain was the most common presenting complaint. AUS and CT remain the preferred imaging. DEMO was the most common surgery.

Intra-abdominal fibrosis in a recent cohort of patients with neuroendocrine ('carcinoid') tumours of the small bowel.

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Druce, M R; Bharwani, N; Akker, S A; Drake, W M; Rockall, A; Grossman, A B

2010-03-01

Fibrosis is a hallmark of neuroendocrine tumours (NETs) arising in the jejunum and ileum and may manifest in the mesentery and elsewhere. It is clinically important and once-established, there are few effective therapies. To examine the frequency, radiological manifestations and clinical significance of intra-abdominal fibrosis in a patient cohort using modern cross-sectional imaging. Current prevalence is compared to historical series and correlation with cardiac fibrosis evaluated. Cross-sectional, retrospective survey of a cohort of patients with mid-gut NETs from a single centre. Review of clinical features, biochemistry and imaging of patients with sporadic mid-gut NET and available imaging between 2002 and 2008. Thirty-one patients were included: 26 (83.9%) had liver metastases and 11 (35.4%) had small-bowel wall thickening; 17 patients (55%) had mesenteric involvement, with a mass, which contained coarse calcification in seven patients and fine calcification in a further two. There was soft-tissue stranding in 13 patients (plus in a further patient with no mass) and 'indrawing' of tissues in 11 patients. Two patients had a 'misty' mesentery and two had early retroperitoneal fibrosis. Mesenteric involvement was unrelated to gender and urinary 5HIAA excretion. Intra-abdominal fibrosis can be detected radiologically in around half of patients with mid-gut NET using contemporary cross-sectional imaging. Although not statistically significant, small-bowel obstruction was seen more frequently in the group with fibrosis. There was no relationship with cardiac fibrosis. Prospective studies are needed to evaluate predictors of fibrosis onset and clinical course and determine optimal methods of prevention and treatment.

Acute abdomen in children due to extra-abdominal causes.

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Tsalkidis, Aggelos; Gardikis, Stefanos; Cassimos, Dimitrios; Kambouri, Katerina; Tsalkidou, Evanthia; Deftereos, Savas; Chatzimichael, Athanasios

2008-06-01

Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra-abdominal organs or systems. The aim of the present study was to establish the most common extra-abdominal causes of acute abdominal pain. The notes of all children (1 month-14 years of age) examined for acute abdominal pain in the Accident and Emergency (A&E) Department of Alexandroupolis District University Hospital in January 2001-December 2005 were analyzed retrospectively. Demographic data, clinical signs and symptoms, and laboratory findings were recorded, as well as the final diagnosis and outcome. Of a total number of 28 124 children who were brought to the A&E department, in 1731 the main complaint was acute abdominal pain. In 51 children their symptoms had an extra-abdominal cause, the most frequent being pneumonia (n = 15), tonsillitis (n = 10), otitis media (n = 9), and acute leukemia (n = 5). Both abdominal and extra-abdominal causes should be considered by a pediatrician who is confronted with a child with acute abdominal pain.

Intra-uterine experimental infection by Ureaplasma diversum induces TNF-α mediated womb inflammation in mice

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Jamile R. Silva

2016-01-01

Full Text Available Ureaplasma diversum is an opportunistic pathogen associated with uterine inflammation, impaired embryo implantation, infertility, abortions, premature birth of calves and neonatal pneumonia in cattle. It has been suggested that the intra-uterine infection by Ureaplasma diversum can cause vascular changes that hinder the success of pregnancy. Thus, the aim of this study was to evaluate the changes of intrauterine site of A/J mice in estrus or proestrus phase inoculated with Ureaplasma diversum. The infection was monitored at 24, 48 and 72 hours by the PCR methodology to detect the Ureaplasma in the inoculation site and the profile of circulating blood cells. Morphological changes, intensity of inflammation and the production of cytokines were compared. The infected mice showed local inflammation through the production of IFN-γ and TNF-α. Ureaplasma diversum infections in the reproductive tract of studied mice seemed to be associated with the production of pro-inflammatory cytokines in uterine parenchyma. The levels of TNF-α of infected mice were dependent on the bacterial load of inoculated Ureaplasma. Uterine experimental infections by Ureaplasma diversum have not been mentioned yet and herein we presented the first report of an intrauterine infection model in mice.

Intra-uterine experimental infection by Ureaplasma diversum induces TNF-α mediated womb inflammation in mice.

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Silva, Jamile R; Ferreira, Lício F A A; Oliveira, Percíllia V S; Nunes, Ivanéia V; Pereira, Ítalo S; Timenetsky, Jorge; Marques, Lucas M; Figueiredo, Tiana B; Silva, Robson A A

2016-01-01

Ureaplasma diversum is an opportunistic pathogen associated with uterine inflammation, impaired embryo implantation, infertility, abortions, premature birth of calves and neonatal pneumonia in cattle. It has been suggested that the intra-uterine infection by Ureaplasma diversum can cause vascular changes that hinder the success of pregnancy. Thus, the aim of this study was to evaluate the changes of intrauterine site of A/J mice in estrus or proestrus phase inoculated with Ureaplasma diversum. The infection was monitored at 24, 48 and 72 hours by the PCR methodology to detect the Ureaplasma in the inoculation site and the profile of circulating blood cells. Morphological changes, intensity of inflammation and the production of cytokines were compared. The infected mice showed local inflammation through the production of IFN-γ and TNF-α. Ureaplasma diversum infections in the reproductive tract of studied mice seemed to be associated with the production of pro-inflammatory cytokines in uterine parenchyma. The levels of TNF-α of infected mice were dependent on the bacterial load of inoculated Ureaplasma. Uterine experimental infections by Ureaplasma diversum have not been mentioned yet and herein we presented the first report of an intrauterine infection model in mice.

The effects of 3-month atorvastatin therapy on arterial inflammation, calcification, abdominal adipose tissue and circulating biomarkers

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Wu, Yen-Wen [National Taiwan University Hospital, Department of Internal Medicine, Taipei (China); National Taiwan University Hospital, Department of Nuclear Medicine, Taipei (China); Kao, Hsian-Li; Chen, Ming-Fong; Lin, Lian-Yu; Wang, Yi-Chih; Lin, Yen-Hung; Lin, Hung-Ju; Huang, Por-Jau [National Taiwan University Hospital, Department of Internal Medicine, Taipei (China); Huang, Chi-Lun [Tao-Yuan General Hospital, Department of Internal Medicine, Tao-Yuan (China); Tzen, Kai-Yuan; Yen, Ruoh-Fang [National Taiwan University Hospital, Department of Nuclear Medicine, Taipei (China); Chi, Yu-Chiao [National Taiwan University, Graduate Institute of Clinical Medicine, College of Medicine, Taipei (China); Yang, Wei-Shiung [National Taiwan University Hospital, Department of Internal Medicine, Taipei (China); National Taiwan University, Graduate Institute of Clinical Medicine, College of Medicine, Taipei (China)

2012-03-15

{sup 18}F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT has the potential to track vascular inflammation and monitor therapeutic response. The purpose of this study was to determine the association between arterial inflammation, calcification and serological biomarkers in subjects with atherosclerosis, and to assess their therapeutic response to 12-week atorvastatin treatment. Forty-three statin-naive subjects with atherosclerosis received atorvastatin (40 mg/day) for 12 weeks and underwent {sup 18}F-FDG PET/CT, coronary calcification and abdominal adipose tissue volume measurements. A panel of serological biomarkers was analysed. Arterial inflammation was measured at seven arterial segments and normalized to venous FDG activity to produce target to background ratios (TBR). Thirty-four subjects without cardiovascular disease who repeated PET 1-4 years apart for routine health check-ups were retrospectively evaluated for comparison. The baseline mean TBR values in atherosclerotic patients were positively correlated with age (R = 0.36), body mass index (R = 0.54), abdominal visceral adipose tissue volume (R = 0.65), coronary calcification score (R = 0.40), levels of low-density lipoprotein cholesterol (R = 0.54), matrix metalloproteinase (MMP)-9 (R = 0.46) and fatty acid binding protein 4 (FABP4) (R = 0.67, all p < 0.05). The TBR as well as high-sensitivity C-reactive protein (hsCRP), E-selectin, MMP-9, monocyte chemotactic protein 1, FABP4 and follistatin values were reduced significantly after the 12-week atorvastatin treatment. The TBR reduction marginally correlated with changes in MMP-9 levels (R = 0.56, p = 0.05). The control group, whose median age was younger, by comparison had lower hsCRP and arterial TBR than the subjects with atherosclerosis (all p < 0.05), and moreover had a slight but insignificant increase in mean TBR at their 2.5{+-}0.8 year follow-up. The medium dose of atorvastatin over a 12-week period resulted in a significant

The effects of 3-month atorvastatin therapy on arterial inflammation, calcification, abdominal adipose tissue and circulating biomarkers

International Nuclear Information System (INIS)

Wu, Yen-Wen; Kao, Hsian-Li; Chen, Ming-Fong; Lin, Lian-Yu.; Wang, Yi-Chih; Lin, Yen-Hung; Lin, Hung-Ju; Huang, Por-Jau; Huang, Chi-Lun; Tzen, Kai-Yuan; Yen, Ruoh-Fang; Chi, Yu-Chiao; Yang, Wei-Shiung

2012-01-01

18 F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT has the potential to track vascular inflammation and monitor therapeutic response. The purpose of this study was to determine the association between arterial inflammation, calcification and serological biomarkers in subjects with atherosclerosis, and to assess their therapeutic response to 12-week atorvastatin treatment. Forty-three statin-naive subjects with atherosclerosis received atorvastatin (40 mg/day) for 12 weeks and underwent 18 F-FDG PET/CT, coronary calcification and abdominal adipose tissue volume measurements. A panel of serological biomarkers was analysed. Arterial inflammation was measured at seven arterial segments and normalized to venous FDG activity to produce target to background ratios (TBR). Thirty-four subjects without cardiovascular disease who repeated PET 1-4 years apart for routine health check-ups were retrospectively evaluated for comparison. The baseline mean TBR values in atherosclerotic patients were positively correlated with age (R = 0.36), body mass index (R = 0.54), abdominal visceral adipose tissue volume (R = 0.65), coronary calcification score (R = 0.40), levels of low-density lipoprotein cholesterol (R = 0.54), matrix metalloproteinase (MMP)-9 (R = 0.46) and fatty acid binding protein 4 (FABP4) (R = 0.67, all p < 0.05). The TBR as well as high-sensitivity C-reactive protein (hsCRP), E-selectin, MMP-9, monocyte chemotactic protein 1, FABP4 and follistatin values were reduced significantly after the 12-week atorvastatin treatment. The TBR reduction marginally correlated with changes in MMP-9 levels (R = 0.56, p = 0.05). The control group, whose median age was younger, by comparison had lower hsCRP and arterial TBR than the subjects with atherosclerosis (all p < 0.05), and moreover had a slight but insignificant increase in mean TBR at their 2.5±0.8 year follow-up. The medium dose of atorvastatin over a 12-week period resulted in a significant reduction of

Biliary stricture due to neuroma after an innocent blunt abdominal trauma.

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Katsinelos, P; Dimiropoulos, S; Galanis, I; Tsolkas, P; Paroutoglu, G; Arvaniti, M; Katsiba, D; Baltaglannis, S; Pilpilidis, I; Papagiannis, A; Vaslliadis, I

2002-10-01

A traumatic neuroma of the biliary tract is rarely associated with biliary obstruction. However, when it arises in the common bile duct (CBD) and is associated with obstructive jaundice, it is difficult to distinguish it from bile duct cancer. We describe a patient who developed obstructive jaundice and itching, due to CBD stricture, 8 years after innocent blunt abdominal trauma. The stricture was resected and hepatico-jejunal anastomosis was performed. Histological examination revealed a traumatic neuroma and a fibrous scar around the common bile duct. Symptoms disappeared following surgical removal of the lesion. Blunt abdominal injury may cause the late onset of a fibrous scar and traumatic neuroma in the common bile duct. To our knowledge, a traumatic neuroma of the biliary tract after blunt abdominal trauma has not been reported previously. We review the clinical picture of this relatively rare problem, along with its diagnosis, pathogenesis and treatment.

Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis.

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Dambrauskas, Zilvinas; Parseliūnas, Audrius; Maleckas, Almantas; Gulbinas, Antanas; Barauskas, Giedrius; Pundzius, Juozas

2010-01-01

Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided percutaneous interventions and/or minimally invasive surgery in the treatment of abdominal compartment syndrome. Forty-four patients with severe acute pancreatitis were enrolled into a prospective study and treated according to the standard management protocol. Interventional and/or surgical management of abdominal compartment syndrome was employed in 6 (13.6%) cases. In the context of this study, we assessed the feasibility and effectiveness of subcutaneous fasciotomy of the anterior m. rectus abdominis sheath, as well as the role of ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections in the management of abdominal compartment syndrome. Subcutaneous fasciotomy of the anterior m. rectus sheath and ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections seem to be safe (minor risk of bleeding or infection, closed abdomen, and easy care for the patient) and effective (resulted in a sustained decrease of intra-abdominal pressure to 13-16 mm Hg and regression of organ failures after intervention). Subcutaneous anterior m. rectus fasciotomy may appear to be beneficial in case of refractory abdominal compartment syndrome avoiding morbidity associated with the open abdomen technique. Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role.

The relationship between regional abdominal fat distribution and both insulin resistance and subclinical chronic inflammation in non-diabetic adults

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2014-01-01

Objective Obesity is associated with a high risk of insulin resistance (IR) and its metabolic complications. It is still debated that distributions of adipose tissue relate to an excess risk of IR and chronic inflammation in different race. This study was designed to examine the relation between insulin sensitivity, chronic inflammation and central fat distribution in non-diabetic volunteers in Taiwanese. Methods There were 328 volunteers without family history of diabetes mellitus and with normal oral glucose tolerance test enrolled. Total body fat and abdominal fat were measured. Abdominal fat was categorized into intraperitoneal (IP), retroperitoneal (RP) and subcutaneous (SC) fat. The IR index was estimated by homeostatic model assessment. Five inflammatory markers: adiponectin, leptin, tumor necrosing factor-α (TNF-α), resistin and high sensitive CRP (hs-CRP) were measured. Results IR was related to IP fat (r = 0.23, p fat, SC fat or total body fat. After correcting for age and sex, IP fat was the only significant predictor of IR (r2 = 58%, p = 0.001). Leptin showed the strongest relationship with all fat compartments (IP fat: r = 0.44, p = 0.001; RP fat: r = 0.36, p = 0.005, SC fat: r = 0.54, p fat: r = 0.61, p fat (r = 0.29, p = 0.004; r = -0.29, p = 0.005, respectively), but not RP, or SC fat. TNF-α and resistin were not correlated to any fat compartment. After correcting for age and sex, leptin variance was mostly explained by SC fat (41.3%), followed by IP fat (33.6%) and RP fat (25.3%). The hs-CRP and adiponectin variance were mostly explained by IP fat (40% and 49% respectively). Conclusions IP fat is better predictors of IR and subclinical chronic inflammation in Taiwanese adults. A disproportionate accumulation of abdominal fat is associated with increased risk of cardiovascular diseases. PMID:24684833

Effect of acute, slightly increased intra-abdominal pressure on intestinal permeability and oxidative stress in a rat model.

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Yuxin Leng

Full Text Available INTRODUCTION: Intra-abdominal hypertension (IAH is known as a common, serious complication in critically ill patients. Bacterial translocation and permeability changes are considered the pathophysiological bases for IAH-induced enterogenic endotoxemia and subsequent multiorgan failure. Nevertheless, the effects of slightly elevated intra-abdominal pressures (IAPs on the intestinal mucosa and the associated mechanisms remain unclear. METHODS: To investigate the acute effects of different nitrogen pneumoperitoneum grades on colonic mucosa, male Sprague-Dawley rats were assigned to six groups with different IAPs (0 [control], 4, 8, 12, 16, and 20 mmHg, n = 6/group. During 90 min of exposure, we dynamically monitored the heart rate and noninvasive hemodynamic parameters. After gradual decompression, arterial blood gas analyses were conducted. Thereafter, structural injuries to the colonic mucosa were identified using light microscopy. Colon permeability was determined using the expression of tight junction proteins, combined with fluorescein isothiocyanate dextran (FD-4 absorption. The pro-oxidant-antioxidant balance was determined based on the levels of malondialdehyde (MDA and antioxidant enzymes. RESULTS: IAH significantly affected the histological scores of the colonic mucosa, tight junction protein expression, mucosal permeability, and pro-oxidant-antioxidant balance. Interestingly, elevations of IAP that were lower than the threshold for IAH also showed a similar, undesirable effect. In the 8 mmHg group, mild hyponatremia, hypocalcemia, and hypoxemia occurred, accompanied by reduced blood and abdominal perfusion pressures. Mild microscopic inflammatory infiltration and increased MDA levels were also detected. Moreover, an 8-mm Hg IAP markedly inhibited the expression of tight junction proteins, although no significant differences in FD-4 permeability were observed between the 0- and 8-mmHg groups. CONCLUSIONS: Acute exposure to slightly

Impact of Percutaneous Drainage on Outcome of Intra-abdominal Infection Associated With Pediatric Perforated Appendicitis.

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Bonadio, William; Langer, Miriam; Cueva, Julie; Haaland, Astrid

2017-10-01

Perforated appendicitis can result in potentially serious complications requiring prolonged medical care. The optimal approach to successfully managing this condition is controversial. Review of 80 consecutive cases of pediatric acute perforated appendicitis with intra-abdominal infection (IAI) medically managed with parenteral antibiotics and percutaneous drainage (PD) during a 7-year period. All patients received broad spectrum parenteral antibiotic therapy. One-third were hospitalized for >2 weeks. IAI was identified on admission in 60% compared with developing during hospitalization in 40% of cases. Before performing PD, the mean duration of antibiotic therapy in those who developed IAI during hospitalization was 6 days. IAI cultures yielded 127 bacterial isolates; polymicrobial infection occurred in 65% of cases. Only 7% of aspirates were sterile. The most common pathogens were Escherichia coli (82%), of which 5 isolates exhibited extended-spectrum β-lactamase production, and streptococci (40%). At the time of PD, 60% were febrile (mean duration of in-hospital fever, 7.5 days); 67% defervesced within 24 hours after the procedure. Posthospitalization abdominal complications (recurrent IAI or appendicitis) occurred in one-third of patients. Children with perforated appendicitis and IAI often have a complicated and prolonged clinical course. Medical management consisting solely of parenteral antibiotic therapy is frequently ineffective in resolving IAI. Rapid clinical improvement commonly follows PD.

Esmolol reduces apoptosis and inflammation in early sepsis rats with abdominal infection.

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Lu, Yang; Yang, Yang; He, Xin; Dong, Shangwen; Wang, Wanhua; Wang, Donghao; Zhang, Peng

2017-10-01

Esmolol is a highly selective beta 1 receptor blocker with various effects such as slowing heart rate, lowering blood pressure and reducing myocardial oxygen consumption. However, few studies have reported the use of beta blockers in sepsis with multiple organ dysfunctions. This study aimed to investigate the effects of esmolol on reducing apoptosis and inflammation in early sepsis rats with abdominal infection. Rats were randomly divided into sham operation group, sepsis group, antibiotic group, Esmolol + antibiotic group with low, median and high dose Esmolol (L group, M group and H group). Values between two or more groups were compared by independent t-tests. In the liver and kidney, we found inflammatory infiltration in sepsis group while pathological aspects reduced in L, M and H groups. Bcl-2 mRNA and protein levels increased while Bax mRNA and protein levels decreased in the liver and kidney of L, M and H groups. Serum IL-6, HMGB-1 and TNF-α levels decreased but IL-10 level increased in L, M and H groups, compared to sepsis group. Compared to sepsis and antibiotic groups, the levels of myocardial enzymes were lower in L, M and H groups. The administration of esmolol in early sepsis may reduce inflammation, inhibit apoptosis and protect key organs. Copyright © 2017 Elsevier Inc. All rights reserved.

Indium 111 leucocyte scintigraphy in abdominal sepsis

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Baba, A.A.; McKillop, J.H.; Gray, H.W.; Cuthbert, G.F.; Neilson, W.; Anderson, J.R.

1990-01-01

We have studied the clinical utility of indium 111 autologous leucocyte scintigraphy retrospectively in 45 patients presenting with suspected intra-abdominal sepsis. The sensitivity was 95% (21/22) and the specificity was 91% (21/23). Some 34 of the studies (17 positive and 17 negative) were considered helpful in furthering patient management (76%) and 8, unhelpful (18%). In 3, the study results were misleading and led to inappropriate treatment. Indium 111 scintigraphy, whether positive or negative, provides information in patients with suspected intra-abdominal sepsis upon which therapeutic decisions can be based. (orig.)

Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life threatening situation.

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Al-Zubaidi, Ali M; Alghamdi, Hassan U; Alzobydi, Abdu H; Dhiloon, Irshad A; Qureshi, Laeeque A

2015-04-16

A 45-year-old man of Middle Eastern origin, morbid obese, with a body mass index of 39 had an intra-gastric balloon, filled with 500 mL of saline/methylene blue and intended as definite therapy, inserted some 8 wk previously. He was admitted to the emergency department with abdominal cramps. An ultrasound of the abdomen was performed in ER which confirmed the balloon to be in place without any abnormality. He was discharged home on symptomatic medication. Patient remains symptomatic therefore he reported back to ER 2 d later. Computed tomography scan was performed this time for further evaluation which revealed a metallic ring present in the small bowel while the intra-gastric balloon was in its proper position. There was no clinical or radiological sign of intestinal obstruction. Patient was hospitalized for observation and conservative management. The following night, patient experienced sudden and severe abdominal pain, therefore an X-ray of the abdomen in erect position was done, which showed free air under the right dome of diaphragm. Patient was transferred to O.R for emergency laparotomy. There were two small perforations identified at the site of the metallic ring entrapment. The ring was removed and the perforations were repaired. Due to increasing prevalence of obesity and advances in modalities for its management, physicians should be aware of treatment options, their benefits, complications and clinical presentation of the known complications. Physicians need to be updated to approach these complications within time, to avoid life-threatening situations caused by these appliances.

Inflammation and Immune Response of Intra-Articular Serotype 2 Adeno-Associated Virus or Adenovirus Vectors in a Large Animal Model

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Akikazu Ishihara

2012-01-01

Full Text Available Intra-articular gene therapy has potential for the treatment of osteoarthritis and rheumatoid arthritis. To quantify in vitro relative gene transduction, equine chondrocytes and synovial cells were treated with adenovirus vectors (Ad, serotype 2 adeno-associated virus vectors (rAAV2, or self-complementary (sc AAV2 vectors carrying green fluorescent protein (GFP. Using 6 horses, bilateral metacarpophalangeal joints were injected with Ad, rAAV2, or scAAV2 vectors carrying GFP genes to assess the in vivo joint inflammation and neutralizing antibody (NAb titer in serum and joint fluid. In vitro, the greater transduction efficiency and sustained gene expression were achieved by scAAV2 compared to rAAV2 in equine chondrocytes and synovial cells. In vivo, AAV2 demonstrated less joint inflammation than Ad, but similar NAb titer. The scAAV2 vectors can induce superior gene transduction than rAAV2 in articular cells, and both rAAV2 and scAAV2 vectors were showed to be safer for intra-articular use than Ad vectors.

[Diagnostic imaging and acute abdominal pain].

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Liljekvist, Mads Svane; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

2015-01-19

Acute abdominal pain is a common clinical condition. Clinical signs and symptoms can be difficult to interpret, and diagnostic imaging may help to identify intra-abdominal disease. Conventional X-ray, ultrasound (US) and computed tomography (CT) of the abdomen vary in usability between common surgical causes of acute abdominal pain. Overall, conventional X-ray cannot confidently diagnose or rule out disease. US and CT are equally trustworthy for most diseases. US with subsequent CT may enhance diagnostic precision. Magnetic resonance seems promising for future use in acute abdominal imaging.

Intra-abdominal fluid extravasation during hip arthroscopy: a survey of the MAHORN group.

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Kocher, Mininder S; Frank, Jeremy S; Nasreddine, Adam Y; Safran, Marc R; Philippon, Marc J; Sekiya, Jon K; Kelly, Bryan T; Byrd, J W Thomas; Guanche, Carlos A; Martin, Hal D; Clohisy, John C; Mohtadi, Nick G; Griffin, Damian R; Sampson, Thomas G; Leunig, Michael; Larson, Christopher M; Ilizaliturri, Victor M; McCarthy, Joseph C; Gambacorta, Peter G

2012-11-01

The purpose of this study was to survey experts in the field of hip arthroscopy from the Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) group to determine the frequency of symptomatic intra-abdominal fluid extravasation (IAFE) after arthroscopic hip procedures, identify potential risk factors, and develop preventative measures and treatment strategies in the event of symptomatic IAFE. A survey was sent to all members of the MAHORN group. Surveys collected data on general hip arthroscopy settings, including pump pressure and frequency of different hip arthroscopies performed, as well as details on cases of symptomatic IAFE. Responses to the survey were documented and analyzed. Fifteen hip arthroscopists from the MAHORN group were surveyed. A total of 25,648 hip arthroscopies between 1984 and 2010 were reviewed. Arthroscopic procedures included capsulotomies, labral reattachment after acetabuloplasty, peripheral compartment arthroscopy, and osteoplasty of the femoral head-neck junction. Of the arthroscopists, 7 (47%) had 1 or more cases of IAFE (40 cases reported). The prevalence of IAFE in this study was 0.16% (40 of 25,650). Significant risk factors associated with IAFE were higher arthroscopic fluid pump pressure (P = .004) and concomitant iliopsoas tenotomy (P arthroscopy is a rare occurrence, with an approximate prevalence of 0.16%. Prevention of IAFE should include close intraoperative and postoperative monitoring of abdominal distention, core body temperature, and hemodynamic stability. Concomitant iliopsoas tenotomy and high pump pressures may be risk factors leading to symptomatic IAFE. Level IV, therapeutic case series. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Fetal Sirenomelia Associated with an Abdominal Cyst Originating from a Saccular Cloaca.

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Kinjo, Yui; Masamoto, Hitoshi; Nitta, Hayase; Kinjo, Tadatsugu; Tamaki, Tomoko; Yoshimi, Naoki; Aoki, Yoichi

2018-01-01

A 40-year-old pregnant woman presented with a fetal abdominal cyst and oligohydramnios. Color Doppler scan revealed a single blood vessel from the fetal aorta into a single umbilical artery. Severe oligohydramnios limited ultrasonographic evaluation of the fetal lower limbs, kidneys, or bladder. The pregnancy was terminated; the fetus showed fused lower limbs, bulging abdomen, and absent external genitalia and was diagnosed with type III sirenomelia. On autopsy, no normal bladder was observed, but duodenal atresia, anorectal atresia, and right renal agenesis were found. An intra-abdominal cyst, diagnosed histologically as a saccular cloaca, occupied the abdominal cavity. Ultrasonographic diagnosis of fetal sirenomelia is difficult due to poor depiction of the lower limbs. A vitelline artery leading to a single umbilical artery and a fetal abdominal cyst occupying most of the abdominal cavity are considered fetal sirenomelia associated with large defects of the gastrointestinal and genitourinary tracts.

Fetal Sirenomelia Associated with an Abdominal Cyst Originating from a Saccular Cloaca

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Yui Kinjo

2018-01-01

Full Text Available A 40-year-old pregnant woman presented with a fetal abdominal cyst and oligohydramnios. Color Doppler scan revealed a single blood vessel from the fetal aorta into a single umbilical artery. Severe oligohydramnios limited ultrasonographic evaluation of the fetal lower limbs, kidneys, or bladder. The pregnancy was terminated; the fetus showed fused lower limbs, bulging abdomen, and absent external genitalia and was diagnosed with type III sirenomelia. On autopsy, no normal bladder was observed, but duodenal atresia, anorectal atresia, and right renal agenesis were found. An intra-abdominal cyst, diagnosed histologically as a saccular cloaca, occupied the abdominal cavity. Ultrasonographic diagnosis of fetal sirenomelia is difficult due to poor depiction of the lower limbs. A vitelline artery leading to a single umbilical artery and a fetal abdominal cyst occupying most of the abdominal cavity are considered fetal sirenomelia associated with large defects of the gastrointestinal and genitourinary tracts.

El uso de circunferencias corporales para la predicción de la grasa intra-abdominal en mujeres obesas con el síndrome del ovario poliquístico

OpenAIRE

Penaforte, F. Rodrigues de Oliveira; Japur, C. Cremonezi; Diez-Garcia, R. W.; Macedo, C. Salles; Chiarello, P. Garcia

2012-01-01

Introduction: Computerizd tomography (CT) is the gold standard for the evaluation of intra- (IAF) and total (TAF) abdominal fat; however, the high cost of the procedure and exposure to radiation limit its routine use. Objective: To develop equations that utilize anthropometric measures for the estimate of IAF and TAF in obese women with polycystic ovary syndrome (PCOS). Methods: The weight, height, BMI, and abdominal (AC), waist (WC), chest (CC), and neck (NC) circumferences of thirty obese w...

Intestinal fatty acid binding protein as a marker for intra-abdominal pressure-related complications in patients admitted to the intensive care unit; study protocol for a prospective cohort study (I-Fabulous study).

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Strang, Steven G; Van Waes, Oscar J F; Van der Hoven, Ben; Ali, Samir; Verhofstad, Michael H J; Pickkers, Peter; Van Lieshout, Esther M M

2015-01-16

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have detrimental effects on all organ systems and are associated with increased morbidity and mortality in critically ill patients admitted to an intensive care unit. Intra-bladder measurement of the intra-abdominal pressure (IAP) is currently the gold standard. However, IAH is not always indicative of intestinal ischemia, which is an early and rapidly developing complication. Sensitive biomarkers for intestinal ischemia are needed to be able to intervene before damage becomes irreversible. Gut wall integrity loss, including epithelial cell disruption and tight junctions breakdown, is an early event in intestinal damage. Intestinal Fatty Acid Binding Protein (I-FABP) is excreted in urine and blood specifically from damaged intestinal epithelial cells. Claudin-3 is a specific protein which is excreted in urine following disruption of intercellular tight junctions. This study aims to investigate if I-FABP and Claudin-3 can be used as a diagnostic tool for identifying patients at risk for IAP-related complications. In a multicenter, prospective cohort study 200 adult patients admitted to the intensive care unit with at least two risk factors for IAH as defined by the World Society of the Abdominal Compartment Syndrome (WSACS) will be included. Patients in whom an intra-bladder IAP measurement is contra-indicated or impossible and patients with inflammatory bowel diseases that may affect I-FABP levels will be excluded. The IAP will be measured using an intra-bladder technique. During the subsequent 72 hours, the IAP measurement will be repeated every six hours. At these time points, a urine and serum sample will be collected for measurement of I-FABP and Claudin-3 levels. Clinical outcome of patients during their stay at the intensive care unit will be monitored using the Sequential Organ Failure Assessment (SOFA) score. Successful completion of this trial will provide evidence on the eventual

Sonographically Assessed Intra-Abdominal Fat And Cardiometabolic Risk Factors in Adolescents with Extreme Obesity

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Anja Moss

2016-04-01

Full Text Available Objective: The metabolic and cardiovascular risk of obesity is predominantly defined through the amount of intra-abdominal fat (IAF. Regarding this risk and the benefits of weight reduction gender-specific differences have been described. The aim of this study was to examine the gender-specific relationship between IAF assessed via ultrasound and the cardiometabolic risk profile in extremely obese adolescents before and after weight loss. Methods: In 107 consecutively admitted adolescents (n = 59 girls, mean age 15.4 ± 2.6 years boys and 15.1 ± 2.1 years girls, mean BMI z-score 3.2 ± 0.6 boys and 3.5 ± 0.6 girls anthropometric and fasting laboratory chemical parameters were measured before and after an in-patient long-term therapy (mean durance 5.6 ± 2.3 months. IAF was determined by measuring the intra-abdominal depth (IAD via ultrasound. Results: IAD was higher in boys as compared to girls (58.0 ± 22.4 mm vs. 51.3 ± 16.0 mm. IAD values were positively associated with BMI-z scores, waist circumferences, HOMA-IR and serum levels of γGT, hs-CRP and IL-6 in both genders. In boys, but not in girls, IAD was significantly correlated with systolic and diastolic blood pressure, serum levels of triglycerides, ALT as well as adiponectin and HDL-cholesterol. After a marked mean weight loss of -27.1 ± 16.2 kg (-20.1 ± 7.9% in boys and of -20.5 ± 11.5 kg (-17.3 ± 7.1% in girls, IAD decreased by -20.7 ± 16.2 mm (--32.4 ± 16.9% in boys and by -18.4 ± 12,7 mm (-34.3 ± 18.4% in girls, resulting in more pronounced ameliorations of cardiovascular risk factors in boys than in girls. Conclusions: The present study indicates that IAF assessed by ultrasound is a good indicator for the cardiometabolic risk factor profile in extremely obese adolescents. Associations between IAF and risk factors are more pronounced in boys than in girls.

Cardiorespiratory fitness and the metabolic syndrome: Roles of inflammation and abdominal obesity

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Wedell-Neergaard, Anne-Sophie; Krogh-Madsen, Rikke; Petersen, Gitte Lindved; Hansen, Åse Marie; Pedersen, Bente Klarlund; Lund, Rikke

2018-01-01

Objective Individuals with metabolic syndrome have increased risk of type 2 diabetes and cardiovascular disease. We aimed to test the hypothesis that a high level of cardiorespiratory fitness (CR-fitness), counteracts accumulation of visceral fat, decreases inflammation and lowers risk factors of the metabolic syndrome. Method The study sample included 1,293 Danes (age 49–52 years) who from 2009 to 2011 participated in the Copenhagen Aging and Midlife Biobank, including a questionnaire, physical tests, and blood samples. Multiple linear regression models were performed with CR-fitness as exposure and plasma levels of cytokines and high sensitive C-reactive protein as outcomes and measures of abdominal obesity were added to test if they explained the potential association. Similarly, multiple linear regression models were performed with CR-fitness as exposure and factors of the metabolic syndrome as outcomes and the potential explanation by inflammatory biomarkers were tested. All models were adjusted for the effect of age, sex, smoking, alcohol consumption, socio-economic status, and acute inflammatory events within the preceding two weeks. Results CR-fitness was inversely associated with high sensitive C-reactive protein, Interleukin (IL)-6, and IL-18, and directly associated with the anti-inflammatory cytokine IL-10, but not associated with tumor necrosis factor alpha, interferon gamma or IL-1β. Abdominal obesity could partly explain the significant associations. Moreover, CR-fitness was inversely associated with an overall metabolic syndrome score, as well as triglycerides, glycated haemoglobin A1c, systolic blood pressure, diastolic blood pressure and directly associated with high-density lipoprotein. Single inflammatory biomarkers and a combined inflammatory score partly explained these associations. Conclusion Data suggest that CR-fitness has anti-inflammatory effects that are partly explained by a reduction in abdominal obesity and a decrease in the

Conditioning pain stimulation does not affect itch induced by intra-epidermal histamine pricks but aggravates neurogenic inflammation in healthy volunteers

DEFF Research Database (Denmark)

Andersen, Hjalte Holm; Imai, Yosuke; Petersen, Kristian Kjær

2016-01-01

This study investigated whether itch induced by intra-epidermal histamine is subjected to modulation by a standardized conditioned pain modulation (CPM) paradigm in 24 healthy volunteers. CPM was induced by computer-controlled cuff pressure algometry and histamine was introduced to the volar...... forearm by skin prick test punctures. Moreover, neurogenic inflammation and wheal reactions induced by histamine and autonomic nervous system responses (heart rate variability and skin conductance) were monitored. CPM did not modulate the intensity of histamine-induced itch suggesting that pruriceptive...... signaling is not inhibited by pain-recruited endogenous modulation, however, CPM was found to aggravate histamine-induced neurogenic inflammation, likely facilitated by efferent sympathetic fibers....

Effects of hyperthermic intraoperative peritoneal lavage on intra ...

African Journals Online (AJOL)

shobha

abdominal pressure (IAP) alone or in combination with peritonitis. ... synergistically with peritonitis to exacerbate intra-abdominal hypertension and is associated with a shortened ..... by several factors after copious HIPL in cases of ... and applicable to clinical situations. ... urge emergency and trauma surgeons who manage.

Urinary bladder incarceration and infarction by an intra-abdominal fat pad in a Virginia opossum (Didelphis virginiana).

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De Voe, Ryan S; Spaulding, Kathy A; Rotstein, Jack; Rotstein, David S

2004-01-01

A 2.5-year-old, female opossum had acute stranguria. Based on radiography and ultrasonographic examination a cystic structure was identified in the caudal abdomen associated with bilateral hydroureter and hydronephrosis. This structure contained a neutrophilic fluid, determined to be urine. There was a neutrophilic leukocytosis. Serum chemistry values were within normal limits. The opossum was euthanized. An intra-abdominal fat pad incarceration of the urinary bladder above the trigone was present, resulting in complete obstruction of the urinary bladder and partial obstruction of the ureters. Vessels to the bladder were involved in the incarceration which resulted in vascular compromise and infarction of the bladder. Mild to moderate hydroureter and hydronephrosis were present.

[Abdomen specific bioelectrical impedance analysis (BIA) methods for evaluation of abdominal fat distribution].

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Ida, Midori; Hirata, Masakazu; Hosoda, Kiminori; Nakao, Kazuwa

2013-02-01

Two novel bioelectrical impedance analysis (BIA) methods have been developed recently for evaluation of intra-abdominal fat accumulation. Both methods use electrodes that are placed on abdominal wall and allow evaluation of intra-abdominal fat area (IAFA) easily without radiation exposure. Of these, "abdominal BIA" method measures impedance distribution along abdominal anterior-posterior axis, and IAFA by BIA method(BIA-IAFA) is calculated from waist circumference and the voltage occurring at the flank. Dual BIA method measures impedance of trunk and body surface at the abdominal level and calculates BIA-IAFA from transverse and antero-posterior diameters of the abdomen and the impedance of trunk and abdominal surface. BIA-IAFA by these two BIA methods correlated well with IAFA measured by abdominal CT (CT-IAFA) with correlatipn coefficient of 0.88 (n = 91, p abdominal adiposity in clinical study and routine clinical practice of metabolic syndrome and obesity.

Common errors in the treatment of intra-abdominal infections: the irrational use of antimicrobial agents

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Belinda De Simone

2016-06-01

Full Text Available Antimicrobial resistance (AR is a global, emergent problem because an increasing numbers of serious community acquired and nosocomial infections are caused by resistant bacterial pathogens. It is a direct consequence of the excessive and irrational use of antibiotics. The use of antimicrobial agents – aimed to decrease morbidity and mortality rate related to intra-abdominal infections – is very high, often improper, in the Departments of General and Emergency Surgery and Intensive Cure Units. Source control and empiric antibiotic therapy have to be administrated as early as possible to decrease high mortality rates in patients with severe sepsis or septic shock and, in this, the general surgeon has a crucial role. Proper antimicrobial stewardship in selecting an appropriate antibiotic and optimizing its dose and duration to cure intraabdominal infections may prevent the emergence of AR and decrease costs for antibiotics.

Intra-Abdominal Desmoplastic Small Round Cell Tumor with Elevated Serum CA 125: A Case Report

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Sheau-Fang Yang

2003-10-01

Full Text Available Desmoplastic small round cell tumor (DSRCT is a rare and highly aggressive tumor usually involving the peritoneum. It occurs more commonly in young males and is characterized by distinctive clinical, histologic, and immunophenotypic features. The histogenesis of DSRCT remains unknown. Coexpression of epithelial, mesenchymal, and neural antigens in the same cell provides evidence that DSRCT may arise from a primitive pluripotent stem cell with divergent differentiation. Recently, according to cytogenetic studies, some authors have proposed that the divergent differentiation of DSRCT may be the result of the fusion of Ewing's sarcoma gene and Wilms' tumor suppressor gene. Clinically, an elevated serum CA 125 concentration is found in some patients with DSRCT. We present the case of a 29-year-old man with diffuse intra-abdominal DSRCT and elevated serum CA 125 concentration and briefly review the relevant literature.

Oral contrast for CT in patients with acute non-traumatic abdominal and pelvic pain: what should be its current role?

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Kielar, Ania Z; Patlas, Michael N; Katz, Douglas S

2016-10-01

Positive oral contrast agents, including barium suspensions and water-soluble iodinated solutions, have traditionally been used in conjunction with the CT evaluation of patients with abdominal and pelvic pain. Due to continued advancements in CT technology, and due to increasing obesity and correspondingly a general increase in the intra-abdominal and intra-pelvic fat separating bowel loops in North American patients and in patients in other parts of the world over the past few decades, the ability of radiologists to accurately evaluate the cause of acute symptoms has substantially improved. Recent research and evolving imaging society guidelines/systematic reviews increasingly support performing CT scans of the abdomen and pelvis without the need for positive oral contrast in these types of adult patient populations, in most clinical situations. Increased patient throughput, patient preference, patient safety, and most importantly, retention of high diagnostic accuracy, are reasons for this recent change in practice to routinely omit the use of enteric contrast agents for the majority of patients presenting with acute abdominal and pelvic pain whom are undergoing emergency CT.

Abdominal X-ray signs of intra-intestinal drug smuggling.

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Niewiarowski, Sylwia; Gogbashian, Andrew; Afaq, Asim; Kantor, Robin; Win, Zarni

2010-05-01

"Body packers" either swallow or insert drug filled packets rectally or vaginally in order to smuggle illicit drugs. AXR is used routinely to screen suspects for the presence of intra-intestinal drug packages. AXR diagnosis can be difficult as stool or gas within the intestine may resemble ingested foreign bodies. We identify the frequency and co-existence of several signs; tic-tac sign, rosette sign, double condom sign, dense surrounding material, density and discover a new sign; parallelism, which will aid in increasing the radiological accuracy. We retrospectively reviewed 285 AXRs performed for suspicion of drug smuggling during the period of March 2006-March 2009 to identify the frequency of these signs. Of the 285 AXRs performed 59 were positive, 221 negative and five were indeterminate. The tic-tac sign was present in 93%, double condom sign in 73%, dense surrounding wrapping material in 36% and parallelism in 27%. Sixty one percentage of drug packages were iso-dense to faeces and 39% hyperdense. Twenty percentage of the positive abdominal radiographs demonstrated one of the radiographic signs, 39% demonstrated two signs, 32% demonstrated three and 7% four. The most common radiographic sign combination was the tic-tac sign with either dense surrounding material or double condom sign. The most commonly encountered radiographic sign is the tic-tac sign, followed by the double condom sign and dense surrounding material. We also discover a new sign, "parallelism" which although uncommon is highly specific. Accuracy is further increased by comparing the density of packages to faeces and looking for the co-existence of multiple signs. Copyright (c) 2010 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Reproducibility of abdominal fat assessment by ultrasound and computed tomography.

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Mauad, Fernando Marum; Chagas-Neto, Francisco Abaeté; Benedeti, Augusto César Garcia Saab; Nogueira-Barbosa, Marcello Henrique; Muglia, Valdair Francisco; Carneiro, Antonio Adilton Oliveira; Muller, Enrico Mattana; Elias Junior, Jorge

2017-01-01

To test the accuracy and reproducibility of ultrasound and computed tomography (CT) for the quantification of abdominal fat in correlation with the anthropometric, clinical, and biochemical assessments. Using ultrasound and CT, we determined the thickness of subcutaneous and intra-abdominal fat in 101 subjects-of whom 39 (38.6%) were men and 62 (61.4%) were women-with a mean age of 66.3 years (60-80 years). The ultrasound data were correlated with the anthropometric, clinical, and biochemical parameters, as well as with the areas measured by abdominal CT. Intra-abdominal thickness was the variable for which the correlation with the areas of abdominal fat was strongest (i.e., the correlation coefficient was highest). We also tested the reproducibility of ultrasound and CT for the assessment of abdominal fat and found that CT measurements of abdominal fat showed greater reproducibility, having higher intraobserver and interobserver reliability than had the ultrasound measurements. There was a significant correlation between ultrasound and CT, with a correlation coefficient of 0.71. In the assessment of abdominal fat, the intraobserver and interobserver reliability were greater for CT than for ultrasound, although both methods showed high accuracy and good reproducibility.

Intra-Hepatic Depletion of Mucosal-Associated Invariant T Cells in Hepatitis C Virus-Induced Liver Inflammation.

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Bolte, Fabian J; O'Keefe, Ashley C; Webb, Lauren M; Serti, Elisavet; Rivera, Elenita; Liang, T Jake; Ghany, Marc; Rehermann, Barbara

2017-11-01

Chronic hepatitis affects phenotypes of innate and adaptive immune cells. Mucosal-associated invariant T (MAIT) cells are enriched in the liver as compared with the blood, respond to intra-hepatic cytokines, and (via the semi-invariant T-cell receptor) to bacteria translocated from the gut. Little is known about the role of MAIT cells in livers of patients with chronic hepatitis C virus (HCV) infection and their fate after antiviral therapy. We collected blood samples from 42 patients with chronic HCV infection who achieved a sustained virologic response after 12 weeks of treatment with sofosbuvir and velpatasvir. Mononuclear cells were isolated from blood before treatment, at weeks 4 and 12 during treatment, and 24 weeks after the end of treatment. Liver biopsies were collected from 37 of the patients prior to and at week 4 of treatment. Mononuclear cells from 56 blood donors and 10 livers that were not suitable for transplantation were used as controls. Liver samples were assessed histologically for inflammation and fibrosis. Mononuclear cells from liver and blood were studied by flow cytometry and analyzed for responses to cytokine and bacterial stimulation. The frequency of MAIT cells among T cells was significantly lower in blood and liver samples of patients with HCV infection than of controls (median, 1.31% vs 2.32% for blood samples, P = .0048; and median, 4.34% vs 13.40% for liver samples, P = .001). There was an inverse correlation between the frequency of MAIT cells in the liver and histologically determined levels of liver inflammation (r = -.5437, P = .0006) and fibrosis (r = -.5829, P = .0002). MAIT cells from the liver had higher levels of activation and cytotoxicity than MAIT cells from blood (P liver inflammation and MAIT cell activation and cytotoxicity, and increased the MAIT cell frequency among intra-hepatic but not blood T cells. The MAIT cell response to T-cell receptor-mediated stimulation did not change during the 12 weeks of

Torsion of abdominal appendages presenting with acute abdominal pain

International Nuclear Information System (INIS)

Al-Jaberi, Tareq M.; Gharabeih, Kamal I.; Yaghan, Rami J.

2000-01-01

Diseases of abnormal appendages are rare causes of abdominal pain in all age groups. Nine patients with torsion and infraction of abdominal appendages were retrospectively reviewed. Four patients had torsion and infarction of the appendices epiploicae, four patients had torsion and infarction of the falciform ligament. The patient with falciform ligament disease represents the first reported case of primary torsion and infarction of the falciform ligament, and the patient with the transverse colon epiplocia represents the first reported case of vibration-induced appendix epiplocia torsion and infarction. The patient with the falciform ligament disease presented with a tender upper abdominal mass and the remaining patients were operated upon with the preoperative diagnosis of acute appendicitis. The presence of normal appendix with free serosanguinous fluid in the peritoneal cavity should raise the possibility of a disease and calls for further evaluation of the intra-abdominal organs. If the diagnosis is suspected preoperatively, CT scan and ultrasound may lead to a correct diagnosis and possibly conservative management. Laparoscopy is playing an increasing diagnostic and therapeutic role in such situations. (author)

An unusual cause of intra-abdominal calcification: A lithopedion

International Nuclear Information System (INIS)

Ramos-Andrade, Daniel; Ruivo, Catarina; Portilha, M. Antónia; Brito, Jorge B.; Caseiro-Alves, Filipe; Curvo-Semedo, Luís

2014-01-01

We report a case of a 77-year-old female who was admitted to the emergency department complaining of diffuse abdominal pain for five days, associated with nausea, vomiting and constipation. Physical examination disclosed a large incarcerated umbilical hernia, which was readily apparent on supine abdominal plain films. These also showed a calcified heterogeneous mass in the mid-abdominal region, which was further characterized by CT as a lithopedion (calcified ectopic pregnancy). This is one of the few cases studied on a MDCT equipment, and it clearly enhances the post-processing abilities of this imaging method which allows diagnostic high-quality MIP images. Lithopedion is a rare entity, with less than 300 cases previously described in the medical literature. However, many reported cases corresponded to cases of skeletonization or collections of fetal bone fragments discovered encysted in the pelvic region at surgery or autopsy. It is thus estimated that true lithopedion is a much rarer entity. The diagnosis may be reached by a suggestive clinical history and a palpable mass on physical examination, while the value of modern cross-sectional techniques is still virtually unknown. Ultrasonography may depict an empty uterine cavity and a calcified abdominal mass of non-specific characteristics, and computed tomography or magnetic resonance imaging are able to reach a conclusive diagnosis and may additionally define the involvement of adjacent structures. The differential diagnosis includes other calcified pathologic situations, including ovarian tumors, uterine fibroids, urinary tract neoplasms, inflammatory masses or epiploic calcifications

Increased Resistin Levels in Intra-abdominal Sepsis: Correlation with proinflammatory cytokines & Acute Physiology & Chronic Health Evaluation II scores

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Tonguç U. Yilmaz

2014-10-01

Full Text Available Objectives: Resistin, a hormone secreted from adipocytes and considered to be a likely cause of insulin resistance, has recently been accepted as a proinflammatory cytokine. This study aimed to determine the correlation between resistin levels in patients with intra-abdominal sepsis and mortality. Methods: Of 45 patients with intraabdominal sepsis, a total of 35 adult patients were included in the study. This study was undertaken from December 2011 to December 2012 and included patients who had no history of diabetes mellitus and who were admitted to the general surgery intensive care units of Gazi University and Bülent Ecevit University School of Medicine, Turkey. Evaluations were performed on 12 patients with sepsis, 10 patients with severe sepsis, 13 patients with septic shock and 15 healthy controls. The patients’ plasma resistin, interleukin-6 (IL-6, tumour necrosis factor alpha (TNF-α, interleukin-1 beta (IL-1β, procalcitonin, lactate and glucose levels and Acute Physiology and Chronic Health Evaluation (APACHE II scores were studied daily for the first five days after admission. A correlation analysis of serum resistin levels with cytokine levels and APACHE II scores was performed. Results: Serum resistin levels in patients with sepsis were significantly higher than in the healthy controls (P <0.001. A significant correlation was found between serum resistin levels and APACHE II scores, serum IL-6, IL-1β, TNF-α, procalcitonin, lactate and glucose levels. Furthermore, a significant correlation was found between serum resistin levels and all-cause mortality (P = 0.02. Conclusion: The levels of resistin were significantly positively correlated with the severity of disease and were a possible mediator of a prolonged inflammatory state in patients with intra-abdominal sepsis.

Not All Abdomens Are the Same: A Comparison of Damage Control Surgery for Intra-abdominal Sepsis versus Trauma.

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Smith, Jason W; Nash, Nick; Procter, Levi; Benns, Matthew; Franklin, Glen A; Miller, Keith; Harbrecht, Brian G; Bernard, Andrew C

2016-05-01

Damage control surgery (DCS) was developed to manage exsanguinating trauma patients, but is increasingly applied to the management of peritoneal sepsis and abdominal catastrophes. Few manuscripts compare the outcomes of these surgeries on disparate patient populations. A multi-institutional three group propensity score matched case cohort study comparing penetrating trauma (PT-DCS), blunt trauma (BT-DCS), and intraperitoneal sepsis (IPS-DCS) was performed comparing patients treated with DSC between 2008 and 2013. Propensity scoring was performed using demographic and presenting physiologic data. Four hundred and twelve patients were treated with DCS across two institutions. Propensity matching for age, gender, and initial Acute Physiology and Chronic Health Evaluation II score 80 identified 80 patients per group for comparison. Rate of primary fascial closure was lowest in the IPS-DCS group, and highest in the penetrating trauma DCS group. Intra-abdominal complication rates were highest in the IPS-DCS group. IPS-DCS had increased time to definitive closure compared with the other two groups (RR 1.8; 1.3-2.2; P eight days were more than twice the risk of death at 90 days across all groups. (RR 2.15; 1.2-3.5; P managed via DCS.

Do we really rely on fast for decision-making in the management of blunt abdominal trauma?

Science.gov (United States)

Carter, Jeffrey W; Falco, Mark H; Chopko, Michael S; Flynn, William J; Wiles Iii, Charles E; Guo, Weidun Alan

2015-05-01

The Focused Assessment with Sonography in Trauma examination (FAST) is currently taught and recommended in the ATLS(®), often as an addendum to the primary survey for patients with blunt abdominal trauma. Although it is non-invasive and rapidly performed at bedside, the utility of FAST in blunt abdominal trauma has been questioned. We designed this study to examine our hypothesis that FAST is not an efficacious screening tool for identifying intra-abdominal injuries. We performed a retrospective chart review of all patients with confirmatory diagnosis of blunt abdominal injuries with CT and/or laparotomy for a period of 1.5 years (from 7/2009 to 11/2010). FAST was performed by ED residents and considered positive when free intra-abdominal fluid was visualized. Abdominal CT, or exploratory laparotomy findings were used as confirmation of intra-abdominal injury. A total of 1671 blunt trauma patients were admitted to and evaluated in the Emergency Department during a 1½ year period and 146 patients were confirmed intra-abdominal injuries by CT and/or laparotomy. Intraoperative findings include injuries to the liver, spleen, kidneys, and bowels. In 114 hemodynamically stable patients, FAST was positive in 25 patients, with a sensitivity of 22%. In 32 hemodynamically unstable patients, FAST was positive in 9 patients, with a sensitivity of 28%. A free peritoneal fluid and splenic injury are associated with a positive FAST on univariate analysis, and are the independent predictors for a positive FAST on multiple logistic regression. FAST has a very low sensitivity in detecting blunt intraabdominal injury. In hemodynamically stable patients, a negative FAST without a CT may result in missed intra-abdominal injuries. In hemodynamically unstable blunt trauma patients, with clear physical findings on examination, the decision for exploratory laparotomy should not be distracted by a negative FAST. Copyright © 2014 Elsevier Ltd. All rights reserved.

Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report

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Ertugrul Gokhan

2012-08-01

Full Text Available Abstract Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; exploration revealed a sigmoid colon injury that was treated by sigmoid loop colostomy. Conclusions Surgical abdominal exploration revealed gross fecal contamination and a perforation site. Intra-abdominal irrigation and a sigmoid loop colostomy were performed. Our patient was discharged on post-operative day six without any problems. Closure of the sigmoid loop colostomy was performed three months after the initial surgery.

Cardiorespiratory effects of balancing PEEP with intra-abdominal pressures during laparoscopic cholecystectomy.

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Kundra, Pankaj; Subramani, Yamini; Ravishankar, M; Sistla, Sarath C; Nagappa, Mahesh; Sivashanmugam, T

2014-06-01

Applying appropriate positive end-expiratory pressure (PEEP) to corresponding intra-abdominal pressure (IAP) can improve gas exchange during capnoperitoneum without any hemodynamic effects. A total of 75 patients were randomly allocated to group 0PEEP (n=25), group 5PEEP (n=25), and group 10PEEP (n=25) according to the level of PEEP, in whom capnoperitoneum was created with IAP of 14, 8, and 14 mm Hg, respectively. Hemodynamic and respiratory parameters were recorded up to 30 minutes after capnoperitoneum. In 0PEEP group, mean end-tidal carbon dioxide demonstrated significant rise 2 minutes after capnoperitoneum and plateaued at about 15 minutes but remained at high level for up to 30 minutes when compared with the 5PEEP and 10PEEP groups (Phigher at 30 minutes when compared with 5PEEP (37.8±2.7 mm Hg) and 10PEEP (37.2±3.9 mm Hg) groups. The oxygenation was better preserved in 5PEEP and 10PEEP groups with significantly higher PaO2/Fio2 ratio. Heart rate, mean arterial pressure, and cardiac output remained stable throughout the study in all the 3 groups. Application of appropriate PEEP corresponding to the IAP helped maintain CO2 elimination and improved oxygenation without any hemodynamic disturbance in patients undergoing laparoscopic cholecystectomy.

Antimicrobial Treatmdent of "Complicated" Intra-Abdominal Infections and The New IDSA Guidelines - A Commentary and an Alternative European Approach According to Clinical Definitions

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Eckmann C

2011-03-01

Full Text Available Abstract Recently, an update of the IDSA guidelines for the treatment of complicated intraabdominal infections has been published. No guideline can cater for all variations in ecology, antimicrobial resistance patterns, patient characteristics and presentation, health care and reimbursement systems in many different countries. In the short time the IDSA guidelines have been available, a number of practical clinical issues have been raised by physicians regarding interpretation of the guidelines. The main debatable issues of the new IDSA guidelines are described as follows: The authors of the IDSA guidelines present recommendations for the following subgroups of "complicated" IAI: community-acquired intra-abdominal infections of mild-to-moderate and high severity and health care-associated intra-abdominal infections (no general treatment recommendations, only information about antimicrobial therapy of specific resistant bacterial isolates. From a clinical point of view, "complicated" IAI are better differentiated into primary, secondary (community-acquired and postoperative and tertiary peritonitis. Those are the clinical presentations of IAI as seen in the emergency room, the general ward and on ICU. Future antibiotic treatment studies of IAI would be more clinically relevant if they included patients in studies for the efficacy and safety of antibiotics for the treatment of the above mentioned forms of IAI, rather than conducting studies based on the vague term "complicated" intra-abdominal infections. The new IDSA guidelines for the treatment of resistant bacteria fail to mention many of new available drugs, although clinical data for the treatment of "complicated IAI" with new substances exist. Further-more, treatment recommendations for cIAI caused by VRE are not included. This group of diseases comprises enough patients (i.e. the entire group of postoperative and tertiary peritonitis, recurrent interventions in bile duct surgery or

Plasma osmotic changes during major abdominal surgery.

Science.gov (United States)

Malone, R A; McLeavey, C A; Arens, J F

1977-12-01

Fluid balance across the capillary membrane is maintained normally by a balance of hydrostatic and colloid osmotic pressures (COP). In 12 patients having major intra-abdominal procedures, the COP was followed during the operative and immediate postoperative periods. The patients' intraoperative fluid management consisted of replacing shed blood with blood and following Shires' concept of crystalloid replacement. Significant decreases in COP to approximately two thirds of the initial value occurred in patients having intra-abdominal procedures versus only a 10 percent decrease in those having peripheral procedures (greater than .001). As a result of this decrease in COP, the balance between hydrostatic and colloid osmotic pressures is lost and risk of pulmonary intersitial edema is increased.

An integrated fluid-chemical model towards modeling the formation of intra-luminal thrombus in abdominal aortic aneurysms

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Jacopo eBiasetti

2012-07-01

Full Text Available Abdominal Aortic Aneurysms (AAAs are frequently characterized by the presenceof an Intra-Luminal Thrombus (ILT known to influence biochemically and biomechanicallytheir evolution. ILT progression mechanism is still unclear and little is known regardingthe impact on this mechanism of the chemical species transported by blood flow.Chemical agonists and antagonists of platelets activation, aggregation, and adhesion andthe proteins involved in the coagulation cascade (CC may play an important role in ILTdevelopment. Starting from this assumption, the evolution of chemical species involvedin the CC, their relation to coherent vortical structures (VSs and their possible effect onILT evolution have been studied. To this end a fluido-chemical model that simulates theCC through a series of convection-diffusion-reaction (CDR equations has been developed.The model involves plasma-phase and surface bound enzymes and zymogens, and includesboth plasma-phase and membrane-phase reactions. Blood is modeled as a non-Newtonianincompressible fluid. VSs convect thrombin in the domain and lead to the high concentration observed in the distal portion of the AAA. This finding is in line with the clinicalobservations showing that the thickest ILT is usually seen in the distal AAA region. Theproposed model, due to its ability to couple the fluid and chemical domains, provides anintegrated mechanochemical picture that potentially could help unveil mechanisms of ILTformation and development.

An integrated fluid-chemical model toward modeling the formation of intra-luminal thrombus in abdominal aortic aneurysms.

Science.gov (United States)

Biasetti, Jacopo; Spazzini, Pier Giorgio; Swedenborg, Jesper; Gasser, T Christian

2012-01-01

Abdominal Aortic Aneurysms (AAAs) are frequently characterized by the presence of an Intra-Luminal Thrombus (ILT) known to influence their evolution biochemically and biomechanically. The ILT progression mechanism is still unclear and little is known regarding the impact of the chemical species transported by blood flow on this mechanism. Chemical agonists and antagonists of platelets activation, aggregation, and adhesion and the proteins involved in the coagulation cascade (CC) may play an important role in ILT development. Starting from this assumption, the evolution of chemical species involved in the CC, their relation to coherent vortical structures (VSs) and their possible effect on ILT evolution have been studied. To this end a fluid-chemical model that simulates the CC through a series of convection-diffusion-reaction (CDR) equations has been developed. The model involves plasma-phase and surface-bound enzymes and zymogens, and includes both plasma-phase and membrane-phase reactions. Blood is modeled as a non-Newtonian incompressible fluid. VSs convect thrombin in the domain and lead to the high concentration observed in the distal portion of the AAA. This finding is in line with the clinical observations showing that the thickest ILT is usually seen in the distal AAA region. The proposed model, due to its ability to couple the fluid and chemical domains, provides an integrated mechanochemical picture that potentially could help unveil mechanisms of ILT formation and development.

Reproducibility of abdominal fat assessment by ultrasound and computed tomography

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Mauad, Fernando Marum; Chagas-Neto, Francisco Abaete; Benedeti, Augusto Cesar Garcia Saab; Nogueira-Barbosa, Marcello Henrique; Muglia, Valdair Francisco; Carneiro, Antonio Adilton Oliveira; Muller, Enrico Mattana; Elias Junior, Jorge, E-mail: fernando@fatesa.edu.br [Faculdade de Tecnologia em Saude (FATESA), Ribeirao Preto, SP (Brazil); Universidade de Fortaleza (UNIFOR), Fortaleza, CE (Brazil). Departmento de Radiologia; Universidade de Sao Paulo (FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Departmento de Medicina Clinica; Universidade de Sao Paulo (FFCLRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Filosofia, Ciencias e Letras; Hospital Mae de Deus, Porto Alegre, RS (Brazil)

2017-05-15

Objective: To test the accuracy and reproducibility of ultrasound and computed tomography (CT) for the quantification of abdominal fat in correlation with the anthropometric, clinical, and biochemical assessments. Materials and Methods: Using ultrasound and CT, we determined the thickness of subcutaneous and intra-abdominal fat in 101 subjects-of whom 39 (38.6%) were men and 62 (61.4%) were women-with a mean age of 66.3 years (60-80 years). The ultrasound data were correlated with the anthropometric, clinical, and biochemical parameters, as well as with the areas measured by abdominal CT. Results: Intra-abdominal thickness was the variable for which the correlation with the areas of abdominal fat was strongest (i.e., the correlation coefficient was highest). We also tested the reproducibility of ultrasound and CT for the assessment of abdominal fat and found that CT measurements of abdominal fat showed greater reproducibility, having higher intraobserver and interobserver reliability than had the ultrasound measurements. There was a significant correlation between ultrasound and CT, with a correlation coefficient of 0.71. Conclusion: In the assessment of abdominal fat, the intraobserver and interobserver reliability were greater for CT than for ultrasound, although both methods showed high accuracy and good reproducibility. (author)

Doripenem in hospital infections: a focus on nosocomial pneumonia, complicated intra-abdominal infections, and complicated urinary tract infections

Directory of Open Access Journals (Sweden)

Tze Shien Lo

2009-06-01

Full Text Available Tze Shien Lo,1 Stephanie M Borchardt,2 Justin M Welch,3 Melissa A Rohrich,3 Augusto M Alonto,4 Anne V Alonto51Infectious Diseases Service, Veterans Administration Medical Center, Fargo, North Dakota, USA; 2Research Service, Veterans Administration Medical Center, Fargo, North Dakota, USA; 3Pharmacy Service, Veterans Administration Medical Center, Fargo, North Dakota, USA; 4Infectious Diseases Department, MeritCare Medical Center, Fargo, North Dakota, USA; 5Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USAAbstract: Doripenem is the latest carbapenem on the market to date. Although not an antibiotic in a new class, it offers a glimmer of hope in combating serious infections secondary to multidrug-resistant Gram-negative bacteria when we have not seen a new class of antibacterial, particularly for Gram-negative bacteria, for more than 10 years. In vitro, doripenem exhibits a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including extended-spectrum β-lactamase (ESBL and Amp-C β-lactamase producing Enterobacteriaceae and anaerobes. Doripenem also exhibits better in vitro activity against Pseudomonas aeruginosa compared to other anti-pseudomonal carbapenems. It combines the desirable activities of both imipenem and meropenem. It has similar activity to imipenem against Gram-positive pathogens and has the antimicrobial spectrum of meropenem against Gram-negative organisms. Several randomized clinical trials have demonstrated that doripenem is non-inferior to meropenem, imipenem, piperacillin/tazobactam, or levofloxacin in its efficacy and safety profile in treating a wide range of serious bacterial infections including intra-abdominal infection, complicated urinary tract infection, and nosocomial pneumonia. Due to its wide spectrum of activity and good safety profile it is susceptible to misuse leading to increasing rates of resistance

Effects of increased intra-abdominal pressure on the healing process after surgical stapling of the stomach of dogs Efeitos da elevação da pressão intra-abdominal e de seu tempo de ação na cicatrização de suturas mecânicas no estômago de cães

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Nilson Chaves Jr

2007-10-01

Full Text Available PURPOSE: To assess the initial healing after surgical stapling of the stomach using a linear cutting stapler and creating pneumoperitoneum (12-14 mmHg for 60 minutes or 120 minutes, and compare it with the healing of a staple line not submitted to increased pressure. METHODS: A total of 30 dogs were divided into three groups of 10 animals each: Group I (control group - surgical stapling, Group II (surgical stapling and increased intra-abdominal pressure for 60 minutes and Group III (surgical stapling and increased intra-abdominal pressure for 120 minutes. All dogs were maintained under general anesthesia for two hours after surgical stapling. Seven days after surgery, the area around the staple line was macroscopically and microscopically examined. RESULTS: The macroscopic examination of the samples (n = 30 did not show dehiscence, fistula or abscess. Adhesions between the omentum and the staple line were observed in all animals of Groups II and III (n = 20, which were significantly different from Group I (p = 0.008*. The histopathological analysis showed normal healing up to day 7 in the control animals (n = 10. When these results were compared with those of Groups II and III (n = 20, non-parametric tests revealed that there was a significant difference with regard to certain parameters of the early stages of healing, such as fibroblast migration (p = 0.011*, edema (p OBJETIVO: Avaliar os efeitos do pneumoperitônio com CO2 sobre a fase inicial da cicatrização (7º dia de uma sutura gástrica mecânica em cães, com diferentes tempos de aumento da pressão intra-abdominal. MÉTODOS: Trinta cães foram divididos em três grupos e submetidos à laparotomia mediana e realização de uma sutura vertical na grande curvatura gástrica com grampeador linear cortante. Após a síntese abdominal, nos animais dos grupos II e III instalou-se pneumoperitônio com CO2, permanecendo os animais com pressão intra-abdominal entre 12 e 14 mmHg durante 60

Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis.

Science.gov (United States)

Mueller, Tara C; Loos, Martin; Haller, Bernhard; Mihaljevic, André L; Nitsche, Ulrich; Wilhelm, Dirk; Friess, Helmut; Kleeff, Jörg; Bader, Franz G

2015-02-01

Surgical site infection (SSI) remains to be one of the most frequent infectious complications following abdominal surgery. Prophylactic intra-operative wound irrigation (IOWI) before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI. However, current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances. To analyze the existing evidence for the effect of IOWI with topical antibiotics, povidone-iodine (PVP-I) solutions or saline on the incidence of SSI following open abdominal surgery, a systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out according to the recommendations of the Cochrane Collaboration. Forty-one RCTs reporting primary data of over 9000 patients were analyzed. Meta-analysis on the effect of IOWI with any solution compared to no irrigation revealed a significant benefit in the reduction of SSI rates (OR = 0.54, 95 % confidence Interval (CI) [0.42; 0.69], p < 0.0001). Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline. However, all of the included trials were at considerable risk of bias according to the quality assessment. These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications.

In women with polycystic ovary syndrome and obesity, loss of intra-abdominal fat is associated with resumption of ovulation.

Science.gov (United States)

Kuchenbecker, Walter K H; Groen, Henk; van Asselt, Sophie J; Bolster, Johanna H T; Zwerver, J; Slart, Riemer H J; Vd Jagt, Erik J; Muller Kobold, Anneke C; Wolffenbuttel, Bruce H R; Land, Jolande A; Hoek, Annemieke

2011-09-01

It is not clear why some anovulatory women with polycystic ovary syndrome (PCOS) and obesity resume ovulation and others remain anovulatory after weight loss. The objective of this study was to compare the changes in body fat distribution and specifically intra-abdominal fat (IAF) and subcutaneous abdominal fat (SAF) between a group of anovulatory women with PCOS and obesity who resume ovulation (RO+) to those who remain anovulatory (RO-) during a lifestyle program. In a prospective pilot cohort study, anovulatory women with PCOS underwent a 6 month lifestyle program in a tertiary fertility clinic. Body fat distribution was assessed by anthropometrics, dual-energy X-ray absorptiometry (DEXA) and single slice abdominal CT scan at intake, after 3 months and after 6 months. Baseline-corrected changes over time were analysed using generalized estimating equations longitudinal regression analysis. In 32 anovulatory women with PCOS (age, 28 ± 4 years; BMI, 37.5 ± 5.0 kg/m²), there were no significant baseline differences in anthropometrics and biochemical assessment between 14 RO+ participants and 18 RO- participants. RO+ women lost more weight (6.3 versus 3.0%) and abdominal fat on DEXA (15.0 versus 4.3%) compared with RO- women. Resumption of ovulation was associated with early and consistent loss of IAF (12.4 versus 5.0% at 3 months and 18.5 versus 8.6% at 6 months). Loss of SAF between the RO+ women and the RO- women was similar at 3 months (6.2 versus 6.1%) but did not change any further in RO- women (6.1%) as it did in RO+ women (11.4%) at 6 months. In anovulatory women with PCOS and obesity undergoing a lifestyle program, RO+ women lose more body weight and abdominal fat on DEXA than RO- women. In addition, this study shows that early and consistent loss of IAF is associated with resumption of ovulation. Future studies should address the mechanisms behind these changes and should assess interventions aimed at loss of IAF to facilitate resumption of ovulation.

Discospondylitis in association with an intra-abdominal abscess in a dog

International Nuclear Information System (INIS)

Siems, J.S.; Jakovljevic, S.; Adams, L.G.; Munjar, T.A.; DeNicola, D.B.

1999-01-01

An 11-year-old German shepherd dog cross was presented with a six-week history of weight loss and abdominal distension. A diagnosis of abdominal abscess and discospondylitis was made. The dog responded to surgical excision of the abscess and conservative medical treatment for discospondylitis

A wolf in wolf's clothing the abdominal compartment syndrome

African Journals Online (AJOL)

abdomen. These findings are consistent with the diagnosis of intra-abdominal compartment syndrome. In 1 case trauma was remote from the abdomen .... although they tend to develop most often in those who have undergone major vascular operations or suffered abdominal trauma. The effects of the pressure on the bowel ...

The Effects of Dexmedetomidine on Secondary Acute Lung and Kidney Injuries in the Rat Model of Intra-Abdominal Sepsis

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Uğur Koca

2013-01-01

Full Text Available In the present study, the effects of dexmedetomidine on secondary lung and kidney injuries were studied in the rat model of intra-abdominal sepsis by immunohistological and biochemical examinations. We measured serum creatinine, kidney tissue malondialdehide and plasma neutrophil gelatinase-associated lipocalin levels. In order to evaluate tissue injury we determined kidney tissue mononuclear cell infiltration score, alveolar macrophage count, histological kidney and lung injury scores and kidney and lung tissue immunoreactivity scores. We demonstrated that dexmedetomidine attenuates sepsis-induced lung and kidney injuries and apoptosis in the rat model of sepsis. There is still need for comparative studies in order to determine the effects of dexmedetomidine on organ functions in early human sepsis.

Case Report Meleney's Ulcer; A Rare but Fatal Abdominal Wall ...

African Journals Online (AJOL)

KIGZ

Meleney's Ulcer; A Rare but Fatal Abdominal Wall Disease Complicating ... Meleney's ulcer or post operative synergistic bacterial gangrene is a rare form of ... Central venous catheterization and parenteral ... is no record of full recovery from the intra-abdominal pathology before the ... chronic undermining ulcer of Meleney.

Late Presentation of Intra-abdominal Foreign Body following ...

African Journals Online (AJOL)

This is a case of delayed wound healing following a caesarean delivery conducted in a peripheral hospital two years ago. Diagnosis of foreign body was also delayed until the foreign body self extrude through a discharging sinus. Abdominal exploration revealed gauze of about 50 cm long encapsulated within the ...

When Should Abdominal Computed Tomography Be Considered in Patients with Lower Rib Fractures?

Science.gov (United States)

Jeroukhimov, Igor; Hershkovitz, Yehuda; Wiser, Itay; Kessel, Boris; Ayyad, Mohammed; Gatot, Inbar; Shapira, Zahar; Jeoravlev, Svetlana; Halevy, Ariel; Lavy, Ron

2017-05-01

Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%-40%. The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures. Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI. Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1-16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1-13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2-4.8; p = 0.016) as independent risk factors for the presence of IAI. Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission. Copyright © 2016 Elsevier Inc. All rights reserved.

Abdominal elephantiasis: a case report.

Science.gov (United States)

Hanna, Dominique; Cloutier, Richard; Lapointe, Roch; Desgagné, Antoine

2004-01-01

Elephantiasis is a well-known condition in dermatology usually affecting the legs and external genitalia. It is characterized by chronic inflammation and obstruction of the lymphatic channels and by hypertrophy of the skin and subcutaneous tissues. The etiology is either idiopathic or caused by a variety of conditions such as chronic filarial disease, leprosy, leishmaniasis, and chronic recurrent cellulites. Elephantiasis of the abdominal wall is very rare. A complete review of the English and French literature showed only two cases reported in 1966 and 1973, respectively. We report a third case of abdominal elephantiasis and we briefly review this entity. We present the case of a 51-year-old woman who had progressively developed an enormous pediculated abdominal mass hanging down her knees. The skin was thickened, hyperpigmented, and fissured. She had a history of multiple abdominal cellulites. She underwent an abdominal lipectomy. Histopathology of the specimen confirmed the diagnosis of abdominal elephantiasis. Abdominal elephantiasis is a rare disease that represents end-stage failure of lymph drainage. Lipectomy should be considered in the management of this condition.

Isolated free intra-abdominal fluid on CT in blunt trauma: The continued diagnostic dilemma.

Science.gov (United States)

Kong, Victor Y; Jeetoo, Damon; Naidoo, Leah C; Oosthuizen, George V; Clarke, Damian L

2015-01-01

The clinical significance of isolated free fluid (FF) without solid organ injury on computed to- mography (CT) continues to pose significant dilemma in the management of patients with blunt abdominal trauma (BAT). We reviewed the incidence of FF and the clinical outcome amongst patients with blunt abdominal trauma in a metropolitan trauma service in South Africa. We performed a retrospective study of 121 consecutive CT scans over a period of 12 months to determine the incidence of isolated FF and the clinical outcome of patients managed in a large metropolitan trauma service. Of the 121 CTs, FF was identified in 36 patients (30%). Seven patients (6%) had isolated FF. Of the 29 patients who had free fluid and associated organ injuries, 33 organ injuries were identified. 86% (25/ 29) of all 29 patients had a single organ injury and 14% had multiple organ injuries. There were 26 solid organ injuries and 7 hollow organ injuries. The 33 organs injured were: spleen, 12; liver, 8; kidney, 5; pancreas, 2; small bowel, 4; duodenum, 1. Six (21%) patients required operative management for small bowel perforations in 4 cases and pancreatic tail injury in 2 cases. All 7 patients with isolated FF were initially observed, and 3 (43%) were eventually subjected to operative intervention. They were found to have an intra-peritoneal bladder rupture in 1 case, a non-expanding zone 3 haematoma in 1 case, and a negative laparotomy in 1 case. Four (57%) patients were successfully managed without surgical interventions. Isolated FF is uncommon and the clinical significance remains unclear. Provided that reli- able serial physical examination can be performed by experienced surgeons, an initial non-operative approach should be considered.

Abdominal auscultation does not provide clear clinical diagnoses.

Science.gov (United States)

Durup-Dickenson, Maja; Christensen, Marie Kirk; Gade, John

2013-05-01

Abdominal auscultation is a part of the clinical examination of patients, but the determining factors in bowel sound evaluation are poorly described. The aim of this study was to assess inter- and intra-observer agreement in physicians' evaluation of pitch, intensity and quantity in abdominal auscultation. A total of 100 physicians were presented with 20 bowel sound recordings in a blinded set-up. Recordings had been made in a mix of healthy volunteers and emergency patients. They evaluated pitch, intensity and quantity of bowel sounds in a questionnaire with three, three and four categories of answers, respectively. Fleiss' multi-rater kappa (κ) coefficients were calculated for inter-observer agreement; for intra-observer agreement, calculation of probability was performed. Inter-observer agreement regarding pitch, intensity and quantity yielded κ-values of 0.19 (p auscultation increases with addition of history and clinics, and may be further improved by systematic training, it should still be used in the examination of patients with acute abdominal pain. not relevant. not relevant.

Sci-Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques - 04: Assessment of intra-fraction motion during lung SABR VMAT using a custom abdominal compression device

Energy Technology Data Exchange (ETDEWEB)

Hyde, Derek; Robinson, Mark; Araujo, Cynthia; Teke, Tony; Halperin, Ross; Petrik, David; Mou, Benjamin; Mohamed, Islam [BCCA - Centre for the Southern Interior (Canada)

2016-08-15

Purpose: Lung SABR patients are treated using Volumetrically Modulated Arc Therapy (VMAT), utilizing 2 arcs with Conebeam CT (CBCT) image-guidance prior to each arc. Intra-fraction imaging can prolong treatment time (up to 20%), and the aim of this study is to determine if it is necessary. Methods: We utilize an in-house abdominal compression device to minimize respiratory motion, 4DCT to define the ITV, a 5 mm PTV margin and a 2–3 mm PRV margin. We treated 23 patients with VMAT, fifteen were treated to 48 Gy in 4 fractions, while eight were treated with up to 60 Gy in 8 fractions. Intrafraction motion was assessed by the translational errors recorded for the second CBCT. Results: There was no significant difference (t-test, p=0.93) in the intra-fraction motion between the patients treated with 4 and 8 fractions, or between the absolute translations in each direction (ANOVA, p=0.17). All 124 intra-fraction CBCT images were analysed and 95% remained localized within the 5 mm PTV margin The mean magnitude of the vector displacement was 1.8 mm. Conclusions: For patients localized with an abdominal compression device, the intrafraction CBCT image may not be necessary, if it is only the tumor coverage that is of concern, as the patients are typically well within the 5 mm PTV margin. On the other hand, if there is a structure with a smaller PRV margin, an intrafraction CBCT is recommended to ensure that the dose limit for the organ at risk is not exceeded.

Don't Forget the Abdominal Wall: Imaging Spectrum of Abdominal Wall Injuries after Nonpenetrating Trauma.

Science.gov (United States)

Matalon, Shanna A; Askari, Reza; Gates, Jonathan D; Patel, Ketan; Sodickson, Aaron D; Khurana, Bharti

2017-01-01

Abdominal wall injuries occur in nearly one of 10 patients coming to the emergency department after nonpenetrating trauma. Injuries range from minor, such as abdominal wall contusion, to severe, such as abdominal wall rupture with evisceration of abdominal contents. Examples of specific injuries that can be detected at cross-sectional imaging include abdominal muscle strain, tear, or hematoma, including rectus sheath hematoma (RSH); traumatic abdominal wall hernia (TAWH); and Morel-Lavallée lesion (MLL) (closed degloving injury). These injuries are often overlooked clinically because of (a) a lack of findings at physical examination or (b) distraction by more-severe associated injuries. However, these injuries are important to detect because they are highly associated with potentially grave visceral and vascular injuries, such as aortic injury, and because their detection can lead to the diagnosis of these more clinically important grave traumatic injuries. Failure to make a timely diagnosis can result in delayed complications, such as bowel hernia with potential for obstruction or strangulation, or misdiagnosis of an abdominal wall neoplasm. Groin injuries, such as athletic pubalgia, and inferior costochondral injuries should also be considered in patients with abdominal pain after nonpenetrating trauma, because these conditions may manifest with referred abdominal pain and are often included within the field of view at cross-sectional abdominal imaging. Radiologists must recognize and report acute abdominal wall injuries and their associated intra-abdominal pathologic conditions to allow appropriate and timely treatment. © RSNA, 2017.

Drain site evisceration of fallopian tube, another reason to discourage abdominal drain: report of a case and brief review of literature.

Science.gov (United States)

Saini, Pradeep; Faridi, M S; Agarwal, Nitin; Gupta, Arun; Kaur, Navneet

2012-04-01

Placement of a drain following abdominal surgery is common despite a lack of convincing evidence in the current literature to support this practice. The use of intra-abdominal drain is associated with many potential and serious complications. We report a drain site evisceration of the right fallopian tube after the removal of an intra-abdominal drain. The drain was placed in the right iliac fossa in a patient who underwent a lower segment Caesarean section (LSCS) for meconium liquor with fetal distress. The Pfannenstiel incision made for LSCS was reopened and the protruding inflamed fimbrial end of the right fallopian tube was excised. The patient made an uneventful recovery. Routine intra-abdominal prophylactic drain following an abdominal surgery including LSCS should be discouraged.

Postmortem abdominal CT: Assessing normal cadaveric modifications and pathological processes

International Nuclear Information System (INIS)

Charlier, P.; Carlier, R.; Roffi, F.; Ezra, J.; Chaillot, P.F.; Duchat, F.; Huynh-Charlier, I.; Lorin de la Grandmaison, G.

2012-01-01

Purpose: To investigate the interest of postmortem non-enhanced computer tomography (CT) for abdominal lesions in a forensic context of suspicions death and to list the different radiological cadaveric modifications occurring normally at abdominal stage, which must be known by non forensic radiologists in case of any postmortem exam. Materials and methods: 30 cadavers have been submitted to a body CT-scan without injection of contrast material. CT exams were reviewed by two independent radiologists and radiological findings were compared with forensic autopsy data. Results: False positive CT findings included physiological postmortem transudates misdiagnosed with intra-abdominal bleedings, and putrefaction gas misdiagnosed with gas embolism, aeroporty, aerobily, digestive parietal pneumatosis. Incidentalomas without any role in death process were also reported. False negative CT findings included small contusions, vascular thromboses, acute infarcts foci, non radio-opaque foreign bodies. Normal cadaveric modifications were due to livor mortis and putrefaction, and are seen quickly (some hours) after death. Conclusion: The non forensic radiologist should be familiar with the normal abdominal postmortem features in order to avoid misdiagnoses, and detect informative lesions which can help and guide the forensic practitioner or the clinical physician.

Abdominal injuries in communal crises: The Jos experience

Directory of Open Access Journals (Sweden)

Emmanuel Olorundare Ojo

2016-01-01

Full Text Available Background: Abdominal injuries contribute significantly to battlefield trauma morbidity and mortality. This study sought to determine the incidence, demographics, clinical features, spectrum, severity, management, and outcome of abdominal trauma during a civilian conflict. Materials and Methods: A prospective analysis of patients treated for abdominal trauma during the Jos civil crises between December 2010 and May 2012 at the Jos University Teaching Hospital. Results: A total of 109 victims of communal conflicts with abdominal injuries were managed during the study period with 89 (81.7% males and 20 (18.3% females representing about 12.2% of the total 897 combat related injuries. The peak age incidence was between 21 and 40 years (range: 3–71 years. The most frequently injured intra-abdominal organs were the small intestine 69 (63.3%, colon 48 (44%, and liver 41 (37.6%. Forty-four (40.4% patients had extra-abdominal injuries involving the chest in 17 (15.6%, musculoskeletal 12 (11%, and the head in 9 (8.3%. The most prevalent weapon injuries were gunshot 76 (69.7%, explosives 12 (11%, stab injuries 11 (10.1%, and blunt abdominal trauma 10 (9.2%. The injury severity score varied from 8 to 52 (mean: 20.8 with a fatality rate of 11 (10.1% and morbidity rate of 29 (26.6%. Presence of irreversible shock, 3 or more injured intra-abdominal organs, severe head injuries, and delayed presentation were the main factors associated with mortality. Conclusion: Abdominal trauma is major life-threatening injuries during conflicts. Substantial mortality occurred with loss of nearly one in every 10 hospitalized victims despite aggressive emergency room resuscitation. The resources expenditure, propensity for death and expediency of timing reinforce the need for early access to the wounded in a concerted trauma care systems.

Anterior Abdominal Wall Desmoids Tumor in a Five Year Old Girl – A ...

African Journals Online (AJOL)

xp

ABSTRACT: Desmoid tumors are rare, slow – growing, mesenchymal monoclinic proliferation. It may occur as intra-abdominal tumor usually affecting the mesentery of the intestine or it could be extra-abdominal in which they may affect the popliteal region, the chest wall or the anterior abdominal wall. Reports in children ...

A Challenging Case of Metastatic Intra-Abdominal Synovial Sarcoma with Unusual Immunophenotype and Its Differential Diagnosis

Directory of Open Access Journals (Sweden)

Yi-Che Changchien

2012-01-01

Full Text Available The primary and metastatic gastrointestinal synovial sarcoma is rare with a wide differential diagnosis. It usually expresses cytokeratins EMA, BCL2 with an occasional CD99, and S100 positivity but not desmin. We present a case of metastatic synovial sarcoma with unusual immunophenotype causing diagnostic challenges. The tumor cells showed focal cytokeratin, EMA, and, unexpectedly, desmin positivity. Additional intranuclear TLE-1 positivity and negativity for CD34 and DOG-1 were also identified. A diagnosis of monophasic synovial sarcoma was confirmed by using FISH break-apart probe. RT-PCR revealed the SYT-SSX1 fusion gene. Intra-abdominal synovial sarcoma, either primary or metastatic, with unusual desmin positivity raises the diagnostic challenge, since a wide range of differential diagnoses could show a similar immunophenotype (leiomyosarcoma, desmoid tumor, myofibroblastic tumor, and rarely GIST etc.. Typical morphology and focal cytokeratin/EMA positivity should alert to this tumor, and FISH and RT-PCR remain the gold standard for the confirmation.

Computed tomographic findings of abdominal complications of Crohn's disease - pictorial essay

International Nuclear Information System (INIS)

Zissin, R.; Hertz, M.; Osadchy, A.; Novis, B.; Gayer, G.

2005-01-01

Crohn's disease (CD) is a chronic, transmural, inflammatory disease of the gastrointestinal tract (CIT) most often affecting the terminal ileum and colon. Diarrhea, abdominal pain, anorexia, nausea, and weight loss are the most common clinical symptoms. Abdominal complications of CD, both intestinal and extraintestinal, are frequent and variable. The most common intestinal complications include ileocolitis with external or internal fistulas and abscess formation, strictures, and bowel obstruction. Less common are free perforation, intussusception, and malignancy. The extraintestinal complications include nephrolithiasis, cholelithiasis, fatty liver, portal vein gas, and thromboembolic events. Nowadays, computed tomography (CT) provides superb anatomic detail and diagnostic accuracy of various intra-abdominal pathological processes, and it thus has become an essential diagnostic tool in the evaluation and management of patients wit known CD for the assessment of bowel wall involvement, the mesenteric extent of the disease, and inn-abdominal complications. In addition, as CT is frequently performed to evaluate patients with acute abdomen, it may encounter clinically unsuspected complications in patients with CD. This article reviews the CT features of various intra-abdominal complications of CD. (author)

Clinical findings and diagnostic imaging of small intestinal rupture due to blunt abdominal trauma

International Nuclear Information System (INIS)

Takahashi, Hitoshi; Sakata, Ikuhiro; Ogawa, Masaaki; Izumoto, Gentaro; Kim, Akio; Maeda, Shigenari; Yasutomi, Masayuki; Yamamoto, Toshio

1987-01-01

Eight patients with small intestinal rupture due to blunt abdominal trauma were analyzed by their clinical findings and diagnostic imaging (plain film, ultrasound and computed tomography). Computed tomography was most useful for identification of intraabdominal extraluminal free air (pneumoperitoneum) and this finding was obtained in seven out of the eight patients (87.5 %). Intraabdominal fluid collection was observed in All the patients and was most clearly detectable by ultrasound and computed tomography. These examinations may be applied to identification of properties of the fluid collection. All the patients eventually developed peritonitis when laparotomy was decided. Thus, close follow up observation of abdominal physical signs was also of critical importance. (author)

Functional abdominal pain.

Science.gov (United States)

Grover, Madhusudan; Drossman, Douglas A

2010-10-01

Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods (Drossman Gastroenterology 130:1377-1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently confused with irritable bowel syndrome and other functional GI disorders in which abdominal pain is associated with eating and bowel movements. FAPS also differs from chronic abdominal pain associated with entities such as chronic pancreatitis or chronic inflammatory bowel disease, in which the pain is associated with peripherally acting factors (eg, gut inflammation or injury). Given the central contribution to the pain experience, concomitant psychosocial disturbances are common and strongly influence the clinical expression of FAPS, which also by definition is associated with loss of daily functioning. These factors make it critical to use a biopsychosocial construct to understand and manage FAPS, because gut-directed treatments are usually not successful in managing this condition.

Effects of Streptokinase and Normal Saline on the Incidence of Intra-abdominal Adhesion 1 Week and 1 Month after Laparotomy in Rats

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Ali Hosseini

2018-01-01

Full Text Available Background: Intra-abdominal adhesions after surgery are usually in the form of bands and can annoy the patient throughout life causing repeated surgical procedures. Therefore, any action to prevent adhesions after surgery can increase longevity and quality of life. For this aim, this study investigates the effect of streptokinase and normal saline on the 7th day and 1 month after laparotomy. Materials and Methods: Experimental study was conducted on thirty healthy male Wistar rats weighing 200–250 g with age of 3 months divided into three groups of 10. Group I: No treatment, Group II: Received normal saline, and Group III: Received normal saline and streptokinase at the same time. One week and 1 month after laparotomy, the frequency of the presence or absence of adhesion bands was performed by a person who was unaware of the sample grouping. The collected information was analyzed with the SPSS software (version 16; SPSS Inc., Chicago, IL, USA. Results: Adhesion frequency was found to be 20% on the 7th day (early and 1 month after laparotomy (late for Group 1, and it was 40% on early and late for Group II, while 0% on the early and late for Group III. Hence, in the group receiving streptokinase, no early or late adhesion was observed; therefore, it had a significant role in the prevention of intra-abdominal adhesions (P 0.05. Conclusion: According to the results of our study, we believe that streptokinase could be a good antiadhesive agent considering its effectiveness.

Intra­‑abdominal adhesions in ultrasound. Part I: The visceroperitoneal bordeline, anatomy and the method of examination

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Andrzej Smereczyński

2012-12-01

Full Text Available It needs to be emphasized that ultrasonography is a primary test performed in order to evaluate the abdominal wall and structures located in their vicinity. It allows for the determination of the anatomy and lesions in this localization. Thorough knowledge con‑ cerning the ultrasound anatomy of the tested structures constitutes a basis of all diagnos‑ tic successes. Therefore, this part of the article is devoted to this subject matter. The pos‑ sibility to diagnose intra-abdominal adhesions with ultrasound is underestimated and rarely used. The aim of this paper is to discuss and document the ultrasound anatomy of the posterior surface of the abdominal wall as well as to present techniques directed at the detection of adhesions, in particular the visceroperitoneal ones. The posterior surface of the abdominal wall constitutes an extensive tissue area of complex structure, with folds and ligaments surrounded by various amounts of the epiperitoneal fat. In some places, this tissue separates the components of the fascia and peritoneum complex. The ultra‑ sound manifestation of this complex is two hyperechogenic lines placed parallelly to each other in the places where they are not separated by the accumulated adipose tissue. Another factor which separates the peritoneum from the viscera is of dynamic character. It is a so-called visceral slide induced by easy or deep breathing. Its size should not be lower than 1 cm and the deflections gradually and symmetrically diminish from the epi‑ gastric to hypogastric region. Last but not least, the evaluation of the reciprocal relation of the abdominal wall with viscera may be aided by rhythmical manual compressions on the abdominal wall (ballottement sign performed below the applied ultrasound trans‑ ducer. During this test, the size of the visceral slide in relation to the abdominal wall is observed. The maneuver is usually performed in uncooperative patients or those with shallow breath. The

Intra-Abdominal Localisation of a Buschke-Lowenstein Tumour: Case Presentation and Review of the Literature

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N. E. Wester

2013-01-01

Full Text Available Giant condyloma acuminatum or Buschke-Lowenstein tumour is a very rare disease which usually is located in the genital, anorectal, and perianal regions. It is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces where it is locally invasive but displays a benign cytology. We describe a case of a 24-year-old woman with persisting condyloma acuminata progressing to a large intra-abdominal Buschke-Lowenstein tumour. To our knowledge such an advanced stage has only been reported once before. The severity and extent of the tumour both determine the treatment and patient outcome. Treatment was impeded by cachexia, an immunosuppressive state after kidney transplantation and difficulties in establishing a reliable diagnose. Interferon treatment was started which initially led to tumour reduction but was complicated by an interferon-induced pancreatitis, pneumonia, and fasciitis necroticans resulting in death. We present a literature overview on the treatment options for a Buschke-Lowenstein tumour, with emphasis on interferon therapy, with all the advantages and disadvantages.

Heterotopic mesenteric and abdominal wall ossification – Two case reports in one institution

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Cátia Ferreira; Carina Gomes; Ana Melo; Nádia Tenreiro; Bruno Pinto; Herculano Moreira; Artur Ribeiro; Paulo Avelar

2017-01-01

Introduction: Heterotopic ossification occurs when bone develops in tissues which usually don’t undergo ossification. Heterotopic mesenteric ossification, also known as intra-abdominal myositis ossificans, is a rare and benign form of ossification, usually related with previous abdominal surgery or trauma. Presentation of cases: We report two cases of heterotopic ossification both after multiple abdominal surgeries, with intraoperative findings of mesenteric and abdominal wall ossification...

Anterior Abdominal Wall Desmoids Tumor in a Five Year Old Girl – A ...

African Journals Online (AJOL)

Desmoid tumors are rare, slow – growing, mesenchymal monoclinic proliferation. It may occur as intra-abdominal tumor usually affecting the mesentery of the intestine or it could be extra-abdominal in which they may affect the popliteal region, the chest wall or the anterior abdominal wall. Reports in children less than 10 ...

[Massive increase of foetal abdominal circumference due to hereditary polycystic kidney disease].

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Dukic, L; Schaffelder, R; Schaible, T; Sütterlin, M; Siemer, J

2010-06-01

Autosomal recessive polycystic kidney disease (ARPKD) is a rare condition with a poor prognosis. We report on a 30-year-old primagravid woman in the 34th) week of gestation who was admitted to our hospital. ARPKD of the foetus had been sonographically suspected since the 26th week of gestation. Ultrasound examination showed big polycystic kidneys on both sides. The non-consanguineous parents wanted a maximum therapy for the infant. Foetal digitalisation because of heart insufficiency and prophylactic lung maturation was started. In the further course, Doppler sonographic values worsened and a Caesarean section was performed in the 34th week of gestation at the demand of the parents and due to the expected problems in case of a vaginal delivery. The weight of the newborn was 3,780 g and the abdominal circumference was 50 cm. The newborn was intubated immediately after birth and artificial ventilation was performed. Extracorporeal membrane oxygenation was not possible due to the bad cardial condition. The boy died 16 h after delivery. The parents refused genetic examination and autopsy of the newborn. ARPKD is a severe disease that may have obstetric relevance, due to the massively increased abdominal circumference. Therefore, termination of pregnancy or preterm induction of labor should be considered in order to avoid Caesarean section. Additionally, early prenatal diagnosis with genetic analysis of PRKD1 in cases of suspected ARPKD can be helpful. Georg Thieme Verlag KG Stuttgart, New York.

Blunt abdominal trauma in children.

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Schonfeld, Deborah; Lee, Lois K

2012-06-01

This review will examine the current evidence regarding pediatric blunt abdominal trauma and the physical exam findings, laboratory values, and radiographic imaging associated with the diagnosis of intra-abdominal injuries (IAI), as well as review the current literature on pediatric hollow viscus injuries and emergency department disposition after diagnosis. The importance of the seat belt sign on physical examination and screening laboratory data remains controversial, although screening hepatic enzymes are recommended in the evaluation of nonaccidental trauma to identify occult abdominal organ injuries. Focused Assessment with Sonography for Trauma (FAST) has modest sensitivity for hemoperitoneum and IAI in the pediatric trauma patient. Patients with concern for undiagnosed IAI, including bowel injury, may be considered for hospital admission and serial abdominal exams without an increased risk of complications, if an exploratory laparotomy is not performed emergently. Although the FAST exam is not recommended as the sole screening tool to rule out IAI in hemodynamically stable trauma patients, it may be used in conjunction with the physical exam and laboratory findings to identify children at risk for IAI. Children with a normal physical exam and normal abdominal CT may not require routine hospitalization after blunt abdominal trauma.

Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome.

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Udigwe, Gerald Okanandu; Eleje, George Uchenna; Ihekwoaba, Eric Chukwudi; Udegbunam, Onyebuchi Izuchukwu; Egeonu, Richard Obinwanne; Okwuosa, Ayodele Obianuju

2016-01-01

Background. Acute intestinal obstruction during pregnancy is a very challenging and unusual nonobstetric surgical entity often linked with considerable fetomaternal morbidity and mortality. When it is synchronous with abdominal pregnancy, it is even rarer. Case Presentation. A 28-year-old lady in her second pregnancy was referred to Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, at 27 weeks of gestation due to vomiting, constipation, and abdominal pain. Examination and ultrasound scan revealed a single live intra-abdominal extrauterine fetus. Plain abdominal X-ray was diagnostic of intestinal obstruction. Conservative treatment was successful till the 34-week gestational age when she had exploratory laparotomy. At surgery, the amniotic sac was intact and the placenta was found to be adherent to the gut. There was also a live female baby with birth weight of 2.3 kg and Apgar scores of 9 and 10 in the 1st and 5th minutes, respectively, with the baby having right clubbed foot. Adhesiolysis and right adnexectomy were done. The mother and her baby were well and were discharged home nine days postoperatively. Conclusion. To the best of our knowledge, this is the first report of abdominal pregnancy as the cause of acute intestinal obstruction in the published literature. Management approach is multidisciplinary.

ABDOMINAL TRAUMA- CLINICAL STUDY

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Vanaja Ratnakumari Billa

2017-08-01

Full Text Available BACKGROUND In the recent times there has been increased incidence of abdominal trauma cases due to several causes. Quick and prompt intervention is needed to decrease the mortality of the patients. So we conducted a study to assess the cause and the management of abdominal trauma cases in our institution. The aim of this study was to know the incidence of blunt and penetrating injuries and their causes, age and sex incidence, importance of various investigations, mode of treatment offered and post-operative complications. To study the cause of death and evolve better management. MATERIALS AND METHODS The present study comprises of patients admitted to and operated in various surgical units in the Department of Surgery at Government General Hospital, attached to Guntur Medical College Guntur, from August 2014 to October 2016. RESULTS Increase incidence seen in age group 20-29 years (30%. Male predominance 77.5%. Mechanism of injury–road traffic accidents 65%. Isolated organ injury–colon and rectum 40%. Other associated injuries–chest injuries with rib fractures 7.5%. Complications–wound infection 17.5%. Duration of hospital stay 8–14 days. Bowel injury management–closure of perforation 84.6%. Resection anastomosis 15.38%. CONCLUSION Thorough clinical examination, diagnostic paracentesis, plain X-ray erect abdomen and ultrasound proved to be very helpful in the diagnosis of intra-abdominal injuries. Spleen is the commonest organ involved in blunt trauma and colon is the commonly injured organ in penetrating abdominal trauma, many patients have associated extremity and axial skeleton injuries. With advances in diagnosis and intensive care technologies, most patients of solid visceral injuries with hemodynamic stability can be managed conservatively. Surgical site infection is the most common complication following surgery. The mortality is high; reason might be patient reaching the hospital late, high incidence of postoperative septic

Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen

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Tahsin Colak

2013-01-01

Full Text Available Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT. The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass.

Prevention of intra-abdominal adhesion by bi-layer electrospun membrane.

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Jiang, Shichao; Wang, Wei; Yan, Hede; Fan, Cunyi

2013-06-04

The aim of this study was to compare the anti-adhesion efficacy of a bi-layer electrospun fibrous membrane consisting of hyaluronic acid-loaded poly(ε-caprolactone) (PCL) fibrous membrane as the inner layer and PCL fibrous membrane as the outer layer with a single-layer PCL electrospun fibrous membrane in a rat cecum abrasion model. The rat model utilized a cecal abrasion and abdominal wall insult surgical protocol. The bi-layer and PCL membranes were applied between the cecum and the abdominal wall, respectively. Control animals did not receive any treatment. After postoperative day 14, a visual semiquantitative grading scale was used to grade the extent of adhesion. Histological analysis was performed to reveal the features of adhesion tissues. Bi-layer membrane treated animals showed significantly lower adhesion scores than control animals (p compared with the PCL membrane. Histological analysis of the bi-layer membrane treated rat rarely demonstrated tissue adhesion while that of the PCL membrane treated rat and control rat showed loose and dense adhesion tissues, respectively. Bi-layer membrane can efficiently prevent adhesion formation in abdominal cavity and showed a significantly decreased adhesion tissue formation compared with the control.

Prophylactic antibiotics for penetrating abdominal trauma.

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Brand, Martin; Grieve, Andrew

2013-11-18

Penetrating abdominal trauma occurs when the peritoneal cavity is breached. Routine laparotomy for penetrating abdominal injuries began in the 1800s, with antibiotics first being used in World War II to combat septic complications associated with these injuries. This practice was marked with a reduction in sepsis-related mortality and morbidity. Whether prophylactic antibiotics are required in the prevention of infective complications following penetrating abdominal trauma is controversial, however, as no randomised placebo controlled trials have been published to date. There has also been debate about the timing of antibiotic prophylaxis. In 1972 Fullen noted a 7% to 11% post-surgical infection rate with pre-operative antibiotics, a 33% to 57% infection rate with intra-operative antibiotic administration and 30% to 70% infection rate with only post-operative antibiotic administration. Current guidelines state there is sufficient class I evidence to support the use of a single pre-operative broad spectrum antibiotic dose, with aerobic and anaerobic cover, and continuation (up to 24 hours) only in the event of a hollow viscus perforation found at exploratory laparotomy. To assess the benefits and harms of prophylactic antibiotics administered for penetrating abdominal injuries for the reduction of the incidence of septic complications, such as septicaemia, intra-abdominal abscesses and wound infections. Searches were not restricted by date, language or publication status. We searched the following electronic databases: the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2013, issue 12 of 12), MEDLINE (OvidSP), Embase (OvidSP), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S) and PubMed. Searches were last conducted in January 2013. All randomised controlled trials of antibiotic prophylaxis in patients with penetrating abdominal trauma versus no

Perforated peptic ulcer associated with abdominal compartment syndrome.

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Lynn, Jiun-Jen; Weng, Yi-Ming; Weng, Chia-Sui

2008-11-01

Abdominal compartment syndrome (ACS) is defined as an increased intra-abdominal pressure with adverse physiologic consequences. Abdominal compartment syndrome caused by perforated peptic ulcer is rare owing to early diagnosis and management. Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS. We report a case of perforated peptic ulcer associated with ACS. A 74-year-old man with old stroke and dementia history was found to have distended abdomen, edema of bilateral legs, and cyanosis. Laboratory tests revealed deterioration of liver and kidney function. Abdominal compartment syndrome was suspected, and image study was arranged to find the cause. The study showed pneumoperitoneum, contrast stasis in heart with decreased caliber of vessels below the abdominal aortic level, and diffuse lymphedema at the abdominal walls. Emergent laparotomy was performed. Perforated peptic ulcer was noted and the gastrorrhaphy was done. The symptoms, and liver and kidney function improved right after emergent operation.

A novel diagnostic aid for intra-abdominal adhesion detection in cine-MR imaging: Pilot study and initial diagnostic impressions.

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Randall, David; Joosten, Frank; ten Broek, Richard; Gillott, Richard; Bardhan, Karna Dev; Strik, Chema; Prins, Wiesje; van Goor, Harry; Fenner, John

2017-07-14

A non-invasive diagnostic technique for abdominal adhesions is not currently available. Capture of abdominal motion due to respiration in cine-MRI has shown promise, but is difficult to interpret. This article explores the value of a complimentary diagnostic aid to facilitate the non-invasive detection of abdominal adhesions using cine-MRI. An image processing technique was developed to quantify the amount of sliding that occurs between the organs of the abdomen and the abdominal wall in sagittal cine-MRI slices. The technique produces a 'sheargram' which depicts the amount of sliding which has occurred over 1-3 respiratory cycles. A retrospective cohort of 52 patients, scanned for suspected adhesions, made 281 cine-MRI sagittal slices available for processing. The resulting sheargrams were reported by two operators and compared to expert clinical judgement of the cine-MRI scans. The sheargram matched clinical judgement in 84% of all sagittal slices and 93-96% of positive adhesions were identified on the sheargram. The sheargram displayed a slight skew towards sensitivity over specificity, with a high positive adhesion detection rate but at the expense of false positives. Good correlation between sheargram and absence/presence of inferred adhesions indicates quantification of sliding motion has potential to aid adhesion detection in cine-MRI. Advances in Knowledge: This is the first attempt to clinically evaluate a novel image processing technique quantifying the sliding motion of the abdominal contents against the abdominal wall. The results of this pilot study reveal its potential as a diagnostic aid for detection of abdominal adhesions.

Mortality indicators and risk factors for intra-abdominal hypertension in severe acute pancreatitis.

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Zhao, J G; Liao, Q; Zhao, Y P; Hu, Y

2014-01-01

This study assessed the risk factors associated with mortality and the development of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP). To identify significant risk factors, we assessed the following variables in 102 patients with SAP: age, gender, etiology, serum amylase level, white blood cell (WBC) count, serum calcium level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, computed tomography severity index (CTSI) score, pancreatic necrosis, surgical interventions, and multiple organ dysfunction syndrome (MODS). Statistically significant differences were identified using the Student t test and the χ (2) test. Independent risk factors for survival were analyzed by Cox proportional hazards regression. The following variables were significantly related to both mortality and IAH: WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, pancreatic necrosis >50%, and MODS. However, it was found that surgical intervention had no significant association with mortality. MODS and pancreatic necrosis >50% were found to be independent risk factors for survival in patients with SAP. Mortality and IAH from SAP were significantly related to WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, and MODS. However, Surgical intervention did not result in higher mortality. Moreover, MODS and pancreatic necrosis >50% predicted a worse prognosis in SAP patients.

Nutritional and metabolic changes due the abdominal radiation: experimental study

International Nuclear Information System (INIS)

Mucerino, Donato R.; Waitzberg, Dan L.; Campos, Fabio G. de; Melo Auricchio, Maria T. de; Gama-Rodrigues, Joaquim J.; Lima-Goncalves, Ernesto L.

1995-01-01

In this study the effects on nutritional status and energetic metabolism due the abdominal irradiation were analysed. Adult male wistar rats (48), were divided in two groups Control (C) and radiated (R). The rats were maintained all time in metabolic cages. the study was done in two periods: period 1 begun at 0 day, were rats adapted to cages and oral diet, had food and water ad libitum. At the day four indirect calorimetric measurements were performed (calorimetry 1). At period 2, group R rats abdominal radiation at a 300 c Gy/day rate, for 5 consecutive days, and group C started a pair-feeding process linked individually to R rats and suffered application to simulated-irradiation. Two other calorimetric measurements (II,III) were performing during period 2. After radiation the last calorimetry was performed (IV). At sacrifice (day 14) blood was collected for determination of hemoglobin, hematocrit, albumin and transferrin. There were no statistical differences among groups C and R during period 1 (p < 0.05). Great reduction in food intake and weight variation were found in period 2, but weight loss was significantly higher in R rats. Nitrogen balance decrease in period 2, but without difference among the groups (p < 0.05). Serum albumin was significantly lower in R rats. Respiratory quotient decreased in both groups during period 2, but rats kept it lower (p < 0.05). The energy expenditure level decreased after radiation in group R. During period 2 total substrate oxidation decreased in R rats. Radiation decrease glucose and protein oxidation. In conclusion, in this study's conditions, radiation produced malnutrition by reducing food intake by bringing weight loss, hypoalbuminemia and decrease nitrogen balance. Radiation was also responsible for a reduction of metabolism, by promoting the fall of energy expenditure. These changes are not only due the anorexia, undoubtful a main factor. (author)

Anaphylaxis, Intra-Abdominal Infections, Skin Lacerations, and Behavioral Emergencies: A Literature Review of Austere Analogs for a near Earth Asteroid Mission

Science.gov (United States)

Chough, Natacha G.; Watkins, Sharmi; Menon, Anil S.

2012-01-01

As space exploration is directed towards destinations beyond low-Earth orbit, the consequent new set of medical risks will drive requirements for new capabilities and more resources to ensure crew health. The Space Medicine Exploration Medical Conditions List (SMEMCL), developed by the Exploration Medical Capability element of the Human Research Program, addresses the risk of "unacceptable health and mission outcomes due to limitations of in-flight medical capabilities". It itemizes 85 evidence-based clinical requirements for eight different mission profiles and identifies conditions warranting further research and technology development. Each condition is given a clinical priority for each mission profile. Four conditions -- intra-abdominal infections, skin lacerations, anaphylaxis, and behavioral emergencies -- were selected as a starting point for analysis. A systematic literature review was performed to understand how these conditions are treated in austere, limited-resource, space-analog environments (i.e., high-altitude and mountain environments, submarines, military deployments, Antarctica, isolated wilderness environments, in-flight environments, and remote, resource-poor, rural environments). These environments serve as analogs to spaceflight because of their shared characteristics (limited medical resources, delay in communication, confined living quarters, difficulty with resupply, variable time to evacuation). Treatment of these four medical conditions in austere environments provides insight into medical equipment and training requirements for exploration-class missions.

Pain pressure threshold algometry of the abdominal wall in healthy women.

Science.gov (United States)

Montenegro, M L L S; Braz, C A; Mateus-Vasconcelos, E L; Rosa-e-Silva, J C; Candido-dos-Reis, F J; Nogueira, A A; Poli-Neto, O B

2012-07-01

The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years) were included. All volunteers had regular menstrual cycles (27-33 days) and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 different days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test). There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

Computed tomographic findings of abdominal complications of Crohn's disease - pictorial essay

Energy Technology Data Exchange (ETDEWEB)

Zissin, R. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel)]. E-mail: zisinrivka@clalit.org.il; Hertz, M. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv (Israel); Osadchy, A. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Novis, B. [Tel-Aviv Univ., Dept. of Gastroenterology, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Gayer, G. [Tel-Aviv Univ., Department of Diagnostic Imaging, Assaf Harode Medical Center, Zrifin, Sackler Faculty of Medicine, Tel Aviv (Israel)

2005-02-15

Crohn's disease (CD) is a chronic, transmural, inflammatory disease of the gastrointestinal tract (CIT) most often affecting the terminal ileum and colon. Diarrhea, abdominal pain, anorexia, nausea, and weight loss are the most common clinical symptoms. Abdominal complications of CD, both intestinal and extraintestinal, are frequent and variable. The most common intestinal complications include ileocolitis with external or internal fistulas and abscess formation, strictures, and bowel obstruction. Less common are free perforation, intussusception, and malignancy. The extraintestinal complications include nephrolithiasis, cholelithiasis, fatty liver, portal vein gas, and thromboembolic events. Nowadays, computed tomography (CT) provides superb anatomic detail and diagnostic accuracy of various intra-abdominal pathological processes, and it thus has become an essential diagnostic tool in the evaluation and management of patients wit known CD for the assessment of bowel wall involvement, the mesenteric extent of the disease, and inn-abdominal complications. In addition, as CT is frequently performed to evaluate patients with acute abdomen, it may encounter clinically unsuspected complications in patients with CD. This article reviews the CT features of various intra-abdominal complications of CD. (author)

Overlap between functional abdominal pain disorders and organic diseases in children.

Science.gov (United States)

Langshaw, A H; Rosen, J M; Pensabene, L; Borrelli, O; Salvatore, S; Thapar, N; Concolino, D; Saps, M

2018-04-02

Functional abdominal pain disorders are highly prevalent in children. These disorders can be present in isolation or combined with organic diseases, such as celiac disease and inflammatory bowel diseases. Intestinal inflammation (infectious and non-infectious) predisposes children to the development of visceral hypersensitivity that can manifest as functional abdominal pain disorders, including irritable bowel syndrome. The new onset of irritable bowel syndrome symptoms in a patient with an underlying organic disease, such as inflammatory bowel disease, is clinically challenging, given that the same symptomatology may represent a flare-up of the inflammatory bowel disease or an overlapping functional abdominal pain disorder. Similarly, irritable bowel syndrome symptoms in a child previously diagnosed with celiac disease may occur due to poorly controlled celiac disease or the overlap with a functional abdominal pain disorder. There is little research on the overlap of functional abdominal disorders with organic diseases in children. Studies suggest that the overlap between functional abdominal pain disorders and inflammatory bowel disease is more common in adults than in children. The causes for these differences in prevalence are unknown. Only a handful of studies have been published on the overlap between celiac disease and functional abdominal pain disorders in children. The present article provides a review of the literature on the overlap between celiac disease, inflammatory bowel disease, and functional abdominal pain disorders in children and establish comparisons with studies conducted on adults. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

The relationship of body mass index and abdominal fat on the radiation dose received during routine computed tomographic imaging of the abdomen and pelvis.

Science.gov (United States)

Chan, Victoria O; McDermott, Shaunagh; Buckley, Orla; Allen, Sonya; Casey, Michael; O'Laoide, Risteard; Torreggiani, William C

2012-11-01

To determine the relationship of increasing body mass index (BMI) and abdominal fat on the effective dose acquired from computed tomography (CT) abdomen and pelvis scans. Over 6 months, dose-length product and total milliamp-seconds (mAs) from routine CT abdomen and pelvis scans of 100 patients were recorded. The scans were performed on a 64-slice CT scanner by using an automatic exposure control system. Effective dose (mSv) based on dose-length product, BMI, periumbilical fat thickness, and intra-abdominal fat were documented for each patient. BMI, periumbilical fat thickness, and intra-abdominal fat were compared with effective dose. Thirty-nine men and 61 women were included in the study (mean age, 56.3 years). The mean BMI was 26.2 kg/m(2). The mean effective dose was 10.3 mSv. The mean periumbilical fat thickness was 2.4 cm. Sixty-five patients had a small amount of intra-abdominal fat, and 35 had a large amount of intra-abdominal fat. The effective dose increased with increasing BMI (P abdominal fat (P abdominal fat significantly increases the effective dose received from CT abdomen and pelvis scans. Copyright © 2012 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Pressure Measurement Techniques for Abdominal Hypertension: Conclusions from an Experimental Model.

Science.gov (United States)

Chopra, Sascha Santosh; Wolf, Stefan; Rohde, Veit; Freimann, Florian Baptist

2015-01-01

Introduction. Intra-abdominal pressure (IAP) measurement is an indispensable tool for the diagnosis of abdominal hypertension. Different techniques have been described in the literature and applied in the clinical setting. Methods. A porcine model was created to simulate an abdominal compartment syndrome ranging from baseline IAP to 30 mmHg. Three different measurement techniques were applied, comprising telemetric piezoresistive probes at two different sites (epigastric and pelvic) for direct pressure measurement and intragastric and intravesical probes for indirect measurement. Results. The mean difference between the invasive IAP measurements using telemetric pressure probes and the IVP measurements was -0.58 mmHg. The bias between the invasive IAP measurements and the IGP measurements was 3.8 mmHg. Compared to the realistic results of the intraperitoneal and intravesical measurements, the intragastric data showed a strong tendency towards decreased values. The hydrostatic character of the IAP was eliminated at high-pressure levels. Conclusion. We conclude that intragastric pressure measurement is potentially hazardous and might lead to inaccurately low intra-abdominal pressure values. This may result in missed diagnosis of elevated abdominal pressure or even ACS. The intravesical measurements showed the most accurate values during baseline pressure and both high-pressure plateaus.

Radiologic findings of small bowel rupture due to blunt abdominal trauma

International Nuclear Information System (INIS)

Ha, Hyeon Kweun; Bahk, Yong Whee

1987-01-01

Bowel rupture due to blunt abdominal trauma is no longer rare, and is among the most challenging problems that confront the physicians and radiologists. It is frequently difficult to diagnose because the symptoms may be trivial during the early stage and masked by more obvious, but less lethal injuries. It is well known that the roentgen examination of the abdomen is also of little value to exclude bowel rupture because of infrequency of positive findings and free gas. The plain films of 23 cases of jejunal rupture and 8 cases of ileal rupture were evaluated to sort and diagnostic features of small bowel rupture caused by blunt abdominal trauma. 1. Free intraperitoneal gas was noted in 6 cases of jejunal rupture (26%) and 1 case of ileal rupture (13%), and definite radiological evidence of free intraperitoneal fluid was present in 16 cases of patients (52%). 2. The contour change of bowel loops such as tapering or indentation were seen in 11 cases of patients (36%), and local opacity along the mesenteric root axis was demonstrated in 19 cases of patients (61%). 3. Paralytic ileus was localized to LUQ in jejunal rupture and to mid-abdomen in ileal rupture, and gastric and transverse-colon distension with gas was noticeable especially in jejunal rupture

An Abdominal Presentation of Churg-Strauss Syndrome

Directory of Open Access Journals (Sweden)

J. R. E. Rees

2010-01-01

inflammation necrotising systemic vasculitis and necrotising glomerulonephritis. We describe a case of Churg-Strauss syndrome presenting with abdominal pain and later during the hospital admission a mono-neuritis multiplex syndrome affecting the lower limbs. The patient presented in such an atypical fashion with abdominal signs and symptoms that they required laparotomy and the diagnosis was made after histological examination of tissue taken at the time of surgery. Treatment with immunosuppression and aggressive rehabilitation achieved a progressive recovery which continued on discharge from hospital.

Meleney's Ulcer; A Rare but Fatal Abdominal Wall Disease ...

African Journals Online (AJOL)

Meleney's ulcer or post operative synergistic bacterial gangrene is a rare form of ... It develops following intra abdominal surgery in the immediate vicinity of the surgical ... appreciated in making the diagnosis and the difficulties of management.

Characterization and pharmacological modulation of intestinal inflammation induced by ionizing radiation; Caracterisation et modulation pharmacologique de l'inflammation intestinale induite par les rayonnements ionisants

Energy Technology Data Exchange (ETDEWEB)

Gremy, O

2006-12-15

The use of radiation therapy to treat abdominal and pelvic malignancies inevitably involves exposure of healthy intestinal tissues which are very radiosensitive. As a result, most patients experience symptoms such as abdominal pain, nausea and diarrhea. Such symptoms are associated with acute damage to intestine mucosa including radio-induced inflammatory processes. With a rat model of colorectal fractionated radiation, we have shown a gradual development of a colonic inflammation during radiation planning, without evident tissue injury. This radio-induced inflammation is characterized not only by the sur expressions of pro-inflammatory cytokines and chemokines, a NF-kB activation, but also by a repression of anti-inflammatory cytokines and the nuclear receptors PPARa and RXRa, both involved in inflammation control. This early inflammation is associated with a discreet neutrophil recruitment and a macrophage accumulation. Macrophages are still abnormally numerous in tissue 27 weeks after the last day of irradiation. Inflammatory process is the most often related to a specific immune profile, either a type Th1 leading to a cellular immune response, or a type Th2 for humoral immunity. According to our studies, a unique abdominal radiation in the rat induces an ileum inflammation and an immune imbalance resulting in a Th2-type profile. Inhibiting this profile is important as its persistence promotes chronic inflammation, predisposition to bacterial infections and fibrosis which is the main delayed side-effect of radiotherapy. The treatment of rats with an immuno-modulator compound, the caffeic acid phenethyl ester (C.A.P.E.), have the potential to both reduce ileal mucosal inflammation and inhibit the radio-induced Th2 status. In order to search new therapeutic molecular target, we has been interested in the PPARg nuclear receptor involved in the maintenance of colon mucosal integrity. In our abdominal irradiation model, we have demonstrated that the prophylactic

Abdominal radiation causes bacterial translocation

International Nuclear Information System (INIS)

Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.

1989-01-01

The purpose of this study was to determine if a single dose of radiation to the rat abdomen leads to bacterial translocation into the mesenteric lymph nodes (MLN). A second issue addressed was whether translocation correlates with anatomic damage to the mucosa. The radiated group (1100 cGy) which received anesthesia also was compared with a control group and a third group which received anesthesia alone but no abdominal radiation. Abdominal radiation lead to 100% positive cultures of MLN between 12 hr and 4 days postradiation. Bacterial translocation was almost nonexistent in the control and anesthesia group. Signs of inflammation and ulceration of the intestinal mucosa were not seen until Day 3 postradiation. Mucosal damage was maximal by Day 4. Bacterial translocation onto the MLN after a single dose of abdominal radiation was not apparently dependent on anatomical, histologic damage of the mucosa

Intravascular application of electrocautery in a rabbit model of abdominal aortic endarterectomy.

Science.gov (United States)

Wang, Chuan; Xin, Yi; Li, Na; Li, Diankun; Li, Jingxing; Gu, Chengxiong

2017-07-01

Effective therapies for preventing perioperative complications such as thrombosis and inflammation after coronary endarterectomy (CE) are lacking. Electrocoagulation electrotomes have been routinely used in surgery for their cutting, clotting, and hemostatic properties. As strong flattening tools, their electrocautery function may prevent mechanical intimal-adventitial injury to arterial circulation and attenuate stenosis. The present study investigated the effects of intravascular application of electrocautery on ameliorating inflammation and thrombosis in a rabbit model of abdominal aortic endarterectomy. New Zealand rabbits were randomly divided into the sham, control (endarterectomy), and study (endarterectomy + electrocautery) groups with 10 in each group. Abdominal aortas were partially blocked and intima was removed. Electrocautery was performed with an electrocoagulation electrotome through the entire blocked vessel lumen. Vascular ultrasound parameters, molecular biological and histological characteristics of the abdominal aorta including vascular diameter, blood flow velocity, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, and apoptosis rate of vascular endothelial cells (ECs) were evaluated postoperatively by vascular Doppler ultrasound, ELISA, real-time RT-PCR, flow cytometry, and immunofluorescence at various time points. Compared with the endarterectomy + electrocautery group, the isolated endarterectomy group had significantly increased levels and gene expression of TNF-α and IL-6 (Pelectrocautery has favorable short-term effects on the abdominal aorta and can reduce inflammation in a rabbit model of abdominal aorta endarterectomy. Long-term anti-inflammatory and anti-thrombotic effects on arterial remodeling and the clinical value of electrocautery in CE remain to be determined.

Melatonin prevents secondary intra-abdominal hypertension in rats possibly through inhibition of the p38 MAPK pathway.

Science.gov (United States)

Chang, Mingtao; Li, Yang; Liu, Dong; Zhang, Lianyang; Zhang, Hongguang; Tang, Hao; Zhang, Huayu

2016-08-01

Exogenous administration of melatonin has been demonstrated to down-regulate inflammatory responses and attenuate organ damage in various models. However, the salutary effect of melatonin against secondary intra-abdominal hypertension (IAH) remains unclear. This study sought to test the influence of melatonin on secondary IAH in a pathophysiological rat model and the underlying mechanisms involved. Before resuscitation, male rats underwent a combination of induced portal hypertension, applying an abdominal restraint device, and hemorrhaging to mean arterial pressure (MAP) of 40mmHg for 2h. After blood reinfusion, the rats were treated with lactated Ringer solution (LR) (30mL/h), melatonin (50mg/kg) +LR, and SB-203580 (10μmol/kg)+LR. LR was continuously infused for 6h. MAP, the inferior vena cava pressure and urine output were monitored. Histopathological examination, immunofluorescence of tight junction proteins, and transmission electron microscopy were administered. Intestinal permeability, myeloperoxidase activity, malondialdehyde, glutathione peroxidase, and levels of TNF-a, IL-2, and IL-6, were assessed. The expression of extracellular signal-regulated kinase, p38, c-Jun NH2-terminal kinase, translocation of nuclear factor kappa B subunit, signal transducers and activators of transcription and tight junction proteins were detected by Western blot. We found that melatonin inhibited the inflammatory responses, decreased expression of p38 MAPK, attenuated intestinal injury, and prevented secondary IAH. Moreover, administration of SB203580 abolished the increase in p38 MAPK and also attenuated intestinal injury. These data indicate that melatonin exerts a protective effect in intestine in secondary IAH primarily by attenuating the inflammatory responses which are in part attributable to p38 MAPK inhibition. Copyright © 2016 Elsevier Inc. All rights reserved.

Vertical compared with transverse incisions in abdominal surgery

DEFF Research Database (Denmark)

Grantcharov, T P; Rosenberg, J

2001-01-01

, and late complications (incisional hernia). RESULTS: Eleven randomised controlled trials and seven retrospective studies were identified. The transverse incision offers as good an access to most intra-abdominal structures as a vertical incision. The transverse incision results in significantly less......OBJECTIVE: To reach an evidence-based consensus on the relative merits of vertical and transverse laparotomy incisions. DESIGN: Review of all published randomised controlled trials that compared the postoperative complications after the two main types of abdominal incisions, vertical and transverse....... SETTING: Teaching hospital, Denmark. SUBJECTS: Patients undergoing open abdominal operations. INTERVENTIONS: For some of the variables (burst abdomen and incisional hernia) it was considered adequate to include retrospective studies. Studies were identified through Medline, Cochrane library, Embase...

Role of F-18 FDG PET/CT in the management of infected abdominal aortic aneurysm due to salmonella

Energy Technology Data Exchange (ETDEWEB)

Choi, Seung Jin; Lee, Jin Soo; Cheong, Moon Hyun; Byun, Sung Su; Hyun, In Young [Inha University College of Medicine, Incheon (Korea, Republic of)

2007-12-15

We present a case of infected abdominal aortic aneurysm due to salmonella enteritidis. F-18 FDG PET/CT was performed to diagnosis and during follow-up after antibiotic treatment. Computed tomography (CT) is considered to be the best diagnostic imaging modality in infected aortic lesions. In this case, a combination of CT and FDG PET/CT provided accurate information for the diagnosis of infected abdominal aortic aneurysm. Moreover, FDG PET/CT made an important contribution of monitoring disease activity during antibiotic treatment.

Vagotomy decreases the neuronal activities of medulla oblongata and alleviates neurogenic inflammation of airways induced by repeated intra-esophageal instillation of HCl in guinea pigs.

Science.gov (United States)

Chen, Zhe; Chen, Hui; Chen, Fagui; Gu, Dachuan; Sun, Lejia; Zhang, Weitao; Fan, Linfeng; Lin, Yong; Dong, Rong; Lai, Kefang

2017-12-20

Neuronal activity in the medulla oblongata and neurogenic inflammation of airways were investigated in a guinea pig model induced by repeated intra-esophageal instillation of hydrochloric acid (HCl) after vagotomy. Unilateral vagotomy was performed in the vagotomy group, while a sham-operation was performed in the sham group. Operation was not conducted in sham control group. Airway inflammation was observed with hematoxylin and eosin (HE) staining. C-fos protein was measured by immunohistochemistry (IHC) and Western blot (WB). Substance P was examined by IHC and enzyme-linked immuno sorbent assay (ELISA). Airway microvascular permeability was detected by evans blue dye (EBD) fluorescence. Inflammation of airway was observed in the trachea and bronchi after chronic HCl perfusion into the lower esophagus, and was alleviated after unilateral vagotomy. C-fos expression in the medulla oblongata was lower in the vagotomy group compared to the sham control and sham groups. Substance P-like immunoreactivity (SP-li), concentration and microvascular leakage in airway were lower in the vagotomy group than that in the other groups. Our results suggest that vagotomy improved neurogenic inflammation of airways and decreased neuronal activities, the afferent nerves and neurons in medulla oblongata may be involved in neurogenic inflammation of airways mediated by esophageal-bronchial reflex.

Pain pressure threshold algometry of the abdominal wall in healthy women

Directory of Open Access Journals (Sweden)

M.L.L.S. Montenegro

2012-07-01

Full Text Available The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years were included. All volunteers had regular menstrual cycles (27-33 days and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test. There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

Imaging in the diagnosis of a patient with an intra-abdominal mass

International Nuclear Information System (INIS)

Funston, M.R.

1985-01-01

There have been rapid and significant developments in the imaging techniques available to the radiologist during the last decade. The clinician investigating an abdominal mass is often baffled by what examinations to request and in what sequence. An attempt is made to simplify this complex problem by outlining the broad principles of the imaging approach. The development of and advances in ultrasonography and CT, both non-invasive techniques, have had a major impact on the pre-operative diagnosis of abdominal masses. Both examinations are rapidly performed and eliminate the wasted man-hours and preparation requested for barium and other contrast-medium examinations. Other techniques discussed are visceral angiography radioisotope scanning and percutaneous fine-needle biopsies. A teamwork approach is advocated because it eliminates unnecessary and costly studies and results in a diagnosis being made with a minimum of hazard, cost and inconvenience to the patient. The author also presents a table of the more common abdominal masses

Characterization and pharmacological modulation of intestinal inflammation induced by ionizing radiation; Caracterisation et modulation pharmacologique de l'inflammation intestinale induite par les rayonnements ionisants

Energy Technology Data Exchange (ETDEWEB)

Gremy, O

2006-12-15

The use of radiation therapy to treat abdominal and pelvic malignancies inevitably involves exposure of healthy intestinal tissues which are very radiosensitive. As a result, most patients experience symptoms such as abdominal pain, nausea and diarrhea. Such symptoms are associated with acute damage to intestine mucosa including radio-induced inflammatory processes. With a rat model of colorectal fractionated radiation, we have shown a gradual development of a colonic inflammation during radiation planning, without evident tissue injury. This radio-induced inflammation is characterized not only by the sur expressions of pro-inflammatory cytokines and chemokines, a NF-kB activation, but also by a repression of anti-inflammatory cytokines and the nuclear receptors PPARa and RXRa, both involved in inflammation control. This early inflammation is associated with a discreet neutrophil recruitment and a macrophage accumulation. Macrophages are still abnormally numerous in tissue 27 weeks after the last day of irradiation. Inflammatory process is the most often related to a specific immune profile, either a type Th1 leading to a cellular immune response, or a type Th2 for humoral immunity. According to our studies, a unique abdominal radiation in the rat induces an ileum inflammation and an immune imbalance resulting in a Th2-type profile. Inhibiting this profile is important as its persistence promotes chronic inflammation, predisposition to bacterial infections and fibrosis which is the main delayed side-effect of radiotherapy. The treatment of rats with an immuno-modulator compound, the caffeic acid phenethyl ester (C.A.P.E.), have the potential to both reduce ileal mucosal inflammation and inhibit the radio-induced Th2 status. In order to search new therapeutic molecular target, we has been interested in the PPARg nuclear receptor involved in the maintenance of colon mucosal integrity. In our abdominal irradiation model, we have demonstrated that the prophylactic

Urethral pressure reflectometry during intra-abdominal pressure increase-an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women.

Science.gov (United States)

Saaby, Marie-Louise; Klarskov, Niels; Lose, Gunnar

2013-11-01

to assess the urethral closure function by urethral pressure reflectometry (UPR) during intra-abdominal pressure-increase in SUI and continent women. Twenty-five urodynamically proven SUI women and eight continent volunteer women were assessed by ICIQ-SF, pad-weighing test, incontinence diary, and UPR. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line ("APIR") and the intercept with the y-axis found. By the equation of the line, Po was calculated for various values of P(Abd), for example, 50 cm H2O (P(o-Abd 50)). The resting P(o) (P(o-rest)) and APIR, respectively, significantly differed in SUI and continent women but could not separate the two groups. The urethral closure equation (UCE) based on P(o-rest) and APIR provided a more detailed characterization of a woman's closure function based on the permanent closure forces (primarily generated by the urethral sphincteric unit) and the adjunctive closure forces (primarily generated by the support system). P(o-Abd 50) and UCE, respectively, which express the combined permanent and adjunctive closure forces and estimate the efficiency of the closure function, separated SUI and continent women and were highly significantly negatively correlated with ICIQ-SF, pad test, and the number of incontinence episodes. New parameters for characterization of the urethral closure function and possible dysfunctions and its efficiency were provided. P(o-Abd 50) and UCE may be used as diagnostic tests and severity measures. © 2013 Wiley Periodicals, Inc.

Abdominal wall reconstruction for large incisional hernia restores expiratory lung function

DEFF Research Database (Denmark)

Jensen, Kristian K; Backer, Vibeke; Jorgensen, Lars N

2017-01-01

BACKGROUND: Respiratory complications secondary to intermittent intra-abdominal hypertension and/or atelectasis are common after abdominal wall reconstruction for large incisional hernias. It is unknown if the respiratory function of this patient group is affected long term or impairs activities...... of daily living. We hypothesized that abdominal wall reconstruction for large incisional hernia would not lead to improved, long-term pulmonary function or respiratory quality of life. METHODS: Eighteen patients undergoing open abdominal wall reconstruction with mesh for a large incisional hernia...... (horizontal fascial defect width >10 cm) were compared with 18 patients with an intact abdominal wall who underwent colorectal resection. Patients were examined pre- and 1-year postoperatively. Examined measures included forced vital capacity, forced expiratory volume in first second, peak expiratory flow...

Chronic inflammation, immune response, and infection in abdominal aortic aneurysms

DEFF Research Database (Denmark)

Lindholt, Jes Sanddal; Shi, G-P

2006-01-01

Abdominal aortic aneurysms (AAA) are associated with atherosclerosis, transmural degenerative processes, neovascularization, decrease in content of vascular smooth muscle cells, and a chronic infiltration, mainly located in the outer aortic wall. The chronic infiltration consists mainly of macrop......Abdominal aortic aneurysms (AAA) are associated with atherosclerosis, transmural degenerative processes, neovascularization, decrease in content of vascular smooth muscle cells, and a chronic infiltration, mainly located in the outer aortic wall. The chronic infiltration consists mainly...... matrix metalloproteases and cysteine proteases for aortic matrix remodeling. The lymphocyte activation may be mediated by microorganisms as well as autoantigens generated from vascular structural proteins, perhaps through molecular mimicry. As in autoimmune diseases, the risk of AAA is increased...

Vaginal Cuff Dehiscence with Small Bowel Evisceration 14 Months after Total Abdominal Hysterectomy

Directory of Open Access Journals (Sweden)

Nida Jareemit, M.D.

2017-11-01

Full Text Available Introduction: Vaginal cuff dehiscence is a rare complication following hysterectomy. The condition coexisting with intraabdominal organ evisceration occurs even rarer. Nevertheless this should not be neglected owing to high morbidity and mortality. Case presentation: The reported case is a 48-year-old widow presenting with vaginal cuff dehiscence and small bowel evisceration after undergoing a total abdominal hysterectomy (TAH in the past 14 months due to myoma uteri. She denied having a history of sexual intercourse after the operation. The exposed bowel, 60 cm in length, appeared viable and no peritoneal sign was observed. There was a vaginal cuff defect approximately 3 cm in length. An exploratory laparotomy was then carried out. Eviscerated bowel was reduced back in the abdominal cavity and the vaginal cuff defect was repaired. No complications such as recurrent dehiscence were observed during one year follow-up. Conclusion: To minimize the incidence of vaginal cuff dehiscence after hysterectomy, surgical techniques should be of concern. Patient instructions, including delaying sexual intercourse and avoiding all possible causes of increased intra-abdominal pressure should be provided postoperatively.

Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities? A cross-sectional study

Directory of Open Access Journals (Sweden)

Walker Mark

2010-11-01

Full Text Available Abstract Background Obesity remains a major public health problem, associated with a cluster of metabolic abnormalities. However, individuals exist who are very obese but have normal metabolic parameters. The aim of this study was to determine to what extent differences in metabolic health in very obese women are explained by differences in body fat distribution, insulin resistance and level of physical activity. Methods This was a cross-sectional pilot study of 39 obese women (age: 28-64 yrs, BMI: 31-67 kg/m2 recruited from community settings. Women were defined as 'metabolically normal' on the basis of blood glucose, lipids and blood pressure. Magnetic Resonance Imaging was used to determine body fat distribution. Detailed lifestyle and metabolic profiles of participants were obtained. Results Women with a healthy metabolic profile had lower intra-abdominal fat volume (geometric mean 4.78 l [95% CIs 3.99-5.73] vs 6.96 l [5.82-8.32] and less insulin resistance (HOMA 3.41 [2.62-4.44] vs 6.67 [5.02-8.86] than those with an abnormality. The groups did not differ in abdominal subcutaneous fat volume (19.6 l [16.9-22.7] vs 20.6 [17.6-23.9]. A higher proportion of those with a healthy compared to a less healthy metabolic profile met current physical activity guidelines (70% [95% CIs 55.8-84.2] vs 25% [11.6-38.4]. Intra-abdominal fat, insulin resistance and physical activity make independent contributions to metabolic status in very obese women, but explain only around a third of the variance. Conclusion A sub-group of women exists who are metabolically normal despite being very obese. Differences in fat distribution, insulin resistance, and physical activity level are associated with metabolic differences in these women, but account only partially for these differences. Future work should focus on strategies to identify those obese individuals most at risk of the negative metabolic consequences of obesity and on identifying other factors that

Enteral Feeding in Abdominal Compartment Syndrome

Directory of Open Access Journals (Sweden)

Ye. V Grigoryev

2009-01-01

Full Text Available Objective: to substantiate the choice of a gastrointestinal tract (GIT function support regimen as a mode for correction of the abdominal compartment syndrome (ACS. Subjects and methods. Forty-three patients with different causes of inadequate GIT function of various origin and ACS (disseminated peritonitis (45%, pancreatitis (24%, and severe concomitant injury (31% were examined. Group 1 (control received complete parenteral nutritional feeding (n=23; APACHE II scores, 21±4; calculated probability of fatal outcome, 33.5%. In Group II (study, complete parenteral feeding in the first 24 hours after stabilization was supplemented with GIT function support with Pepsisorb (Nutricia in doses of 500, 1000, and 1500 ml on days 1, 2, and 3, respectively (n=20; APACHE II scores, 20±6; calculated probability of fatal outcome, 37.1%. During early enteral nutritional support, the SOFA score was significantly less than that in Group 1 on days 2—3; the oxygenation index significantly increased on day 3; the value of intra-abdominal hypertension decreased to the control values. The positive effect of the GIT function support regimen on regression of the multiple organ dysfunction syndrome (MODS was confirmed by the lowered levels of biological markers (von Willebrand factor (WF and endothelin-1 as markers of endothelial damage of MODS. Correlation analysis showed a direct correlation between the markers of endothelial damage and the SOFA scores (r=0.34; p=0.05 for WF and r=0.49;p=0.03 for endothelin. Conclusion. The GIT function support regimen via early enteral alimentation with Peptisorb, which was initiated in the first 24 hours after admission, is able to level off the manifestations of the early stages of the abdominal compartment syndrome, with the acceptable values of oxygen balance and water-electrolyte and osmotic homeostasis being achieved. Key words: abdominal compartment syndrome, nutritional support, biological markers, oxygenation index

Acute transfusion-related abdominal injury in trauma patients: a case report.

Science.gov (United States)

Michel, P; Wähnert, D; Freistühler, M; Laukoetter, M G; Rehberg, S; Raschke, M J; Garcia, P

2016-10-19

Secondary abdominal compartment syndrome is well known as a life-threatening complication in critically ill patients in an intensive care unit. Massive crystalloid fluid resuscitation has been identified as the most important risk factor. The time interval from hospital admittance to the development of manifest abdominal compartment syndrome is usually greater than 24 hours. In the absence of any direct abdominal trauma, we observed a rapidly evolving secondary abdominal compartment syndrome shortly after hospital admittance associated with massive transfusion of blood products and only moderate crystalloid resuscitation. We report the case of an acute secondary abdominal compartment syndrome developing within 3 to 4 hours in a 74-year-old polytraumatized white woman. Although multiple fractures of her extremities and a B-type pelvic ring fracture were diagnosed by a full body computed tomography scan, no intra-abdominal injury could be detected. Hemorrhagic shock with a drop in her hemoglobin level to 5.7 g/dl was treated by massive transfusion of blood products and high doses of catecholamines. Shortly afterwards, her pulmonary gas exchange progressively deteriorated and mechanical ventilation became almost impossible with peak airway pressures of up to 60 cmH 2 O. Her abdomen appeared rigid and tense accompanied by a progressive hemodynamic decompensation necessitating mechanic cardiopulmonary resuscitation. Although preoperative computed tomography scans showed no signs of intra-abdominal fluid, a decompressive laparotomy under cardiopulmonary resuscitation conditions was performed and 2 liters of ascites-like fluid disgorged. Her hemodynamics and pulmonary ventilation improved immediately. This case report describes for the first time acute secondary abdominal compartment syndrome in a trauma patient, evolving in a very short time period. We hypothesize that the massive transfusion of blood products along with high doses of catecholamines triggered the acute

Clinical significance of abdominal scintigraphy using {sup 99m}Tc-HMPAO-labelled leucocytes in patients with seronegative spondyloarthropathies

Energy Technology Data Exchange (ETDEWEB)

Alonso Farto, J.C.; Almoguera Arias, I.; Ortega Valle, A.; Perez Vazquez, J.M. [Department of Nuclear Medicine, Univ. Complutense, Madrid (Spain); Lopez Longo, F.J.; Gonzalez Fernandez, C.M.; Monteagudo Saez, I.; Bascones, M.; Carreno Perez, L. [Department of Rheumatology, ' ' Hospital Universitario Gregorio Maranon' ' , Universidad Complutense, Madrid (Spain)

2000-12-01

Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime ({sup 99m}Tc-HMPAO)-labelled leucocytes. {sup 99m}Tc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P<0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P<0.005; OR=3.4; 95% CI=1.5-7.4). It is concluded that (a) abdominal scintigraphy using {sup 99m}Tc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27. (orig.)

Diffuse Abdominal Splenosis Mimicking Peritoneal Metastases in a 35-Year-Old Man with a Resectable Carcinoma of the Ampulla of Vater

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Steffen Filskov Sorensen

2013-09-01

Full Text Available A 35-year-old man with a history of blunt abdominal trauma and splenic rupture was diagnosed with an ampullary adenocarcinoma. At workup, a CT scan showed multiple intra-abdominal lesions similar to peritoneal carcinosis, and the patient was referred for palliative chemotherapy. On clinical suspicion, however, a biopsy was performed on an intra-abdominal lesion, establishing the diagnosis of abdominal splenosis. A radical pancreaticoduodenectomy ad modum Whipple was performed, followed by adjuvant chemotherapy with gemcitabine. At the 18-month follow-up, the patient was free from recurrent disease. We conclude that splenosis should be considered as a differential diagnosis of peritoneal metastases in cancer patients with a history of abdominal trauma and/or splenectomy. Other reports on splenosis in cancer patients and diagnostic workup are discussed.

Characterization and pharmacological modulation of intestinal inflammation induced by ionizing radiation

International Nuclear Information System (INIS)

Gremy, O.

2006-12-01

The use of radiation therapy to treat abdominal and pelvic malignancies inevitably involves exposure of healthy intestinal tissues which are very radiosensitive. As a result, most patients experience symptoms such as abdominal pain, nausea and diarrhea. Such symptoms are associated with acute damage to intestine mucosa including radio-induced inflammatory processes. With a rat model of colorectal fractionated radiation, we have shown a gradual development of a colonic inflammation during radiation planning, without evident tissue injury. This radio-induced inflammation is characterized not only by the sur expressions of pro-inflammatory cytokines and chemokines, a NF-kB activation, but also by a repression of anti-inflammatory cytokines and the nuclear receptors PPARa and RXRa, both involved in inflammation control. This early inflammation is associated with a discreet neutrophil recruitment and a macrophage accumulation. Macrophages are still abnormally numerous in tissue 27 weeks after the last day of irradiation. Inflammatory process is the most often related to a specific immune profile, either a type Th1 leading to a cellular immune response, or a type Th2 for humoral immunity. According to our studies, a unique abdominal radiation in the rat induces an ileum inflammation and an immune imbalance resulting in a Th2-type profile. Inhibiting this profile is important as its persistence promotes chronic inflammation, predisposition to bacterial infections and fibrosis which is the main delayed side-effect of radiotherapy. The treatment of rats with an immuno-modulator compound, the caffeic acid phenethyl ester (C.A.P.E.), have the potential to both reduce ileal mucosal inflammation and inhibit the radio-induced Th2 status. In order to search new therapeutic molecular target, we has been interested in the PPARg nuclear receptor involved in the maintenance of colon mucosal integrity. In our abdominal irradiation model, we have demonstrated that the prophylactic

Synergistic Effect of Combined Hollow Viscus Injuries on Intra-Abdominal Abscess Formation.

Science.gov (United States)

Paulus, Elena M; Croce, Martin A; Shahan, Charles P; Zarzaur, Ben L; Sharpe, John P; Dileepan, Amirtha; Boyd, Brandon S; Fabian, Timothy C

2015-07-01

The strong association between penetrating colon injuries and intra-abdominal abscess (IAA) formation is well established and attributed to high colon bacterial counts. Since trauma patients are rarely fasting at injury, stomach and small bowel colony counts are also elevated. We hypothesized that there is a synergistic effect of increased IAA formation with concomitant stomach and/or colon injuries when compared to small bowel injuries alone. Consecutive patients at a level one trauma center with penetrating small bowel (SB), stomach (S), and/or colon (C) injuries from 1996 to 2012 were reviewed. Logistic regression determined associations with IAA, adjusting for age, gender, Injury Severity Score (ISS), admission Glasgow Coma Score, transfusions, and concurrent pancreas or liver injury. A total of 1518 patients (91% male, ISS = 15.9 ± 8.4) were identified: 496 (33%) SB, 231 (15%) S, 288 (19%) C, 40 (3%) S + SB, 69 (5%) S + C, 338 (22%) C + SB, and 56 (4%) S + C + SB. 148 (10%) patients developed IAA: 4 per cent SB, 9 per cent S, 10 per cent C, 5 per cent S + SB, 22 per cent S + C, 13 per cent C + SB, and 25 per cent S + C + SB. Multiple logistic regression demonstrated that ISS, 24 hour blood transfusions, and concomitant pancreatic or liver injuries were associated with IAA. Compared with reference SB, S or S + SB injuries were no more likely to develop IAA. However, S + C, SB + C, and S + C + SB injuries were significantly more likely to have IAA. In conclusion, combined stomach + colon, small bowel + colon, and stomach, colon, + small bowel injuries have a synergistic effect leading to increased IAA formation after penetrating injuries. Heightened clinical suspicion for IAA formation is necessary in these combined hollow viscus injury patients.

Tc-99m sulfur colloid scanning in blunt trauma: detection of abdominal bleeding

International Nuclear Information System (INIS)

Bronfman, H.J.; Kunkel, B.K.; Rabin, H.S.

1981-01-01

Tc-99m sulfur colloid scintigraphy can detect and locate active lower gastrointestinal bleeding. The same principles apply to the detection and location of active intra-abdominal or pelvic hemorrhage following blunt abdominal trauma. We report two patients with abdominal bleeding who were correctly diagnosed by this method. As part of the routine examination of all patients having Tc-99m sulfur colloid liver-spleen scans for trauma, 500,000-count images should be made of the rest of the abdomen and pelvis

Risk factors and outcome of intra-abdominal hypertension in patients with severe acute pancreatitis.

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Ke, Lu; Ni, Hai-Bin; Sun, Jia-Kui; Tong, Zhi-Hui; Li, Wei-Qin; Li, Ning; Li, Jie-Shou

2012-01-01

Intra-abdominal hypertension (IAH) is common in patients with severe acute pancreatitis (SAP). The aim of the present study was to investigate the risk factors of IAH in SAP patients and assess the prognosis of SAP combined with IAH. To analyze the data from patients with SAP, both univariate and multivariate logistic regression analyses were applied, using 16 indices, including age, gender, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), 24 h fluid balance, hematocrit, serum calcium level, and so on. Clinical prognosis such as mortality, hospital duration, of SAP patients with or without IAH was also compared. First 24 h fluid balance (Odds Ratio [OR], 1.003; 95% Confidence Interval [CI], 1.001-1.006), number of fluid collections (OR, 1.652; 95% CI, 1.023-2.956), and serum calcium level (OR, 0.132; 95% CI, 0.012-0.775) were found to be independent risk factors for IAH in patients with SAP. Moreover, patients with SAP and IAH had significantly longer average length of stay, both in the hospital and in the intensive care unit, higher rates of systemic and local complications, and more invasive treatments. The significant risk factors for IAH in patients with SAP include 24 h fluid balance (first day), number of fluid collections, and serum calcium level. Additionally, IAH is associated with extremely poor prognosis, evidenced by high rates of mortality, morbidity, and the need for invasive interventions.

Lead intoxication due to ayurvedic medications as a cause of abdominal pain in adults.

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Mehta, Varun; Midha, Vandana; Mahajan, Ramit; Narang, Vikram; Wander, Praneet; Sood, Ridhi; Sood, Ajit

2017-02-01

Though a majority of cases of lead intoxication come from occupational exposures, traditional and folk remedies have also been reported to contain toxic amounts of lead. We present a large series of patients with lead poisoning due to intake of Ayurvedic medicines, all of whom presented with unexplained abdominal pain. This was a retrospective, observational case series from a tertiary care center in India. The charts of patients who underwent blood lead level (BLL) testing as a part of workup for unexplained abdominal pain between 2005 and 2013 were reviewed. The patients with lead intoxication (BLLs >25 μg/dl) were identified and demographics, history, possible risk factors, clinical presentation and investigations were reviewed. Treatment details, duration, time to symptomatic recovery, laboratory follow-up and adverse events during therapy were recorded. BLLs were tested in 786 patients with unexplained abdominal pain and high levels were identified in 75 (9.5%) patients, of which a majority (73 patients, 9.3%) had history of Ayurvedic medication intake and only two had occupational exposure. Five randomly chosen Ayurvedic medications were analyzed and lead levels were impermissibly high (14-34,950 ppm) in all of them. Besides pain in abdomen, other presenting complaints were constipation, hypertension, neurological symptoms and acute kidney injury. Anemia and abnormal liver biochemical tests were observed in all the 73 patients. Discontinuing the Ayurvedic medicines and chelation with d-penicillamine led to improvement in symptoms and reduction in BLLs in all patients within 3-4 months. The patients presenting with severe recurrent abdominal pain, anemia and history of use of Ayurvedic medicines should be evaluated for lead toxicity. Early diagnosis in such cases can prevent unnecessary investigations and interventions, and permits early commencement of the treatment.

The association of mast cells and serotonin in children with chronic abdominal pain of unknown etiology

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Shankar Ravi

2010-10-01

Full Text Available Abstract Background Abdominal pain of unknown origin affects up to 20% of school-aged children. Evaluation of children is symptom-based without clear guidelines to investigate molecular mechanisms of abdominal pain. Aberrant molecular mechanisms may increase intestinal permeability leading to interactions between the immune and nervous systems, subclinical inflammation, and visceral pain. This study evaluated the association between interleukin-6 (IL-6, mast cell infiltrates, and serotonin (5-HT levels in gastrointestinal (GI biopsies, with perceived abdominal pain in a pediatric cohort. Methods Clinical data and biopsy samples from pediatric patients (n = 48 with chronic abdominal pain, with and without inflammation were included. Formalin-fixed paraffin-embedded GI biopsies were sectioned and immunohistochemistry performed for IL-6 and 5-HT; mast cells were identified with toluidine blue stain. Histological findings were compared to self-reported abdominal pain between groups. Results There was significantly greater IL-6 immunoreactivity in biopsies with confirmed histologic inflammation (p = 0.004. There was a greater number of mast cells per HPF in non-inflammatory biopsies (3.5 ± 2.9 compared to the inflammatory biopsies (2.6 ± 1.8 p = 0.049. The non-inflammatory biopsy group was significantly less likely to respond to standard treatment as evidenced by higher pain reports (p = .018. Mast cells (p = .022 and 5-HT (p = .02 were significantly related to abdominal pain scores. Conclusions A potential association between self-reported abdominal pain, number of mast cells, and 5-HT levels, which may contribute to perceived GI pain in pediatric patients may exist.

Early enteral nutrition prevents intra-abdominal hypertension and reduces the severity of severe acute pancreatitis compared with delayed enteral nutrition: a prospective pilot study.

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Sun, Jia-Kui; Li, Wei-Qin; Ke, Lu; Tong, Zhi-Hui; Ni, Hai-Bin; Li, Gang; Zhang, Lu-Yao; Nie, Yao; Wang, Xin-Ying; Ye, Xiang-Hong; Li, Ning; Li, Jie-Shou

2013-09-01

To investigate the effects of early enteral nutrition (EEN) on intra-abdominal pressure (IAP) and disease severity in patients with severe acute pancreatitis (SAP). Enteral nutrition (EN) was started within 48 h after admission in the EEN group and from the 8th day in the delayed enteral nutrition (DEN) group. The IAP and intra-abdominal hypertension (IAH) incidence were recorded for 2 weeks. The caloric intake and feeding intolerance (FI) incidence were recorded daily after EN was started. The severity markers and clinical outcome variables were also recorded. Sixty patients were enrolled to this study. No difference about IAP was found. The IAH incidence of the EEN group was significantly lower than that of the DEN group from the 9th day (8/30 versus 18/30; P = 0.009) after admission. The FI incidence of the EEN group was higher than that of the DEN group during the initial 3 days of feeding (25/30 versus 12/30; P = 0.001; 22/30 versus 9/30; P = 0.001; 15/30 versus 4/30; P = 0.002). Patients with an IAP FI incidence than those with an IAP ≥15 mmHg on the 1st day (20/22 versus 17/38; P < 0.001), the 3rd day (11/13 versus 8/47; P < 0.001), and the 7th day (3/5 versus 3/55; P = 0.005) of feeding. The severity markers and clinical outcome variables of the EEN group were significantly improved. Early enteral nutrition did not increase IAP. In contrast, it might prevent the development of IAH. In addition, EEN might be not appropriate during the initial 3-4 days of SAP onset. Moreover, EN might be of benefit to patients with an IAP <15 mmHg. Early enteral nutrition could improve disease severity and clinical outcome, but did not decrease mortality of SAP.

Non-Operative Management of Isolated Pneumoperitoneum Due to Severe Blunt Abdominal Trauma

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Murat Kilic

2016-02-01

Full Text Available Nonoperative management of blunt abdominal trauma is the treatment of choice for hemodynamically stable patients. The results of nonoperative management are more successful in isolated solid organ injuries such as the liver and spleen than hollow viscus injury. In this approach, both the clinical course of the patient and the computed tomography findings play an important role. Isolated pneumoperitoneum in blunt abdominal trauma may be a surgical challenge for clinicians because it is usually a significant radiological sign for hallow viscus perforations. Here, we report a case of isolated pneumoperitoneum detected on computed tomography and managed non-surgically, in a young man suffered from a severe blunt abdominal trauma. Our aim is to attract the attention of surgeons to the management problems of the presence of pneumoperitoneum in the absence of other radiological findings in blunt abdominal trauma.

Urinary free light chains may help to identify infection in patients with elevated systemic inflammation due to rheumatic disease.

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Bramlage, Carsten P; Froelich, Britta; Wallbach, Manuel; Minguet, Joan; Grupp, Clemens; Deutsch, Cornelia; Bramlage, Peter; Müller, Gerhard A; Koziolek, Michael

2017-04-01

The risk of infection in patients with rheumatic diseases is elevated, but a clear marker to differentiate the cause of the systemic inflammation is missing. We assessed the ability urinary immunoglobulin free light chains (FLCs) to indicate the presence of infection in patients with rheumatic disease. We performed a retrospective analysis of patients with rheumatic disease attending the Georg-August University Hospital in Goettingen, Germany, from January 2011 to December 2013. Subjects were included if they had urine levels of κ and λ FLCs available. A reference group of patients without autoimmune disease, but with documented infection, was constructed. A total of 1500 patients had their urinary FLCs quantified during the study period. Of the 382 patients with rheumatic disease, 172 (45%) displayed no systemic inflammation, 162 (42%) had inflammation due to the underlying disease activity, and 48 (13%) had inflammation due to a confirmed infection. Urinary FLC concentrations were much higher in patients with rheumatic diseases and infection (κ 68.8 ± 81.8 mg/L, λ 31.4 ± 53.5 mg/L) compared to those with inflammation due to rheumatic disease activity (κ 22.7 ± 26.3 mg/L, λ 8.1 ± 9.1 mg/L, κ p rheumatic disease activity from that due to the additional presence of infection. The ability to quantify these proteins in urine provides a simple alternative to the use of blood.

A case of gastrointestinal bleeding due to right hepatic artery pseudoaneurysm following total remnant pancreatectomy: A case report

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Atsushi Fujio

Full Text Available Introduction: Pseudoaneurysm is a serious complication after pancreatic surgery, which mainly depends on the presence of a preceding pancreatic fistula. Postpancreatectomy hemorrhage following total pancreatectomy is a rare complication due to the absence of a pancreatic fistula. Here we report an unusual case of massive gastrointestinal bleeding due to right hepatic artery (RHA pseudoaneurysm following total remnant pancreatectomy. Presentation of case: A 75-year-old man was diagnosed with intraductal papillary mucinous carcinoma recurrence following distal pancreatectomy and underwent total remnant pancreatectomy. After discharge, he was readmitted to our hospital with melena because of the diagnosis of gastrointestinal bleeding. Gastrointestinal endoscopy was performed to detect the origin of bleeding, but an obvious bleeding point could not be detected. Abdominal computed tomography demonstrated an expansive growth, which indicated RHA pseudoaneurysm. Emergency angiography revealed gastrointestinal bleeding into the jejunum from the ruptured RHA pseudoaneurysm. Transcatheter arterial embolization was performed; subsequently, bleeding was successfully stopped for a short duration. Because of improvements in his general condition, the patient was discharged. Discussion: To date, very few cases have described postpancreatectomy hemorrhage following total remnant pancreatectomy. We suspect that the aneurysm ruptured into the jejunum, possibly because of the scarring and inflammation associated with his two complex surgeries. Conclusion: Pseudoaneurysm should be considered when the fragility of blood vessels is suspected, despite no history of anastomotic leak and intra-abdominal abscess. Our case also highlighted that detecting gastrointestinal bleeding is necessary to recognize sentinel bleeding if the origin of bleeding is undetectable. Abbreviations: PPH, RHA, CT, IPMC, RCCs, POD, LHA, GIE, TAE, Keywords: Case report, Pseudoaneurysm, Total

Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension.

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Duchesne, Juan C; Kaplan, Lewis J; Balogh, Zsolt J; Malbrain, Manu L N G

2015-01-01

Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. Review of the relevant literature via PubMed search. The recognition of the association between the development of ACS and resuscitation urged the need for new approach in traumatic shock management. Over a decade after wide spread application of damage control surgery damage control resuscitation was developed. DCR differs from previous resuscitation approaches by attempting an earlier and more aggressive correction of coagulopathy, as well as metabolic derangements like acidosis and hypothermia, often referred to as the 'deadly triad' or the 'bloody vicious cycle'. Permissive hypotension involves keeping the blood pressure low enough to avoid exacerbating uncontrolled haemorrhage while maintaining perfusion to vital end organs. The potential detrimental mechanisms of early, aggressive crystalloid resuscitation have been described. Limitation of fluid intake by using colloids, hypertonic saline (HTS) or hyperoncotic albumin solutions have been associated with favourable effects. HTS allows not only for rapid restoration of circulating intravascular volume with less administered fluid, but also attenuates post-injury oedema at the microcirculatory level and may improve microvascular perfusion. Capillary leak represents the maladaptive, often excessive, and undesirable loss of fluid and electrolytes with or without protein into the interstitium that generates oedema. The global increased permeability syndrome (GIPS) has been articulated in patients with persistent systemic inflammation failing

Coil Embolization of an Arteriobiliary Fistula Caused by Hepatic Intra-Arterial Chemotherapy

International Nuclear Information System (INIS)

Takao, Hidemasa; Doi, Ippei; Makita, Kohzoh; Watanabe, Toshiaki

2005-01-01

Arteriobiliary fistula is a rare complication of hepatic intra-arterial chemotherapy. We report successful coil embolization of an arteriobiliary fistula. An 80-year-old woman underwent percutaneous placement of an indwelling catheter into the replaced right hepatic artery for intra-arterial chemotherapy of liver metastases. Coil embolization of the left hepatic artery was not performed. The patient complained of abdominal pain during intra-arterial chemotherapy. Angiography revealed a fistula between the replaced right hepatic artery and the common bile duct. The fistula was successfully treated by coil embolization via the indwelling catheter, and the indwelling catheter was removed. Although such complications usually herald the termination of intra-arterial chemotherapy, the patient underwent percutaneous implantation of a new catheter-port system, and intra-arterial chemotherapy was restarted

Computed tomography and nonoperative treatment for blunt abdominal trauma

International Nuclear Information System (INIS)

Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro; Takahashi, Toshio.

1990-01-01

Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author)

Computed tomography and nonoperative treatment for blunt abdominal trauma

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Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro [Saiseikai Shiga Hospital, Shiga (Japan); Takahashi, Toshio

1990-01-01

Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author).

Amniotic Fluid Soluble Myeloid Differentiation-2 (sMD-2) as Regulator of Intra-amniotic Inflammation in Infection-induced Preterm Birth.

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Dulay, Antonette T; Buhimschi, Catalin S; Zhao, Guomao; Oliver, Emily A; Abdel-Razeq, Sonya S; Shook, Lydia L; Bahtiyar, Mert O; Buhimschi, Irina A

2015-06-01

TLR4 mediates host responses to pathogens through a mechanism that involves protein myeloid differentiation-2 (MD-2) and its soluble form sMD-2. The role of sMD2 in intra-amniotic inflammation-induced preterm birth has not been previously explored. Human amniotic fluid (AF) sMD-2 was studied by Western blotting in 152 AF samples of patients who had an amniocentesis to rule-out infection (yes infection, n = 50; no infection, n = 50) or women with normal pregnancy outcome (second trimester genetic karyotyping, n = 26; third trimester lung maturity testing, n = 26). Histological localization and mRNA expression of MD2 in fetal membranes were studied by immunohistochemistry and RT-PCR. The ability of fetal membrane to release sMD-2 and inflammatory cytokines was studied in vitro. Human AF contains three sMD-2 proteoforms whose levels of expression were lower at term. Intra-amniotic infection upregulated sMD-2. MD-2 mRNA and immunohistochemistry findings concurred. In vitro, LPS and monensin increased, while cycloheximide decreased sMD-2 production. Recombinant sMD-2 modulated TNF-α and IL-6 levels in a dose- and time-dependent fashion. sMD2 proteoforms are constitutively present in human AF. The intensity of the intra-amniotic inflammatory response to bacteria or perhaps to other TLR4 ligands may be facilitated through synthesis and release of sMD2 by the amniochorion. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Clinical and economic outcomes associated with community-acquired intra-abdominal infections caused by extended spectrum beta-lactamase (ESBL) producing bacteria in China.

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Hu, Bijie; Ye, Huifeng; Xu, Yingchun; Ni, Yuxing; Hu, Yunjian; Yu, Yunsong; Huang, Zhenfei; Ma, Larry

2010-06-01

To compare clinical and economic outcomes in patients with community-acquired intra-abdominal infection (IAI) due to extended spectrum beta-lactamase (ESBL) producing (ESBL-positive) bacteria versus non-ESBL-producing (ESBL-negative) bacteria in China. This was a retrospective chart review study of patients hospitalized with community-acquired IAI due to ESBL-positive or ESBL-negative infections caused by Escherichia coli or Klebsiella spp. Data were collected from six hospitals in China that participated in the Study for Monitoring Antibiotic Resistance Trends (SMART) during 2006-2007. Outcomes included clinical response at discharge and following first-line antibiotic, number of antibiotic agents and classes, duration of hospitalization, and overall hospitalization and intravenous antibiotic costs. Of the 85 patients included in the study, 32 (37.6%) had ESBL-positive and 53 (62.4%) had ESBL-negative infections; E. coli was responsible for 77.6% of infections. Infection resolved at discharge in 30 (93.8%) ESBL-positive and 48 (90.6%) ESBL-negative patients (P = NS). Fewer ESBL-positive patients achieved complete response following first-line antibiotics (56.3% versus 83.0%; P = 0.01). ESBL-positive patients required longer antibiotic treatment, more antibiotics, longer hospitalization (24.3 versus 14.6 days; 1.67-fold ratio; P = 0.001), and incurred higher hospitalization costs ( yen24,604 vs. yen13,788; $3604 vs. $2020; 1.78-fold ratio; P < 0.001). Patients with ESBL-positive infection had similar resolution rates at discharge compared to those with ESBL-negative infection, despite poorer first-line antibiotic response. However, ESBL-positive infection led to significantly greater hospitalization cost and intravenous antibiotic cost, and longer hospital stay.

Reliability of ultrasound thickness measurement of the abdominal muscles during clinical isometric endurance tests.

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ShahAli, Shabnam; Arab, Amir Massoud; Talebian, Saeed; Ebrahimi, Esmaeil; Bahmani, Andia; Karimi, Noureddin; Nabavi, Hoda

2015-07-01

The study was designed to evaluate the intra-examiner reliability of ultrasound (US) thickness measurement of abdominal muscles activity when supine lying and during two isometric endurance tests in subjects with and without Low back pain (LBP). A total of 19 women (9 with LBP, 10 without LBP) participated in the study. Within-day reliability of the US thickness measurements at supine lying and the two isometric endurance tests were assessed in all subjects. The intra-class correlation coefficient (ICC) was used to assess the relative reliability of thickness measurement. The standard error of measurement (SEM), minimal detectable change (MDC) and the coefficient of variation (CV) were used to evaluate the absolute reliability. Results indicated high ICC scores (0.73-0.99) and also small SEM and MDC scores for within-day reliability assessment. The Bland-Altman plots of agreement in US measurement of the abdominal muscles during the two isometric endurance tests demonstrated that 95% of the observations fall between the limits of agreement for test and retest measurements. Together the results indicate high intra-tester reliability for the US measurement of the thickness of abdominal muscles in all the positions tested. According to the study's findings, US imaging can be used as a reliable method for assessment of abdominal muscles activity in supine lying and the two isometric endurance tests employed, in participants with and without LBP. Copyright © 2014 Elsevier Ltd. All rights reserved.

The role of imaging studies in pancreatic injury due to blunt abdominal trauma in children

International Nuclear Information System (INIS)

Bosboom, D.; Braam, A.W.E.; Blickman, J.G.; Wijnen, R.M.H.

2006-01-01

Background: The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma. Method: Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma. Results: Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths. Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade 1 was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts. Conclusion: Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions

La medición de la presión intrabdominal, una herramienta diagnóstica para el médico de familia Intra-abdominal pressure measurement, a diagnostic tool for family physician

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Nizahel Estévez Álvarez

2010-09-01

Full Text Available Resulta muy oportuno establecer un diagnóstico precoz de las afecciones intrabdominales agudas, por eso consideramos prudente poner en manos de nuestro personal de salud que labora en el sistema de urgencia del nivel primario, una herramienta diagnóstica más para el Médico de Familia, como es la medición de la presión intrabdominal, por no existir prácticamente experiencias de su empleo fuera de las unidades de atención al paciente grave. Es este un método perfectamente implementable en nuestro medio por su fácil aplicabilidad técnica y su alta especificidad diagnóstica, que permite inferir, en las primeras horas de evolución de los pacientes con cuadros dolorosos abdominales, cuáles resultarían potencialmente necesitados de tratamiento quirúrgico, y de esta manera, ganar en resolutividad. La imposibilidad de realizar esta técnica nunca debería de retrasar la remisión del paciente para su valoración por un especialista en cirugía general, por tanto, esta solo pudiera ser considerada como un complemento más del arsenal diagnóstico al alcance del Médico de Familia, en centros acondicionados para su implementación y con el entrenamiento previo adecuado.It is very appropriate to establish an early diagnosis of acute intra-abdominal infections, thus, authors believe cautious that our health staff working in the primary level of emergence system to count on another diagnostic tool for Family Physician, the intra-abdominal pressure measurement, due to practically the lack of experience of its job out of the care units for the severe patient. This is a method perfectly applicable in our environment by its easy technical application and its high diagnostic specificity allowing inferring during the first hours of evolution of patients presenting with abdominal painful symptoms, who will be potentially needed of surgical treatment and so to achieve a solution. The impossibility to perform this technique never must to retard the

The open abdomen and temporary abdominal closure systems--historical evolution and systematic review.

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Quyn, A J; Johnston, C; Hall, D; Chambers, A; Arapova, N; Ogston, S; Amin, A I

2012-08-01

Several techniques for temporary abdominal closure have been developed. We systematically review the literature on temporary abdominal closure to ascertain whether the method can be tailored to the indication. Medline, Embase, the Cochrane Central Register of Controlled Trials and relevant meeting abstracts until December 2009 were searched using the following headings: open abdomen, laparostomy, VAC (vacuum assisted closure), TNP (topical negative pressure), fascial closure, temporary abdominal closure, fascial dehiscence and deep wound dehiscence. The data were analysed by closure technique and aetiology. The primary end-points included delayed fascial closure and in-hospital mortality. The secondary end-points were intra-abdominal complications. The search identified 106 papers for inclusion. The techniques described were VAC (38 series), mesh/sheet (30 series), packing (15 series), Wittmann patch (eight series), Bogotá bag (six series), dynamic retention sutures (three series), zipper (15 series), skin only and locking device (one series each). The highest facial closure rates were seen with the Wittmann patch (78%), dynamic retention sutures (71%) and VAC (61%). Temporary abdominal closure has evolved from simple packing to VAC based systems. In the absence of sepsis Wittmann patch and VAC offered the best outcome. In its presence VAC had the highest delayed primary closure and the lowest mortality rates. However, due to data heterogeneity only limited conclusions can be drawn from this analysis. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

Childhood abdominal cystic lymphangioma

International Nuclear Information System (INIS)

Konen, Osnat; Rathaus, Valeria; Shapiro, Myra; Dlugy, Elena; Freud, Enrique; Kessler, Ada; Horev, Gadi

2002-01-01

Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two. Conclusions: US

Childhood abdominal cystic lymphangioma

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Konen, Osnat; Rathaus, Valeria; Shapiro, Myra [Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba (Israel); Dlugy, Elena [Department of Paediatric Surgery, Schneider Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Freud, Enrique [Department of Paediatric Surgery, Sapir Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Kessler, Ada [Department of Diagnostic Imaging, Sourasky Medical Centre, Tel-Aviv (Israel); Horev, Gadi [Department of Diagnostic Imaging, Schneider Medical Centre, Tel-Aviv (Israel)

2002-02-01

Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two

Emergency CT in blunt abdominal trauma of multiple injury patients

International Nuclear Information System (INIS)

Kinnunen, J.; Kivioja, A.; Poussa, K.; Laasonen, E.M.

1994-01-01

Multiple injury patients with blunt abdominal trauma (n = 110) were examined by abdominal CT. An i.v., but not peroral, contrast medium was used, thereby eliminating the delay caused by administering peroral contrast medium and any subsequent delay in making the diagnoses and beginning operative treatment. Eighteen patients underwent emergency laparotomy after the initial CT examination. The preoperative CT findings were compared to the laparotomy findings. CT revealed all but one of the severe parenchymal organ lesions requiring surgery. The one liver laceration that went undetected had caused hemoperitoneum, which was diagnosed by CT. The bowel and mesenteric lesions presented as intra-abdominal blood, and the hemoperitoneum was discovered in every patient with these lesions. Fourteen patients also initially had positive abdominal CT findings; 10 of them underwent an additional abdominal CT within 3 days, but the repeat studies did not reveal any lesions in need of surgery. Omission of the oral contrast medium did not jeopardize making the essential diagnoses, but it did save time. (orig.)

Abdominal compartment syndrome following abdominoplasty: A case report and review

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Arash Izadpanah

2014-01-01

Full Text Available Abdominoplasty is among the most commonly performed aesthetic procedures in plastic surgery. Despite high complication rate, abdominal contouring procedures are expected to rise in popularity with the advent of bariatric surgery. Patients with a history of gastric bypass surgery have an elevated incidence of small bowel obstruction from internal herniation, which is associated with non-specific upper abdominal pain, nausea, and a decrease in appetite. Internal hernias, when subjected to elevated intra-abdominal pressures, have a high-risk of developing ischemic bowel. We present a case report of patient with previous laparoscopic Roux-en-y gastric bypass who developed acute ischemic bowel leading to abdominal compartment syndrome following abdominoplasty. To the best of our knowledge, this is the first reported case in the literature. We herein emphasise on the subtle symptoms and signs that warrant further investigations in prospective patients for an abdominal contouring procedure with a prior history of gastric bypass surgery.

Rapid non-contrast magnetic resonance imaging for post appendectomy intra-abdominal abscess in children

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Lee, Megan H. [Washington University School of Medicine in St. Louis, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Eutsler, Eric P.; Khanna, Geetika [Washington University School of Medicine in St. Louis, Pediatric Radiology, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Sheybani, Elizabeth F. [Mercy Hospital St. Louis, Department of Radiology, St. Louis, MO (United States)

2017-07-15

Acute appendicitis, especially if perforated at presentation, is often complicated by postoperative abscess formation. The detection of a postoperative abscess relies primarily on imaging. This has traditionally been done with contrast-enhanced computed tomography. Non-contrast magnetic resonance imaging (MRI) has the potential to accurately detect intra-abdominal abscesses, especially with the use of diffusion-weighted imaging (DWI). To evaluate our single-center experience with a rapid non-contrast MRI protocol evaluating post-appendectomy abscesses in children with persistent postsurgical symptoms. In this retrospective, institutional review board-approved study, all patients underwent a clinically indicated non-contrast 1.5- or 3-Tesla abdomen/pelvis MRI consisting of single-shot fast spin echo, inversion recovery and DWI sequences. All MRI studies were reviewed by two blinded pediatric radiologists to identify the presence of a drainable fluid collection. Each fluid collection was further characterized as accessible or not accessible for percutaneous or transrectal drainage. Imaging findings were compared to clinical outcome. Seven of the 15 patients had a clinically significant fluid collection, and 5 of these patients were treated with percutaneous drain placement or exploratory laparotomy. The other patients had a phlegmon or a clinically insignificant fluid collection and were discharged home within 48 h. Rapid non-contrast MRI utilizing fluid-sensitive and DWI sequences can be used to identify drainable fluid collections in post-appendectomy patients. This protocol can be used to triage patients between conservative management vs. abscess drainage without oral/intravenous contrast or exposure to ionizing radiation. (orig.)

Rapid non-contrast magnetic resonance imaging for post appendectomy intra-abdominal abscess in children

International Nuclear Information System (INIS)

Lee, Megan H.; Eutsler, Eric P.; Khanna, Geetika; Sheybani, Elizabeth F.

2017-01-01

Acute appendicitis, especially if perforated at presentation, is often complicated by postoperative abscess formation. The detection of a postoperative abscess relies primarily on imaging. This has traditionally been done with contrast-enhanced computed tomography. Non-contrast magnetic resonance imaging (MRI) has the potential to accurately detect intra-abdominal abscesses, especially with the use of diffusion-weighted imaging (DWI). To evaluate our single-center experience with a rapid non-contrast MRI protocol evaluating post-appendectomy abscesses in children with persistent postsurgical symptoms. In this retrospective, institutional review board-approved study, all patients underwent a clinically indicated non-contrast 1.5- or 3-Tesla abdomen/pelvis MRI consisting of single-shot fast spin echo, inversion recovery and DWI sequences. All MRI studies were reviewed by two blinded pediatric radiologists to identify the presence of a drainable fluid collection. Each fluid collection was further characterized as accessible or not accessible for percutaneous or transrectal drainage. Imaging findings were compared to clinical outcome. Seven of the 15 patients had a clinically significant fluid collection, and 5 of these patients were treated with percutaneous drain placement or exploratory laparotomy. The other patients had a phlegmon or a clinically insignificant fluid collection and were discharged home within 48 h. Rapid non-contrast MRI utilizing fluid-sensitive and DWI sequences can be used to identify drainable fluid collections in post-appendectomy patients. This protocol can be used to triage patients between conservative management vs. abscess drainage without oral/intravenous contrast or exposure to ionizing radiation. (orig.)

Pitfall of ultrasonographic diagnosis in abdominal tuberculosis

International Nuclear Information System (INIS)

Lee, Y. H.; Yoo, H.S.; Kim, K. W.; Lee, J. T.; Park, C. Y.

1983-01-01

Intestinal tuberculosis is generally diagnosed using conventional barium studies, however recent diagnostic modalities such as ultrasonography and CT scan are widely applicated in conjunction with conventional studies for the search of lymph node presentation and associated extra-intestinal organs. It is important to differentiate intra-abdominal tuberculosis from metastatic or lymphomatous disease clinically. And it might be especially of worth to find out if there is any differential point between tuberculosis and other lymph nodal disease entities when we meet similar findings on imaging modalities. Authors have tried to evaluate ultrasonographic findings in conjunction with other studies in nine cases of abdominal tuberculosis which showed mainly extra-intestinal and/or lymph nodal involvement

Evaluating the Relationship between Rib Fractures and the Probability of Abdominal Trauma; a Brief Report

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Vahid Monsef Kasmaei

2015-02-01

Full Text Available Introduction: Trauma is one of the most important causes of death in patients under 40 years of age and the third common cause of death regardless of age. Rib cage damages are one of the major reasons for death in the early minutes post-trauma. Therefore, the present study aimed to evaluate the frequency of intra-abdominal injury in the patients with rib fracture who were referred to emergency department. Methods: This cross-sectional study included 60 patients with rib fractures who were admitted to the emergency department of Poorsina Hospital, Rasht, Iran, from March 2011 to March2012. A checklist was filled out for all the patients including age, sex, trauma mechanism, side and site of fracture, the number of broken ribs, the results of abdominal ultrasonography, the need for laparotomy and mortality. The collected data were classified based on descriptive statistics and analyzed using SPSS 16. Results: 60 patients with the mean age of 47.26±13.71 years were admitted to the emergency department during this time (81.7% male. The most common mechanism of trauma was car accident [22(36.7%]. Among these 60 patients, 71 rib fractures in 3 levels of chest (upper, middle, lower were detected and 50 (83.3% in the same area. Mean number of fractured ribs was 2.85±2.2 (minimum: 1, maximum 10. In 3 (5% patients, fracture was on both sides. The results of abdominal ultrasonography in 7 (11.7% patients were positive. The number of fractured ribs (p=0.017 and the area of the fracture (p=0.048 showed a significant correlation with the presence of intra-abdominal free fluid. The fracture of more than 2 ribs directly correlated with the possibility of intra-abdominal hemorrhage (p<0.0001. Conclusion: Based on the results of this study, it seems that the number and area of the fractured ribs directly and significantly correlate with the probability of abdominal trauma based on the results of abdominal ultrasonography.

Fasting gall bladder volume and lithogenicity in relation to glucose tolerance, total and intra-abdominal fat masses in obese non-diabetic subjects

DEFF Research Database (Denmark)

Hendel, H W; Højgaard, L; Andersen, T

1998-01-01

OBJECTIVE: To investigate whether total body fat mass or fat distribution and associated metabolic disturbances in glucose and lipid metabolism influence the well known gallstone pathogenetic factors in obese subjects in order to explain why some obese subjects develop gallstones and some do not...... with a specific radioimmunoassay. Insulin sensitivity was measured by the Minimal Model and glucose tolerance by an oral glucose tolerance test (OGTT). Serum lipid concentrations were measured by standard methods. RESULTS: The gallbladder volume in the fasting state increased with increasing intra-abdominal fat...... mass (P=0.006) and was increased in subjects with impaired glucose tolerance (41 vs 27 ml, P=0.001). The lithogenic index was > 1 in all subjects and correlated with total fat mass (P=0.04). CONCLUSION: Gallstone pathogenesis in obesity seems to be influenced by the total body fat mass and its regional...

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy.

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Juan, Hsu-Cheng; Lin, Hung-Yu; Chou, Yii-Her; Yang, Yi-Hsin; Shih, Paul Ming-Chen; Chuang, Shu-Mien; Shen, Jung-Tsung; Juan, Yung-Shun

2012-08-01

To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. • Unenhanced CT is now widely used to assess ureteric calculi. • The same CT protocol can provide measurements of abdominal fat distribution. • Ureteric calculi are usually treated by shock wave lithotripsy (SWL). • Greater intra-abdominal fat stores are generally associated with poorer SWL results.

Simultaneous repair of abdominal aortic aneurysm and resection of unexpected, associated abdominal malignancies.

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Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Lorusso, Riccardo; Ceccanei, Gianluca; Vietri, Francesco

2004-12-15

The management of unexpected intra-abdominal malignancy, discovered at laparotomy for elective treatment of an abdominal aortic aneurysm (AAA), is controversial. It is still unclear whether both conditions should be treated simultaneously or a staged approach is to be preferred. To contribute in improving treatment guidelines, we retrospectively reviewed the records of patients undergoing laparotomy for elective AAA repair. From January 1994 to March 2003, 253 patients underwent elective, trans-peritoneal repair of an AAA. In four patients (1.6%), an associated, unexpected neoplasm was detected at abdominal exploration, consisting of one renal, one gastric, one ileal carcinoid, and one ascending colon tumor. All of them were treated at the same operation, after aortic repair and careful isolation of the prosthetic graft. The whole series' operative mortality was 3.6%. None of the patients simultaneously treated for AAA and tumor resection died in the postoperative period. No graft-related infections were observed. Simultaneous treatment of AAA and tumor did not prolong significantly the mean length of stay in the hospital, compared to standard treatment of AAA alone. Except for malignancies of organs requiring major surgical resections, simultaneous AAA repair and resection of an associated, unexpected abdominal neoplasm can be safely performed, in most of the patients, sparing the need for a second procedure. Endovascular grafting of the AAA can be a valuable tool in simplifying simultaneous treatment, or in staging the procedures with a very short delay.

Antimicrobial susceptibility of Gram-negative bacteria causing intra-abdominal infections in China: SMART China 2011.

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Zhang, Hui; Yang, Qiwen; Xiao, Meng; Chen, Minjun; Badal, Robert E; Xu, Yingchun

2014-01-01

The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide. In 2011, 1 929 aerobic and facultative GNBs from 21 hospitals in 16 cities in China were collected. All isolates were tested using a panel of 12 antimicrobial agents, and susceptibility was determined following the Clinical Laboratory Standards Institute guidelines. Among the Gram-negative pathogens causing IAIs, Escherichia coli (47.3%) was the most commonly isolated, followed by Klebsiella pneumoniae (17.2%), Pseudomonas aeruginosa (10.1%), and Acinetobacter baumannii (8.3%). Enterobacteriaceae comprised 78.8% (1521/1929) of the total isolates. Among the antimicrobial agents tested, ertapenem and imipenem were the most active agents against Enterobacteriaceae, with susceptibility rates of 95.1% and 94.4%, followed by amikacin (93.9%) and piperacillin/tazobactam (87.7%). Susceptibility rates of ceftriaxone, cefotaxime, ceftazidime, and cefepime against Enterobacteriaceae were 38.3%, 38.3%, 61.1%, and 50.8%, respectively. The leastactive agent against Enterobacteriaceae was ampicillin/sulbactam (25.9%). The extended-spectrum β-lactamase (ESBL) rates among E. coli, K. pneumoniae, Klebsiella oxytoca, and Proteus mirabilis were 68.8%, 38.1%, 41.2%, and 57.7%, respectively. Enterobacteriaceae were the major pathogens causing IAIs, and the most active agents against the study isolates (including those producing ESBLs) were ertapenem, imipenem, and amikacin. Including the carbapenems, most agents exhibited reduced susceptibility against ESBL-positive and multidrug-resistant isolates.

Computed tomographic evaluation of abdominal fat in minipigs.

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Chang, Jinhwa; Jung, Joohyun; Lee, Hyeyeon; Chang, Dongwoo; Yoon, Junghee; Choi, Mincheol

2011-03-01

Computed tomography (CT) exams were conducted to determine the distribution of abdominal fat identified based on the CT number measured in Hounsfield Units (HU) and to measure the volume of the abdominal visceral and subcutaneous fat in minipigs. The relationship between the CT-based fat volumes of several vertebral levels and the entire abdomen and anthropometric data including the sagittal abdominal diameter and waist circumference were evaluated. Moreover, the total fat volumes at the T11, T13, L3, and L5 levels were compared with the total fat volume of the entire abdomen to define the landmark of abdominal fat distribution. Using a single-detector CT, six 6-month-old male minipigs were scanned under general anesthesia. Three radiologists then assessed the HU value of visceral and subcutaneous abdominal fat by drawing the region of interest manually at the T11, T13, L1, L3, and L5 levels. The CT number and abdominal fat determined in this way by the three radiologists was found to be correlated (intra-class coefficient = 0.9). The overall HU ranges for the visceral and subcutaneous fat depots were -147.47 to -83.46 and -131.62 to -90.97, respectively. The total fat volume of the entire abdomen was highly correlated with the volume of abdominal fat at the T13 level (r = 0.97, p abdominal adipose tissue measured at the T13 level using CT is a strong and reliable predictor of total abdominal adipose volume.

CT findings in ischaemic hepatic failure due to intra-arterial embolisation: A case report

International Nuclear Information System (INIS)

Catalano, O.

1997-01-01

Liver infarction is relatively uncommon. It may be secondary to several conditions such as sepsis, shock, sickle-cell anaemia, eclampsia, vasculitis, metastatic disease, bacterial endocarditis, rheumatic heart disease, trauma, portal venous occlusion or compression, oral contraception, anaesthesia, hepatic artery thrombosis, therapeutical or inadvertent hepatic artery ligation, intra-arterial chemotherapy or embolisation. A case of hepatic infraction, unusual for iatrogenic pathogenesis, submassive extension with acute hepatic failure, and CT findings of an internally branching pattern due to intravascular gas was observed. (orig./AJ)

Intra-articular injection of Botulinum toxin A reduces neurogenic inflammation in CFA-induced arthritic rat model.

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Wang, Lin; Wang, Kaile; Chu, Xiao; Li, Tieshan; Shen, Nana; Fan, Chenglei; Niu, Zhenyuan; Zhang, Xiaochen; Hu, Luoman

2017-02-01

Currently, administration of Botulinum toxin Type A (BoNT/A) to treat arthritic pain has promising efficacy in clinical research. However, the mechanisms underlying anti-neurogenic inflammation mediated by BoNT/A remains unclear. The aim of this study was to demonstrate the effectiveness in macro and micro levels and to explore the causal mechanism of BoNT/A. Wistar rats (n = 60) were injected with 50ul complete Freund's adjuvant (CFA) in the left ankle joint capsule to establish a model of chronic monoarthritis. Pain behaviour (Evoked pain assessment) and infrared thermal imaging testing were performed at the macroscopic level to assess the effectiveness of analgesia and anti-inflammation. Western blotting and immunofluorescence staining were used at the microscopic level in an attempt to determine the mechanisms of anti-nociceptive or anti-inflammatory effects of BoNT/A. Additionally, hematoxylin-eosin staining was also used to visualise the cartilage and the synovial degenerative conditions of arthritis. By comparing the outcome of the evoked pain test and immunofluorescence staining, there was a significant improvement in BoNT/A compared with the normal saline (NS) injected control group. In addition, thermal variations showed that the temperature of ipsilateral ankle joint increased between 1 and 2 weeks following injection of CFA, but decreased after 3 weeks (still above the contralateral side). However, the temperature showed no difference between the BoNT/A group and NS group after treatment. The expression of IL-1β or TNF-α in the ankle synovial tissue was significantly decreased in the BoNT/A group compared to the NS group (p < 0.05). Based on the HE assessment, cartilage degeneration and infiltration of inflammatory cells in the BoNT/A group was alleviated compared to the NS group after treatment. In conclusion, we proposed the hypothesis that intra-articular BoNT/A administration does play an important role in anti-neurogenic inflammation. The

Splenic Trauma during Colonoscopy: The Role of Intra-Abdominal Adhesions

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Chime, Chukwunonso; Ishak, Charbel; Kumar, Kishore; Kella, Venkata; Chilimuri, Sridhar

2018-01-01

Splenic rupture following colonoscopy is rare, first reported in 1974, with incidence of 1–21/100,000. It is critical to anticipate splenic trauma during colonoscopy as one of the causes of abdominal pain after colonoscopy especially when located in the left upper quadrant or left shoulder. Postoperative adhesions is a predisposing factor for splenic injury, and management is either operative or nonoperative, based on hemodynamic stability and/or extravasation which can be seen on contrast-en...

Inflammatory Microenvironment Persists After Bone Healing in Intra-articular Ankle Fractures.

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Adams, Samuel B; Leimer, Elizabeth M; Setton, Lori A; Bell, Richard D; Easley, Mark E; Huebner, Janet L; Stabler, Thomas V; Kraus, Virginia B; Olson, Steven A; Nettles, Dana L

2017-05-01

Post-traumatic osteoarthritis (PTOA) is responsible for the majority of cases of ankle arthritis. While acute and end-stage intra-articular inflammation has previously been described, the state of the joint between fracture healing and end-stage PTOA remains undefined. This study characterized synovial fluid (SF) composition of ankles after bone healing of an intra-articular fracture to identify factors that may contribute to the development of PTOA. Of an original 21 patients whose SF was characterized acutely following intra-articular ankle fractures, 7 returned for planned hardware (syndesmotic screw) removal after bone healing (approximately 6 months) and consented to a second bilateral SF collection. SF concentrations of 15 cytokines and matrix metalloproteinases (MMPs) and 2 markers each of cartilage catabolism (CTXII and glycosaminoglycan) and hemarthrosis (biliverdin and bilirubin) were compared for previously fractured and contralateral, uninjured ankles from the same patient. Analysis was also performed to determine the effect of the number of fracture lines and involvement of soft tissue on SF composition. Interleukin (IL)-6, IL-8, MMP-1, MMP-2, and MMP-3 were significantly elevated in the SF from healed ankles compared to matched contralateral uninjured ankles at approximately 6 months after fracture. There were no differences in markers of cartilage catabolism or hemarthrosis. Only IL-1α was affected by the number of fracture lines while differences were not detected for other analytes or with respect to the involvment of soft tissue. Sustained intra-articular inflammation, even after complete bone healing, was suggested by elevations of pro-inflammatory cytokines (IL-6 and IL-8). In addition, elevated concentrations of MMPs were also noted and were consistent with a persistent inflammatory environment. This study suggests new evidence of persistent intra-articular inflammation after intra-articular ankle fracture healing and suggests potential

Obesity-Associated Abdominal Elephantiasis

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Ritesh Kohli

2013-01-01

Full Text Available Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications.

Temporary abdominal closure in the critically ill patients with an open abdomen.

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Ghodratollah Maddah

2014-05-01

Full Text Available The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags (Bogotá bag. The study population comprised of 11 (57.9% male and 8 (42.1% female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 (57.9% patients, subjective judgment that the fascia closure is too tight in 6 (31.6% patient's damage control surgery in one patient (5.3% and development of abdominal compartment surgery in one patient (5.3%. Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 (47.4% patients, post operative intestinal fistula in 4 (21.1% patients, post traumatic intra abdominal bleeding in 3 (15.8% patients and intestinal obstructions in 3 (15.8% patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one (10.0% patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 (%21.1 early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 (26.3% late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 (range 2-54 months. Currently 10 patients (52.6% are alive at a follow up of 45 (range 1

The effect of Kombucha on post-operative intra-abdominal adhesion formation in rats.

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Maghsoudi, Hemmat; Mohammadi, Hussein Benagozar

2009-04-01

Peritoneal adhesions are fibrous bands of tissues formed between organs that are normally separated and/or between organs and the internal body wall after peritoneal injury. The aim of the study was to investigate the effect of intra-peritoneal administration of Kombucha on intra-peritoneal adhesions. Eighty Wistar rats were subjected to standardized lesion by scraping model and were randomly divided into two groups. Group I received no treatment, and Group II received 15 ml of Kombucha solution intra-peritoneally. On the post-operative 14th day adhesion intensity score, inflammatory cell reaction and number of adhesion bands were determined. In the control group, there were no rats with grade 0 and I adhesions. In the group II, there were 26 rats (78.8%) with grade 0-2 adhesions. Adhesion intensity was significantly less in group II (PKombucha might be useful for preventing peritoneal adhesions.

Strength of pelvic floor in men: reliability intra examiners

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Patricia Zaidan

2018-05-01

Full Text Available Abstract Introduction: The obtaining of urinary continence is due to the strength of the pelvic floor muscles (MAPs at the moment of muscle contraction, when there are sudden increases in intra-abdominal pressure, which increases urethral closure pressure and decreases the possibility of urinary loss. Objective: To verify the reliability, type: stability, intra-examiner, of the measure of the strength of MAPs held with Peritron. Methods: Test and retest study to assess the intra-rater reliability of Peritron to measure the strength of MAPs. The sample consisted of 36 male patients, mean age 65.3 ± 7.2 years, all with urinary incontinence (UI after radical prostatectomy. The physical therapist conducted a training for familiarization with the procedures of MAPs strength assessment with Peritron for two weeks. The strength of MAPs was measured by a perineometer of the Peritron brand (PFX 9300®, Cardio-Design Pty. Ltd, Baulkham Hills, Australia, 2153. Results: The intraclass correlation coefficient (ICC was equal to 0.99; P = 0.0001. The typical measurement error (ETM was equal to 3.1 cmH2O and ETM% of 4. Conclusion: Peritron showed high reliability for measuring the strength of MAPs in men, both for clinical practice and for the production of scientific knowledge. It should be noted that such measures were carried out in stability, so it is suggested that in internal consistency reliability is equivalent.

Analysis on the use of Multi-Sequence MRI Series for Segmentation of Abdominal Organs

International Nuclear Information System (INIS)

Selver, M A; Selvi, E; Kavur, E; Dicle, O

2015-01-01

Segmentation of abdominal organs from MRI data sets is a challenging task due to various limitations and artefacts. During the routine clinical practice, radiologists use multiple MR sequences in order to analyze different anatomical properties. These sequences have different characteristics in terms of acquisition parameters (such as contrast mechanisms and pulse sequence designs) and image properties (such as pixel spacing, slice thicknesses and dynamic range). For a complete understanding of the data, computational techniques should combine the information coming from these various MRI sequences. These sequences are not acquired in parallel but in a sequential manner (one after another). Therefore, patient movements and respiratory motions change the position and shape of the abdominal organs. In this study, the amount of these effects is measured using three different symmetric surface distance metrics performed to three dimensional data acquired from various MRI sequences. The results are compared to intra and inter observer differences and discussions on using multiple MRI sequences for segmentation and the necessities for registration are presented

Surface functionality affects the biodistribution and microglia-targeting of intra-amniotically delivered dendrimers.

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Zhang, Fan; Nance, Elizabeth; Zhang, Zhi; Jasty, Venkatasai; Kambhampati, Siva P; Mishra, Manoj K; Burd, Irina; Romero, Roberto; Kannan, Sujatha; Kannan, Rangaramanujam M

2016-09-10

Cerebral Palsy (CP) is a chronic childhood disorder with limited therapeutic options. Maternal intrauterine inflammation/infection is a major risk factor in the pathogenesis of CP. In pre-clinical models, dendrimer-based therapies are viable in postnatal period, attenuating inflammation and improving motor function in vivo. However, treatment to the mother, in the prenatal period, may provide the possibility of preventing/resolving inflammation at early stages. Towards this goal, we used a maternal intrauterine inflammation-induced rabbit model of CP to study fetal-maternal transport and neuroinflammation targeting of intra-amniotically administrated dendrimers with neutral/anionic surface functionality. Our study suggested both hydroxyl-terminated 'neutral' (D-OH) and carboxyl-terminated 'anionic' (D-COOH) Polyamidoamine (PAMAM) dendrimers were absorbed by fetuses and demonstrated bi-directional transport between fetuses and mother. D-OH was more effective in crossing the fetal blood-brain barrier, and targeting activated microglia. The cell-specific targeting was associated with the extent of microglia activation. This study demonstrated intra-amniotically administered hydroxyl PAMAM dendrimers could be an effective drug delivery vehicle for targeting fetal inflammation and preventing subsequent neurologic injury associated with chorioamnionitis. Copyright © 2016 Elsevier B.V. All rights reserved.

Surface functionality affects the biodistribution and microglia-targeting of intra-amniotically delivered dendrimers☆

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Zhang, Fan; Nance, Elizabeth; Zhang, Zhi; Jasty, Venkatasai; Kambhampati, Siva P.; Mishra, Manoj K.; Burd, Irina; Romero, Roberto; Kannan, Sujatha; Kannan, Rangaramanujam M.

2017-01-01

Cerebral Palsy (CP) is a chronic childhood disorder with limited therapeutic options. Maternal intrauterine inflammation/infection is a major risk factor in the pathogenesis of CP. In pre-clinical models, dendrimer-based therapies are viable in postnatal period, attenuating inflammation and improving motor function in vivo. However, treatment to the mother, in the prenatal period, may provide the possibility of preventing/resolving inflammation at early stages. Towards this goal, we used a maternal intrauterine inflammation-induced rabbit model of CP to study fetal-maternal transport and neuroinflammation targeting of intra-amniotically administrated dendrimers with neutral/anionic surface functionality. Our study suggested both hydroxyl-terminated ‘neutral’ (D-OH) and carboxyl-terminated ‘anionic’ (D-COOH) Polyamidoamine (PAMAM) dendrimers were absorbed by fetuses and demonstrated bi-directional transport between fetuses and mother. D-OH was more effective in crossing the fetal blood-brain barrier, and targeting activated microglia. The cell-specific targeting was associated with the extent of microglia activation. This study demonstrated intra-amniotically administered hydroxyl PAMAM dendrimers could be an effective drug delivery vehicle for targeting fetal inflammation and preventing subsequent neurologic injury associated with chorioamnionitis. PMID:27378700

Clinical and economic consequences of failure of initial antibiotic therapy for patients with community-onset complicated intra-abdominal infections.

Directory of Open Access Journals (Sweden)

Yong Pil Chong

Full Text Available Complicated intra-abdominal infection (cIAI is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI.A retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week.A total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14% had health care-associated infection, and 48 (9% experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred $3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13.To improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.

Diagnosis of abdominal abscesses with 67gallium

International Nuclear Information System (INIS)

Noguera, E.C.; Mothe, G.A.

1987-01-01

Twenty six patients were studied with 67 Gallium to detect and localize the site of intra-abdominal and intraperitoneal infection. They were divided in two groups: a) with and b) without physical symptoms that could localize an abcess in the abdominal cavity. All the patients with suppuration had persistent up-take of 67 Ga in one anatomic area of the abdomen, subsequently documented by computarized axial tomography (CAT) in 58% of the cases or by laparotomy in 88% of them. Scintigraphy with 67 Ga in the patients with recent surgery not only detected focal infection in 67% of the cases but excluded subphernic collection. In 78% of patients with prolonged fever, the infection was localized. There was no false positive result. The comparison in 56% of the cases with CAT demonstrated that both techniques are 100% sensitive for the diagnosis of abdominal suppurative processes. Three of the 26 patients, after six weeks of medical treatment, were restudied with 67 Ga and CAT, showing total resolution of their previous abnormalities. It is concluded that 67 Ga scintigraphy performed as the first study in febrile patients independent of the presence or absence of physical symptoms that could localize the abdominal infection, is sensitive for the detection and localization of an abdominal abscess and that a negative result excludes it. (Author) [es

Abdominal trauma

International Nuclear Information System (INIS)

Giordany, B.R.

1985-01-01

Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

Reproducibility of regional DEXA examinations of abdominal fat and lean tissue.

Science.gov (United States)

Tallroth, Kaj; Kettunen, Jyrki A; Kujala, Urho M

2013-01-01

The aim of this study was to develop and test the validity of a new repeatable method to delimit abdominal areas for follow-up of fat mass (FM) and lean tissue mass (LM) in DEXA examinations. 37 male volunteers underwent two DEXA examinations. Total body FM and LM measurements and corresponding abdominal measurements in a carefully defined region were calculated from the first scan. After repositioning of the subjects and a second scan, the delimited region was copied and the abdominal tissues re-calculated. The mean LM of the abdominal area was 2.804 kg (SD 0.556), and the mean FM was 1.026 kg (SD 0.537). The intra-class correlation coefficient for the repeated abdominal LM, FM, and LM/FM ratio measurements was 0.99. The mean difference (bias) for the repeated abdominal LM measurements was -13 g (95% confidence interval (CI) -193.0 to 166.8), and for the repeated abdominal FM measurements it was -35 g (95% CI -178.9 to 108.5). The results indicate that regional DEXA is a sensitive method with excellent reproducibility in the measurements of the abdominal fat and lean tissues. The method may serve as a useful tool for evaluation and follow-up of various dietary and training programmes.

Dairy Foods in a Moderate Energy Restricted Diet Do Not Enhance Central Fat, Weight, and Intra-Abdominal Adipose Tissue Losses nor Reduce Adipocyte Size or Inflammatory Markers in Overweight and Obese Adults: A Controlled Feeding Study

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Marta D. Van Loan

2011-01-01

Full Text Available Background. Research on dairy foods to enhance weight and fat loss when incorporated into a modest weight loss diet has had mixed results. Objective. A 15-week controlled feeding study to determine if dairy foods enhance central fat and weight loss when incorporated in a modest energy restricted diet of overweight and obese adults. Design. A 3-week run-in to establish energy needs; a 12-week 500 kcal/d energy reduction with 71 low-dairy-consuming overweight and obese adults randomly assigned to diets: ≤1 serving dairy/d (low dairy, LD or ≤4 servings dairy/d (adequate dairy, AD. All foods were weighed and provided by the metabolic kitchen. Weight, fat, intra-abdominal adipose tissue (IAAT, subcutaneous adipose tissue (SAT macrophage number, SAT inflammatory gene expression, and circulating cytokines were measured. Results. No diet differences were observed in weight, fat, or IAAT loss; nor SAT mRNA expression of inflammation, circulating cytokines, fasting lipids, glucose, or insulin. There was a significant increase (P=0.02 in serum 25-hydroxyvitamin D in the AD group. Conclusion. Whether increased dairy intake during weight loss results in greater weight and fat loss for individuals with metabolic syndrome deserves investigation. Assessment of appetite, hunger, and satiety with followup on weight regain should be considered.

Modulação da pressão intracraniana em um modelo experimental de hipertensão abdominal e lesão pulmonar aguda

OpenAIRE

Zampieri,Fernando Godinho; Almeida,Juliana Roberta; Schettino,Guilherme Pinto de Paula; Park,Marcelo; Machado,Fabio Santana; Azevedo,Luciano Cesar Pontes

2011-01-01

OBJETIVO: Avaliar o efeito de alterações hemodinâmicas, respiratórias e metabólicas sobre a pressão intracraniana em um modelo de lesão pulmonar aguda e síndrome compartimental abdominal. MÉTODOS: Oito porcos Agroceres foram submetidos, após a instrumentação, a cinco cenários clínicos: 1) estado basal com baixa pressão intra-abdominal e pulmão sadio; 2) pneumoperitôneo, com pressão intra-abdominal de 20 mm Hg; 3) lesão pulmonar aguda induzida por lavagem pulmonar e desativação de surfactante;...

A-Part Gel, an adhesion prophylaxis for abdominal surgery: a randomized controlled phase I-II safety study [NCT00646412].

Science.gov (United States)

Lang, Reinhold; Baumann, Petra; Schmoor, Claudia; Odermatt, Erich K; Wente, Moritz N; Jauch, Karl-Walter

2015-01-01

Intra-abdominal surgical intervention can cause the development of intra-peritoneal adhesions. To reduce this problem, different agents have been tested to minimize abdominal adhesions; however, the optimal adhesion prophylaxis has not been found so far. Therefore, the A-Part(®) Gel was developed as a barrier to diminish postsurgical adhesions; the aim of this randomized controlled study was a first evaluation of its safety and efficacy. In this prospective, controlled, randomized, patient-blinded, monocenter phase I-II study, 62 patients received either the hydrogel A-Part-Gel(®) as an anti-adhesive barrier or were untreated after primary elective median laparotomy. Primary endpoint was the occurrence of peritonitis and/or wound healing impairment 28 ± 10 days postoperatively. As secondary endpoints anastomotic leakage until 28 days after surgery, adverse events and adhesions were assessed until 3 months postoperatively. A lower rate of wound healing impairment and/or peritonitis was observed in the A-Part Gel(®) group compared to the control group: (6.5 vs. 13.8 %). The difference between the two groups was -7.3%, 90 % confidence interval [-20.1, 5.4 %]. Both treatment groups showed similar frequency of anastomotic leakage but incidence of adverse events and serious adverse events were slightly lower in the A-Part Gel(®) group compared to the control. Adhesion rates were comparable in both groups. A-Part Gel(®) is safe as an adhesion prophylaxis after abdominal wall surgery but no reduction of postoperative peritoneal adhesion could be found in comparison to the control group. This may at least in part be due to the small sample size as well as to the incomplete coverage of the incision due to the used application. NCT00646412.

The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy

International Nuclear Information System (INIS)

Lorijn, Fleur de; Voskuijl, Wieger P.; Taminiau, Jan A.; Benninga, Marc A.; Rijn, Rick R. van; Henneman, Onno D.F.; Heijmans, Jarom; Reitsma, Johannes B.

2006-01-01

The data concerning the value of a plain abdominal radiograph in childhood constipation are inconsistent. Recently, positive results have been reported of a new radiographic scoring system, ''the Leech method'', for assessing faecal loading. To assess intra- and interobserver variability and determine diagnostic accuracy of the Leech method in identifying children with functional constipation (FC). A total of 89 children (median age 9.8 years) with functional gastrointestinal disorders were included in the study. Based on clinical parameters, 52 fulfilled the criteria for FC, six fulfilled the criteria for functional abdominal pain (FAP), and 31 for functional non-retentive faecal incontinence (FNRFI); the latter two groups provided the controls. To assess intra- and interobserver variability of the Leech method three scorers scored the same abdominal radiograph twice. A Leech score of 9 or more was considered as suggestive of constipation. ROC analysis was used to determine the diagnostic accuracy of the Leech method in separating patients with FC from control patients. Significant intraobserver variability was found between two scorers (P=0.005 and P<0.0001), whereas there was no systematic difference between the two scores of the other scorer (P=0.89). The scores between scorers differed systematically and displayed large variability. The area under the ROC curve was 0.68 (95% CI 0.58-0.80), indicating poor diagnostic accuracy. The Leech scoring method for assessing faecal loading on a plain abdominal radiograph is of limited value in the diagnosis of FC in children. (orig.)

Addictive genes and the relationship to obesity and inflammation.

Science.gov (United States)

Heber, David; Carpenter, Catherine L

2011-10-01

There is increasing evidence that the same brain reward circuits involved in perpetuating drug abuse are involved in the hedonic urges and food cravings observed clinically in overweight and obese subjects. A polymorphism of the D2 dopamine receptor which renders it less sensitive to dopamine stimulation has been proposed to promote self-stimulatory behavior such as consuming alcohol, abusing drugs, or binging on foods. It is important to determine how this polymorphism may interact with other well-known candidate genes for obesity including polymorphisms of the leptin receptor gene and the opiomelanocortin gene. Leptin is a proinflammatory cytokine as well as a long-term signal maintaining body fat. Upper-body obesity stimulates systemic inflammation through the action of multiple cytokines including leptin throughout many organs including the brain. The association of numerous diseases including diabetes mellitus, heart disease, as well as depression with chronic low-grade inflammation due to abdominal obesity has raised the possibility that obesity-associated inflammation affecting the brain may promote addictive behaviors leading to a self-perpetuating cycle that may affect not only foods but addictions to drugs, alcohol, and gambling. This new area of interdisciplinary research holds the promise of developing new approaches to treating drug abuse and obesity.

Evaluation of organ dose and estimation of risk due to the abdominal region radiography in Indian adults

International Nuclear Information System (INIS)

Kumaresan, M.; Chaubey, Ajay; Kantharia, Surita; Karira, V.; Kumar, Rajesh; Biju, K.; Rao, B.S.

2006-01-01

Organ dose, risk of carcinogenesis and genetic effect due to the abdominal region radiography in Indian adult with the help of Monte-Carlo MCNP code by measuring the entrance skin dose by LiF: Mg, Cu, P TL phosphor and the risk coefficients provided by ICRP 60 were estimated. The entrance skin dose for abdominal region radiography was ranges from 2.75 mSv to 18.88 mSv while average entrance skin dose was 8.3 mSv. The bladder, testes and ovary are the important organ those are getting higher dose. The maximum dose for testes, ovary and bladder is 5.37 mSv, 1.45 mSv and 4.74 mSv respectively. The frequency of occurrence of fatal cancers and serious genetic disorders as a consequence of abdominal region radiography ranges from 0.1 to 38.8 risk/10 6 of fatal cancer. Although the estimated risks are small but cannot be neglected. It is important to avoid unnecessary repetitions and also to carry out proper quality assurance tests on the equipment and in the long run it will help reduce the risks and maximize the benefits of radiodiagnosis. These studies may lead to setting up of national reference levels for the diagnostic procedures India. (author)

Abdominal wall sinus due to impacting gallstone during laparoscopic cholecystectomy: an unusual complication.

Science.gov (United States)

Pavlidis, T E; Papaziogas, B T; Koutelidakis, I M; Papaziogas, T B

2002-02-01

During laparoscopic cholecystectomy, perforation of the gallbladder can occurs in extraction of the gallbladder. The fate of such lost gallstones, which can lead to the formation of an abscess, an abdominal wall mass, or a persistent sinus, has not been studied adequately. Herein we report the case of a persistent sinus of the abdominal wall after an emergent laparoscopic cholecystectomy in an 82-year-old woman with gangrenous cholecystitis and perforation of the friable wall in association with an empyema of the gallbladder. The culture of the obtained pus was positive for Escherichia coli. After a small leak of dirty fluid from the wound of the epigastric port site of 4 months' duration, surgical exploration under local anesthesia revealed that the sinus was caused by spilled gallstones impacting into the abdominal wall between the posterior sheath and left rectus abdominalis muscle. The removal of the stones resulted in complete healing. Long-term complications after laparoscopic cholecystectomy involving the abdominal wall are rare but important possible consequences that could be avoided.

Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score

DEFF Research Database (Denmark)

Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten

2016-01-01

BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has nev...... emergency high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting....

The Potential Role of Aerobic Exercise-Induced Pentraxin 3 on Obesity-Related Inflammation and Metabolic Dysregulation.

Science.gov (United States)

Slusher, Aaron L; Huang, Chun-Jung; Acevedo, Edmund O

2017-01-01

Obesity is defined as the excess accumulation of intra-abdominal body fat, resulting in a state of chronic, low-grade proinflammation that can directly contribute to the development of insulin resistance. Pentraxin 3 (PTX3) is an acute-phase protein that is expressed by a variety of tissue and cell sources and provides an anti-inflammatory property to downregulate the production of proinflammatory cytokines, in particular interleukin-1 beta and tumor necrosis factor alpha. Although PTX3 may therapeutically aid in altering the proinflammatory milieu in obese individuals, and despite elevated expression of PTX3 mRNA observed in adipose tissue, the circulating level of PTX3 is reduced with obesity. Interestingly, aerobic activity has been demonstrated to elevate PTX3 levels. Therefore, the purpose of this review is to discuss the therapeutic potential of PTX3 to positively regulate obesity-related inflammation and discuss the proposition for utilizing aerobic exercise as a nonpharmacological anti-inflammatory treatment strategy to enhance circulating PTX3 concentrations in obese individuals.

Helicobacter pylori infection, serum pepsinogens, and pediatric abdominal pain: a pilot study.

Science.gov (United States)

Kassem, Eias; Naamna, Medhat; Mawassy, Kadri; Beer-Davidson, Gany; Muhsen, Khitam

2017-08-01

The significance of Helicobacter pylori (H. pylori) infection in pediatric abdominal pain remains poorly recognized. We examined associations of H. pylori infection and serum pepsinogens (PGs), as non-invasive markers of gastritis, with pediatric abdominal pain. A case-control study was conducted among 99 children aged 5-17 years admitted to one hospital for abdominal pain (cases) without an apparent organic reason. Using enzyme-linked immunosorbent assays, sera were tested and compared with 179 controls for anti-H. pylori immunoglobulin G (IgG) antibodies and PGI and PGII levels. Multivariable analysis was performed to adjust for potential confounders. H. pylori IgG sero-positivity was 34.3 and 36.3% in cases and controls, respectively, P = 0.7. H. pylori-infected children had higher median PGI and PGII levels and a lower PGI/PGII ratio than uninfected children. Cases infected with H. pylori had a higher median PGII level (P < 0.001) and lower PGI/PGII ratio (P = 0.036) than controls infected with H. pylori. The percentage of cases with PGII ≥7.5 μg/L, as indication for antral inflammation, was higher than in controls: 58.6 versus 44.7%, P = 0.027. Children with PGII levels ≥7.5 μg/L had increased risk for abdominal pain: adjusted prevalence ratio 1.73 [95% confidence intervals 1.02, 2.93], P = 0.039. Children with increased serum PGII levels, as an indication of gastritis, are more likely to have abdominal pain. Serum PGs can be a useful non-invasive marker for gastritis, in evaluating children with severe abdominal pain with no apparent organic reason. What is Known: • The significance of Helicobacter pylori infection in pediatric abdominal pain remains debated. • Serum pepsinogens (PGs), non-invasive markers of gastric inflammation, were rarely utilized in assessing the association between H. pylori in pediatric abdominal pain of unknown origin. What is New: • High serum PGII level, as an indication of gastritis, rather than H. pylori

Intra-articular morphine in horses

DEFF Research Database (Denmark)

Lindegaard, Casper

separated by a three week washout period. Before each treatment, radiocarpal synovitis was induced by IA injection of lipopolysaccharide (LPS). For each of the two 168-hours study periods, local and systemic measures of pain and inflammation as well as blood and synovial fluid (SF) samples...... for pharmacological analysis were obtained repeatedly. Pain was evaluated by degree of lameness as well as using a visual analogue scale of pain intensity (VAS) and a composite measure pain scale (CMPS), developed for this purpose. Intra-articular injection of LPS elicited a marked synovitis resulting in lameness...... and pain. Intra-articularly administered morphine showed a significant analgesic effect as measured by reduced lameness scores, less administered rescue analgesia and lower pain scores. A significant anti-inflammatory effect was demonstrated by reduced joint swelling, reduced SF serum amyloid A (SAA...

Acute abdominal compartment syndrome complicating a colonoscopic perforation: a case report

Directory of Open Access Journals (Sweden)

Souadka Amine

2012-02-01

Full Text Available Abstract Introduction A perforation occurring during colonoscopy is an extremely rare complication that may be difficult to diagnose. It can be responsible for acute abdominal compartment syndrome, a potentially lethal complex pathological state in which an acute increase in intra-abdominal pressure may provoke the failure of several organ systems. Case presentation We report a case of acute abdominal compartment syndrome after perforation of the bowel during a colonoscopy in a 60-year-old North African man with rectal cancer, resulting in respiratory distress, cyanosis and cardiac arrest. Our patient was treated by needle decompression after the failure of cardiopulmonary resuscitation. An emergency laparotomy with anterior resection, including the perforated sigmoid colon, was then performed followed by immediate anastomosis. Our patient remains alive and free of disease three years later. Conclusion Acute abdominal compartment syndrome is a rare disease that may occasionally occur after a colonoscopic perforation. It should be kept in mind during colonoscopy, especially considering its simple salvage treatment.

Intra-trackway morphological variations due to substrate consistency: the El Frontal dinosaur tracksite (Lower Cretaceous, Spain.

Directory of Open Access Journals (Sweden)

Novella L Razzolini

Full Text Available An ichnological and sedimentological study of the El Frontal dinosaur tracksite (Early Cretaceous, Cameros basin, Soria, Spain highlights the pronounced intra-trackway variation found in track morphologies of four theropod trackways. Photogrammetric 3D digital models revealed various and distinct intra-trackway morphotypes, which reflect changes in footprint parameters such as the pace length, the track length, depth, and height of displacement rims. Sedimentological analyses suggest that the original substrate was non-homogenous due to lateral changes in adjoining microfacies. Multidata analyses indicate that morphological differences in these deep and shallow tracks represent a part of a continuum of track morphologies and geometries produced by a gradient of substrate consistencies across the site. This implies that the large range of track morphologies at this site resulted from similar trackmakers crossing variable facies. The trackways at the El Frontal site present an exemplary case of how track morphology, and consequently potential ichnotaxa, can vary, even when produced by a single trackmaker.

Nutritional and metabolic changes due the abdominal radiation: experimental study; Alteracoes nutricionais e do metabolismo energetico na irradiacao abdominal: estudo experimental

Energy Technology Data Exchange (ETDEWEB)

Mucerino, Donato R; Waitzberg, Dan L; Campos, Fabio G. de; Melo Auricchio, Maria T. de; Gama-Rodrigues, Joaquim J; Lima-Goncalves, Ernesto L [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Div. de Clinica Cirurgica II

1995-01-01

In this study the effects on nutritional status and energetic metabolism due the abdominal irradiation were analysed. Adult male wistar rats (48), were divided in two groups Control (C) and radiated (R). The rats were maintained all time in metabolic cages. the study was done in two periods: period 1 begun at 0 day, were rats adapted to cages and oral diet, had food and water ad libitum. At the day four indirect calorimetric measurements were performed (calorimetry 1). At period 2, group R rats abdominal radiation at a 300 c Gy/day rate, for 5 consecutive days, and group C started a pair-feeding process linked individually to R rats and suffered application to simulated-irradiation. Two other calorimetric measurements (II,III) were performing during period 2. After radiation the last calorimetry was performed (IV). At sacrifice (day 14) blood was collected for determination of hemoglobin, hematocrit, albumin and transferrin. There were no statistical differences among groups C and R during period 1 (p < 0.05). Great reduction in food intake and weight variation were found in period 2, but weight loss was significantly higher in R rats. Nitrogen balance decrease in period 2, but without difference among the groups (p < 0.05). Serum albumin was significantly lower in R rats. Respiratory quotient decreased in both groups during period 2, but rats kept it lower (p < 0.05). The energy expenditure level decreased after radiation in group R. During period 2 total substrate oxidation decreased in R rats. Radiation decrease glucose and protein oxidation. In conclusion, in this study`s conditions, radiation produced malnutrition by reducing food intake by bringing weight loss, hypoalbuminemia and decrease nitrogen balance. Radiation was also responsible for a reduction of metabolism, by promoting the fall of energy expenditure. These changes are not only due the anorexia, undoubtful a main factor. (author). 60 refs., 3 figs., 4 tabs.

The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy

Energy Technology Data Exchange (ETDEWEB)

Lorijn, Fleur de; Voskuijl, Wieger P.; Taminiau, Jan A.; Benninga, Marc A. [Emma Children' s Hospital, Department of Paediatric Gastroenterology and Nutrition, Amsterdam (Netherlands); Rijn, Rick R. van; Henneman, Onno D.F. [Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Heijmans, Jarom [Emma Children' s Hospital, Department of Paediatric Gastroenterology and Nutrition, Amsterdam (Netherlands); Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Reitsma, Johannes B. [Academic Medical Centre, Department of Clinical Epidemiology and Biostatistics, Amsterdam (Netherlands)

2006-01-01

The data concerning the value of a plain abdominal radiograph in childhood constipation are inconsistent. Recently, positive results have been reported of a new radiographic scoring system, ''the Leech method'', for assessing faecal loading. To assess intra- and interobserver variability and determine diagnostic accuracy of the Leech method in identifying children with functional constipation (FC). A total of 89 children (median age 9.8 years) with functional gastrointestinal disorders were included in the study. Based on clinical parameters, 52 fulfilled the criteria for FC, six fulfilled the criteria for functional abdominal pain (FAP), and 31 for functional non-retentive faecal incontinence (FNRFI); the latter two groups provided the controls. To assess intra- and interobserver variability of the Leech method three scorers scored the same abdominal radiograph twice. A Leech score of 9 or more was considered as suggestive of constipation. ROC analysis was used to determine the diagnostic accuracy of the Leech method in separating patients with FC from control patients. Significant intraobserver variability was found between two scorers (P=0.005 and P<0.0001), whereas there was no systematic difference between the two scores of the other scorer (P=0.89). The scores between scorers differed systematically and displayed large variability. The area under the ROC curve was 0.68 (95% CI 0.58-0.80), indicating poor diagnostic accuracy. The Leech scoring method for assessing faecal loading on a plain abdominal radiograph is of limited value in the diagnosis of FC in children. (orig.)

Benign hepatic portal venous gas following blunt abdominal trauma

International Nuclear Information System (INIS)

Dill-Mackay, M.J.

1997-01-01

A 71-year-old man presented to Royal Perth Hospital Emergency Department with back pain following a fall from the roof of his house. There was no history of loss of consciousness. Physical examination revealed epigastric tenderness and guarding and a suspicion of CSF otorrhoea. All other clinical parameters were normal. His past medical history included alcohol abuse, chronic obstructive airways disease, peripheral vascular disease, cerebellar infarction and a right total hip replacement. Spinal radiographs demonstrated crush fractures involving the T12 and L1 vertebral bodies and a CT scan of the skull base was normal. An abdominal CT scan performed with intravenous contrast demonstrated gas within the portal veins of the anterior segments of the liver and a small fluid collection in the anterior pararenal space. During the ensuing 24 hours a repeat non-contrast abdominal Ct scan was performed and reveled complete resolution of the fluid. No other intra-abdominal abnormality was detected to warrant an invasive procedure

Benign hepatic portal venous gas following blunt abdominal trauma

Energy Technology Data Exchange (ETDEWEB)

Dill-Mackay, M.J. [Royal Perth Hospital, Perth, WA (Australia). Department of Radiology

1997-05-01

A 71-year-old man presented to Royal Perth Hospital Emergency Department with back pain following a fall from the roof of his house. There was no history of loss of consciousness. Physical examination revealed epigastric tenderness and guarding and a suspicion of CSF otorrhoea. All other clinical parameters were normal. His past medical history included alcohol abuse, chronic obstructive airways disease, peripheral vascular disease, cerebellar infarction and a right total hip replacement. Spinal radiographs demonstrated crush fractures involving the T12 and L1 vertebral bodies and a CT scan of the skull base was normal. An abdominal CT scan performed with intravenous contrast demonstrated gas within the portal veins of the anterior segments of the liver and a small fluid collection in the anterior pararenal space. During the ensuing 24 hours a repeat non-contrast abdominal Ct scan was performed and reveled complete resolution of the fluid. No other intra-abdominal abnormality was detected to warrant an invasive procedure. 20 refs., 1 tab., 2 figs.

Unusual initial abdominal presentations of invasive meningococcal disease.

Science.gov (United States)

Guiddir, Tamazoust; Gros, Marion; Hong, Eva; Terrade, Aude; Denizon, Mélanie; Deghmane, Ala-Eddine; Taha, Muhamed-Kheir

2018-03-28

Invasive meningococcal disease (IMD) is recognized as septicemia and/or meningitis. However, early symptoms may vary and are frequently nonspecific. Early abdominal presentations have been increasingly described. We aimed to explore a large cohort of patients with initial abdominal presentations for association with particular meningococcal strains. Confirmed IMD cases in France between 1991-2016 were screened for the presence within the 24 hours before diagnosis of at least one of the following criteria (1) abdominal pain, (2) gastro-enteritis with diarrhea and vomiting, (3) diarrhea only. Whole genome sequencing was performed on all cultured isolates. We identified 105 cases (median age 19 years) of early abdominal presentations with a sharp increase since 2014. Early abdominal pain alone was the most frequent symptom (n=67, 64%), followed by gastro-enteritis (n=26, 25%) and diarrhea alone (n=12, 11%). Twenty patients (20%) had abdominal surgery. A higher case fatality rate (24%) was observed in these cases compared to 10.4% in all IMD in France (p=0.007) with high levels of inflammation markers in the blood. Isolates of group W were significantly more predominant in these cases compared to all IMD. Most of these isolates belonged to clonal complex ST-11 (cc11) of the sublineages of the South American-UK strain. Abdominal presentations are frequently provoked by hyperinvasive isolates of meningococci. Delay in the management of these cases and the virulence of the isolates may explain the high fatality rate. Rapid recognition is a key element to improve their management.

Moxifloxacin in Pediatric Patients with Complicated Intra-Abdominal Infections: Results of the MOXIPEDIA Randomized Controlled Study.

Science.gov (United States)

Wirth, Stefan; Emil, Sherif G S; Engelis, Arnis; Digtyar, Valeri; Criollo, Margarita; DiCasoli, Carl; Stass, Heino; Willmann, Stefan; Nkulikiyinka, Richard; Grossmann, Ulrike

2018-01-18

This study was designed to evaluate primarily the safety and also the efficacy of moxifloxacin (MXF) in children with complicated intra-abdominal infections (cIAIs). In this multicenter, randomized, double-blind, controlled study, 451 pediatric patients aged 3 months to 17 years with cIAIs were treated with intravenous/oral MXF (N = 301) or comparator (COMP, intravenous ertapenem followed by oral amoxicillin/clavulanate; N = 150) for 5 to 14 days. Doses of MXF were selected based on the results of a Phase 1 study in pediatric patients (NCT01049022). The primary endpoint was safety, with particular focus on cardiac and musculoskeletal safety; clinical and bacteriological efficacy at test of cure were also investigated. The proportion of patients with adverse events (AEs) was comparable between the two treatment arms (MXF: 58.1% and COMP: 54.7%). The incidence of drug-related AEs was higher in the MXF arm than the COMP arm (14.3% and 6.7%, respectively). No cases of QTc interval prolongation-related morbidity or mortality were observed. The proportion of patients with musculoskeletal AEs was comparable between treatment arms; no drug-related events were reported. Clinical cure rates were 84.6% and 95.5% in the MXF and COMP arms, respectively, in patients with confirmed pathogen(s) at baseline. MXF treatment was well tolerated in children with cIAIs. However, a lower clinical cure rate was observed with MXF treatment compared with COMP. This study does not support a recommendation of MXF for children with cIAIs when alternative more efficacious antibiotics with better safety profile are available.

Changes in concentrations of haemostatic and inflammatory biomarkers in synovial fluid after intra-articular injection of lipopolysaccharide in horses

DEFF Research Database (Denmark)

Andreassen, Stine Mandrup; Vinther, Anne Mette Lindberg; Nielsen, Søren Saxmose

2017-01-01

BACKGROUND: Septic arthritis is a common and potentially devastating disease characterized by severe intra-articular (IA) inflammation and fibrin deposition. Research into equine joint pathologies has focused on inflammation, but recent research in humans suggests that both haemostatic and inflam......BACKGROUND: Septic arthritis is a common and potentially devastating disease characterized by severe intra-articular (IA) inflammation and fibrin deposition. Research into equine joint pathologies has focused on inflammation, but recent research in humans suggests that both haemostatic...... and inflammatory pathways are activated in the joint compartment in arthritic conditions. The aim of this study was to characterize the IA haemostatic and inflammatory responses in horses with experimental lipopolysaccharide (LPS)-induced joint inflammation. Inflammation was induced by IA injection of LPS into one...... antebrachiocarpal joint of six horses. Horses were evaluated clinically with subjective grading of lameness, and blood and synovial fluid (SF) samples were collected at post injection hours (PIH) -120, -96, -24, 0, 2, 4, 8, 16, 24, 36, 48, 72 and 144. Total protein (TP), white blood cell counts (WBC), serum amyloid...

Endovascular abdominal aortic aneurysm repair complicated by spondylodiscitis and iliaco-enteral fistula.

Science.gov (United States)

de Koning, Heleen D; van Sterkenburg, Steven M M; Pierie, Maurice E N; Reijnen, Michel M P J

2008-06-01

Infections of abdominal aortic endografts are rare. There are no reports on the association with spondylodiscitis. We report a case of a 74-year-old man who underwent endovascular aneurysm repair (EVAR) and subsequently femorofemoral bypass placement due to occlusion of the right limb of the endograft. Six months later, he presented with rectal bleeding, weight loss, back pain, and low abdominal pain. Computed tomography revealed extensive abscess formation with air in and around the endograft and psoas muscles, in continuity with destructive spondylodiscitis L3-4. There was a small bowel loop in close proximity to the occluded right leg of the endograft, which was filled with air bubbles. An axillofemoral bypass was created followed by a laparotomy. Intra-operatively, an iliaco-enteral fistula was found. The small bowel defect was sutured, the endograft completely removed, and the infrarenal aorta and both common iliac arteries were closed. Necrotic fragments of the former L3-4 disk were removed. The postoperative course was uneventful. Seven months postoperatively, the patient had recovered well. Iliaco-enteric fistula and spondylodiscitis are rare complications of aortic aneurysm repair. This is the first report of spondylodiscitis after EVAR.

Common Functional Gastroenterologic Disorders Associated With Abdominal Pain

Science.gov (United States)

Bharucha, Adil E.; Chakraborty, Subhankar; Sletten, Christopher D.

2016-01-01

Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in a variety of peripheral (eg, postinfectious inflammation, luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be very helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids. PMID:27492916

Abdominal fat and risk of coronary heart disease in patients with peripheral arterial disease

NARCIS (Netherlands)

Brouwer, Beate G.; Visseren, Frank L. J.; Stolk, Ronald P.; van der Graaf, Yolanda

Objective: We investigated whether the presence of concomitant coronary heart disease (CHD) in patients with peripheral arterial disease (PAD) can be explained by intra-abdominal fat accumulation and compared different measures of adiposity as predictors of CHD in patients with PAD. Research Methods

Abdominal colic due to ureteric diverticulum with stone formation

International Nuclear Information System (INIS)

Roodhooft, A.M.; Boven, K.; Acker, K.J. van; Gentens, P.

1987-01-01

In a 15-year-old boy right lower abdominal colicky pain was caused by intermittent obstruction of the ureter by stones which had accumulated in a ureteric diverticulum. As was shown by repeated X-rays, each of these stones had moved to the ureter and back to the diverticulum. Ureteric diverticulum mostly remains asymptomatic in children: stone formation and obstruction of the ureter by the stones is one of the instances which may cause symptoms. (orig.)

Proteomic profiling of the amniotic fluid to detect inflammation, infection, and neonatal sepsis.

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Catalin S Buhimschi

2007-01-01

Full Text Available Proteomic analysis of amniotic fluid shows the presence of biomarkers characteristic of intrauterine inflammation. We sought to validate prospectively the clinical utility of one such proteomic profile, the Mass Restricted (MR score.We enrolled 169 consecutive women with singleton pregnancies admitted with preterm labor or preterm premature rupture of membranes. All women had a clinically indicated amniocentesis to rule out intra-amniotic infection. A proteomic fingerprint (MR score was generated from fresh samples of amniotic fluid using surface-enhanced laser desorption ionization (SELDI mass spectrometry. Presence or absence of the biomarkers of the MR score was interpreted in relationship to the amniocentesis-to-delivery interval, placental inflammation, and early-onset neonatal sepsis for all neonates admitted to the Newborn Special Care Unit (n = 104. Women with "severe" amniotic fluid inflammation (MR score of 3 or 4 had shorter amniocentesis-to-delivery intervals than women with "no" (MR score of 0 inflammation or even "minimal" (MR score of 1 or 2 inflammation (median [range] MR 3-4: 0.4 d [0.0-49.6 d] versus MR 1-2: 3.8 d [0.0-151.2 d] versus MR 0: 17.0 d [0.1-94.3 d], p 100 cells/mm3, whereas the combination of Gram stain and MR score was best for rapid prediction of intra-amniotic infection (positive amniotic fluid culture.High MR scores are associated with preterm delivery, histological chorioamnionitis, and early-onset neonatal sepsis. In this study, proteomic analysis of amniotic fluid was shown to be the most accurate test for diagnosis of intra-amniotic inflammation, whereas addition of the MR score to the Gram stain provides the best combination of tests to rapidly predict infection.

Evaluation of Forty-Nine Patients with Abdominal Tuberculosis

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Murat Kilic

2014-12-01

Full Text Available Aim: Abdominal tuberculosis is an uncommon form of extrapulmonary infection. In this study, we aimed to highlight the nonspecific clinical presentations and diagnostic difficulties of abdominal tuberculosis. Material and Method: Clinical features, diagnostic methods, and the therapeutic outcomes of 49 patients diagnosed as abdominal tuberculosis between 2003 and 2014 were retrospectively analyzed. Results: The patients were classified into four subgroups including peritoneal (28, nodal (14, intestinal (5, and solid organ tuberculosis (2. The most frequent symptoms were abdominal pain, abdominal distention and fatique. Ascites appeared to be the most frequent clinical finding. Ascites and enlarged abdominal lymph nodes were the most frequent findings on ultrasonography and tomography. Diagnosis of abdominal tuberculosis was mainly depended on histopathology of ascitic fluid and biopsies from peritoneum, abdominal lymph nodes or colonoscopic materials. Forty patients healed with standart 6-month therapy while extended treatment for 9-12 months was needed in 8 whom had discontinued drug therapy and had persistent symptoms and signs. One patient died within the treatment period due to disseminated infection. Discussion: The diagnosis of abdominal tuberculosis is often difficult due to diverse clinical presentations. The presence of ascites, personal/familial/contact history of tuberculosis, and coexisting active extraabdominal tuberculosis are the most significant marks in diagnosis. Diagnostic laparoscopy and tissue sampling seem to be the best diagnostic approach for abdominal tuberculosis.

The value of plain abdominal radiographs in management of abdominal emergencies in Luth.

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Ashindoitiang, J A; Atoyebi, A O; Arogundade, R A

2008-01-01

The plain abdominal x-ray is still the first imaging modality in diagnosis of acute abdomen. The aim of this study was to find the value of plain abdominal x-ray in the management of abdominal emergencies seen in Lagos university teaching hospital. The accurate diagnosis of the cause of acute abdominal pain is one of the most challenging undertakings in emergency medicine. This is due to overlapping of clinical presentation and non-specific findings of physical and even laboratory data of the multifarious causes. Plain abdominal radiography is one investigation that can be obtained readily and within a short period of time to help the physician arrive at a correct diagnosis The relevance of plain abdominal radiography was therefore evaluated in the management of abdominal emergencies seen in Lagos over a 12 month period (April 2002 to March 2003). A prospective study of 100 consecutively presenting patients with acute abdominal conditions treated by the general surgical unit of Lagos University Teaching Hospital was undertaken. All patients had supine and erect abdominal x-ray before any therapeutic intervention was undertaken. The diagnostic features of the plain films were compared with final diagnosis to determine the usefulness of the plain x-ray There were 54 males and 46 females (M:F 1.2:1). Twenty-four percent of the patients had intestinal obstruction, 20% perforated typhoid enteritis; gunshot injuries and generalized peritonitis each occurred in 13%, blunt abdominal trauma in 12%, while 8% and 10% had acute appendicitis and perforated peptic ulcer disease respectively. Of 100 patients studied, 54% had plain abdominal radiographs that showed positive diagnostic features. Plain abdominal radiograph showed high sensitivity in patients with intestinal obstruction 100% and perforated peptic ulcer 90% but was less sensitive in patients with perforated typhoid, acute appendicitis, and blunt abdominal trauma and generalized peritonitis. In conclusion, this study

Evaluation of the levels of metalloproteinsase-2 in patients with abdominal aneurysm and abdominal hernias.

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Antoszewska, Magdalena

2013-05-01

Abdominal aortic aneurysms and abdominal hernias become an important health problems of our times. Abdominal aortic aneurysm and its rupture is one of the most dangerous fact in vascular surgery. There are some theories pointing to a multifactoral genesis of these kinds of diseases, all of them assume the attenuation of abdominal fascia and abdominal aortic wall. The density and continuity of these structures depend on collagen and elastic fibers structure. Reducing the strength of the fibers may be due to changes in the extracellular matrix (ECM) by the proteolytic enzymes-matrix metalloproteinases (MMPs) that degrade extracellular matrix proteins. These enzymes play an important role in the development of many disease: malignant tumors (colon, breast, lung, pancreas), cardiovascular disease (myocardial infarction, ischemia-reperfusion injury), connective tissue diseases (Ehler-Danlos Syndrome, Marfan's Syndrome), complications of diabetes (retinopathy, nephropathy). One of the most important is matrix metalloproteinase-2 (MMP-2). The aim of the study was an estimation of the MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia, and in patients with only abdominal aortic aneurysm. The study involved 88 patients aged 42 to 89 years, including 75 men and 13 women. Patients were divided into two groups: patients with abdominal aortic aneurysm and primary abdominal hernia (45 persons, representing 51.1% of all group) and patients with only abdominal aortic aneurysm (43 persons, representing 48,9% of all group). It was a statistically significant increase in MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia compared to patients with only abdominal aortic aneurysm. It was a statistically significant increase in the prevalence of POCHP in patients with only abdominal aortic aneurysm compared to patients with abdominal aortic aneurysm and primary abdominal hernia. Statistically significant

Thermography Examination of Abdominal Area Skin Temperatures in Individuals With and Without Focal-Onset Epilepsy.

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King, Hollis H; Cayce, Charles Thomas; Herrin, Jeph

Early osteopathic theory and practice, and the work of the medical intuitive Edgar Cayce suggested that the abdominal areas of individuals with epilepsy would manifest "cold spots." The etiology for this phenomenon was thought to be abdominal adhesions caused by inflammation and viscero-somatic reflexes caused by adhesions or injury to visceral or musculoskeletal system structures. Indeed, until that advent of electroencephalography in the 1930s, medical practice regarding epilepsy focused on abdominal neural and visceral structures. Following two hypotheses were formulated to evaluate any abdominal temperature phenomena: (1) an abdominal quadrant division analysis would find one or more quadrants "colder" in the focal-onset epilepsy group (ICD9-CM 345.4 and 345.5) compared to controls. (2) Total abdominal areas of individuals with focal-onset epilepsy wound be colder than a control group. Overall, 50 patients with the diagnosis of focal-onset epilepsy were recruited from the office of the Epilepsy Foundation of Florida and 50 control subjects with no history of epilepsy were recruited through advertising to the public. Under controlled room conditions all subjects had infrared thermographic images made and recorded by Med-Hot Model MH-731 FLIR equipment. There were no significant demographic difference between experimental patients and control subjects, though the control group tended to be younger and more often male; however, these were controlled for in all analyses. In the quadrant analysis, there were significant differences in that more epileptic patients had colder left upper abdominal quadrant temperatures than the control group (66.8% versus 44.9%; P = .030). In the total abdominal analysis, however, there were no significant differences. The results support the hypothesis that individuals with focal-onset epilepsy have colder abdominal areas. If substantiated in further research, present study results will require further examination of the mechanisms of

Mesothelioma as a rapidly developing Giant Abdominal Cyst

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Vyas Dinesh

2012-12-01

Full Text Available Abstract The benign cystic mesothelioma of the peritoneum is a rare lesion and is known for local recurrence. This is first case report of a rapidly developing massive abdominal tumor with histological finding of benign cystic mesothelioma (BCM. We describe a BCM arising in the retroperitoneal tis[sue on the right side, lifting ascending colon and cecum to the left side of abdomen. Patient was an active 58-year-old man who noticed a rapid abdominal swelling within a two month time period with a weight gain of 40 pounds. Patient had no risk factors including occupational (asbestos, cadmium, family history, social (alcohol, smoking or history of trauma. We will discuss the clinical, radiologic, intra-operative, immunohistochemical, pathologic findings, and imaging six months after surgery. Patient has no recurrence and no weight gain on follow up visits and imaging.

Thoracic epidural analgesia reduces myocardial injury in ischemic patients undergoing major abdominal cancer surgery

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Mohamad MF

2017-04-01

Full Text Available Mohamad Farouk Mohamad,1 Montaser A Mohammad,1 Diab F Hetta,1 Eman Hasan Ahmed,2 Ahmed A Obiedallah,3 Alaa Ali M Elzohry1 1Department of Anesthesia, ICU and Pain Relief, 2Department of Clinical Pathology, South Egypt Cancer Institute, 3Department of Internal Medicine, Faculty of Medicine, Assiut University, Arab Republic of Egypt Background and objectives: Major abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery.Patients and methods: One hundred and twenty patients (American Society of Anesthesiologists grade II and III of either sex were scheduled for elective upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (60 patients each to receive, besides general anesthesia: continuous intra and postoperative intravenous (IV infusion with fentanyl for 72 h postoperatively (patient controlled intravenous analgesia [PCIA] group or continuous intra and postoperative epidural infusion with bupivacaine 0.125% and fentanyl (PCEA group for 72 h postoperatively. Perioperative hemodynamics were recorded. Postoperative pain was assessed over 72 h using visual analog scale (VAS. All patients were screened for occurrence of myocardial injury (MI by electrocardiography, echocardiography, and cardiac troponin I serum level. Other postoperative complications as arrhythmia, deep venous thrombosis (DVT, pulmonary embolism, pneumonia, and death were recorded.Results: There was a significant reduction in overall adverse cardiac events (myocardial injury, arrhythmias, angina, heart failure and nonfatal cardiac arrest in PCEA group in comparison to PCIA group. Also, there was a significant reduction in dynamic VAS pain score in group PCEA in comparison

Common Functional Gastroenterological Disorders Associated With Abdominal Pain.

Science.gov (United States)

Bharucha, Adil E; Chakraborty, Subhankar; Sletten, Christopher D

2016-08-01

Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia and depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in various peripheral (eg, postinfectious inflammation and luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation

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Alexander Abreu

2017-07-01

Full Text Available Resumen El embarazo ectópico abdominal secundario tiene una baja frecuencia de presentación en la práctica clínica, pero puede llevar al incremento de la mortalidad materna. Se presenta el caso de una paciente con embarazo abdominal secundario a una perforación uterina, causada por una interrupción voluntaria del embarazo. Este evolucionó durante nueve semanas con dolor abdominal y sangramiento vaginal escaso. A la paciente se le realizaron diagnósticos como enfermedad inflamatoria pélvica aguda, infección del tracto urinario, restos ovulares post aborto y definitivamente se concluyó como embarazo ectópico abdominal mediante ecografía abdominal. Se le realizó laparotomía exploradora y se extrajo el feto y la placenta sin dificultades con una evolución postoperatoria favorable hacia la curación. Se concluyó que la perforación uterina durante el curetaje de la cavidad pudo pasar inadvertida, llevando a implantación abdominal secundaria del embarazo con un cuadro clínico variable. En dicho cuadro, el ultrasonido juega un papel fundamental para su diagnóstico, siendo el manejo laparotómico el más apropiado en estos casos.

Diagnostic imaging of blunt abdominal trauma in pediatric patients.

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Miele, Vittorio; Piccolo, Claudia Lucia; Trinci, Margherita; Galluzzo, Michele; Ianniello, Stefania; Brunese, Luca

2016-05-01

Trauma is a leading cause of morbidity and mortality in childhood, and blunt trauma accounts for 80-90 % of abdominal injuries. The mechanism of trauma is quite similar to that of the adults, but there are important physiologic differences between children and adults in this field, such as the smaller blood vessels and the high vasoconstrictive response, leading to the spreading of a non-operative management. The early imaging of children undergoing a low-energy trauma can be performed by CEUS, a valuable diagnostic tool to demonstrate solid organ injuries with almost the same sensitivity of CT scans; nevertheless, as for as urinary tract injuries, MDCT remains still the technique of choice, because of its high sensitivity and accuracy, helping to discriminate between an intra-peritoneal form a retroperitoneal urinary leakage, requiring two different managements. The liver is the most common organ injured in blunt abdominal trauma followed by the spleen. Renal, pancreatic, and bowel injuries are quite rare. In this review we present various imaging findings of blunt abdominal trauma in children.

Treatment strategy for ruptured abdominal aortic aneurysms.

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Davidovic, L

2014-07-01

Rupture is the most serious and lethal complication of the abdominal aortic aneurysm. Despite all improvements during the past 50 years, ruptured abdominal aortic aneurysms are still associated with very high mortality. Namely, including patients who die before reaching the hospital, the mortality rate due to abdominal aortic aneurysm rupture is 90%. On the other hand, during the last twenty years, the number of abdominal aortic aneurysms significantly increased. One of the reasons is the fact that in majority of countries the general population is older nowadays. Due to this, the number of degenerative AAA is increasing. This is also the case for patients with abdominal aortic aneurysm rupture. Age must not be the reason of a treatment refusal. Optimal therapeutic option ought to be found. The following article is based on literature analysis including current guidelines but also on my Clinics significant experience. Furthermore, this article show cases options for vascular medicine in undeveloped countries that can not apply endovascular procedures at a sufficient level and to a sufficient extent. At this moment the following is evident. Thirty-day-mortality after repair of ruptured abdominal aortic aneurysms is significantly lower in high-volume hospitals. Due to different reasons all ruptured abdominal aortic aneurysms are not suitable for EVAR. Open repair of ruptured abdominal aortic aneurysm should be performed by experienced open vascular surgeons. This could also be said for the treatment of endovascular complications that require open surgical conversion. There is no ideal procedure for the treatment of AAA. Each has its own advantages and disadvantages, its own limits and complications, as well as indications and contraindications. Future reductions in mortality of ruptured abdominal aortic aneurysms will depend on implementation of population-based screening; on strategies to prevent postoperative organ injury and also on new medical technology

Phase 2, Dose-Ranging Study of Relebactam with Imipenem-Cilastatin in Subjects with Complicated Intra-abdominal Infection.

Science.gov (United States)

Lucasti, Christopher; Vasile, Liviu; Sandesc, Dorel; Venskutonis, Donatas; McLeroth, Patrick; Lala, Mallika; Rizk, Matthew L; Brown, Michelle L; Losada, Maria C; Pedley, Alison; Kartsonis, Nicholas A; Paschke, Amanda

2016-10-01

Relebactam (REL [MK-7655]) is a novel class A/C β-lactamase inhibitor intended for use with imipenem for the treatment of Gram-negative bacterial infections. REL restores imipenem activity against some resistant strains of Klebsiella and Pseudomonas In this multicenter, double-blind, controlled trial (NCT01506271), subjects who were ≥18 years of age with complicated intra-abdominal infection were randomly assigned (1:1:1) to receive 250 mg REL, 125 mg REL, or placebo, each given intravenously (i.v.) with 500 mg imipenem-cilastatin (IMI) every 6 h (q6h) for 4 to 14 days. The primary efficacy endpoint was the proportion of microbiologically evaluable (ME) subjects with a favorable clinical response at discontinuation of i.v. therapy (DCIV). A total of 351 subjects were randomized, 347 (99%) were treated, and 255 (73%) were ME at DCIV (55% male; mean age, 49 years). The most common diagnoses were complicated appendicitis (53%) and complicated cholecystitis (17%). Thirty-six subjects (13%) had imipenem-resistant Gram-negative infections at baseline. Both REL doses plus IMI were generally well tolerated and demonstrated safety profiles similar to that of IMI alone. Clinical response rates at DCIV were similar in subjects who received 250 mg REL plus IMI (96.3%) or 125 mg REL plus IMI (98.8%), and both were noninferior to IMI alone (95.2%; one-sided P imipenem exposure at the proposed dose of 500 mg IMI with 250 mg REL q6h provides coverage of >90% of carbapenem-resistant bacterial strains. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

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Sartelli Massimo

2012-05-01

Full Text Available Abstract The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012. This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period. Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs were included in the study. 912 patients with a mean age of 54.4 years (range 4–98 were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified. The overall mortality rate was 6.4% (58/912. According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality. White Blood Cell counts (WBCs greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.

The Potential Role of Aerobic Exercise-Induced Pentraxin 3 on Obesity-Related Inflammation and Metabolic Dysregulation

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Aaron L. Slusher

2017-01-01

Full Text Available Obesity is defined as the excess accumulation of intra-abdominal body fat, resulting in a state of chronic, low-grade proinflammation that can directly contribute to the development of insulin resistance. Pentraxin 3 (PTX3 is an acute-phase protein that is expressed by a variety of tissue and cell sources and provides an anti-inflammatory property to downregulate the production of proinflammatory cytokines, in particular interleukin-1 beta and tumor necrosis factor alpha. Although PTX3 may therapeutically aid in altering the proinflammatory milieu in obese individuals, and despite elevated expression of PTX3 mRNA observed in adipose tissue, the circulating level of PTX3 is reduced with obesity. Interestingly, aerobic activity has been demonstrated to elevate PTX3 levels. Therefore, the purpose of this review is to discuss the therapeutic potential of PTX3 to positively regulate obesity-related inflammation and discuss the proposition for utilizing aerobic exercise as a nonpharmacological anti-inflammatory treatment strategy to enhance circulating PTX3 concentrations in obese individuals.

CT diagnosis of abdominal abscess in children

International Nuclear Information System (INIS)

Li Xin; Yang Zhiyong

1998-01-01

Purpose: To evaluate CT in the diagnosis of abdominal abscess in children. Methods: Analysis of CT manifestations in 23 cases proved by operation and needle aspiration. Causes: acute appendicitis 13 cases, ascending colon perforation 1 case, Meckel diverticulitis 2 cases, cause obscured 7 cases. Bolus injection of contrast medium was given in 19 cases. Results: The CT value had no relationship to the course of disease and type of bacteria, amount of abscess had positive relevance relative with course of illness. Air-fluid level or scattered gas bubbles was seen in abscesses in 52%; little calcified plague was present in 22%. All cases presented nonhomogeneous thick wall enhancement after one week of illness. Conclusion: The characteristic CT features of intra-abdominal abscess were the presence of air and little calcified plague shadow; a large air-fluid level was indicative of fistula, while the absence of air in the abscess can not exclude fistula

Preventive Intra Oral Treatment of Sea Cucumber Ameliorate OVA-Induced Allergic Airway Inflammation.

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Lee, Da-In; Park, Mi-Kyung; Kang, Shin Ae; Choi, Jun-Ho; Kang, Seok-Jung; Lee, Jeong-Yeol; Yu, Hak Sun

2016-01-01

Sea cucumber extracts have potent biological effects, including anti-viral, anti-cancer, antibacterial, anti-oxidant, and anti-inflammation effects. To understand their anti-asthma effects, we induced allergic airway inflammation in mice after 7 oral administrations of the extract. The hyper-responsiveness value in mice with ovalbumin (OVA)-alum-induced asthma after oral injection of sea cucumber extracts was significantly lower than that in the OVA-alum-induced asthma group. In addition, the number of eosinophils in the lungs of asthma-induced mice pre-treated with sea cucumber extract was significantly decreased compared to that of PBS pre-treated mice. Additionally, CD4[Formula: see text]CD25[Formula: see text]Foxp3[Formula: see text]T (regulatory T; Treg) cells significantly increased in mesenteric lymph nodes after 7 administrations of the extract. These results suggest that sea cucumber extract can ameliorate allergic airway inflammation via Treg cell activation and recruitment to the lung.

[Protein losing enteropathy (PLE) detected by Tc99m-labelled human serum albumin abdominal scintigraphy--case report].

Science.gov (United States)

Hubalewska-Hoła, Alicja; Sowa-Staszczak, Anna; Szczerbiński, Tomasz; Lis, Grzegorz; Huszno, Bohdan; Szybiński, Zbigniew

2003-01-01

Protein losing enteropathy (PLE) is a gastrointestinal disorder that is associated with excessive loss of plasma protein into the gut resulting from abnormal mucosal permeability. The disease is usually caused by inflammation. The loss of protein in PLE is a nonselective process affecting albumin, globulin and transferrin. Abdominal scintigraphy with human serum albumin marked by Tc99m seems to be an easy and sensitive method for diagnosing PLE. An 4-year-old girl was presented to an outside Pediatric Department due to hypoproteinemia and recurrent pneumonia which had caused several prior hospitalizations. The laboratory tests revealed hypoproteinemia, hypoalbuminemia, low level of IgG, sideropenia, and a decreased level of T lymphocytes. The loss of protein into the gut was confirmed by fecal clearance of alfa-1 antitrypsin. Only nonspecific inflammation was detected by biopsy of the small intestine. These clinical and laboratory findings, quickly decreasing IgG and albumin levels in spite of i.v. supplementation and the lack of proteinuria permitted PLE diagnosis. The abdominal scintigraphy was planned to assess and localise protein losing through GIT and for strategy of possible surgical treatment. Abdominal dynamic scintigraphy was performed immediately after the injection of 300 MBq Tc99m human albumin. 90 images were taken within 180 minutes. Delayed abdominal images were obtained 6 and 24 hours after the tracer injection. Anterior abdominal scintigraphy showed pathological activity of Tc99m-albumin in small bowel in the upper left segment of the abdomen in the 40th minute after injection. Extensive accumulation of albumin was seen in the 160th minute. Delayed images, after 3 and 6 hours, revealed translocation of the tracer into the lower right abdominal segment. The further passage and tracer concentration was detected in ascendant and transverse colon. Based on the laboratory tests and scintigraphic images the girl was suspected to have segmental

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

International Nuclear Information System (INIS)

Becker, C.D.; Terrier, F.; Mentha, G.

1998-01-01

Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.)

Associations of −308G/A Polymorphism of Tumor Necrosis Factor(TNF)–α Gene and Serum TNF-α Levels with Measures of Obesity, Intra-Abdominal and Subcutaneous Abdominal Fat, Subclinical Inflammation and Insulin Resistance in Asian Indians in North India

Science.gov (United States)

Vikram, Naval K.; Bhatt, Surya Prakash; Bhushan, Bharat; Luthra, Kalpana; Misra, Anoop; Poddar, Pawan K.; Pandey, Ravindra M.; Guleria, Randeep

2011-01-01

Objectives: Obesity is associated with high levels proinflammatory cytokines like tumour necrosis factor alpha (TNF-α), which may play an important role in the genesis of insulin resistance. We evaluated the relationship of −308G/A polymorphism of TNF-α gene with obesity and insulin resistance in Asian Indians in north India. Methods: This cross-sectional study included 151 apparently healthy individuals (79 males, 72 females) 18–50 yrs of age from New Delhi, India. Body composition by dual-energy x-ray absorptiometry (DEXA) and abdominal fat by magnetic resonance imaging (MRI) were measured. Biochemical measurements included OGTT, lipids, fasting insulin, hs-CRP and TNF-α levels. We analysed −308G/A polymorphism of TNF-α gene and studied its association with obesity and biochemical parameters. Results: At comparable BMI, abdominal obesity was more prevalent in females (50%) as compared to males (20%). The wild genotype (GG) was present in 78.8%, GA in 17.9%, and AA in 3.3% subjects. Measures of body composition, abdominal fat distribution, lipids, insulin, hs-CRP and TNF-α levels were not influenced by the presence of −308G/A polymorphism. Serum TNF-α levels correlated significantly with fasting insulin in both genders. Conclusion: TNF-α levels correlate with fasting insulin but not with indicators of body composition in Asian Indians. The −308G/A polymorphism of TNF-α gene is not associated with differences in the serum levels of TNF-α in Asian Indians. PMID:21846948

Correct the Coagulopathy and Scoop It Out: Complete Reversal of Anuric Renal Failure through the Operative Decompression of Extraperitoneal Hematoma-Induced Abdominal Compartment Syndrome

Directory of Open Access Journals (Sweden)

Paul B. McBeth

2012-01-01

Full Text Available We report two cases of extraperitoneal compression of the intra-abdominal space resulting in abdominal compartment syndrome (ACS with overt renal failure, which responded to operative decompression of the extra-peritoneal spaces. This discussion includes patient presentation, clinical course, diagnosis, interventions, and outcomes. Data was collected from the patient’s electronic medical record and a radiology database. ACS appears to be a rare but completely reversible complication of both retroperitoneal hematoma (RH and rectus sheath hematoma (RSH. In patients with large RH or RSH consideration of intra-abdominal pressure (IAP monitoring combined with aggressive operative drainage after correction of the coagulopathy should be considered. These two cases illustrate how a relatively benign pathology can result in increased IAP, organ failure, and ultimately ACS. Intervention with decompressive laparotomy and evacuation of clot resulted in return to normal physiologic function.

Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation

OpenAIRE

Alexander Abreu; Ndivhuwo Michael Ndwambi; Fermín Luis Martínez

2017-01-01

Resumen El embarazo ectópico abdominal secundario tiene una baja frecuencia de presentación en la práctica clínica, pero puede llevar al incremento de la mortalidad materna. Se presenta el caso de una paciente con embarazo abdominal secundario a una perforación uterina, causada por una interrupción voluntaria del embarazo. Este evolucionó durante nueve semanas con dolor abdominal y sangramiento vaginal escaso. A la paciente se le realizaron diagnósticos como enfermedad inflamatoria pélvica...

An Abdominal Presentation of Churg-Strauss Syndrome

Science.gov (United States)

Rees, J. R. E.; Burgess, P.

2010-01-01

Churg-Strauss syndrome is a small and medium vessel vasculitis that is also known as allergic granulomatous angiitis. It most commonly presents with an asthma like symptoms. It was first described in Mount Siani Hospital, New York in 1951 by Jacob Churg and Lotte Stauss and was recognised after the study of a series of 13 patients who had asthma, eosinophilia, granulomatous inflammation necrotising systemic vasculitis and necrotising glomerulonephritis. We describe a case of Churg-Strauss syndrome presenting with abdominal pain and later during the hospital admission a mono-neuritis multiplex syndrome affecting the lower limbs. The patient presented in such an atypical fashion with abdominal signs and symptoms that they required laparotomy and the diagnosis was made after histological examination of tissue taken at the time of surgery. Treatment with immunosuppression and aggressive rehabilitation achieved a progressive recovery which continued on discharge from hospital. PMID:20814555

Inibição da formação de abscesso abdominal em rato: mortalidade por sepse Inhibition of abdominal abscess formation in rat: Mortality by sepsis

Directory of Open Access Journals (Sweden)

Fernando Henrique Oliveira Carmo Rodrigues

2005-03-01

Full Text Available RACIONAL: Atribui-se aos abscessos intra-abdominais e às aderências peritoniais a função de isolar os processos sépticos e proteger o organismo da bacteremia. Por outro lado, esses fenômenos também dificultam o afluxo de fatores imunitários e antibióticos para a região infectada. OBJETIVO: Avaliar o efeito da prevenção de abscessos na sobrevida após peritonite bacteriana. MÉTODOS: Foram estudados 30 ratos Wistar machos que receberam solução de fezes a 50% intra-abdominal e que foram distribuídos em três grupos (n = 10. Grupo 1: controle (solução de fezes; grupo 2: solução de fezes mais solução salina a 0,9%; grupo 3: solução de fezes mais carboximetilcelulose a 1%, para inibir a formação de aderências. Os três grupos foram divididos em dois subgrupos (n = 5: subgrupo A: nova laparotomia, após 4 dias, para inspeção da cavidade abdominal; e subgrupo B: acompanhamento durante 30 dias para avaliação da mortalidade e da causa de morte. A análise estatística utilizou o teste exato de Fisher. RESULTADOS: O acréscimo de solução salina a 0,9% não aumentou a mortalidade do grupo. Entretanto, no grupo em que se acrescentou a solução de carboximetilcelulose, houve menor formação de abscessos, que também foram mais tênues e a mortalidade aumentou em relação ao grupo controle. CONCLUSÃO: A inibição na formação de aderências peritoniais e de abscessos acompanha-se de maior mortalidade decorrente do processo séptico intra-abdominal generalizado.

Update of incidence and antimicrobial susceptibility trends of Escherichia coli and Klebsiella pneumoniae isolates from Chinese intra-abdominal infection patients.

Science.gov (United States)

Zhang, Hui; Yang, Qiwen; Liao, Kang; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Wang, Yong; Wu, Anhua; Feng, Xianju; Luo, Yanping; Chu, Yunzhuo; Chen, Shulan; Cao, Bin; Su, Jianrong; Duan, Qiong; Zhang, Shufang; Shao, Haifeng; Kong, Haishen; Gui, Bingdong; Hu, Zhidong; Badal, Robert; Xu, Yingchun

2017-12-18

To evaluate in vitro susceptibilities of aerobic and facultative Gram-negative bacterial (GNB) isolates from intra-abdominal infections (IAIs) to 12 selected antimicrobials in Chinese hospitals from 2012 to 2014. Hospital acquired (HA) and community acquired (CA) IAIs were collected from 21 centers in 16 Chinese cities. Extended spectrum beta-lactamase (ESBL) status and antimicrobial susceptibilities were determined at a central laboratory using CLSI broth microdilution and interpretive standards. From all isolated strains the Enterobacteriaceae (81.1%) Escherichia coli accounted for 45.4% and Klebsiella pneumoniae for 20.1%, followed by Enterobacter cloacae (5.2%), Proteus mirabilis (2.1%), Citrobacter freundii (1.8%), Enterobacter aerogenes (1.8%), Klebsiella oxytoca (1.4%), Morganella morganii (1.2%), Serratia marcescens (0.7%), Citrobacter koseri (0.3%), Proteus vulgaris (0.3%) and others (1.0%). Non- Enterobacteriaceae (18.9%) included Pseudomonas aeruginosa (9.8%), Acinetobacter baumannii (6.7%), Stenotrophomonas maltophilia (0.9%), Aeromonas hydrophila (0.4%) and others (1.1%). ESBL-screen positive Escherichia coli isolates (ESBL+) showed a decreasing trend from 67.5% in 2012 to 58.9% in 2014 of all Escherichia coli isolates and the percentage of ESBL+ Klebsiella pneumoniae isolates also decreased from 2012 through 2014 (40.4% to 26.6%), which was due to reduced percentages of ESBL+ isolates in HA IAIs for both bacteria. The overall susceptibilities of all 5160 IAI isolates were 87.53% to amikacin (AMK), 78.12% to piperacillin-tazobactam (TZP) 81.41% to imipenem (IMP) and 73.12% to ertapenem (ETP). The susceptibility of ESBL-screen positive Escherichia coli strains was 96.77%-98.8% to IPM, 91.26%-93.16% to ETP, 89.48%-92.75% to AMK and 84.86%-89.34% to TZP, while ESBL-screen positive Klebsiella pneumoniae strains were 70.56%-80.15% susceptible to ETP, 80.0%-87.5% to IPM, 83.82%-87.06% to AMK and 63.53%-68.38% to TZP within the three year study

The Effect of Preoperative Intra-Articular Methylprednisolone on Pain After TKA

DEFF Research Database (Denmark)

Luna, Iben E; Kehlet, Henrik; Jensen, Claus M

2017-01-01

In a randomized, double-blind, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered 1 week before total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥5...... groups in postoperative sensitization was found (P > .4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group versus placebo (median change in IL-6 = -70 pg/mL, interquartile range = -466 to 0 vs. 32 pg/mL, interquartile range = -26 to 75, P = .029). Alternative central...

Ultrasound surface probe as a screening method for evaluating the patients with blunt abdominal trauma

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Mohammad Nasr-Esfahani

2014-01-01

Full Text Available Background: Blunt abdominal trauma is one of the causes of mortality in emergency department. Free fluid in the abdomen due to intra-abdominal blunt trauma can be determined by the surface probe of ultrasound. Since the importance of this free fluid in hemodynamic stable patients with blunt trauma is associated with the unknown outcome for surgeons, this study was performed to evaluate the role of ultrasound surface probe as a screening method in evaluating the patients with blunt abdominal trauma. Materials and Methods: A descriptive-analytical study was done on 45 patients with blunt abdominal trauma and hemodynamic stability. The patients were evaluated twice during the three-hours, including repeated ultrasound surface probe and clinical examinations. Computerized tomography was also performed. The patients were divided based on the amount of the free fluid in the abdomen during the evaluations into two groups: Fixed or increased, and decreased free fluid. The results of the different evaluated methods were compared using the sensitivity and specificity. Results: From 17 patients with CT abnormalities, free fluid increased in 14 patients (82.4%. Free fluid was decreased in three patients who were discharged well from the surgery service without any complication. Surface probe in prognosis detection had a sensitivity of 82.4% and specificity of 92.9%. The percentage of false positive and negative ultrasound compared with CT scan was 7.1% and 17.6%. Also, positive and negative predictive value of the ultrasound with surface probe was 87.5% and 89.7% respectively. Conclusion: The use of the ultrasound with surface probe in the diagnosis of free fluid in blunt abdominal trauma in hemodynamic stable patients can be considered as a useful screening method.

Diet-Induced Abdominal Obesity, Metabolic Changes, and Atherosclerosis in Hypercholesterolemic Minipigs

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Ahmed Ludvigsen Al-Mashhadi

2018-01-01

Full Text Available Background. Obesity and metabolic syndrome (MetS are major risk factors for atherosclerotic diseases; however, a causal link remains elusive. Animal models resembling human MetS and its complications, while important, are scarce. We aimed at developing a porcine model of human MetS. Methods. Forty pigs with familial hypercholesterolemia were fed a high fat + fructose diet for 30 weeks. Metabolic assessments and subcutaneous fat biopsies were obtained at 18 and 30 weeks, and fat distribution was assessed by CT-scans. Postmortem, macrophage density, and phenotype in fat tissues were quantified along with atherosclerotic burden. Results. During the experiment, we observed a >4-fold in body weight, a significant but small increase in fasting glucose (4.1 mmol/L, insulin (3.1 mU/L, triglycerides (0.5 mmol/L, and HDL cholesterol (2.6 mmol/L. Subcutaneous fat correlated with insulin resistance, but intra-abdominal fat correlated inversely with insulin resistance and LDL cholesterol. More inflammatory macrophages were found in visceral versus subcutaneous fat, and inflammation decreased in subcutaneous fat over time. Conclusions. MetS based on human criteria was not achieved. Surprisingly, visceral fat seemed part of a healthier metabolic and inflammatory profile. These results differ from human findings, and further research is needed to understand the relationship between obesity and MetS in porcine models.

Angiogenesis Research to Improve Therapies for Vascular Leak Syndromes, Intra-Abdominal Adhesions, and Arterial Injuries

National Research Council Canada - National Science Library

Folkman, Judah; Puder, Mark; Bischoff, Joyce

2006-01-01

...) to develop angiogenesis inhibitors which would inhibit post-operative abdominal adhesions; and (iii) to isolate endothelial progenitor cells from blood capable of being expanded in vitro and applied to vascular grafts...

Angiogenesis Research to Improve Therapies for Vascular Leak Syndromes, Intra-Abdominal Adhesions, and Arterial Injuries

National Research Council Canada - National Science Library

Folkman, Judah; Puder, Mark; Bischoff, Joyce

2007-01-01

...) to develop angiogenesis inhibitors which would inhibit post-operative abdominal adhesions; and, (iii) to isolate endothelial progenitor cells from blood, capable of being expanded in vitro and applied to vascular grafts...

Angiogenesis Research to Improve Therapies for Vascular Leak Syndromes, Intra-abdominal Adhesions, and Arterial Injuries

National Research Council Canada - National Science Library

Folkman, Judah

2008-01-01

...) to develop angiogenesis inhibitors which would inhibit post-operative abdominal adhesions; and, (iii) to isolate endothelial progenitor cells from blood, capable of being expanded in vitro and applied to vascular grafts...

Mechanical characterization of porcine abdominal organs.

Science.gov (United States)

Tamura, Atsutaka; Omori, Kiyoshi; Miki, Kazuo; Lee, Jong B; Yang, King H; King, Albert I

2002-11-01

Typical automotive related abdominal injuries occur due to contact with the rim of the steering wheel, seatbelt and armrest, however, the rate is less than in other body regions. When solid abdominal organs, such as the liver, kidneys and spleen are involved, the injury severity tends to be higher. Although sled and pendulum impact tests have been conducted using cadavers and animals, the mechanical properties and the tissue level injury tolerance of abdominal solid organs are not well characterized. These data are needed in the development of computer models, the improvement of current anthropometric test devices and the enhancement of our understanding of abdominal injury mechanisms. In this study, a series of experimental tests on solid abdominal organs was conducted using porcine liver, kidney and spleen specimens. Additionally, the injury tolerance of the solid organs was deduced from the experimental data.

Abdominal compartment syndrome and open abdomen management with negative pressure devices.

Science.gov (United States)

Surace, Alessandra; Ferrarese, Alessia; Marola, Silvia; Cumbo, Jacopo; Valentina, Gentile; Borello, Alessandro; Solej, Mario; Martino, Valter; Nano, Mario

2015-01-01

Abdominal compartment syndrome (ACS) is defined as an increase of intra-abdominal pressure (IAH) to values higher than 20 mmHg, associated with reduced perfusion and organ dysfunction. There is a classification of open abdomen which stratifies patients according to the natural history of improvement or clinical deterioration. The aim of treatment is to maintain the open abdomen at the lowest level and to prevent progression to a more complex level. Surgical treatment essentially consists in abdominal decompression by leaving the abdomen open. Analysis of the literature shows that negative pressure increases the rate of primary fascial closure; entero-cutaneous fistulas are seen in a minority of cases, without seeming consequence of the application of the dressing. Open abdomen management consists of three treatment stages: acute (24-48 hours), intermediate (from 48 hours to 10 days) and late or reconstruction (from 10 days to the final closure). It's important to recognize patients at risk of IAH and the first signs of ACS and intervene early with abdominal decompression if this will establish itself. Management of the open abdomen is now facilitated by negative pressure devices, which positively affect the morbidity and mortality of patients with ACS.

Unsupervised quantification of abdominal fat from CT images using Greedy Snakes

Science.gov (United States)

Agarwal, Chirag; Dallal, Ahmed H.; Arbabshirani, Mohammad R.; Patel, Aalpen; Moore, Gregory

2017-02-01

Adipose tissue has been associated with adverse consequences of obesity. Total adipose tissue (TAT) is divided into subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). Intra-abdominal fat (VAT), located inside the abdominal cavity, is a major factor for the classic obesity related pathologies. Since direct measurement of visceral and subcutaneous fat is not trivial, substitute metrics like waist circumference (WC) and body mass index (BMI) are used in clinical settings to quantify obesity. Abdominal fat can be assessed effectively using CT or MRI, but manual fat segmentation is rather subjective and time-consuming. Hence, an automatic and accurate quantification tool for abdominal fat is needed. The goal of this study is to extract TAT, VAT and SAT fat from abdominal CT in a fully automated unsupervised fashion using energy minimization techniques. We applied a four step framework consisting of 1) initial body contour estimation, 2) approximation of the body contour, 3) estimation of inner abdominal contour using Greedy Snakes algorithm, and 4) voting, to segment the subcutaneous and visceral fat. We validated our algorithm on 952 clinical abdominal CT images (from 476 patients with a very wide BMI range) collected from various radiology departments of Geisinger Health System. To our knowledge, this is the first study of its kind on such a large and diverse clinical dataset. Our algorithm obtained a 3.4% error for VAT segmentation compared to manual segmentation. These personalized and accurate measurements of fat can complement traditional population health driven obesity metrics such as BMI and WC.

CT identification of abdominal injuries in abused pre-school-age children

International Nuclear Information System (INIS)

Hilmes, Melissa A.; Hernanz-Schulman, Marta; Kan, J.H.; Greeley, Christopher S.; Piercey, Lisa M.; Yu, Chang

2011-01-01

Although the abdominopelvic CT findings of abdominal trauma in children have been described, little has been written about the subset of children who are victims of abuse. Our purpose is to describe abdominopelvic injuries in abused pre-school-age children as identified on CT. An IRB-approved retrospective review of our institutional child abuse registry was performed. Searching a 14-year period, we identified 84 children ≤ 5 years of age with medically diagnosed abuse who underwent CT. We reviewed imaging studies, operative reports, autopsy findings and patient outcomes. Consensus review of the CT examinations was performed by CAQ-certified pediatric radiologists, and findings were categorized as normal or by injury types (solid organ versus bowel). The injuries were analyzed in light of existing literature on pediatric accidental and non-accidental injuries. Of the 84 children, 35 (41.7%) had abdominal injuries. Abdominal injuries included liver (15), bowel (13), mesentery (4), spleen (6), kidneys (7), pancreas (4) and adrenal glands (3). Of these children, 26% (9/35) required surgical intervention for bowel, mesenteric and pancreatic injuries. Another 9/35 children died, not as a result of abdominal injuries but as a direct result of inflicted intracranial injuries. Our data indicate that abdominal injuries in abused children present in a pattern similar to that of children with accidental abdominal trauma, underscoring the need for vigilance and correlative historical and clinical data to identify victims of abuse. Mortality in abused children with intra-abdominal injury was frequently related to concomitant head injury. (orig.)

CT identification of abdominal injuries in abused pre-school-age children

Energy Technology Data Exchange (ETDEWEB)

Hilmes, Melissa A.; Hernanz-Schulman, Marta; Kan, J.H. [Vanderbilt Children' s Hospital, Department of Radiology and Radiological Sciences, Nashville, TN (United States); Greeley, Christopher S. [University of Texas Health Science Center at Houston, Department of Pediatrics, Houston, TX (United States); Piercey, Lisa M. [Vanderbilt Children' s Hospital, Department of Pediatrics, Nashville, TN (United States); Yu, Chang [Vanderbilt University, Department of Biostatistics, Nashville, TN (United States)

2011-05-15

Although the abdominopelvic CT findings of abdominal trauma in children have been described, little has been written about the subset of children who are victims of abuse. Our purpose is to describe abdominopelvic injuries in abused pre-school-age children as identified on CT. An IRB-approved retrospective review of our institutional child abuse registry was performed. Searching a 14-year period, we identified 84 children {<=} 5 years of age with medically diagnosed abuse who underwent CT. We reviewed imaging studies, operative reports, autopsy findings and patient outcomes. Consensus review of the CT examinations was performed by CAQ-certified pediatric radiologists, and findings were categorized as normal or by injury types (solid organ versus bowel). The injuries were analyzed in light of existing literature on pediatric accidental and non-accidental injuries. Of the 84 children, 35 (41.7%) had abdominal injuries. Abdominal injuries included liver (15), bowel (13), mesentery (4), spleen (6), kidneys (7), pancreas (4) and adrenal glands (3). Of these children, 26% (9/35) required surgical intervention for bowel, mesenteric and pancreatic injuries. Another 9/35 children died, not as a result of abdominal injuries but as a direct result of inflicted intracranial injuries. Our data indicate that abdominal injuries in abused children present in a pattern similar to that of children with accidental abdominal trauma, underscoring the need for vigilance and correlative historical and clinical data to identify victims of abuse. Mortality in abused children with intra-abdominal injury was frequently related to concomitant head injury. (orig.)

Computerized abdominal tomography in Wilson's disease

Energy Technology Data Exchange (ETDEWEB)

Tsuchikura, Keiko; Ogawa, Teruyuki; Nakajima, Akihisa; Ono, Yasuhiko

1986-05-01

Cranial and abdominal computerized tomography (CT) was performed in a 10-year-old boy with Wilson's disease complicated by liver cirrhosis. Abdominal CT showed diffuse high density areas over the whole part of the liver propably due to copper sediments, although there was no abnormal cranial CT findings. Decreased high density area of the liver was seen 60 days after the administration of D-penicillamine, suggesting the excretion of copper from the liver. Abdominal CT, as well as cranial CT, may be of help to diagnose Wilson's disease and evaluate therapeutic effects. (Namekawa, K.).

Intra-Hepatic Spillage of Gallstones as a Late Complication of Laparoscopic Cholecystectomy: MR Imaging Findings

International Nuclear Information System (INIS)

Ragozzino, Alfonso; Puglia, Marta; Romano, Federica; Imbriaco, Massimo

2016-01-01

Spillage of gallstones in the abdominal cavity may rarely occur during the course of laparoscopic cholecystectomy. Dropped gallstones in the peritoneal and extra-peritoneal cavity are usually asymptomatic. However, they may lead to abscess formation with an estimated incidence of about 0.3%. Common locations of the abscess are in the abdominal wall followed by the intra-abdominal cavity, usually in the sub-hepatic or retro-peritoneum inferior to the sub-hepatic space. We hereby describe an unusual case of infected spilled gallstones in the right sub-phrenic space, prospectively detected on abdominal MRI performed two years after laparoscopic cholecystectomy, in a patient with only a mild right-sided abdominal complaint. This case highlights the role of MRI in suggesting the right diagnosis in cases with vague or even absent symptomatology. In our case the patient’s history together with high quality abdomen MRI allowed the correct diagnosis. Radiologists should be aware of this rare and late onset complication, even after many years from surgery as an incidental finding in almost asymptomatic patients

Enhanced Inflammation without Impairment of Insulin Signaling in the Visceral Adipose Tissue of 5α-Dihydrotestosterone-Induced Animal Model of Polycystic Ovary Syndrome.

Science.gov (United States)

Milutinović, Danijela Vojnović; Nikolić, Marina; Veličković, Nataša; Djordjevic, Ana; Bursać, Biljana; Nestorov, Jelena; Teofilović, Ana; Antić, Ivana Božić; Macut, Jelica Bjekić; Zidane, Abdulbaset Shirif; Matić, Gordana; Macut, Djuro

2017-09-01

Polycystic ovary syndrome is a heterogeneous endocrine and metabolic disorder associated with abdominal obesity, dyslipidemia and insulin resistance. Since abdominal obesity is characterized by low-grade inflammation, the aim of the study was to investigate whether visceral adipose tissue inflammation linked to abdominal obesity and dyslipidemia could lead to impaired insulin sensitivity in the animal model of polycystic ovary syndrome.Female Wistar rats were treated with nonaromatizable 5α-dihydrotestosterone pellets in order to induce reproductive and metabolic characteristics of polycystic ovary syndrome. Glucose, triglycerides, non-esterified fatty acids and insulin were determined in blood plasma. Visceral adipose tissue inflammation was evaluated by the nuclear factor kappa B intracellular distribution, macrophage migration inhibitory factor protein level, as well as TNFα, IL6 and IL1β mRNA levels. Insulin sensitivity was assessed by intraperitoneal glucose tolerance test and homeostasis model assessment index, and through analysis of insulin signaling pathway in the visceral adipose tissue.Dihydrotestosterone treatment led to increased body weight, abdominal obesity and elevated triglycerides and non-esterified fatty acids, which were accompanied by the activation of nuclear factor kappa B and increase in macrophage migration inhibitory factor, IL6 and IL1β levels in the visceral adipose tissue. In parallel, insulin sensitivity was affected in 5α-dihydrotestosterone-treated animals only at the systemic and not at the level of visceral adipose tissue.The results showed that abdominal obesity and dyslipidemia in the animal model of polycystic ovary syndrome were accompanied with low-grade inflammation in the visceral adipose tissue. However, these metabolic disturbances did not result in decreased tissue insulin sensitivity. © Georg Thieme Verlag KG Stuttgart · New York.

Dual energy X-ray absorptiometry spine scans to determine abdominal fat in post-menopausal women

Science.gov (United States)

Bea, J. W.; Blew, R. M.; Going, S. B.; Hsu, C-H; Lee, M. C.; Lee, V. R.; Caan, B.J.; Kwan, M.L.; Lohman, T. G.

2016-01-01

Body composition may be a better predictor of chronic disease risk than body mass index (BMI) in older populations. Objectives We sought to validate spine fat fraction (%) from dual energy X-ray absorptiometry (DXA) spine scans as a proxy for total abdominal fat. Methods Total body DXA scan abdominal fat regions of interest (ROI) that have been previously validated by magnetic resonance imaging were assessed among healthy, postmenopausal women who also had antero-posterior spine scans (n=103). ROIs were 1) lumbar vertebrae L2-L4 and 2) L2-Iliac Crest (L2-IC), manually selected by two independent raters, and 3) trunk, auto-selected by DXA software. Intra-class correlation coefficients evaluated intra and inter-rater reliability on a random subset (N=25). Linear regression models, validated by bootstrapping, assessed the relationship between spine fat fraction (%) and total abdominal fat (%) ROIs. Results Mean age, BMI and total body fat were: 66.1 ± 4.8y, 25.8 ± 3.8kg/m2 and 40.0 ± 6.6%, respectively. There were no significant differences within or between raters. Linear regression models adjusted for several participant and scan characteristics were equivalent to using only BMI and spine fat fraction. The model predicted L2-L4 (Adj. R2: 0.83) and L2-IC (Adj.R2:0.84) abdominal fat (%) well; the adjusted R2 for trunk fat (%) was 0.78. Model validation demonstrated minimal over-fitting (Adj. R2: 0.82, 0.83, and 0.77 for L2-L4, L2-IC, and trunk fat respectively). Conclusions The strong correlation between spine fat fraction and DXA abdominal fat measures make it suitable for further development in post-menopausal chronic disease risk prediction models. PMID:27416964

Uso da peritoneostomia na sepse abdominal Laparostomy in abdominal sepsis

Directory of Open Access Journals (Sweden)

Juvenal da Rocha Torres Neto

2007-09-01

Full Text Available Dentre as modalidades terapêuticas da sepse abdominal, a peritoneostomia tem papel decisivo permitindo explorações e lavagens da cavidade de forma facilitada. Observamos pacientes com diagnóstico clínico de sepse abdominal internados no Serviço de Coloproctologia do Hospital Universitário da Universidade Federal de Sergipe, e que foram submetidos a peritoneostomia de janeiro de 2004 a janeiro de 2006. Foram avaliados quanto ao diagnóstico primário e secundário, tipo de peritonite secundária, antibioticoterapia, esquema de lavagens, tempo de peritoneostomia, complicações e desfecho. Estudamos 12 pacientes, com idade de 15 a 57, média de 39,3 anos. Diagnóstico primário: abdome agudo inflamatório em 6(50%, abdome agudo obstrutivo em 2(16,7%, abdome agudo perfurativo em 2(16,7%, fístula enterocutânea em 1(8,3% e abscesso intra-cavitário em 1(8,3%. Diagnóstico secundário: perfuração de cólon em 4(33,3%, abscessos intra-cavitários em 3(25%, deiscências de anastomoses em 3(25%, 1(8,3% com tumor perfurado de sigmóide e 1(8,3% com necrose de cólon abaixado. Peritonite fecal em 10(83,3% e purulenta em 2(16,7%. A antibioticoterapia teve duração média de 19 dias. Lavagens de demanda em 6(50%, programadas em 4(33,3% e regime misto em 2(16,7%. O tempo médio de peritoneostomia foi de 10,9 dias (1-36. Como complicações: evisceração em 2(16,7% e fistulização em 1(8,3%. Quatro pacientes evoluíram com óbito.Among the therapeutics approach form of abdominal sepsis, the laparostomy has a decisive role allowing cavity explorations and lavages in an easier way. We study patients with abdominal sepsis diagnoses admitted to our surgical service of Coloproctology form Sergipe´s Federal University Hospital who underwent a Bogotá Bag laparostomy associated or not with polypropylene mesh from January 2004 to January 2006. These patients were assessed as: first and second diagnosis; secondary peritonitis type; antibiotic

INTERLEUKIN-6 TRANS-SIGNALING SYSTEM IN INTRA-AMNIOTIC INFLAMMATION, PRETERM BIRTH AND PRETERM PREMATURE RUPTURE OF THE MEMBRANES

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Lee, Sarah Y.; Buhimschi, Irina A.; Dulay, Antonette T.; Ali, Unzila A.; Zhao, Guomao; Abdel-Razeq, Sonya S.; Bahtiyar, Mert O.; Thung, Stephen F.; Funai, Edmund F.; Buhimschi, Catalin S.

2013-01-01

Classic IL-6 signaling is conditioned by the transmembrane receptor (IL-6R) and homodimerization of gp130. During trans-signaling, IL-6 binds to soluble IL-6R (sIL-6R) enabling activation of cells expressing solely gp130. Soluble gp130 (sgp130) selectively inhibits IL-6 trans-signaling. To characterize amniotic fluid IL-6 trans-signaling molecules (IL-6, sIL-6R, sgp130) in normal gestations and pregnancies complicated by intra-amniotic inflammation (IAI) we studied 301 women during second trimester (n=39), third trimester (n=40) and preterm labor with intact (n=131, 85 IAI negative & 46 IAI positive) or preterm premature rupture of membranes (PPROM: n=91, 61 IAI negative & 30 IAI positive). ELISA, Western blotting and RT-PCR were used to investigate amniotic fluid, placenta and amniochorion for protein and mRNA expression of sIL-6R, sgp130, IL-6R and gp130. Tissues were immunostained for IL-6R, gp130, CD15+ (polymorphonuclear) and CD3+ (T-cell) inflammatory cells. The ability of sIL-6R and sgp130 to modulate basal and LPS-stimulated release of amniochorion matrix-metalloprotease-9 (MMP-9) was tested ex-vivo. We showed that in physiologic gestations amniotic fluid sgp130 decreases toward term. Amniotic fluid IL-6 and sIL-6R were elevated in IAI whereas sgp130 was decreased in PPROM. Our results suggested that fetal membranes are the probable source of amniotic fluid sIL-6R and sgp130. Immunohistochemistry and RT-PCR revealed increased IL-6R and decreased gp130 expression in amniochorion of women with IAI. Ex-vivo, sIL-6R and LPS augmented amniochorion MMP-9 release whereas sgp130 opposed this effect. We conclude that IL-6 trans-signaling molecules are physiologic constituents of the amniotic fluid regulated by gestational age and inflammation. PPROM likely involves functional loss of sgp130. PMID:21282511

IL-6 trans-signaling system in intra-amniotic inflammation, preterm birth, and preterm premature rupture of the membranes.

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Lee, Sarah Y; Buhimschi, Irina A; Dulay, Antonette T; Ali, Unzila A; Zhao, Guomao; Abdel-Razeq, Sonya S; Bahtiyar, Mert O; Thung, Stephen F; Funai, Edmund F; Buhimschi, Catalin S

2011-03-01

Classic IL-6 signaling is conditioned by the transmembrane receptor (IL-6R) and homodimerization of gp130. During trans-signaling, IL-6 binds to soluble IL-6R (sIL-6R), enabling activation of cells expressing solely gp130. Soluble gp130 (sgp130) selectively inhibits IL-6 trans-signaling. To characterize amniotic fluid (AF) IL-6 trans-signaling molecules (IL-6, sIL-6R, sgp130) in normal gestations and pregnancies complicated by intra-amniotic inflammation (IAI), we studied 301 women during second trimester (n = 39), third trimester (n = 40), and preterm labor with intact (n = 131, 85 negative IAI and 46 positive IAI) or preterm premature rupture of membranes (PPROM; n = 91, 61 negative IAI and 30 positive IAI). ELISA, Western blotting, and real-time RT-PCR were used to investigate AF, placenta, and amniochorion for protein and mRNA expression of sIL-6R, sgp130, IL-6R, and gp130. Tissues were immunostained for IL-6R, gp130, CD15(+) (polymorphonuclear), and CD3(+) (T cell) inflammatory cells. The ability of sIL-6R and sgp130 to modulate basal and LPS-stimulated release of amniochorion matrix metalloprotease-9 was tested ex vivo. We showed that in physiologic gestations, AF sgp130 decreases toward term. AF IL-6 and sIL-6R were increased in IAI, whereas sgp130 was decreased in PPROM. Our results suggested that fetal membranes are the probable source of AF sIL-6R and sgp130. Immunohistochemistry and RT-PCR revealed increased IL-6R and decreased gp130 expression in amniochorion of women with IAI. Ex vivo, sIL-6R and LPS augmented amniochorion matrix metalloprotease-9 release, whereas sgp130 opposed this effect. We conclude that IL-6 trans-signaling molecules are physiologic constituents of the AF regulated by gestational age and inflammation. PPROM likely involves functional loss of sgp130.

Genetic variations in toll-like receptor 4 in Mexican-Mestizo patients with intra-abdominal infection and/or pneumonia.

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Rodriguez-Osorio, Carlos A; Lima, Guadalupe; Herrera-Caceres, Jaime O; Villegas-Torres, Beatriz E; Zuñiga, Joaquin; Ponce-de-Leon, Sergio; Llorente, Luis; Sifuentes-Osornio, Jose

2013-06-01

Sepsis is a leading cause of death around the world, and 73-83% of all sepsis cases requiring attention in intensive care units are linked to intra-abdominal infection (IAI) or pneumonia. The activation of innate immunity is central to the manifestation of sepsis, and toll-like receptor (TLR) 4 plays an important role in this activation process. The 299G and 399I alleles of TLR4 have been linked with an increased risk of Gram-negative bacteria (GNB) infections and septic shock in some populations. This case-control study evaluated the prevalence of D299G/T399I polymorphisms in Mexican patients with IAI and/or pneumonia and in healthy controls. Genotyping revealed that 1 in 44 patients (2.3%; CI 95%: 0.05-12.0%) and 4 in 126 controls (3.2%; CI 95%: 0.9-7.9%) were heterozygous for both the D299G and T399l polymorphisms (OR: 0.71, CI 95%: 0.01-7.44, p = NS), confirming the co-segregation of these alleles in this population. Furthermore, the patients with a GNB infection and severe sepsis were not carriers of the risk alleles. In summary, this report shows that the frequency of the D299G and T399I polymorphisms in Mexican-Mestizos is lower than anticipated in comparison with other ethnic groups, emphasizing the variable distribution of TLR4 polymorphisms among different populations. Consequently, this study was not able to detect associations between TLR4 polymorphisms and sepsis in this population. Copyright © 2013 Elsevier B.V. All rights reserved.

Multiple intra-abdominal serosal myxosarcomas in two koalas (Phascolarctos cinereus).

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Astudillo, V González; Schaffer-White, A; Allavena, R; Palmieri, C

2015-01-01

Two adult koalas (Phascolarctos cinereus) were presented for necropsy examination without any clinical history. A diffuse, severe gelatinous effusion was found in the abdominal cavity, while numerous 1-3 mm diameter, round, well-demarcated, multifocal to coalescing, raised, firm nodules containing a clear gelatinous fluid were scattered on the surface of the parietal peritoneum, diaphragm, liver, gastrointestinal tract and mesentery. Microscopically, the nodular lesions consisted of spindle-shaped to stellate neoplastic cells, with scant eosinophilic cytoplasm and moderate anisocytosis and anisokaryosis. The neoplastic cells were admixed with and surrounded by abundant acellular pale eosinophilic material that was stained by Alcian blue and only weakly by the periodic acid-Schiff reaction. Serosal proliferations are described rarely in koalas and to the authors' knowledge this is the first reported case of serosal myxosarcoma. The significance and pathogenesis of this condition in the koala population is unknown. Copyright © 2015 Elsevier Ltd. All rights reserved.

Umbilical Microflora, Antiseptic Skin Preparation, and Surgical Site Infection in Abdominal Surgery.

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Kleeff, Jörg; Erkan, Mert; Jäger, Carsten; Menacher, Maximilian; Gebhardt, Friedemann; Hartel, Mark

2015-08-01

Surgical site infections (SSI) following abdominal surgery are frequent and a major cause of postoperative morbidity and prolonged hospital stay. Besides antibiotic prophylaxis, antiseptic skin preparation is an important measure to prevent SSI. Here we prospectively analyzed the effectiveness of antiseptic skin preparation in a cohort of 93 patients undergoing laparotomy, with special emphasis on the umbilical region. The microflora of the umbilicus contained a large number of resident (mostly staphylococci species and corynebacteria) and transient germs (including enterococci species). Following antiseptic skin preparation, bacteria could still be cultured from 24.7% of the patients' umbilici. In case of postoperative SSI, only one of seven SSI was caused by the microorganism that was present in the umbilicus before and after skin preparation. Antiseptic skin preparation fails to completely eradicate the microflora of the umbilical region in one quarter of the patients. However, at least in abdominal surgery, the vast majority of SSI are caused by intra-abdominal contamination rather than the skin microflora.

Refractory Abdominal Pain in a Patient with Chronic Lymphocytic Leukemia: Be Wary of Acquired Angioedema due to C1 Esterase Inhibitor Deficiency

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Abdullateef Abdulkareem

2018-01-01

Full Text Available Acquired angioedema due to C1 inhibitor deficiency (C1INH-AAE is a rare and potentially fatal syndrome of bradykinin-mediated angioedema characterized by episodes of angioedema without urticaria. It typically manifests with nonpitting edema of the skin and edema in the gastrointestinal (GI tract mucosa or upper airway. Edema of the upper airway and tongue may lead to life-threatening asphyxiation. C1INH-AAE is typically under-diagnosed because of its rarity and its propensity to mimic more common abdominal conditions and allergic reactions. In this article, we present the case of a 62-year-old male with a history of recently diagnosed chronic lymphocytic leukemia (CLL who presented to our hospital with recurrent abdominal pain, initially suspected to have Clostridium difficile colitis and diverticulitis. He received a final diagnosis of acquired angioedema due to C1 esterase inhibitor deficiency due to concomitant symptoms of lip swelling, cutaneous nonpitting edema of his lower extremities, and complement level deficiencies. He received acute treatment with C1 esterase replacement and icatibant and was maintained on C1 esterase infusions. He also underwent chemotherapy for his underlying CLL and did not experience further recurrence of his angioedema.

Laparoscopic management of abdominal lymphatic cyst in children.

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Tran, Ngoc Son; Nguyen, Thanh Liem

2012-06-01

The aim of this study is to investigate the feasibility and effectiveness of laparoscopic surgery (LS) in management of abdominal lymphatic cyst (ALC) in children. Medical records of all patients undergoing LS for ALC at the National Hospital of Pediatrics, Hanoi, Vietnam, from May 2007 to June 2011 were reviewed. For LS, one umbilical port of 10 mm and up to three other 3-5-mm ports were used. Cystic fluid was aspirated prior to removal of the cyst. When intestinal resection was indicated, the mesenteric cyst with the bowel loop was delivered out of the abdomen through a minimally enlarged umbilical incision; resection of the intestinal segment together with the cyst and the bowel anastomosis were both performed extracorporally. Forty-seven patients were identified, with a mean age of 4.3 ± 3.7 years. The most common symptoms were abdominal pain (72.3%) and abdominal distention (34.0%). Four patients presented with acute abdomen due to infection or hemorrhage of the cyst. Mean size of the ALC was 9.5 ± 5.5 cm (range, 3.4-30 cm). In 12 cases the ALC was omental, and in 35 cases it was mesenteric. Laparoscopic cyst excision was performed in 36 cases (76.6%) versus laparoscopy-assisted bowel resection en bloc with the cyst in 8 cases (17.0%); in 3 patients (6.4%), conversion to open surgery was required. Mean operative time was 79 ± 39 minutes. There were no intra- or postoperative complications. Mean length of hospital stay after laparoscopic management was 3.8 ± 1.6 days. The results of pathologic investigation showed benign cystic lymphangioma in all cases. During follow-up ranging from 1 month to 4 years, recurrence was seen in 1 patient (2.1%) with complex mesenteric cyst. All other patients remained in good health. Laparoscopic management is safe, feasible, and effective and should be the treatment of choice for most cases of ALC in children.

The role of inflammation in lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and its potential impact on medical therapy.

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Ficarra, Vincenzo; Rossanese, Marta; Zazzara, Michele; Giannarini, Gianluca; Abbinante, Maria; Bartoletti, Riccardo; Mirone, Vincenzo; Scaglione, Francesco

2014-12-01

A chronic prostatic inflammation seems to play a crucial role in benign prostatic hyperplasia (BPH) pathogenesis and progression. Therefore, inflammation could represent a new potential target for medical therapy of lower urinary tract symptoms (LUTS) due to BPH (LUTS/BPH). This review article analyzes the evidence supporting the role of inflammation in the onset and progression of BPH, and it assesses the potential impact of previous mechanisms on medical therapy of LUTS/BPH. Literature data support the role of inflammation as a relevant factor in the pathogenesis of BPH. Indeed, several data favour the role of infiltrating lymphocytes in the development and progression of prostate adenoma as an effect of a self-maintaining remodeling process. Although available drugs commonly used in the treatment of LUTS/BPH do not exhibit an anti-inflammatory activity, it seems to be obvious considering the inflammation as a new target in the treatment of LUTS/BPH. Drugs currently investigated for the treatment of prostatic inflammation include the hexanic lipidosterolic extract of Serenoa repens, nonsteroidal anti-inflammatory drugs, and vitamin D receptor agonists.

Polyethylene Glycol (PEG-3350, Colyte Poisoning due to Intra-Peritoneal Leakage in an Elderly Patient

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Jae Hee Chung

Full Text Available Polyethylene glycol (PEG-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

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Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, Geneva (Switzerland)

1998-05-01

Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.) With 11 figs., 5 tabs., 64 refs.

Hemorrhagic intra splenic pseudocyst as a complication of chronic pancreatitis in acute phase - a case report

International Nuclear Information System (INIS)

Almeida, Fabiola Assuncao de; Marchiori, Edson; Mello, Walter de Assis; Nogueira, Aline Silva; Sales, Anderson Ribeiro; Martins, Renata Romano; Santos, Tereza Cristina C.R.S. dos

1999-01-01

The authors report a case of hemorrhagic intra splenic pseudocyst as a complication of chronic pancreatitis in acute phase. A 43-year-old woman, chronic alcoholic, who had pancreatitis 5 years ago, with symptoms of strong abdominal pain in the epigastrium, nausea and fever. Abdominal sonography showed a lesion contiguous to the spleen and computed tomography demonstrated an heterogeneous lesion of not well defined limits, in the lateral and posterior parts of the spleen. The patient was submitted to Roux-Y cystojejunostomy, he does not present any symptoms at the moment, and is undergoing clinical control. (author)

Predictive value of C-reactive protein in critically ill patients after abdominal surgery

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Frédéric Sapin

Full Text Available OBJECTIVES: The development of sepsis after abdominal surgery is associated with high morbidity and mortality. Due to inflammation, it may be difficult to diagnose infection when it occurs, but measurement of C-reactive protein could facilitate this diagnosis. In the present study, we evaluated the predictive value and time course of C-reactive protein in relation to outcome in patients admitted to the intensive care unit (ICU after abdominal surgery. METHODS: We included patients admitted to the ICU after abdominal surgery over a period of two years. The patients were divided into two groups according to their outcome: favorable (F; left the ICU alive, without modification of the antibiotic regimen and unfavorable (D; death in the ICU, surgical revision with or without modification of the antibiotic regimen or just modification of the regimen. We then compared the highest C-reactive protein level on the first day of admission between the two groups. RESULTS: A total of 308 patients were included: 86 patients had an unfavorable outcome (group D and 222 had a favorable outcome (group F. The groups were similar in terms of leukocytosis, neutrophilia, and platelet count. C-reactive protein was significantly higher at admission in group D and was the best predictor of an unfavorable outcome, with a sensitivity of 74% and a specificity of 72% for a threshold of 41 mg/L. No changes in C-reactive protein, as assessed based on the delta C-reactive protein, especially at days 4 and 5, were associated with a poor prognosis. CONCLUSIONS: A C-reactive protein cut-off of 41 mg/L during the first day of ICU admission after abdominal surgery was a predictor of an adverse outcome. However, no changes in the C-reactive protein concentration, especially by day 4 or 5, could identify patients at risk of death.

Melatonin attenuates inflammation of acute pulpitis subjected to dental pulp injury

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Li, Ji-Guo; Lin, Jia-Ji; Wang, Zhao-Ling; Cai, Wen-Ke; Wang, Pei-Na; Jia, Qian; Zhang, An-Sheng; Wu, Gao-Yi; Zhu, Guo-Xiong; Ni, Long-Xing

2015-01-01

Acute pulpitis (AP), one of the most common diseases in the endodontics, usually causes severe pain to the patients, which makes the search for therapeutic target of AP essential in clinic. Toll-like receptor 4 (TLR4) signaling is widely involved in the mechanism of pulp inflammation, while melatonin has been reported to have an inhibition for a various kinds of inflammation. We hereby studied whether melatonin can regulate the expression of TLR4/NF-ĸB signaling in the pulp tissue of AP and in human dental pulp cells (HDPCs). Two left dental pulps of the adult rat were drilled open to establish the AP model, and the serum levels of melatonin and pro-inflammatory cytokines, including interleukin 1β (IL-1β), interleukin 18 (IL-18) and tumor necrosis factor α (TNF-α), were assessed at 1, 3 and 5 d post injury. At the same time points, the expression of TLR4 signaling in the pulp was explored by quantitative real-time PCR and immunohistochemistry. The AP rats were administered an abdominal injection of melatonin to assess whether melatonin rescued AP and TLR4/NF-ĸB signaling. Dental pulp injury led to an approximately five-day period acute pulp inflammation and necrosis in the pulp and a significant up-regulation of IL-1β, IL-18 and TNF-α in the serum. ELISA results showed that the level of melatonin in the serum decreased due to AP, while an abdominal injection of melatonin suppressed the increase in serum cytokines and the percentage of necrosis at the 5 d of the injured pulp. Consistent with the inflammation in AP rats, TLR4, NF-ĸB, TNF-α and IL-1β in the pulp were increased post AP compared with the baseline expression. And melatonin showed an inhibition on TLR4/NF-ĸB signaling as well as IL-1β and TNF-α production in the pulp of AP rats. Furthermore, melatonin could also regulate the expression of TLR4/NF-ĸB signaling in LPS-stimulated HDPCs. These data suggested that dental pulp injury induced AP and reduced the serum level of melatonin and that

Tuberculosis abdominal Abdominal tuberculosis

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T. Rubio; M. T. Gaztelu; A. Calvo; M. Repiso; H. Sarasíbar; F. Jiménez Bermejo; A. Martínez Echeverría

2005-01-01

La tuberculosis abdominal cursa con un cuadro inespecífico, con difícil diagnóstico diferencial respecto a otras entidades de similar semiología. Presentamos el caso de un varón que ingresa por presentar dolor abdominal, pérdida progresiva y notoria de peso corporal y fiebre de dos meses de evolución. El cultivo de la biopsia de colon mostró presencia de bacilo de Koch.Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with re...

Hydro-MRI for abdominal diagnostics in children

International Nuclear Information System (INIS)

Kern, A.; Schunk, K.; Oberholzer, K.; Thelen, M.; Kessler, M.

2001-01-01

A clinical evaluation of hydro-MRI as an alternative method to barium studies in children with abdominal pain of unknown origin is presented. Patients and Methods: 20 children with abdominal pain of unknown origin aged from 9 - 16 years were examined after oral bowel opacification using 1000 ml of 2.5% mannitol solution with a 1.0T MRI system. The investigation was done in 2 planes (coronal and axial) under breath-hold conditions. Imaging procedures included various sequences (T2W HASTE + FS, contrast-enhanced T1W FLASH FS). Suspicious findings in bowel segments and extra-intestinal changes were assessed. Results: In 21/24 examinations the small bowel was completely visualized, in 15/24 cases colon segments were identified. An accurate assessment of the terminal ileum was not possible in 3/24 procedures. Breathing artefacts occurred in 3/24 examinations. Signs of Crohn's disease were found in 4 examinations, inflammatory changes of the ileum were detected in 3 cases. Inflammation of the colon was demonstrated in 2 children. Furthermore, pathological findings included constipation in one child and inflammation of the ileo-colic and mesenterial lymph nodes were found in another child. Extra-intestinal changes in 3 children were caused by ovarian cysts, and in one case by pleural effusion. In 4 examinations we detected ascites in the absence of other pathological findings. In 5 children there was no pathological correlation in the bowel or extra-intestinal region for the complaints. The children tolerated the hydro-MRI very well. There were no side effects using oral mannitol. (orig.) [de

Antimicrobial susceptibility of gram-negative pathogens isolated from patients with complicated intra-abdominal infections in South African hospitals (SMART Study 2004-2009): impact of the new carbapenem breakpoints.

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Brink, Adrian J; Botha, Roelof F; Poswa, Xoliswa; Senekal, Marthinus; Badal, Robert E; Grolman, David C; Richards, Guy A; Feldman, Charles; Boffard, Kenneth D; Veller, Martin; Joubert, Ivan; Pretorius, Jan

2012-02-01

The Study for Monitoring Antimicrobial Resistance Trends (SMART) follows trends in resistance among aerobic and facultative anaerobic gram-negative bacilli (GNB) isolated from complicated intra-abdominal infections (cIAIs) in patients around the world. During 2004-2009, three centralized clinical microbiology laboratories serving 59 private hospitals in three large South African cities collected 1,218 GNB from complicated intra-abdominal infections (cIAIs) and tested them for susceptibility to 12 antibiotics according to the 2011 Clinical Laboratory Standards Institute (CLSI) guidelines. Enterobacteriaceae comprised 83.7% of the isolates. Escherichia coli was the species isolated most commonly (46.4%), and 7.6% of these were extended-spectrum β-lactamase (ESBL)-positive. The highest ESBL rate was documented for Klebsiella pneumoniae (41.2%). Overall, ertapenem was the antibiotic most active against susceptible species for which it has breakpoints (94.6%) followed by amikacin (91.9%), piperacillin-tazobactam (89.3%), and imipenem-cilastatin (87.1%), whereas rates of resistance to ceftriaxone, cefotaxime, ciprofloxacin, and levofloxacin were documented to be 29.7%, 28.7%, 22.5%, and 21.1%, respectively. Multi-drug resistance (MDR), defined as resistance to three or more antibiotic classes, was significantly more common in K. pneumoniae (27.9%) than in E. coli (4.9%; p<0.0001) or Proteus mirabilis (4.1%; p<0.05). Applying the new CLSI breakpoints for carbapenems, susceptibility to ertapenem was reduced significantly in ESBL-positive E. coli compared with ESBL-negative isolates (91% vs. 98%; p<0.05), but this did not apply to imipenem-cilastatin (95% vs. 99%; p=0.0928). A large disparity between imipenem-cilastatin and ertapenem susceptibility in P. mirabilis and Morganella morganii was documented (24% vs. 96% and 15% vs. 92%, respectively), as most isolates of these two species had imipenem-cilastatin minimum inhibitory concentrations in the 2-4 mcg/mL range, which

CHOLECYSTITIS AS A CAUSE OF ABDOMINAL PAIN IN PATIENTS WITH ACUTE VIRAL HEPATITIS A AND B

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Miodrag Radunović

2012-03-01

Full Text Available Acute cholecystitis is an inflammation of the gallbladder wall, usually caused by gallstones in the cystic duct, which causes attacks of severe pain. At least 95% of the population with acute inflammation of the gallbladder have gallstones. Acute viral hepatitis is the liver inflammation accompanied by nausea, faintness, vomiting, pain below the right rib arch, jaundice. The presence of acute cholecystitis intensifies the existing symptoms. The aim of the paper was to show the incidence of the gallbladder inflammation in patients with acute hepatitis A or B. This retrospective-prospective study involved 110 patients treated for viral hepatitis A or B and had severe abdominal pain during hospitalization. The selected sample involved more male examinees - 63 (62% compared to female ones - 47 (38%. The most frequent age of examinees was 30-50 years, 82 (83%, and cholecystitis during hepatitis was also most common in the age group 30-50 years, 28 (73% patients. Cholecystitis was more common in patients with acute hepatitis B - 21 (55% examinees than in patients with acute hepatitis A - 17 (45% examinees. Ultrasound examination, performed in 24 (63% examinees showed gallstones in inflamed gallbladder, while 14 (37% examinees had the inflammation of the gallbladder without gallstones. The most common cause of severe abdominal pain in patients with acute liver infection caused by HAV and HBV infection was the gallbladder, 38 (34.5% patients. Cholecystitis was more common in patients with acute hepatitis B, 21 (55% examinees, than in those with an acute hepatitis A, 17 (45% examinees.

Dual energy X-ray absorptiometry spine scans to determine abdominal fat in postmenopausal women.

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Bea, J W; Blew, R M; Going, S B; Hsu, C-H; Lee, M C; Lee, V R; Caan, B J; Kwan, M L; Lohman, T G

2016-11-01

Body composition may be a better predictor of chronic disease risk than body mass index (BMI) in older populations. We sought to validate spine fat fraction (%) from dual energy X-ray absorptiometry (DXA) spine scans as a proxy for total abdominal fat. Total body DXA scan abdominal fat regions of interest (ROI) that have been previously validated by magnetic resonance imaging were assessed among healthy, postmenopausal women who also had antero-posterior spine scans (n = 103). ROIs were (1) lumbar vertebrae L2-L4 and (2) L2-Iliac Crest (L2-IC), manually selected by two independent raters, and (3) trunk, auto-selected by DXA software. Intra-class correlation coefficients evaluated intra and inter-rater reliability on a random subset (N = 25). Linear regression models, validated by bootstrapping, assessed the relationship between spine fat fraction (%) and total abdominal fat (%) ROIs. Mean age, BMI, and total body fat were 66.1 ± 4.8 y, 25.8 ± 3.8 kg/m 2 and 40.0 ± 6.6%, respectively. There were no significant differences within or between raters. Linear regression models adjusted for several participant and scan characteristics were equivalent to using only BMI and spine fat fraction. The model predicted L2-L4 (Adj. R 2 : 0.83) and L2-IC (Adj. R 2 : 0.84) abdominal fat (%) well; the adjusted R 2 for trunk fat (%) was 0.78. Model validation demonstrated minimal over-fitting (Adj. R 2 : 0.82, 0.83, and 0.77 for L2-L4, L2-IC, and trunk fat, respectively). The strong correlation between spine fat fraction and DXA abdominal fat measures make it suitable for further development in postmenopausal chronic disease risk prediction models. Am. J. Hum. Biol. 28:918-926, 2016. © 2016Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Mediators of low-grade chronic inflammation in polycystic ovary syndrome (PCOS).

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Ojeda-Ojeda, Miriam; Murri, Mora; Insenser, María; Escobar-Morreale, Héctor F

2013-01-01

Chronic low-grade subclinical inflammation has been increasingly recognized as an interposer in the endocrine, metabolic and reproductive disturbances that characterize the polycystic ovary syndrome (PCOS). Abdominal adiposity and obesity are often present in PCOS. Mounting evidence indicates that adipose tissue is involved in innate and adaptive immune responses. Continuous release of inflammatory mediators such as cytokines, acute phase proteins, and adipokines perpetuates the inflammatory condition associated with obesity in women with PCOS, possibly contributing to insulin resistance and other long-term cardiometabolic risk factors. Genetic variants in the genes encoding inflammation-related mediators underlie the development of PCOS and their interaction with environmental factors may contribute to the heterogeneous clinical phenotype of this syndrome. In the future, strategies ameliorating inflammation may prove useful for the management of PCOS and associated conditions.

Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

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Dejan V. Radenkovic

2016-01-01

Full Text Available Abdominal compartment syndrome (ACS in patients with severe acute pancreatitis (SAP is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective.

Science.gov (United States)

Radenkovic, Dejan V; Johnson, Colin D; Milic, Natasa; Gregoric, Pavle; Ivancevic, Nenad; Bezmarevic, Mihailo; Bilanovic, Dragoljub; Cijan, Vladimir; Antic, Andrija; Bajec, Djordje

2016-01-01

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 1: definitions and pathophysiology.

Science.gov (United States)

Malbrain, Manu L N G; Roberts, Derek J; De Laet, Inneke; De Waele, Jan J; Sugrue, Michael; Schachtrupp, Alexander; Duchesne, Juan; Van Ramshorst, Gabrielle; De Keulenaer, Bart; Kirkpatrick, Andrew W; Ahmadi-Noorbakhsh, Siavash; Mulier, Jan; Ivatury, Rao; Pracca, Francisco; Wise, Robert; Pelosi, Paolo

2014-01-01

Over the last few decades, increasing attention has been paid to understanding the pathophysiology, aetiology, prognosis, and treatment of elevated intra-abdominal pressure (IAP) in trauma, surgical, and medical patients. However, there is presently a relatively poor understanding of intra-abdominal volume (IAV) and the relationship between IAV and IAP (i.e. abdominal compliance). Consensus definitions on Cab were discussed during the 5th World Congress on Abdominal Compartment Syndrome and a writing committee was formed to develop this article. During the writing process, a systematic and structured Medline and PubMed search was conducted to identify relevant studies relating to the topic. According to the recently updated consensus definitions of the World Society on Abdominal Compartment Syndrome (WSACS), abdominal compliance (Cab) is defined as a measure of the ease of abdominal expansion, which is determined by the elasticity of the abdominal wall and diaphragm. It should be expressed as the change in IAV per change in IAP (mL [mm Hg]⁻¹). Importantly, Cab is measured differently than IAP and the abdominal wall (and its compliance) is only a part of the total abdominal pressure-volume (PV) relationship. During an increase in IAV, different phases are encountered: the reshaping, stretching, and pressurisation phases. The first part of this review article starts with a comprehensive list of the different definitions related to IAP (at baseline, during respiratory variations, at maximal IAV), IAV (at baseline, additional volume, abdominal workspace, maximal and unadapted volume), and abdominal compliance and elastance (i.e. the relationship between IAV and IAP). An historical background on the pathophysiology related to IAP, IAV and Cab follows this. Measurement of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The Cab is one of the most neglected parameters in critically ill patients, although it plays a

An Unusual Cause of Abdominal Pain: Three Lead Pellets within the Appendix Vermiformis

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Orhan Veli Ozkan

2015-01-01

Full Text Available Most ingested foreign bodies usually pass out in the feces uneventfully. Complications such as intestinal perforation and bleeding usually occur with sharp, thin, stiff, long, and pointed objects. This case describes the management of three lead pellets within the appendix vermiformis. A 45-year-old male visited our clinic complaining of a 4-month history of abdominal pain. The patient inquiry revealed that he had eaten hunted rabbit meat on numerous occasions and had unintentionally ingested three lead pellets. Plain abdominal films and a barium enema showed foreign bodies in the right lower abdominal quadrant. Since the lead pellets were thought to have migrated extraluminally, they were removed through laparotomy under fluoroscopic guidance. An appendectomy was performed. Pathologically, three lead pellets were embedded in the appendix, which showed signs of intramucosal inflammation. Foreign bodies causing appendicitis are rare. However, if stiff or pointed objects enter the appendicular lumen, there is a high risk of appendicitis, perforation, or abdominal pain. An appendectomy was required to remove the ingested lead pellets in the appendix.

Abdominal angina

International Nuclear Information System (INIS)

Becker, G.J.; Stewart, J.; Holden, R.W.; Yune, H.Y.; Mail, J.T.; Klatte, E.C.

1988-01-01

Abdominal angina due to occlusive disease of the mesenteric arteries has been the to become clinically manifest only in the presence of severe disease in at least two of the following vessels: celiac, SMA, and IMA. Still, many patients who gradually develop significant two-vessel disease have few or no associated symptoms. Differences in collateral circulation and in cardiac index account for some of the clinical variation. The usual clinical manifestations include severe post-prandial pain, sitophobia (fear of eating because of the anticipated symptoms), and profound weight loss. Uncommonly, diarrhea, nausea, or vomiting may be encountered. Smoking is a common historical feature. Most series document a female predilection. Aside from occasional abdominal bruits and (more commonly) findings of peripheral vascular occlusive disease, the physical exam discloses only cachexia. But the differential diagnosis of profound weight loss is extensive. Therefore, abdominal angina has always created a diagnostic challenge. Multiple imaging modalities are often employed, and a seemingly negative evaluation often culminates in biplane aortography. The latter typically reveals stenoses and/or occlusions in at least two of the three mesenteric arteries. The authors discuss how a variety of surgical treatments, including thromboendarterectomy and bypass grafting, have evolved. Recently reported results have been excellent

Staged abdominal re-operation for abdominal trauma.

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Taviloglu, Korhan

2003-07-01

To review the current developments in staged abdominal re-operation for abdominal trauma. To overview the steps of damage control laparotomy. The ever increasing importance of the resuscitation phase with current intensive care unit (ICU) support techniques should be emphasized. General surgeons should be familiar to staged abdominal re-operation for abdominal trauma and collaborate with ICU teams, interventional radiologists and several other specialties to overcome this entity.

Intra-articular administration of an antibody against CSF-1 receptor reduces pain-related behaviors and inflammation in CFA-induced knee arthritis.

Science.gov (United States)

Alvarado-Vazquez, P A; Morado-Urbina, C E; Castañeda-Corral, G; Acosta-Gonzalez, R I; Kitaura, H; Kimura, K; Takano-Yamamoto, T; Jiménez-Andrade, J M

2015-01-01

Several studies have shown that blockade of colony stimulating factor-1 (CSF-1) or its receptor (CSF-1R) inhibits disease progression in rodent models of rheumatoid arthritis (RA); however, the role of the CSF-1/CSF-1R pathway in RA-induced pain and functional deficits has not been studied. Thus, we examined the effect of chronic intra-articular administration of a monoclonal anti-CSF-1R antibody (AFS98) on spontaneous pain, knee edema and functional disabilities in mice with arthritis. Unilateral arthritis was produced by multiple injections of complete Freund's adjuvant (CFA) into the right knee joint of adult male ICR mice. CFA-injected mice were then treated twice weekly from day 10 until day 25 with anti-CSF-1R antibody (3 and 10 μg/5 μL per joint), isotype control (rat IgG 10 μg/5 μL per joint) or PBS (5 μl/joint). Knee edema, spontaneous flinching, vertical rearing and horizontal exploratory activity were assessed at different days. Additionally, counts of peripheral leukocytes and body weight were measured to evaluate general health status. Intra-articular treatment with anti-CSF-1R antibody significantly increased horizontal exploratory activity and vertical rearing as well as reduced spontaneous flinching behavior and knee edema as compared to CFA-induced arthritis mice treated with PBS. Treatment with this antibody neither significantly affect mouse body weight nor the number of peripheral leukocytes. These results suggest that blockade of CSF-1R at the initial injury site (joint) could represent a therapeutic alternative for improving the functional disabilities and attenuating pain and inflammation in patients with RA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Intra-oral pressure-based voicing control of electrolaryngeal speech with intra-oral vibrator.

Science.gov (United States)

Takahashi, Hirokazu; Nakao, Masayuki; Kikuchi, Yataro; Kaga, Kimitaka

2008-07-01

In normal speech, coordinated activities of intrinsic laryngeal muscles suspend a glottal sound at utterance of voiceless consonants, automatically realizing a voicing control. In electrolaryngeal speech, however, the lack of voicing control is one of the causes of unclear voice, voiceless consonants tending to be misheard as the corresponding voiced consonants. In the present work, we developed an intra-oral vibrator with an intra-oral pressure sensor that detected utterance of voiceless phonemes during the intra-oral electrolaryngeal speech, and demonstrated that an intra-oral pressure-based voicing control could improve the intelligibility of the speech. The test voices were obtained from one electrolaryngeal speaker and one normal speaker. We first investigated on the speech analysis software how a voice onset time (VOT) and first formant (F1) transition of the test consonant-vowel syllables contributed to voiceless/voiced contrasts, and developed an adequate voicing control strategy. We then compared the intelligibility of consonant-vowel syllables among the intra-oral electrolaryngeal speech with and without online voicing control. The increase of intra-oral pressure, typically with a peak ranging from 10 to 50 gf/cm2, could reliably identify utterance of voiceless consonants. The speech analysis and intelligibility test then demonstrated that a short VOT caused the misidentification of the voiced consonants due to a clear F1 transition. Finally, taking these results together, the online voicing control, which suspended the prosthetic tone while the intra-oral pressure exceeded 2.5 gf/cm2 and during the 35 milliseconds that followed, proved efficient to improve the voiceless/voiced contrast.

[Cutaneous atrophy and hypopigmentation secondary to intra-articular corticosteroid injection].

Science.gov (United States)

Loarte Pasquel, E P; Cabal García, A A

2014-04-01

Epicondylitis is the most common disease of the elbow. It is a tendinitis caused, in most cases, by repetitive motion of the forearm extensor muscles, and belongs to the group of occupational diseases that are related to work activity or sport. Intra-articular injections of glucocorticoids are often used by dermatologists, rheumatologists, orthopaedic surgeons, and primary care due to their ease of administration. However, this procedure has potential side effects. There are a limited number of case reports describing atrophy and hypopigmentation of the skin as a side effect. The general indications for glucocorticoid injections are monofocal and multifocal inflammatory disease, multifocal articular or soft tissue disease. It is more often used in more severe monofocal or multifocal inflammation, failure of drug treatment and/or rehabilitatory when other treatments are contraindicated. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

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Juan, Hsu-Cheng; Chou, Yii-Her [Kaohsiung Medical University Hospital, Department of Urology, Kaohsiung (China); Lin, Hung-Yu [Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung (China); E-Da Hospital/ I-Shou University, Department of Urology, Kaohsiung (China); Yang, Yi-Hsin [Kaohsiung Medical University, Institute of Oral Health Sciences, Kaohsiung (China); Shih, Paul Ming-Chen [Kaohsiung Municipal Hsiao-Kang Hospital, Department of Radiology, Kaohsiung (China); Kaohsiung Medical University, Department of Radiology, Kaohsiung (China); Chuang, Shu-Mien [Yuh-Ing Junior College of Health Care and Management, Kaohsiung (China); Shen, Jung-Tsung [Kaohsiung Municipal Hsiao-Kang Hospital, Department of Urology, Kaohsiung (China); Juan, Yung-Shun [Kaohsiung Medical University Hospital, Department of Urology, Kaohsiung (China); Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung (China); Kaohsiung Medical University, Department of Urology, Faculty of Medicine, Kaohsiung (China)

2012-08-15

To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. (orig.)

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

International Nuclear Information System (INIS)

Juan, Hsu-Cheng; Chou, Yii-Her; Lin, Hung-Yu; Yang, Yi-Hsin; Shih, Paul Ming-Chen; Chuang, Shu-Mien; Shen, Jung-Tsung; Juan, Yung-Shun

2012-01-01

To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. (orig.)

Tuberculous abdominal abscess in an HIV-infected man: Neither infection previously diagnosed

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Kuo-Yao Kao

2010-11-01

Full Text Available A 38-year-old man had a 1-week history of right lower quadrant abdominal pain; the initial impression was that he had diverticulitis of the ascending colon with an intra-abdominal abscess. Signs of peritonitis mandated an immediate right hemicolectomy. The unusual location of the abscess and the patient’s unusual postoperative course suggested that he might also have a systemic disease. Testing for HIV infection was positive. After 2 weeks in hospital, he was treated as an outpatient for both tuberculosis and HIV with a favourable outcome. In Taiwan a pre-operative HIV test is not performed routinely, and the HIV seroprevalence in surgical patient populations is unknown. Surgeons should keep the possibility of HIV infection in mind in a patient with an unusual clinical course.

Abdominal pregnancy - Case presentation.

Science.gov (United States)

Bohiltea, R; Radoi, V; Tufan, C; Horhoianu, I A; Bohiltea, C

2015-01-01

Abdominal pregnancy, a rare diagnosis, belongs to the ectopic pregnancy group, the leading cause of pregnancy related exitus. The positive diagnosis is very difficult to establish most often in an acute setting, leading to a staggering percent of feto-maternal morbidity and mortality. We present the case of 26-weeks-old abdominal pregnancy with partial feto-placental detachment in a patient, after hysteroscopy and in vitro fertilization, which until the acute symptoms that led to emergency laparotomy went unrecognized. The patient recovered completely and satisfactorily after surgery and, due to the high risk of uterine rupture with regard to a second pregnancy, opted for a surrogate mother. Abdominal pregnancy can be regarded as a difficult to establish diagnosis, with a greater chance in case of increased awareness. It is compulsory to be well informed in order not to be surprised by the diagnosis and to apply the correct treatment immediately as the morbidity and mortality rate is elevated.

Lactoferrin: Balancing Ups and Downs of Inflammation Due to Microbial Infections

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Maria Elisa Drago-Serrano

2017-03-01

Full Text Available Lactoferrin (Lf is a glycoprotein of the primary innate immune-defense system of mammals present in milk and other mucosal secretions. This protein of the transferrin family has broad antimicrobial properties by depriving pathogens from iron, or disrupting their plasma membranes through its highly cationic charge. Noteworthy, Lf also exhibits immunomodulatory activities performing up- and down-regulation of innate and adaptive immune cells, contributing to the homeostasis in mucosal surfaces exposed to myriad of microbial agents, such as the gastrointestinal and respiratory tracts. Although the inflammatory process is essential for the control of invasive infectious agents, the development of an exacerbated or chronic inflammation results in tissue damage with life-threatening consequences. In this review, we highlight recent findings in in vitro and in vivo models of the gut, lung, oral cavity, mammary gland, and liver infections that provide experimental evidence supporting the therapeutic role of human and bovine Lf in promoting some parameters of inflammation and protecting against the deleterious effects of bacterial, viral, fungal and protozoan-associated inflammation. Thus, this new knowledge of Lf immunomodulation paves the way to more effective design of treatments that include native or synthetic Lf derivatives, which may be useful to reduce immune-mediated tissue damage in infectious diseases.

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

International Nuclear Information System (INIS)

Marincek, B.

2002-01-01

Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

Energy Technology Data Exchange (ETDEWEB)

Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

2002-09-01

Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital.

Science.gov (United States)

Raka, Lul; Krasniqi, Avdyl; Hoxha, Faton; Musa, Ruustem; Mulliqi, Gjyle; Krasniqi, Selvete; Kurti, Arsim; Dervishaj, Antigona; Nuhiu, Beqir; Kelmendi, Baton; Limani, Dalip; Tolaj, Ilir

2008-01-01

Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p 2, use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.

Vestibular system paresis due to emergency endovascular catheterization

OpenAIRE

Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

2012-01-01

Summary Objective:?The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case:?Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing ...

The podoplanin-CLEC-2 axis inhibits inflammation in sepsis.

Science.gov (United States)

Rayes, Julie; Lax, Siân; Wichaiyo, Surasak; Watson, Stephanie K; Di, Ying; Lombard, Stephanie; Grygielska, Beata; Smith, Stuart W; Skordilis, Kassiani; Watson, Steve P

2017-12-21

Platelets play a critical role in vascular inflammation through the podoplanin and collagen/fibrin receptors, C-type-lectin-like-2 (CLEC-2) and glycoprotein VI (GPVI), respectively. Both receptors regulate endothelial permeability and prevent peri-vascular bleeding in inflammation. Here we show that platelet-specific deletion of CLEC-2 but not GPVI leads to enhanced systemic inflammation and accelerated organ injury in two mouse models of sepsis-intra-peritoneal lipopolysaccharide and cecal ligation and puncture. CLEC-2 deficiency is associated with reduced numbers of podoplanin-expressing macrophages despite increased cytokine and chemokine levels in the infected peritoneum. Pharmacological inhibition of the interaction between CLEC-2 and podoplanin regulates immune cell infiltration and the inflammatory reaction during sepsis, suggesting that activation of podoplanin underlies the anti-inflammatory action of platelet CLEC-2. We suggest podoplanin-CLEC-2 as a novel anti-inflammatory axis regulating immune cell recruitment and activation in sepsis.

Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes.

Science.gov (United States)

Han, Juyoung; Kim, So Hun; Suh, Young Ju; Lim, Hyun Ae; Shin, Heekyoung; Cho, Soon Gu; Kim, Chei Won; Lee, Seung Youn; Lee, Dae Hyung; Hong, Seongbin; Kim, Yong Seong; Nam, Moon-Suk

2016-06-01

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (β = 0.001, P abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.

Sepsis due to clostridium septicum: case report

International Nuclear Information System (INIS)

Foga, M.M.; McGinn, G.J.; Kroeker, M.A.; Guzman, R.

2000-01-01

Clostridium septicum is an unusual anaerobic, gram-positive, gas-producing bacillus, which has been identified as a cause of fulminant rapidly fatal infection in humans. Infection with C. septicum usually occurs in patients with cancer, patients receiving immunosuppressive chemotherapy, or patients with a nonmalignant hematological disorder such as hemolytic uremic syndrome. C. septicum infection most commonly involves the abdomen, and a recent review article has identified 164 cases in the medical literature describing the abdominal findings in this disease. Intracranial manifestation of C. septicum infection are less common and include meningitis, cerebritis, abscess formation and pneumocephalus. There have been only 12 documented cases in the English literature describing central nervous system lesions associated with C. septicum. We present a case report of a 56-year-old man in whom septicemia due to C. septicum developed as a complication of Crohn's disease. To our knowledge, there has never been a previous report of C. septicum sepsis related to underlying Crohn's disease. Our case is also remarkable in that an intracerebral gas collection developed at the site of a mycotic infarct related to C. septicum bacteremia, Intracranial, intraparenchymal gas formation related to anaerobic infection is extremely rare; to our knowledge, this radiological finding related to C. septicum sepsis has been described in only 1 previous case report in the medical literature. We also describe the intra-abdominal manifestations of C. septicum sepsis that occurred in this patient as well as the associated radiographic and pathologic findings. (author)

Intra-operative Ultrasound as a Tool to Assess Free Borders of Primary Vascular Aortic Tumors During Resection

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R.M. Andersen

Full Text Available : Introduction: Primary vascular tumors are rare and, in general, have a poor prognosis. Complete resection is associated with a better prognosis. Radical resection depends on safe discrimination of tumor borders. Technical summary: A 54 year old woman presented with abdominal pain. Imaging revealed a mass in the thoracic aorta, highly suspicious of angiosarcoma which was confirmed post-operatively by histological analysis. Open surgery was performed. Prior to clamping of the aorta, intra-operative ultrasound established clear delineation of the tumor borders. Conclusion: Intra-operative ultrasound was, in this case, a safe and easy method to determine the tumor borders, providing a simple guide to in toto tumor removal. Keywords: Angiosarcoma, Intra-operative ultrasound, In toto tumor removal, Fludeoxyglucose positron emission tomography/computed tomography, Magnetic resonance imaging

Tumor desmoplásico de pequenas células redondas abdominal da infância: relato de caso Abdominal desmoplastic small round cell tumor of childhood: case report

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Ulysses dos Santos Torres

2010-02-01

Full Text Available O tumor desmoplásico de pequenas células redondas (TDPCR é uma neoplasia rara e altamente agressiva, que afeta predominantemente jovens do sexo masculino. Relata-se um caso de TDPCR em um paciente do sexo masculino, de 11 anos, com acometimento intra-abdominal marcado por volumosa massa retroperitoneal em hipocôndrio esquerdo. O estudo histológico da massa revelou presença de blocos de pequenas células tumorais redondas e azuis, envoltas por estroma desmoplásico; a análise imuno-histoquímica evidenciou positividade para desmina, WT-1 e citoceratinas. Após o diagnóstico, o paciente foi submetido a tratamento quimiorradioterápico, tendo evoluído a óbito durante o 24º mês de acompanhamento.Desmoplastic small round cell tumor (DSRCT is a rare and highly aggressive neoplasm, which predominantly affects young males. We report a case of DSRCT affecting an 11-year-old male patient, with intra-abdominal involvement characterized by a large retroperitoneal mass in left hypochondrium. Histological examination of the mass showed the presence of clusters of small blue round tumor cells surrounded by a dense desmoplastic stroma. Immunohistochemical analysis disclosed a positive reaction to desmin, WT-1 and cytokeratins. After diagnosis, the patient underwent chemo radiotherapy treatment, but died at the 24th month of follow-up.

Nutrient-Induced Inflammation in Polycystic Ovary Syndrome: Role in the Development of Metabolic Aberration and Ovarian Dysfunction.

Science.gov (United States)

González, Frank

2015-07-01

A pathophysiology paradigm shift has emerged with the discovery that polycystic ovary syndrome (PCOS) is a proinflammatory state. Despite the dogma that the compensatory hyperinsulinemia of insulin resistance is the promoter of hyperandrogenism, physiological insulin infusion has no effect on androgen levels in PCOS. The dogma also does not explain the cause of hyperandrogenism and ovarian dysfunction in the 30 to 50% of women with PCOS who are of normal weight and lack insulin resistance. Inflammation is the underpinning of insulin resistance in obesity and type 2 diabetes, and may also be the cause of insulin resistance when present in PCOS. The origin of inflammation in PCOS has been ascribed to excess abdominal adiposity or frank obesity. However, nutrients such as glucose and saturated fat can incite inflammation from circulating mononuclear cells (MNC) of women with PCOS independent of excess adiposity and insulin resistance, and can also promote atherogenesis. Hyperandrogenism activates MNC in the fasting state to increase MNC sensitivity to nutrients, and is a potential mechanism for initiating inflammation in PCOS. However, chronic ovarian androgen suppression does not reduce inflammation in normal-weight women with PCOS. Direct exposure of ovarian theca cells to proinflammatory stimuli in vitro increases androgen production. These findings may be corroborated in vivo with anti-inflammatory therapy to normal-weight insulin-sensitive women with PCOS without abdominal adiposity to observe for amelioration of ovarian dysfunction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

INTRA graphical package - INTRA-Graph 1.0

International Nuclear Information System (INIS)

Hofman, D.; Edlund, O.

2001-04-01

INTRA-Graph 1.0 has been developed at Studsvik Eco and Safety AB in the frame of the European Fusion Technology Programme for application in the safety analysis using the INTRA code. INTRA-Graph 1.0 is a graphical package producing 2-dimensional plots of results generated by the INTRA code. INTRA-Graph 1.0 has been developed by extending the Grace package source code, distributed under the terms of GNU General Public License. The changes in the Grace source files are limited to provide easy updates of the INTRA-Graph when a new version of Grace will be released. The INTRA-related functionality has been implemented in new source files. The present report describes and gives complete listing of these files. The changes in the Grace source files are also described and the listing of the changed parts of the files is presented. The report gives detailed explanations and examples of files required for installation and configuration of INTRA-Graph on the different types of Unix workstations

Diagnostic Accuracy of Secondary Ultrasound Exam in Blunt Abdominal Trauma

International Nuclear Information System (INIS)

Rajabzadeh Kanafi, Alireza; Giti, Masoumeh; Gharavi, Mohammad Hossein; Alizadeh, Ahmad; Pourghorban, Ramin; Shekarchi, Babak

2014-01-01

In stable patients with blunt abdominal trauma, accurate diagnosis of visceral injuries is crucial. To determine whether repeating ultrasound exam will increase the sensitivity of focused abdominal sonography for trauma (FAST) through revealing additional free intraperitoneal fluid in patients with blunt abdominal trauma. We performed a prospective observational study by performing primary and secondary ultrasound exams in blunt abdominal trauma patients. All ultrasound exams were performed by four radiology residents who had the experience of more than 400 FAST exams. Five routine intraperitoneal spaces as well as the interloop space were examined by ultrasound in order to find free fluid. All patients who expired or were transferred to the operating room before the second exam were excluded from the study. All positive ultrasound results were compared with intra-operative and computed tomography (CT) findings and/or the clinical status of the patients. Primary ultrasound was performed in 372 patients; 61 of them did not undergo secondary ultrasound exam; thus, were excluded from the study.Three hundred eleven patients underwent both primary and secondary ultrasound exams. One hundred and two of all patients were evaluated by contrast enhanced CT scan and 31 underwent laparotomy. The sensitivity of ultrasound exam in detecting intraperitoneal fluid significantly increased from 70.7% for the primary exam to 92.7% for the secondary exam. Examining the interloop space significantly improved the sensitivity of ultrasonography in both primary (from 36.6% to 70.7%) and secondary (from 65.9% to 92.7%) exams. Performing a secondary ultrasound exam in stable blunt abdominal trauma patients and adding interloop space scan to the routine FAST exam significantly increases the sensitivity of ultrasound in detecting intraperitoneal free fluid

Intratracheal IL-6 protects against lung inflammation in direct, but not indirect, causes of acute lung injury in mice.

Science.gov (United States)

Bhargava, Rhea; Janssen, William; Altmann, Christopher; Andrés-Hernando, Ana; Okamura, Kayo; Vandivier, R William; Ahuja, Nilesh; Faubel, Sarah

2013-01-01

Serum and bronchoalveolar fluid IL-6 are increased in patients with acute respiratory distress syndrome (ARDS) and predict prolonged mechanical ventilation and poor outcomes, although the role of intra-alveolar IL-6 in indirect lung injury is unknown. We investigated the role of endogenous and exogenous intra-alveolar IL-6 in AKI-mediated lung injury (indirect lung injury), intraperitoneal (IP) endotoxin administration (indirect lung injury) and, for comparison, intratracheal (IT) endotoxin administration (direct lung injury) with the hypothesis that IL-6 would exert a pro-inflammatory effect in these causes of acute lung inflammation. Bronchoalveolar cytokines (IL-6, CXCL1, TNF-α, IL-1β, and IL-10), BAL fluid neutrophils, lung inflammation (lung cytokines, MPO activity [a biochemical marker of neutrophil infiltration]), and serum cytokines were determined in adult male C57Bl/6 mice with no intervention or 4 hours after ischemic AKI (22 minutes of renal pedicle clamping), IP endotoxin (10 µg), or IT endotoxin (80 µg) with and without intratracheal (IT) IL-6 (25 ng or 200 ng) treatment. Lung inflammation was similar after AKI, IP endotoxin, and IT endotoxin. BAL fluid IL-6 was markedly increased after IT endotoxin, and not increased after AKI or IP endotoxin. Unexpectedly, IT IL-6 exerted an anti-inflammatory effect in healthy mice characterized by reduced BAL fluid cytokines. IT IL-6 also exerted an anti-inflammatory effect in IT endotoxin characterized by reduced BAL fluid cytokines and lung inflammation; IT IL-6 had no effect on lung inflammation in AKI or IP endotoxin. IL-6 exerts an anti-inflammatory effect in direct lung injury from IT endotoxin, yet has no role in the pathogenesis or treatment of indirect lung injury from AKI or IP endotoxin. Since intra-alveolar inflammation is important in the pathogenesis of direct, but not indirect, causes of lung inflammation, IT anti-inflammatory treatments may have a role in direct, but not indirect, causes of ARDS.

Intratracheal IL-6 protects against lung inflammation in direct, but not indirect, causes of acute lung injury in mice.

Directory of Open Access Journals (Sweden)

Rhea Bhargava

Full Text Available Serum and bronchoalveolar fluid IL-6 are increased in patients with acute respiratory distress syndrome (ARDS and predict prolonged mechanical ventilation and poor outcomes, although the role of intra-alveolar IL-6 in indirect lung injury is unknown. We investigated the role of endogenous and exogenous intra-alveolar IL-6 in AKI-mediated lung injury (indirect lung injury, intraperitoneal (IP endotoxin administration (indirect lung injury and, for comparison, intratracheal (IT endotoxin administration (direct lung injury with the hypothesis that IL-6 would exert a pro-inflammatory effect in these causes of acute lung inflammation.Bronchoalveolar cytokines (IL-6, CXCL1, TNF-α, IL-1β, and IL-10, BAL fluid neutrophils, lung inflammation (lung cytokines, MPO activity [a biochemical marker of neutrophil infiltration], and serum cytokines were determined in adult male C57Bl/6 mice with no intervention or 4 hours after ischemic AKI (22 minutes of renal pedicle clamping, IP endotoxin (10 µg, or IT endotoxin (80 µg with and without intratracheal (IT IL-6 (25 ng or 200 ng treatment.Lung inflammation was similar after AKI, IP endotoxin, and IT endotoxin. BAL fluid IL-6 was markedly increased after IT endotoxin, and not increased after AKI or IP endotoxin. Unexpectedly, IT IL-6 exerted an anti-inflammatory effect in healthy mice characterized by reduced BAL fluid cytokines. IT IL-6 also exerted an anti-inflammatory effect in IT endotoxin characterized by reduced BAL fluid cytokines and lung inflammation; IT IL-6 had no effect on lung inflammation in AKI or IP endotoxin.IL-6 exerts an anti-inflammatory effect in direct lung injury from IT endotoxin, yet has no role in the pathogenesis or treatment of indirect lung injury from AKI or IP endotoxin. Since intra-alveolar inflammation is important in the pathogenesis of direct, but not indirect, causes of lung inflammation, IT anti-inflammatory treatments may have a role in direct, but not indirect, causes of

Deaths from abdominal trauma: analysis of 1888 forensic autopsies

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POLYANNA HELENA COELHO BORDONI

Full Text Available ABSTRACT Objective: to evaluate the epidemiological profile of deaths due to abdominal trauma at the Forensic Medicine Institute of Belo Horizonte, MG - Brazil. Methods: we conducted a retrospective study of the reports of deaths due to abdominal trauma autopsied from 2006 to 2011. Results: we analyzed 1.888 necropsy reports related to abdominal trauma. Penetrating trauma was more common than blunt one and gunshot wounds were more prevalent than stab wounds. Most of the individuals were male, brown-skinned, single and occupationally active. The median age was 34 years. The abdominal organs most injured in the penetrating trauma were the liver and the intestines, and in blunt trauma, the liver and the spleen. Homicide was the most prevalent circumstance of death, followed by traffic accidents, and almost half of the cases were referred to the Forensic Medicine Institute by a health unit. The blood alcohol test was positive in a third of the necropsies where it was performed. Cocaine and marijuana were the most commonly found substances in toxicology studies. Conclusion: in this sample. there was a predominance of penetrating abdominal trauma in young, brown and single men, the liver being the most injured organ.

Deletion of the NR4A nuclear receptor NOR1 in hematopoietic stem cells reduces inflammation but not abdominal aortic aneurysm formation.

Science.gov (United States)

Qing, Hua; Jones, Karrie L; Heywood, Elizabeth B; Lu, Hong; Daugherty, Alan; Bruemmer, Dennis

2017-10-18

The NR4A3 orphan nuclear hormone receptor, NOR1, functions as a constitutively active transcription factor to regulate inflammation, proliferation, and cell survival during pathological vascular remodeling. Inflammatory processes represent key mechanisms leading to abdominal aortic aneurysm (AAA) formation. However, a role of NOR1 in AAA formation has not been investigated previously. Inflammatory gene expression was analyzed in bone marrow-derived macrophages isolated from NOR1-deficient mice. Low-density lipoprotein receptor-deficient (LDLr -/- ) mice were irradiated and reconstituted with hematopoietic stem cells obtained from NOR1-/- or wild-type littermate mice. Animals were infused with angiotensin II and fed a diet enriched in saturated fat to induce AAA formation. Quantification of AAA formation was performed by ultrasound and ex vivo measurements. Among 184 inflammatory genes that were analyzed, 36 genes were differentially regulated in LPS-treated NOR1-deficient macrophages. Albeit this difference in gene regulation, NOR1-deficiency in hematopoietic stem cells did not affect development of AAA formation in bone marrow-derived stem cell transplanted LDLr-deficient mice. NOR1 deletion induced differential inflammatory gene transcription in macrophages but did not influence AAA formation in mice.

Bilateral adrenal haemorrhage secondary to intra-abdominal sepsis: a case report.

LENUS (Irish Health Repository)

Egan, Aoife M

2012-01-31

INTRODUCTION: Bilateral adrenal haemorrhage is a rare cause of adrenal failure. Clinical features are non-specific and therefore a high index of suspicion must be maintained in patients at risk. Predisposing factors include infection, malignancy and the post-operative state. CASE PRESENTATION: We report the case of a patient who underwent a left hemicolectomy with primary anastomosis and formation of a defunctioning loop ileostomy for an obstructing colon carcinoma at the splenic flexure. En-bloc splenectomy was performed to ensure an oncologic resection. The patient developed a purulent abdominal collection post-operatively and became septic with hypotension and pyrexia. This precipitated acute bilateral adrenal haemorrhage with consequent adrenal insufficiency. Clinical suspicion was confirmed by radiological findings and a co-syntropin test. Following drainage of the collection, antibiotic therapy and corticosteroid replacement, the patient made an excellent recovery. CONCLUSION: This case highlights the importance of prompt diagnosis and treatment of adrenal failure. In their absence, this condition can rapidly lead to death of the patient.

Balancing renewable on intra day electricity markets

International Nuclear Information System (INIS)

Sokol, R.; Bems, J.

2012-01-01

Intra day electricity markets contribute to facilitate transition from conventional sources to renewable which need to be balanced on real-time basic due to the unpredictable nature of weather. This paper describes the way from regional electricity markets to a single pan-european market model which is target model of the European Commission. Single liquid intra day electricity market where market participants can balance their portfolios is prerequisite to a full utilisation of renewable power sources and a solution for some problems experienced by TSOs with loop and parallel flows from neighbouring countries. Integrated German and French intra day electricity market which uses Flexible Intra day Trading Scheme is described in this paper as a market which could be extended further to the CEE region with very poor liquidity of its local intra day markets. (Authors)

Lornoxicam Side Effects May Lead to Surgical Mismanagement, in Case of Postoperative Intra-Abdominal Collection: A Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Mohammad Bukhetan Alharbi

2015-01-01

Full Text Available Postoperative collection is a known complication of abdominal surgery, especially after major surgery; however, minor surgical procedures may also be associated with this phenomenon. Utilization of nonsteroidal anti-inflammatory drugs, such as lornoxicam, and the adverse effects thereof, may affect the surgeon’s judgment regarding the need for, and extent of, draining of these collections. Here I report the case of a 25-year-old male who presented with perforated acute retrocaecal subhepatic appendicitis complicated by pleural effusion and a small abdominal collection. The pleural effusion resolved almost completely over time. However, the patient showed incomplete recovery, as demonstrated by nausea, vomiting, and mood disturbance along with abdominal pain, tachycardia, and a persistent small abdominal collection. We initially suspected infection caused by a highly virulent type of bacteria and planned to perform percutaneous drainage. However, owing to skin erythematic changes, administration of lornoxicam was ceased, which resulted in complete recovery of the symptoms and consequently in avoidance of unnecessary invasive intervention to drain the abdominal collection. These findings suggest that the utilization and adverse effects of some painkillers for postoperative pain, such as lornoxicam, may affect the surgeon’s judgment regarding the most appropriate surgical workup in cases of postoperative fluid collection.

Prevention of Trauma/Hemorrhagic Shock-Induced Mortality, Apoptosis, Inflammation and Mitochondrial Dysfunction

Science.gov (United States)

2015-02-01

a new class of signal transducer and activator of transcription 3 inhibitors that suppresses growth of prostate and breast tumors through induction...trauma deaths in the US in 2005, more Americans died of in- juries than from cancers of the breast , colon, prostate, liver and pancreas combined.3...Pneumonia 11 Intra-abdominal abscess 9 Bacteremia and sepsis 5 Urinary tract infection 4 Wound infection 4 Other (empyema) 1nucleosome levels in

Associations of maximal voluntary isometric hip extension torque with muscle size of hamstring and gluteus maximus and intra-abdominal pressure.

Science.gov (United States)

Tayashiki, Kota; Hirata, Kosuke; Ishida, Kiraku; Kanehisa, Hiroaki; Miyamoto, Naokazu

2017-06-01

Muscle size of the hamstring and gluteus maximus (GM) as well as intra-abdominal pressure (IAP) are considered as factors affecting the torque development during hip extension. This study examined the associations of torque development during maximal voluntary isometric hip extension with IAP and muscle size of the hamstring and GM. Anatomical cross-sectional area (ACSA) of the hamstring and thickness of GM were determined in 20 healthy young males using an ultrasonography apparatus (Experiment 1). Torque and IAP were simultaneously measured while subjects performed maximal voluntary isometric hip extension. The IAP was measured using a pressure transducer placed in the rectum and determined at the time at which the developed torque reached to the maximal. In Experiment 2, torque and IAP were measured during maximal voluntary isometric hip flexion in 18 healthy young males. The maximal hip extension torque was significantly correlated with the IAP (r = 0.504, P = 0.024), not with the ACSA of the hamstring (r = 0.307, P = 0.188) or the thickness of GM (r = 0.405, P = 0.076). The relationship was still significant even when the ACSA of the hamstring and the thickness of GM were adjusted statistically (r = 0.486, P = 0.041). The maximal hip flexion torque was not significantly correlated with the IAP (r = -0.118, P = 0.642). The current results suggest that IAP can contribute independently of the muscle size of the agonists to maximal voluntary hip extension torque.

Automated segmentation and recognition of abdominal wall muscles in X-ray torso CT images and its application in abdominal CAD

International Nuclear Information System (INIS)

Zhou, X.; Kamiya, N.; Hara, T.; Fujita, H.; Chen, H.; Yokoyama, R.; Hoshi, H.

2007-01-01

The information of abdominal wall is very important for the planning of surgical operation and abdominal organ recognition. In research fields of computer assisted radiology and surgery and computer-aided diagnosis, the segmentation and recognition of the abdominal wall muscles in CT images is a necessary pre-processing step. Due to the complexity of the abdominal wall structure and indistinctive in CT images, the automated segmentation of abdominal wall muscles is a difficult issue and has not been solved completely. We propose an approach to segment the abdominal wall muscles and divide it into three categories (front abdominal muscles including rectus abdominis; left and right side abdominal muscles including external oblique, internal oblique and transversus abdominis muscles) automatically. The approach, first, makes an initial classification of bone, fat, and muscles and organs based on the CT number. Then a layer structure is generated to describe the 3-D anatomical structures of human torso by stretching the torso region onto a thin-plate for easy recognition. The abdominal wall muscles are recognized on the layer structures using the spatial relations to the skeletal structure and CT numbers. Finally, the recognized regions are mapped back to the 3-D CT images using an inverse transformation of the stretching process. This method is applied to 20 cases of torso CT images and evaluations are based on visual comparison of the recognition results and the original CT images by an expert in anatomy. The results show that our approach can segment and recognize abdominal wall muscle regions effectively. (orig.)

Chronic abdominal wall pain misdiagnosed as functional abdominal pain.

Science.gov (United States)

van Assen, Tijmen; de Jager-Kievit, Jenneke W A J; Scheltinga, Marc R; Roumen, Rudi M H

2013-01-01

The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected. A total of 535 patients ≥18 years old who were registered with a functional abdominal pain diagnosis were approached when they were symptomatic to complete the questionnaire (maximum 18 points). Responders who scored at least the 10-point cutoff value (sensitivity, 0.94; specificity, 0.92) underwent a diagnostic evaluation to establish their final diagnosis. The main outcome was the presence and prevalence of ACNES in a group of symptomatic patients diagnosed with functional abdominal pain. Of 535 patients, 304 (57%) responded; 167 subjects (31%) recently reporting symptoms completed the questionnaire. Of 23 patients who scored above the 10-point cutoff value, 18 were available for a diagnostic evaluation. In half of these subjects (n = 9) functional abdominal pain (including IBS) was confirmed. However, the other 9 patients were suffering from abdominal wall pain syndrome, 6 of whom were diagnosed with ACNES (3.6% prevalence rate of symptomatic subjects; 95% confidence interval, 1.7-7.6), whereas the remaining 3 harbored a painful lipoma, an abdominal herniation, and a painful scar. A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.

Abdominal wall hernias: imaging with spiral CT

International Nuclear Information System (INIS)

Stabile Ianora, A.A.; Midiri, M.; Vinci, R.; Rotondo, A.; Angelelli, G.

2000-01-01

Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other diseases such as hematomas, abscesses and neoplasia. In this study we examined the CT images of 94 patients affected by abdominal wall hernias observed over a period of 6 years. Computed tomography clearly demonstrates the anatomical site of the hernial sac, the content and any occlusive bowel complications due to incarceration or strangulation. Clinical diagnosis of external hernias is particularly difficult in obese patients or in those with laparotic scars. In these cases abdominal imaging is essential for a correct preoperative diagnosis and to determine the most effective treatment. (orig.)

Dietary sodium, adiposity, and inflammation in healthy adolescents.

Science.gov (United States)

Zhu, Haidong; Pollock, Norman K; Kotak, Ishita; Gutin, Bernard; Wang, Xiaoling; Bhagatwala, Jigar; Parikh, Samip; Harshfield, Gregory A; Dong, Yanbin

2014-03-01

To determine the relationships of sodium intake with adiposity and inflammation in healthy adolescents. A cross-sectional study involved 766 healthy white and African American adolescents aged 14 to 18 years. Dietary sodium intake was estimated by 7-day 24-hour dietary recall. Percent body fat was measured by dual-energy x-ray absorptiometry. Subcutaneous abdominal adipose tissue and visceral adipose tissue were assessed using magnetic resonance imaging. Fasting blood samples were measured for leptin, adiponectin, C-reactive protein, tumor necrosis factor-α, and intercellular adhesion molecule-1. The average sodium intake was 3280 mg/day. Ninety-seven percent of our adolescents exceeded the American Heart Association recommendation for sodium intake. Multiple linear regressions revealed that dietary sodium intake was independently associated with body weight (β = 0.23), BMI (β = 0.23), waist circumference (β = 0.23), percent body fat (β = 0.17), fat mass (β = 0.23), subcutaneous abdominal adipose tissue (β = 0.25), leptin (β = 0.20), and tumor necrosis factor-α (β = 0.61; all Ps sodium intake and visceral adipose tissue, skinfold thickness, adiponectin, C-reactive protein, or intercellular adhesion molecule-1. All the significant associations persisted after correction for multiple testing (all false discovery rates sodium consumption of our adolescents is as high as that of adults and more than twice the daily intake recommended by the American Heart Association. High sodium intake is positively associated with adiposity and inflammation independent of total energy intake and sugar-sweetened soft drink consumption.

Hemoperitoneum due to ruptured paraumbilical vein in a cirrhotic patient with portal hypertension : treatment by means of coil embolization

International Nuclear Information System (INIS)

Lee, Jong Myeong; Kim, Hyung Lyul; Lee, Young Hwan; Lee, So Hyun; Kim, Jong Kun

2000-01-01

The paraumbilical vein is one of the anastomotic channels between the portal and systemic circulatory systems, and rupture of the intra-abdominal varix is an unusual complication of portal hypertension that can lead to life-threatening hemoperitoneum. We experienced a case of hemoperitoneum due to a ruptured paraumbilical vein revealed by ultrasonography (US), computed tomography (CT) and percutaneous transhepatic portography. The last mentioned demonstrated a dilated paraumbilical vein draining two branches of the left portal vein into the right external iliac vein, and we performed coil embolization at the site at which the presumed site of paraumbilical vein was presumed to cause hemoperitoneum. We describe this this unusual case of hemoperitoneum due to a ruptured paraumbilical vein in a known liver cirrhosis patient in whom portal hypertension was treated by means of coil embolization. (author)

VACUUM THERAPY VERSUS ABDOMINAL EXERCISES ON ABDOMINAL OBESITY

Directory of Open Access Journals (Sweden)

Nevein Mohammed Mohammed Gharib

2016-06-01

Full Text Available Background: Obesity is a medical condition that may adversely affect wellbeing and leading to increased incidence of many health problems. Abdominal obesity tends to be associated with weight gain and obesity and it is significantly connected with different disorders like coronary heart disease and type II diabetes mellitus.This study was conducted to investigate the efficacy of vacuum therapy as compared to abdominal exercises on abdominal obesity in overweight and obese women. Methods: Thirtyoverweight and obese women participated in this study with body mass index > 25 kg/m2andwaist circumference ≥ 85 cm. Their ages ranged from 28 - 40 years old.The subjects were excluded if they have diabetes, abdominal infection diseases or any physical limitation restricting exercise ability. They were randomly allocated into two equal groups; group I and group II. Group I received vacuum therapy sessions (by the use of LPG device in addition to aerobic exercise training. Group II received abdominal exercises in addition to the same aerobic exercisesgiven to group I. This study was extended for successive 8 weeks (3 sessions/ week. All subjects were assessed for thickness ofnthe abdominal skin fold, waist circumference and body mass index. Results: The results of this study showeda significant difference between group I and group II post-interventionas regarding to the mean values of waist circumference and abdominal skin fold thickness (p<0.05. Conclusion: It can be concluded that aerobic exercises combined with vacuum therapy (for three sessions/week for successive 8 weeks have a positive effect on women with abdominal obesity in terms of reducing waist circumference and abdominal skin fold thickness.

Pulmonary atelectasis in patients with neurological or muscular disease. Gravity-related lung compression by the heart and intra-abdominal organs on persistent supine position

International Nuclear Information System (INIS)

Toyoshima, Mitsuo; Maeoka, Yukinori; Kawahara, Hitoshi; Maegaki, Yoshihiro; Ohno, Kousaku

2006-01-01

We report 10 cases of pulmonary atelectasis diagnosed by chest computed tomography in patients with neurological or muscular disease. Atelectasis was frequently seen in hypotonic patients who could not roll over on their own. The atelectases located mostly in the dorsal bronchopulmonary segments, adjacent to the heart or diaphragm. Atelectasis diminished in two patients after they became able to roll themselves over. Gravity-related lung compression by the heart and intra-abdominal organs on persistent supine position can cause pulmonary atelectasis in patients with neurological or muscular disease who can not roll over by their own power. To confirm that the prone position reduces compression of the lungs, chest computed tomography was performed in both the supine and the prone position in three patients. Sagittal images with three-dimensional computed tomographic reconstruction revealed significant sternad displacements of the heart and caudal displacements of the dorsal portion of the diaphragm on prone position compared with supine position. The prone position, motor exercises for rolling over, and biphasic cuirass ventilation are effective in reducing gravity-related lung compression. Some patients with intellectual disabilities were also able to cooperate in chest physiotherapy. Chest physiotherapy is useful in preventing atelectasis in patients with neurological or muscular disease. (author)

Abdominal wall phlebitis due to Prevotella bivia following renal transplantation in a patient with an occluded inferior vena cava.

Science.gov (United States)

Janssen, S; van Donselaar-van der Pant, K A M I; van der Weerd, N C; Develter, W; Bemelman, F J; Grobusch, M P; Idu, M M; Ten Berge, I J M

2013-02-01

Pre-existing occlusion of the inferior vena cava may complicate renal transplantation. Suppurative abdominal wall phlebitis following renal transplantation was diagnosed in a patient with pre-existing thrombosis of the inferior vena cava of unknown cause. The phlebitis developed in the subcutaneous collateral veins of the abdominal wall contra-laterally to the renal transplant. Cultures from abdominal wall micro-abscesses yielded Prevotella bivia as the causative agent. This complication has not been described before in the context of renal transplantation. The pathogenesis and management of this serious complication are discussed in this paper.

Metastasectomy of Abdominal Wall Lesions due to Prostate Cancer Detected Through PET/CT Gallium 68-PMSA: First Case Report.

Science.gov (United States)

Ochoa, Claudia; Ramirez, Angie; Varela, Rodolfo; Godoy, Fabian; Vargas, Rafael; Forero, Jorge; Rojas, Andres; Roa, Carmen; Céspedes, Carlos; Ramos, Jose; Cabrera, Marino; Calderon, Andres

2017-05-01

Introducing the topic of abdominal wall metastasis secondary to prostate cancer with a reminder of the disease's rarity, being the first published case. This article is about a 66 year old patient diagnosed with prostate cancer [cT2aNxMx iPSA: 5,6 ng/ml Gleason 3+3, (Grade 1 Group)], treated with radical prostatectomy as well as accompanied with amplified pelvic lymphadenectomy, who subsequently presented metastatic lesions to the abdominal wall diagnosed with PET/CT Gallium 68-PMSA technique and treated with abdominal metastasectomy with adequate short term results.

Abdominal tuberculosis: clinical presentation and outcome

International Nuclear Information System (INIS)

Kumar, R.; Saddique, M.; Iqbal, P.

2007-01-01

To study the clinical presentation and outcome of cases of Abdominal Tuberculosis. Fifty four patients of Abdominal Tuberculosis were seen during the study period. Four patients were lost to follow-up, which were excluded. Detailed information of all the patients including age, sex, symptoms, signs, investigations and management was recorded, analyzed and compared with local and international data. Out of the 50 patients with Abdominal Tuberculosis, 31 were females and 19 males. Their ages ranged from 17 to 63 years, with a mean age of 25.1 years. Thirty five cases were admitted through Emergency and 15 through Outpatients departments. Abdominal pain was the most common symptom found in 44 (88%) patients followed by vomiting in 33 (66%). Abdominal tenderness was seen in 22 (44%) patients, while 16 (32%) patients had rigidity and other features of peritonitis. Surgery was performed in all these patients, limited right hemicolectomy in 17 (34%), segmental resection and anastomosis in 12 (24%), ileostomy and strictureplasty in six (12%) each, repair of perforation in five (10%) and adhesiolysis in four (8%) patients. Overall mortality was 8% due to septicaemia and multiorgan failure. Abdominal Tuberculosis is a significant clinical entity with lethal complications in neglected cases. It affects a younger age group and is more common in females. Clinical features are rather non-specific but vague ill health, low grade fever, weight loss and anorexia may help to diagnose the case. (author)

Imagery of the abdominal reticulo-histiocytary system [lymphatic nodes

International Nuclear Information System (INIS)

Ruel, Y.; Begon, D.

1996-01-01

Radiography and ultrasonography used together provide useful help in the clinical exploration of spleen and of abdominal lymphatic node abnormalities. These organs are difficult to examine by other techniques. Examination by radiography and ultrasonography often allows the abnormality to be localized and described, to visualize its spread and to observe its extension to other organs. Although these examinations do not allow this aspect they are invaluable in effective diagnosis. The information provided by these studies should avoid some exploratory laparotomies, to prepare for future surgical operations, to help in the prognostic (observation of metastasis,..), even to complete direct visual pre-operation examination (intra-hepatic metastasis)

Evaluation of polynomial image deformation for matching of 3D- abdominal MR-images using anatomical landmarks and for atlas construction

CERN Document Server

Kimiaei, S; Jonsson, E; Crafoord, J; Maguire, G Q

1999-01-01

The aim of this study is to compare and evaluate the potential usability of linear and non-linear (polynomial) 3D-warping for constructing an atlas by matching abdominal MR-images from a number of different individuals using manually picked anatomical landmarks. The significance of this study lies in the fact that it illustrates the potential to use polynomial matching at a local or organ level. This is a necessary requirement for constructing an atlas and for fine intra-patient image matching and fusion. Finally 3D-image warping using anatomical landmark for inter-patient intra-modality image co-registration and fusion was found to be a very powerful and robust method. Additionally it can be used for intra-patient inter- modality image matching.

Two similar cases of elderly women with moderate abdominal pain and pneumoperitoneum of unknown origin: a surgeon's successful conservative management.