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Sample records for abdominal wall caused

  1. Necrotizing Fasciitis of the Abdominal Wall Caused by Serratia Marcescens.

    PubMed

    Lakhani, Naheed A; Narsinghani, Umesh; Kumar, Ritu

    2015-04-15

    In this article, we present the first case of necrotizing fasciitis affecting the abdominal wall caused by Serratia marcescens and share results of a focused review of S. marcescens induced necrotizing fasciitis. Our patient underwent aorto-femoral bypass grafting for advanced peripheral vascular disease and presented 3 weeks postoperatively with pain, erythema and discharge from the incision site in the left lower abdominal wall and underwent multiple debridement of the affected area. Pathology of debrided tissue indicated extensive necrosis involving the adipose tissue, fascia and skeletal muscle. Wound cultures were positive for Serratia marcescens. She was successfully treated with antibiotics and multiple surgical debridements. Since necrotizing fasciitis is a medical and surgical emergency, it is critical to examine infectivity trends, clinical characteristics in its causative spectrum. Using PubMed we found 17 published cases of necrotizing fasciitis caused by Serratia marcescens, and then analyzed patterns among those cases. Serratia marcescens is prominent in the community and hospital settings, and information on infection presentations, risk factors, characteristics, treatment, course, and complications as provided through this study can help identify cases earlier and mitigate poor outcomes. Patients with positive blood cultures and those patients where surgical intervention was not provided or delayed had a higher mortality. Surgical intervention is a definite way to establish the diagnosis of necrotizing infection and differentiate it from other entities.

  2. Spontaneous abscesses of the abdominal wall, omentum and abdominal cavity caused by group G streptococci: a case report.

    PubMed

    De Brabandere, K; Vanpaemel, G; Verheyen, L

    2008-01-01

    We report the first case, to our knowledge, of spontaneous abscess of the abdominal wall, omentum and abdominal cavity caused by group G streptococci. A 52-year-old diabetic woman presented with abdominal tenderness and weight loss that had persisted for a few weeks. CT scan showed several abscesses of the abdominal wall, omentum and abdominal cavity. The abscesses were drained laparoscopically and antibiotics were given postoperatively. Biopsies and cultures showed group G streptococci. The patient recovered without any complication and left our hospital on the 17th postoperative day.

  3. Primary Liver Abscess with Anterior Abdominal Wall Extension Caused by Mycobacterium tuberculosis Complex

    PubMed Central

    Kandekar, Rahul Vilas; Tiwari, Ajeet Ramamani; Kadam, Rahul; Adhikari, Devbrata Radhikamohan

    2016-01-01

    Tubercular liver abscess is generally secondary to some other primary foci in the body, most notably pulmonary and gastrointestinal system. To find primary tubercular liver abscess is rare, with prevalence of 0.34% in patients with hepatic tuberculosis. Abscess tracking into abdominal wall from spinal and para spinal tuberculosis is known, however primary liver tuberculosis rupturing into anterior abdominal wall has been reported only twice in literature. We report a case of 43-year-old female with direct invasion of the anterior abdominal wall from an isolated tubercular parenchymal liver abscess, caused by Mycobacterium tuberculosis complex, diagnosed primarily on smear for Acid Fast Bacilli (AFB), imaging and isolated by culture and BACTEC MGIT 960 KIT. We discuss here the diagnostic dilemma, management and outcome of primary tubercular liver parenchymal abscess with direct invasion into anterior abdominal wall. PMID:28050433

  4. Necrotizing cellulitis of the abdominal wall, caused by Pediococcus sp., due to rupture of a retroperitoneal stromal cell tumor

    PubMed Central

    Michalopoulos, Nick; Arampatzi, Stergiani; Papavramidis, Theodossis S.; Kotidis, Efstathios; Laskou, Styliani; Papavramidis, Spiros T.

    2013-01-01

    INTRODUCTION Soft tissue necrotizing infections are a significant cause of morbidity and mortality. The aim of this study is to present a patient with necrotizing infection of abdominal wall resulting from the rupture of a retroperitoneal stromal tumor. PRESENTATION OF CASE We present a 60-year-old Caucasian male patient with necrotizing infection of abdominal wall secondary to the rupture of a retroperitoneal stromal tumor. The patient was initially treated with debridement and fasciotomy of the anterior abdominal wall. Laparotomy revealed purulent peritonitis caused by infiltration and rupture of the splenic flexure by the tumor. Despite prompt intervention the patient died 19 days later. The isolated microorganism causing the infection was the rarely identified as cause of infections in humans Pediococcus sp., a gram-positive, catalase-negative coccus. DISCUSSION Necrotizing infections of abdominal wall are usually secondary either to perineal or to intra-abdominal infections. Gastrointestinal stromal cell tumors could be rarely complicated with perforation and abscess formation. In our case, the infiltrated by the extra-gastrointestinal stromal cell tumor ruptured colon was the source of the infection. The pediococci are rarely isolated as the cause of severe septicemia. CONCLUSION Ruptured retroperitoneal stromal cell tumors are extremely rare cause of necrotizing fasciitis, and before this case, Pediococcus sp. has never been isolated as the responsible agent. PMID:23357010

  5. Lateral Abdominal Wall Reconstruction

    PubMed Central

    Baumann, Donald P.; Butler, Charles E.

    2012-01-01

    Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage. PMID:23372458

  6. Delay in diagnosis and lessons learnt from a case of abdominal wall abscess caused by fishbone perforation.

    PubMed

    Hakeem, A; Shanmugam, V; Badrinath, K; Dube, M; Panto, P

    2015-04-01

    Complications following foreign body (FB) ingestion are an uncommon clinical problem. A 59-year-old man presented with a 4-week history of left iliac fossa pain and 1 episode of dark red blood mixed with stools. Inflammatory markers were elevated, and computed tomography (CT) of the abdomen and pelvis showed an ill defined abdominal wall inflammatory collection in close contact with the small bowel loops. He was treated with antibiotics, and follow-up CT, colonoscopy and small bowel enema were mostly unremarkable. The patient presented again ten months later with left iliac fossa cellulitis and fever. Multiplanar CT (the patient's fourth scan) demonstrated a 10cm abdominal wall collection with a linear hyperdense structure in the collection. The radiologists suspected a FB and on close scrutiny of the previous scans, they noted it to have been present on all of them. A targeted incision led to the removal of a 3cm fishbone from the collection. This case highlights the need to consider the possibility of a FB being the underlying cause in any unexplained intra-abdominal or abdominal wall inflammatory process so that the diagnosis is made in a timely manner.

  7. Economics of abdominal wall reconstruction.

    PubMed

    Bower, Curtis; Roth, J Scott

    2013-10-01

    The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias.

  8. Abdominal wall surgery

    MedlinePlus

    ... the results of abdominoplasty. Many feel a new sense of self-confidence. Alternative Names Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty Images Abdominoplasty - series Abdominal muscles References McGrath MH, Pomerantz J. Plastic surgery. In: Townsend ...

  9. Recovery after abdominal wall reconstruction.

    PubMed

    Jensen, Kristian Kiim

    2017-03-01

    Incisional hernia is a common long-term complication to abdominal surgery, occurring in more than 20% of all patients. Some of these hernias become giant and affect patients in several ways. This patient group often experiences pain, decreased perceived body image, and loss of physical function, which results in a need for surgical repair of the giant hernia, known as abdominal wall reconstruction. In the current thesis, patients with a giant hernia were examined to achieve a better understanding of their physical and psychological function before and after abdominal wall reconstruction. Study I was a systematic review of the existing standardized methods for assessing quality of life after incisional hernia repair. After a systematic search in the electronic databases Embase and PubMed, a total of 26 studies using standardized measures for assessment of quality of life after incisional hernia repair were found. The most commonly used questionnaire was the generic Short-Form 36, which assesses overall health-related quality of life, addressing both physical and mental health. The second-most common questionnaire was the Carolinas Comfort Scale, which is a disease specific questionnaire addressing pain, movement limitation and mesh sensation in relation to a current or previous hernia. In total, eight different questionnaires were used at varying time points in the 26 studies. In conclusion, standardization of timing and method of quality of life assessment after incisional hernia repair was lacking. Study II was a case-control study of the effects of an enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction for a giant hernia. Sixteen consecutive patients were included prospectively after the implementation of a new enhanced recovery after surgery pathway at the Digestive Disease Center, Bispebjerg Hospital, and compared to a control group of 16 patients included retrospectively in the period immediately prior to the

  10. Blunt traumatic abdominal wall disruption with evisceration

    PubMed Central

    McDaniel, Ellen; Stawicki, Stanislaw PA; Bahner, David P

    2011-01-01

    Blunt traumatic abdominal wall disruptions associated with evisceration are very rare. The authors describe a case of traumatic abdominal wall disruption with bowel evisceration that occurred after a middle-aged woman sustained direct focal blunt force impact to the lower abdomen. Abdominal exploration and surgical repair of the abdominal wall defect were performed, with good clinical outcome. A brief overview of literature pertinent to this rare trauma scenario is presented. PMID:22229144

  11. Remote revascularization of abdominal wall transplants using the forearm.

    PubMed

    Giele, H; Bendon, C; Reddy, S; Ramcharan, R; Sinha, S; Friend, P; Vaidya, A

    2014-06-01

    Primary abdominal wall closure following small bowel transplantation is frequently impossible due to contraction of the abdominal domain. Although abdominal wall transplantation was reported 10 years ago this, technique has not been widely adopted, partly due to its complexity, but largely because of concerns that storing the abdominal allograft until the end of a prolonged intestinal transplant procedure would cause severe ischemia-reperfusion injury. We report six cases of combined small bowel and abdominal wall transplantation where the ischemic time was minimized by remotely revascularizing the abdominal wall on the forearm vessels, synchronous to the intestinal procedure. When the visceral transplant was complete, the abdominal wall was removed from the forearm and revascularized on the abdomen (n = 4), or used to close the abdomen while still vascularized on the forearm (n = 2). Primary abdominal wall closure was achieved in all. Mean cold ischemia was 305 min (300-330 min), and revascularization on the arm was 50 min (30-60 min). Three patients had proven abdominal wall rejection, all treated successfully. Immediate revascularization of the abdominal wall allograft substantially reduces cold ischemia without imposing constraints on the intestinal transplant. Reducing storage time may also have benefits with respect to ischemia-reperfusion-related graft immunogenicity.

  12. Pulmonary complications of abdominal wall defects.

    PubMed

    Panitch, Howard B

    2015-01-01

    The abdominal wall is an integral component of the chest wall. Defects in the ventral abdominal wall alter respiratory mechanics and can impair diaphragm function. Congenital abdominal wall defects also are associated with abnormalities in lung growth and development that lead to pulmonary hypoplasia, pulmonary hypertension, and alterations in thoracic cage formation. Although infants with ventral abdominal wall defects can experience life-threatening pulmonary complications, older children typically experience a more benign respiratory course. Studies of lung and chest wall function in older children and adolescents with congenital abdominal wall defects are few; such investigations could provide strategies for improved respiratory performance, avoidance of respiratory morbidity, and enhanced exercise ability for these children.

  13. Soft tissue coverage in abdominal wall reconstruction.

    PubMed

    Baumann, Donald P; Butler, Charles E

    2013-10-01

    Abdominal wall defects requiring soft tissue coverage can be either partial-thickness defects or full-thickness composite defects. Soft tissue flap reconstruction offers significant advantages in defects that cannot be closed primarily. Flap reconstruction is performed in a single-stage procedure obviating chronic wound management. If the defect size exceeds the availability of local soft tissue for coverage, regional pedicled flaps can be delivered into the abdominal wall while maintaining blood supply from their donor site. Microsurgical free tissue transfer increases the capacity to provide soft tissue coverage for abdominal wall defects that are not amenable to either local or regional flap coverage.

  14. Reconstruction of complex abdominal wall defects.

    PubMed

    Leppäniemi, A; Tukiainen, E

    2013-01-01

    Complex abdominal wall defects refer to situations where simple ventral hernia repair is not feasible because the defect is very large, there is a concomitant infection or failed previous re-pair attempt, or if there is not enough original skin to cover the repair. Usually a complex abdominal wall repair is preceded by a period of temporary abdominal closure where the short-term aims include closure of the catabolic drain, protection of the viscera and preventing fistula formation, preventing bowel adherence to the abdominal wall, and enabling future fascial and skin closure. Currently the best way to achieve these goals is the vacuum- and mesh-mediated fascial traction method achieving close to 90% fascial closure rates. The long-term aims of an abdominal closure following a planned hernia strategy include intact skin cover, fascial closure at midline (if possible), good functional outcome with innervated abdominal musculature, no pain and good cosmetic result. The main methods of abdominal wall reconstruction include the use of prosthetic (mesh) or autologous material (tissue flaps). In patients with original skin cover over the fascial defect (simple ventral hernia), the most commonly used method is hernia repair with an artificial mesh. For more complex defects, our first choice of reconstruction is the component separation technique, sometimes combined with a mesh. In contaminated fields where component separation alone is not feasible, a combination with a biological mesh can be used. In large defects with grafted skin, a free TFL flap is the best option, sometimes reinforced with a mesh and enhanced with components separation.

  15. Synthetic, biological and composite scaffolds for abdominal wall reconstruction.

    PubMed

    Meintjes, Jennifer; Yan, Sheng; Zhou, Lin; Zheng, Shusen; Zheng, Minghao

    2011-03-01

    The reconstruction of abdominal wall defects remains a huge surgical challenge. Tension-free repair is proven to be superior to suture repair in abdominal wall reconstruction. Scaffolds are essential for tension-free repair. They are used to bridge a defect or reinforce the abdominal wall. A huge variety of scaffolds are now commercially available. Most of the synthetic scaffolds are composed of polypropylene. They provide strong tissue reinforcement, but cause a foreign body reaction, which can result in serious complications. Absorbable synthetic scaffolds, such as Dexon™ (polyglycolic acid) and Vicryl™ (polyglactin 910), are not suitable for abdominal wall reconstruction as they usually require subsequent surgeries to repair recurrent hernias. Composite scaffolds combine the strength of nonabsorbable synthetic scaffolds with the antiadhesive properties of the absorbable scaffold, but require long-term follow-up. Biological scaffolds, such as Permacol™, Surgisis(®) and Alloderm(®), are derived from acellular mammalian tissues. Non-cross-linked biological scaffolds show excellent biocompatibility and degrade slowly over time. However, remnant DNA has been found in several products and the degradation leads to recurrence. Randomized controlled trials with long-term follow-up studies are lacking for all of the available scaffolds, particularly those derived from animal tissue. This article provides an overview of the different types of scaffolds available, and presents the key clinical studies of the commercially available synthetic, composite and biological scaffolds for abdominal wall reconstruction.

  16. Genetics Home Reference: abdominal wall defect

    MedlinePlus

    ... Aug;6(4):232-6. Citation on PubMed Islam S. Clinical care outcomes in abdominal wall defects. Curr ... Site Map Customer Support Selection Criteria for Links USA.gov Copyright Privacy Accessibility FOIA Viewers & Players U.S. ...

  17. Mesh Sutured Repairs of Abdominal Wall Defects

    PubMed Central

    Lanier, Steven T.; Jordan, Sumanas W.; Miller, Kyle R.; Ali, Nada A.; Stock, Stuart R.

    2016-01-01

    Background: A new closure technique is introduced, which uses strips of macroporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes. Methods: Strips of macroporous polypropylene mesh of 2 cm width were passed through the abdominal wall and tied as simple interrupted sutures. The surgical technique and surgical outcomes are presented. Results: One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias. Conclusions: Mesh sutured repairs reliably appose tissue under tension using concepts of force distribution and resistance to suture pull-through. The technique reduces the amount of foreign material required in comparison to sheet meshes, and avoids the shortcomings of monofilament sutures. Mesh sutured closures seem to be tolerant of bacterial contamination with low hernia recurrence rates and have replaced our routine use of mesh sheets and bioprosthetic grafts. PMID:27757361

  18. Cytoreductive strategy for multiple intra-abdominal and abdominal wall desmoid tumors in familial adenomatous polyposis: report of three cases.

    PubMed

    Tanaka, Koji; Toiyama, Yuji; Okugawa, Yoshinaga; Hiro, Junichiro; Kawamoto, Aya; Inoue, Yasuhiro; Uchida, Keiichi; Araki, Toshimitsu; Mohri, Yasuhiko; Kusunoki, Masato

    2012-10-01

    Desmoid tumors (DTs) are benign myofibroblastic neoplasms originating from the fascia or muscle aponeurosis, which occur in one-third of patients with familial adenomatous polyposis (FAP). Most FAP-associated DTs occur in the intra-abdominal or abdominal wall region, thus, their infiltrative or expansive growth causes life-threatening organ damage, such as intestinal obstruction, urethral obstruction, and mesenteric infiltration with the involvement of mesenteric vessels. Treatments including surgical resection, cytotoxic chemotherapy, nonsteroidal anti-inflammatory drugs and anti-estrogen therapy have all been tried with variable success. Here, we report on three patients with FAP who developed multiple intra-abdominal and abdominal wall DTs after total proctocolectomy and ileal pouch-anal anastomosis. Two cases underwent surgical resection of uncontrolled abdominal wall DTs after successful control of intra-abdominal DTs by systemic chemotherapy. The remaining case underwent repeated surgical resections of multiple intra-abdominal and abdominal wall DTs, and consequently had recurrent intra-abdominal DTs, with involvement of the small bowel and ureter. Surgical intervention as tumor volume reduction (cytoreduction) may be useful for cases with medical treatment-refractory or symptomatic FAP-associated abdominal DTs.

  19. Abdominal Wall Haematoma Complicating Laparoscopic Cholecystectomy

    PubMed Central

    Tate, J. J. T.; Davidson, B. R.; Hobbs, K. E. F.

    1994-01-01

    Of 61 consecutive patients undergoing laparoscopic cholecystectomy, 4 (6.25%) developed abdominal wall haematomas. This complication of laparoscopic cholecystectomy may occur more commonly than existing literature suggests, and manifests in the post-operative period (days 2 to 6) by visible bruising, excessive pain or an asymptomatic drop in haematocrit. It is readily confirmed by ultrasonography. While no specific treatment is necessary apart from replacement of significant blood loss, the patient requires reassurance that this apparently alarming complication will rapidly resolve. PMID:8204548

  20. Isolated Abdominal Wall Metastasis of Endometrial Carcinoma

    PubMed Central

    Simões, Jorge; Gonçalves, Matilde; Matos, Isabel

    2014-01-01

    A woman in her mid-60s presented with a bulky mass on the anterior abdominal wall. She had a previous incidental diagnosis of endometrial adenocarcinoma FIGO stage IB following a vaginal hysterectomy. Physical exam and imaging revealed a well circumscribed bulging tumour at the umbilical region, measuring 10 × 9 × 9 cm, with overlying intact skin and subcutaneous tissue. Surgical resection was undertaken, and histological examination showed features of endometrial carcinoma. She began chemotherapy and is alive with no signs of recurrent disease one year after surgery. This case brings up to light an atypical location of a solitary metastasis of endometrial carcinoma. PMID:25349753

  1. Abdominal radiation causes bacterial translocation

    SciTech Connect

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

    1989-02-01

    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.

  2. Is abdominal wall tenderness a useful sign in the diagnosis of non-specific abdominal pain?

    PubMed Central

    Gray, D. W.; Dixon, J. M.; Seabrook, G.; Collin, J.

    1988-01-01

    Pain arising from the abdominal wall has been implicated as a cause of non-specific abdominal pain (NSAP), and the presence of abdominal wall tenderness (AWT) has been proposed as an accurate diagnostic test for NSAP. One hundred and fifty eight patients admitted to hospital with abdominal pain were tested for the presence of positive AWT. In 53 patients the final diagnosis was appendicitis and positive AWT was found in five. Thirty eight patients were found to have a variety of other recognised pathological diagnoses, none of whom had a positive AWT. In 67 patients a diagnosis of NSAP was made in the absence of other pathological diagnosis, 19 of whom had positive AWT, which was significantly different from the other diagnostic groups. This study confirms the presence of AWT in up to 28% of patients with NSAP, and suggests that testing for AWT is of value in patients with abdominal pain, although a positive AWT is not as accurate a predictor of NSAP as previously reported. PMID:2970820

  3. Modern reconstructive techniques for abdominal wall defects after oncologic resection.

    PubMed

    Khansa, Ibrahim; Janis, Jeffrey E

    2015-04-01

    Resection of abdominal wall tumors often leaves patients with debilitating soft tissue defects. Modern reconstructive techniques can be used to restore abdominal wall integrity. In this article, we present an overview of preoperative patient evaluation, analysis of the defect, surgical planning, and the spectrum of available surgical techniques, ranging from simple to complex. The established clinical evidence in the field of abdominal wall reconstruction is summarized and a case example is provided.

  4. Vertically transmitted hypoplasia of the abdominal wall musculature.

    PubMed

    Chan, Yuin-Chew; Bird, Lynne M

    2004-01-01

    The prune belly syndrome (OMIM 100100) is an association of bladder dilation with hypoplasia of the abdominal wall muscles. This malformation sequence is due to early urethral obstruction. We report a family with abdominal wall muscular hypoplasia as an isolated defect, not associated with the urethral obstruction sequence. The proband is a q3-year-old male who presented with abdominal wall laxity and severe constipation. His mother, maternal grandmother and younger brother had varying degrees of abdominal wall muscular deficiency and constipation. His mother's condition was aggravated by her 2 pregnancies. This family shows vertical transmission (compatible with autosomal dominant or mitochondrial inheritance) of the abdominal phenotype of prune belly sequence without any evidence of urinary tract or renal pathology. The expression in the sons may remain incomplete because abdominal distention due to pregnancy will not occur.

  5. Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

    SciTech Connect

    Peled, I.J.; Kaplan, H.Y.; Herson, M.; Wexler, M.R.

    1983-08-01

    We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

  6. [MORPHOLOGICAL PECULIARITIES OF MUSCULO-APONEUROTIC TISSUES OF ANTERIOR ABDOMINAL WALL IN PATIENTS, SUFFERING MORBID OBESITY].

    PubMed

    Usenko, O Yu; Gomolyako, I V; Kondratenko, B M; Moskalenko, V V

    2015-11-01

    Results of morphological investigation of musculo-aponeurotic structures of anterior abdominal wall were presented in the morbid obesity patients. The role of obesity as a primary cause for morphofunctional insufficience of musculo-aponeurotic structures was established.

  7. Niche reconstructive techniques for complex abdominal wall reconstruction: a review.

    PubMed

    Sue, Gloria R; Narayan, Deepak

    2014-04-01

    Abdominal wall defects resulting from recurrent hernias, trauma, and radiation necrosis are difficult and challenging to repair given the high rates of recurrence and surgical morbidity. Complex abdominal wall defects often require the transposition of autologous material to bridge the fascial gap. We present a review of niche reconstructive techniques that have been used in complex abdominal wall repair. The specific techniques reviewed include use of delayed and tunneled pedicled tensor fascia lata myofascial flap, de-epithelialized flap closure, free latissimus dorsi myocutaneous flap with or without innervation, and abdominal wall transplant. These niche surgical techniques have great potential to reduce recurrence rates when used in the proper setting for complex abdominal wall reconstruction. More studies are needed to evaluate the relative use of these techniques with the more widely established surgical methods of reconstruction.

  8. [Hypogastric abdominal wall reconstruction with a pedicled anterolateral thigh flap].

    PubMed

    Moullot, P; Philandrianos, C; Gonnelli, D; Casanova, D

    2014-10-01

    Looking at a full-thickness abdominal wall defect, it is necessary to use reconstructive surgery techniques. The authors present an original case of reconstruction of the abdominal wall, using an anterolateral thigh flap (ALT) harvested with vascularised fascia lata. We describe the advantages of this technique, which has rarely been used for this indication. An 80-year-old woman presenting a full-thickness abdominal wall defect of 15×18cm was reconstructed by a pedicled ALT flap. Skin wound healing was obtained within 15 days, with no complication. There was no donor site sequela. The pedicled ALT flap appears to be a good solution for hypogastric abdominal wall defect in a one step procedure. Vacularised fascia lata bring with the cutaneous flap is useful to reconstruct the abdominal fascia.

  9. Practical Approaches to Definitive Reconstruction of Complex Abdominal Wall Defects.

    PubMed

    Latifi, Rifat

    2016-04-01

    With advances in abdominal surgery and the management of major trauma, complex abdominal wall defects have become the new surgical disease, and the need for abdominal wall reconstruction has increased dramatically. Subsequently, how to reconstruct these large defects has become a new surgical question. While most surgeons use native abdominal wall whenever possible, evidence suggests that synthetic or biologic mesh needs to be added to large ventral hernia repairs. One particular group of patients who exemplify "complex" are those with contaminated wounds, enterocutaneous fistulas, enteroatmospheric fistulas, and/or stoma(s), where synthetic mesh is to be avoided if at all possible. Most recently, biologic mesh has become the new standard in high-risk patients with contaminated and dirty-infected wounds. While biologic mesh is the most common tissue engineered used in this field of surgery, level I evidence is needed on its indication and long-term outcomes. Various techniques for reconstructing the abdominal wall have been described, however the long-term outcomes for most of these studies, are rarely reported. In this article, I outline current practical approaches to perioperative management and definitive abdominal reconstruction in patients with complex abdominal wall defects, with or without fistulas, as well as those who have lost abdominal domain.

  10. Advanced Gastric Cancer Perforation Mimicking Abdominal Wall Abscess

    PubMed Central

    Cho, Jinbeom; Park, Ilyoung; Lee, Dosang; Sung, Kiyoung; Baek, Jongmin

    2015-01-01

    Surgeons occasionally encounter a patient with a gastric cancer invading an adjacent organ, such as the pancreas, liver, or transverse colon. Although there is no established guideline for treatment of invasive gastric cancer, combined resection with radical gastrectomy is conventionally performed for curative purposes. We recently treated a patient with a large gastric cancer invading the abdominal wall, which was initially diagnosed as a simple abdominal wall abscess. Computed tomography showed that an abscess had formed adjacent to the greater curvature of the stomach. During surgery, we made an incision on the abdominal wall to drain the abscess, and performed curative total gastrectomy with partial excision of the involved abdominal wall. The patient received intensive treatment and wound management postoperatively with no surgery-related adverse events. However, the patient could not receive adjuvant chemotherapy and expired on the 82nd postoperative day. PMID:26468420

  11. Prosthetics and Techniques in Repair of Animal's Abdominal Wall

    PubMed Central

    Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled

    2016-01-01

    The management of abdominal wall repair continues to present a challenging problem, especially in the repair of major defects. Many abdominal wall defects can be repaired by primary closure; however, if the defect is large and there is a tension on the closure of the wound, the use of prosthetic materials becomes indispensable. Many studies have been performed with various materials and implant techniques, without the comparison of their degrees of success, based on sound meta-analysis and/or inclusive epidemiologic studies. This review covered the effectiveness of recent advances in prosthetic materials and implant procedures used in repair of abdominal wall, based on biomechanical properties and economic aspects of reconstructed large abdominal wall defects and hernias in animals. The presented results in this review helped to reach treatment algorithms that could maximize outcomes and minimize morbidity. PMID:27293982

  12. Prosthetics and Techniques in Repair of Animal's Abdominal Wall.

    PubMed

    Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled

    2016-01-01

    The management of abdominal wall repair continues to present a challenging problem, especially in the repair of major defects. Many abdominal wall defects can be repaired by primary closure; however, if the defect is large and there is a tension on the closure of the wound, the use of prosthetic materials becomes indispensable. Many studies have been performed with various materials and implant techniques, without the comparison of their degrees of success, based on sound meta-analysis and/or inclusive epidemiologic studies. This review covered the effectiveness of recent advances in prosthetic materials and implant procedures used in repair of abdominal wall, based on biomechanical properties and economic aspects of reconstructed large abdominal wall defects and hernias in animals. The presented results in this review helped to reach treatment algorithms that could maximize outcomes and minimize morbidity.

  13. Desmoid tumor of the abdominal wall: a case report

    PubMed Central

    2011-01-01

    Introduction Desmoid tumors are rare lesions without any metastatic potential but a strong tendency to invade locally and to recur. These tumors are associated with women of fertile age, especially during and after pregnancy. Case presentation The case of a desmoid tumor of the anterior abdominal wall in a 40-year-old Caucasian man with no relevant family history is presented, describing its appearance on computed tomography and ultrasonography. The patient, who presented with a painless mass in the left anterolateral abdomen, had a history of previous urgent abdominal surgery after a shotgun injury two years earlier. Radical resection of the affected abdominal wall musculature was performed, and the defect was reconstructed with polypropylene mesh. Conclusion The diagnosis of desmoid tumor should be strongly considered even in male patients with an abdominal mass and a history of previous abdominal surgery. The goal of its treatment is complete tumor excision and avoidance of the development of complications such as hernia. PMID:21787413

  14. Wandering Ascaris Coming Out Through the Abdominal Wall

    PubMed Central

    Wani, Mohd L; Rather, Ajaz A.; Parray, Fazl Q.; Ahangar, Abdul G.; Bijli, Akram H.; Irshad, Ifat; Nayeem-Ul-Hassan; Khan, Tahir S.

    2013-01-01

    A rare case of ascaris coming out through the anterior abdominal wall is reported here. A 40-year-old female had undergone dilatation and curettage by a quack. On the second day she presented with presented with features of peritonitis. She was explored. Resection anastomosis of the ileum was done for multiple perforations of the ileum. Patient developed a fistula in the anterior abdominal wall which was draining bile-colored fluid. On the 12th postoperative day a 10-cm-long worm was seen coming out through the fistulous tract which was found to be Ascaris lumbricoids. Ascaris lumbricoids can lead to many complications ranging from worm colic to intestinal obstruction, volvulus, peritonitis, pancreatitis, cholangiohepatitis, liver abscess and many more. Worm has been reported to come out through mouth, nostrils, abdominal drains, T-tubes etc. But ascaris coming out through the anterior abdominal wall is very rare hence reported here. PMID:23930192

  15. Wandering ascaris coming out through the abdominal wall.

    PubMed

    Wani, Mohd L; Rather, Ajaz A; Parray, Fazl Q; Ahangar, Abdul G; Bijli, Akram H; Irshad, Ifat; Nayeem-Ul-Hassan; Khan, Tahir S

    2013-06-01

    A rare case of ascaris coming out through the anterior abdominal wall is reported here. A 40-year-old female had undergone dilatation and curettage by a quack. On the second day she presented with presented with features of peritonitis. She was explored. Resection anastomosis of the ileum was done for multiple perforations of the ileum. Patient developed a fistula in the anterior abdominal wall which was draining bile-colored fluid. On the 12(th) postoperative day a 10-cm-long worm was seen coming out through the fistulous tract which was found to be Ascaris lumbricoids. Ascaris lumbricoids can lead to many complications ranging from worm colic to intestinal obstruction, volvulus, peritonitis, pancreatitis, cholangiohepatitis, liver abscess and many more. Worm has been reported to come out through mouth, nostrils, abdominal drains, T-tubes etc. But ascaris coming out through the anterior abdominal wall is very rare hence reported here.

  16. Abdominal wall abscesses in patients with Crohn's disease: clinical outcome.

    PubMed

    Neufeld, David; Keidar, Andrei; Gutman, Mordechai; Zissin, Rivka

    2006-03-01

    Abdominal wall abscess due to Crohn's Disease used to be one of the definitive indications for operative treatment. The advent of interventional radiology, the accessibility to percutaneous drainage, and the availability of new medications raised the possibility of nonoperative treatment of this condition. The clinical presentation, treatment, and follow-up of 13 patients with abdominal wall abscesses secondary to Crohn's Disease were retrospectively reviewed. During a 10-year period (1993-2003), 13 patients with abdominal wall abscess were treated. Five patients had an anterolateral abdominal wall abscess and eight had a posterior abscess (psoas). In 11 patients, 17 drainage procedures were performed: 12 percutaneous and 5 operative. Despite initial adequate drainage and resolution of the abscess, all 13 patients eventually needed resection of the offending bowel segment, which was undertaken in 12 patients. The mean time between abscess presentation and definitive operation was 2 months. Percutaneous drainage is an attractive option in most cases of abdominal abscesses. However, in Crohn's Disease patients with an abdominal wall abscess, we found a high failure rate despite initial adequate drainage. We suggest that surgical resection of the diseased bowel segment should be the definitive therapy.

  17. Management of strangulated abdominal wall hernias with mesh; early results

    PubMed Central

    Ozbagriacik, Mustafa; Bas, Gurhan; Basak, Fatih; Sisik, Abdullah; Acar, Aylin; Kudas, Ilyas; Yucel, Metin; Ozpek, Adnan; Alimoglu, Orhan

    2015-01-01

    OBJECTIVE: Surgery for abdominal wall hernias is a common procedure in general surgery practice. The main causes of delay for the operation are comorbid problems and patient unwillingness, which eventually, means that some patients are admitted to emergency clinics with strangulated hernias. In this report, patients who admitted to the emergency department with strangulated adominal wall hernias are presented together with their clinical management. METHODS: Patients who admitted to our clinic between January 2009 and November 2011 and underwent emergency operation were included in the study retrospectively. Demographic characteristics, hernia type, length of hospital stay, surgical treatment and complications were assessed. RESULTS: A total 81 patients (37 female, 44 male) with a mean age of 52.1±17.64 years were included in the study. Inguinal, femoral, umbilical and incisional hernias were detected in 40, 26, 9 and 6 patients respectively. Polypropylene mesh was used in 75 patients for repair. Primary repair without mesh was used in six patients. Small bowel (n=10; 12.34%), omentum (n=19; 23.45%), appendix (n=1; 1.2%) and Meckel’s diverticulum (n=1; 1.2%) were resected. Median length of hospital stay was 2 (1–7) days. Surgical site infection was detected in five (6.2%) patients. No significant difference was detected for length of hospital stay and surgical site infection in patients who had mesh repair (p=0.232 and 0.326 respectively). CONCLUSION: The need for bowel resection is common in strangulated abdominal wall hernias which undergo emergency operation. In the present study, an increase of morbidity was seen in patients who underwent bowel resection. No morbidity was detected related to the usage of prosthetic materials in repair of hernias. Hence, we believe that prosthetic materials can be used safely in emergency cases. PMID:28058336

  18. Improving the efficiency of abdominal aortic aneurysm wall stress computations.

    PubMed

    Zelaya, Jaime E; Goenezen, Sevan; Dargon, Phong T; Azarbal, Amir-Farzin; Rugonyi, Sandra

    2014-01-01

    An abdominal aortic aneurysm is a pathological dilation of the abdominal aorta, which carries a high mortality rate if ruptured. The most commonly used surrogate marker of rupture risk is the maximal transverse diameter of the aneurysm. More recent studies suggest that wall stress from models of patient-specific aneurysm geometries extracted, for instance, from computed tomography images may be a more accurate predictor of rupture risk and an important factor in AAA size progression. However, quantification of wall stress is typically computationally intensive and time-consuming, mainly due to the nonlinear mechanical behavior of the abdominal aortic aneurysm walls. These difficulties have limited the potential of computational models in clinical practice. To facilitate computation of wall stresses, we propose to use a linear approach that ensures equilibrium of wall stresses in the aneurysms. This proposed linear model approach is easy to implement and eliminates the burden of nonlinear computations. To assess the accuracy of our proposed approach to compute wall stresses, results from idealized and patient-specific model simulations were compared to those obtained using conventional approaches and to those of a hypothetical, reference abdominal aortic aneurysm model. For the reference model, wall mechanical properties and the initial unloaded and unstressed configuration were assumed to be known, and the resulting wall stresses were used as reference for comparison. Our proposed linear approach accurately approximates wall stresses for varying model geometries and wall material properties. Our findings suggest that the proposed linear approach could be used as an effective, efficient, easy-to-use clinical tool to estimate patient-specific wall stresses.

  19. Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction

    PubMed Central

    Wang, Frederick; Buonocore, Samuel; Narayan, Deepak

    2011-01-01

    This study describes the treatment of two patients with recurrent, infected abdominal wall defects using bilateral delayed and tunnelled pedicled tensor fascia lata (TFL) myofascial flaps. TFL flaps were elevated and delayed for 4 weeks in both cases. In the second case, Parietex Composite mesh was positioned underneath the TFL flap and allowed to incorporate. After a delay of 4 weeks, the flaps were harvested and tunnelled subcutaneously to repair the abdominal wall defect. Both patients have stable repairs but had donor site seromas requiring drainage. Cadaver dissection was also performed to identify structures related to TFL flap harvest. We identified a variant of lateral femoral cutaneous nerve that traversed the TFL flap, necessitating meticulous dissection during surgery. In summary, we describe a new technique of incorporating mesh into the TFL prior to flap harvest for reconstruction of complex abdominal wall. PMID:22707661

  20. Abdominal wall closure after a stomal reversal procedure.

    PubMed

    López-Cano, Manuel; Pereira, José Antonio; Villanueva, Borja; Vallribera, Francesc; Espin, Eloy; Armengol Carrasco, Manuel; Arbós Vía, María Antonia; Feliu, Xavier; Morales-Conde, Salvador

    2014-01-01

    The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.

  1. Takedown of enterocutaneous fistula and complex abdominal wall reconstruction.

    PubMed

    Slade, Dominic Alexander James; Carlson, Gordon Lawrence

    2013-10-01

    Key steps in managing patients with enterocutaneous fistulation and an abdominal wall defect include dealing effectively with abdominal sepsis and providing safe and effective nutritional support and skin care, then assessing intestinal and abdominal anatomy, before undertaking reconstructive surgery. The complexity, cost, and morbidity associated with such cases justifies creation of specialized centers in which gastroenterologic, hernia, and plastic surgical expertise, as well as experienced wound and stoma nursing and nutritional and psychological support, can be made available for patients with these challenging problems.

  2. Hereditary angioedema (HAE): a cause for recurrent abdominal pain.

    PubMed

    Soni, Parita; Kumar, Vivek; Alliu, Samson; Shetty, Vijay

    2016-11-14

    A 44-year-old Hispanic woman presented to the emergency room with a 2-day history of sudden onset of severe cramping left lower quadrant abdominal pain associated with ∼20 episodes diarrhoea. Abdominal CT scan exhibited bowel wall oedema and acute extensive colitis. On the basis of the preliminary diagnosis of acute abdomen, the patient was admitted under the surgical team and treated for acute colitis. Since her family history was significant for hereditary angioedema (HAE), complement studies were performed which revealed low complement C4 levels and abnormally low values of C1q esterase inhibitor. Thus, the diagnosis of HAE type I was established. This case report summarises that the symptoms of HAE are often non-specific, hence making the underlying cause difficult to diagnose.

  3. Ultrasonography and computed tomography of inflammatory abdominal wall lesions

    SciTech Connect

    Yeh, H.C.; Rabinowitz, J.G.

    1982-09-01

    Twenty-four patients with inflammatory lesions of the abdominal wall were examined by ultrasonography. Nine of these patients underwent computed tomographic (CT) scanning as well. Both ultrasonography and CT clearly delineated the exact location and extent of abdominal wall abscesses. Abscesses were easily differentiated from cellulitis or phlegmon with ultrasound. The peritoneal line was more clearly delineated on ultrasonograms than on CT scans; abscesses were also more distinct on the ultrasonograms because of their low echogenicity compared with the surrounding structures. Gas bubbles, fat density with specific low attenuation values, and underlying inflamed bowel loops in obese patients with Crohn's disease were better delineated by CT.

  4. [A Case of Abdominal Wall Hernia Rupture during Bevacizumab Treatment].

    PubMed

    Sugimoto, Satoshi; Miyazaki, Yasuaki; Hirose, Sou; Michiura, Toshiya; Fujita, Shigeo; Yamabe, Kazuo; Miyazaki, Satoru; Nagaoka, Makio

    2015-11-01

    A 78 -year-old man with rectal cancer underwent abdominoperineal resection of the rectum. In the postoperative period, the patient experienced wound infection, leading to an abdominal wall hernia. Two years following surgery, a rise in the serum CEA level was seen. A metastatic tumor was detected in the right lung on chest CT. VATS right lung inferior lobe segmental resection was performed. After lobectomy, the serum CEA level continued to increase. Another metastatic tumor was detected in the right lung on chest CT. Chemotherapy with capecitabine, oxaliplatin, and bevacizumab was commenced. The erosive part of the abdominal wall scar hernia extended during the nine weeks of chemotherapy. The chemotherapy was then discontinued. In the follow-up CT scan, a right pleural recurrence, local recurrence in the pelvis, and a liver metastasis were detected. Chemotherapy was re-introduced 3 years after surgery. The erosive part of the abdominal wall hernia again began to spread with chemotherapy recommencement. Four months after restarting chemotherapy, the hernia ruptured, with a loop of the small intestine protruding out of it. The patient covered this with a sheet of vinyl and was taken by the ambulance to our hospital. The erosive part of the abdominal wall hernia had split by 10 cm, and a loop of the small intestine was protruding. As ischemia of the small intestine was not observed, we replaced it into the abdominal cavity, and performed a temporary suture repair of the hernia sac. Following this, bevacizumab was discontinued, and the erosive part reduced. We performed a radical operation for abdominal wall scar hernia repair 11 weeks after the discontinuation of bevacizumab.

  5. Transversus abdominal plane block as a sole anesthetic technique for abdominal wall hematoma drainage.

    PubMed

    Varela, N; Golvano, M; Monedero, P

    2016-10-01

    Transversus abdominal plane (TAP) block is a known and useful technique, widely used for postoperative pain management of abdominal wall incisions. During the past years, and following the expansion of ultrasound guided techniques, its use has even gained more adepts. It is usually used as an adjuvant technique, primarily in order to control postoperative pain and reduce opioids consumption. We report the case of an 82 years old patient admitted for drainage of a postoperative abdominal wall hematoma after correction of a McBurney incisional hernia. The corrective surgery had gone on without incident, under general anesthesia with laryngeal mask. Two weeks later, the patient came back to our emergency department with a clear hematoma of the abdominal wall. Surgery was decided. A sole local anesthetic technique was achieved, using a TAP block. The block was performed under ultrasound guidance, using a subcostal approach. The surgery went on without complications. Therefore, TAP block offers a hemodynamic stability, appropriate intra-operative anesthesia and post-surgical analgesia of the abdominal wall.

  6. Which mesh or graft? Prosthetic devices for abdominal wall reconstruction.

    PubMed

    Abid, Shazia; El-Hayek, Kevin

    2016-03-01

    This article reviews the ever-increasing number of prosthetic devices--both synthetic mesh and biologic grafts--now in use for abdominal wall reconstruction. It also introduces a novel hybrid synthetic/biologic graft (Zenapro) and suture passer device (Novapass).

  7. Extragastrointestinal Stromal Tumour of The Abdominal Wall - A Case Report

    PubMed Central

    Kumar, A. Sathish Selva; Padmini, R; Veena, G; Murugesan, N

    2013-01-01

    Stromal tumours occurring in areas other than the GastroIntestinal Tract (GIT) are known as Extra GastroIntestinal Stromal Tumours (EGISTs). They usually arise in the mesentery, omentum or retroperitoneum, while EGISTs which occur in the abdominal wall are very rare. Both gastrointestinal stromal tumours (GISTs) and EGISTs are histologically and immunophenotypically similar. We are reporting a case of EGIST, which occurred in the anterior abdominal wall in a twenty five-year-old female patient. The tumour was present in the right loin and imaging studies suggested that it was a desmoid tumour. It was surgically excised by doing an abdominal wall mesh repair. The histological examinations revealed a tumour with spindle cell morphology, with <2 mitoses per 50 High Power Field (HPF) and no necrosis, with tumour free margins. Immunohistochemistry was strongly positive for CD117 and Smooth Muscle Actin (SMA), while it was negative for β-catenin and S100. The patient is well post operatively and is on close follow up. EGISTs should be considered in the differential diagnosis of mesenchymal tumours which occur in the abdominal wall, inspite of their rarity, as the high risk patients may need Imatinib chemotherapy. PMID:24551695

  8. Planned hernia repair and late abdominal wall reconstruction.

    PubMed

    Leppäniemi, Ari; Tukiainen, Erkki

    2012-03-01

    Planned ventral hernia is a management strategy in which the abdominal fascial layer has been left unclosed and the viscera are covered only with original or grafted skin. Leaving the fascia open can be deliberate or unavoidable and most commonly results from staged repair of the abdominal wall due to trauma, peritonitis, pancreatitis, abdominal vascular emergencies, or abdominal compartment syndrome. The abdominal wall defects can be categorized as type I or II defects depending on whether there is intact, stable skin coverage. In defects with intact skin coverage, the most commonly used methods are the components separation technique and a prosthetic repair, sometimes used in combination. The advantages of the components separation technique is the ability to close the linea alba at the midline, creating a better functional result than a repair with inert mesh. Although the reherniation risk seems higher after components separation, the risk of infection is considerably lower. With a type II defect, with absent or unstable skin coverage, fascial repair alone is inadequate. Of the more complex reconstruction techniques, the use of a free tensor fasciae latae (TFL) flap utilizing a saphenous vein arteriovenous loop is the most promising. The advantages of the TFL flap include constant anatomy of the pedicle, a strong fascial layer, large-caliber vessels matching the size of the AV loop, and the ability to use large flaps (up to 20 × 35 cm). Whatever technique is used, the repair of complex abdominal wall defects requires close collaboration with plastic and abdominal surgeons, which is best managed in specialized centers.

  9. Abdominal wall abscess: more than meets the eye.

    PubMed

    Gandhi, Jamish; Gandhi, Natasha

    2010-01-01

    An 83-year-old, mildly demented rest home resident presented to the emergency department with a 2 day history of a right sided abdominal wall mass. He had a mechanical fall 2 days previously and landed on his right side and had attributed the mass to this. He had no symptoms apart from feeling bloated and not being able to pass wind for a day. He had passed a normal bowel motion the day before presentation. On abdominal examination there was an 11 × 4 cm mass in the right lower quadrant. It was firm in consistency, non-fluctuant and non-tender to touch. There was mild erythema over the area but no skin breaks. Chest radiograph was unremarkable. The abdominal film showed dilated small bowel and no large bowel could be seen. A computed tomography (CT) scan showed a thick walled gallbladder with multiple calculi and air present. There was also an extensive air and fluid collection in the layers of the abdominal wall and subcutaneous fat which arose from a perforation of the gallbladder. The patient was not a surgical candidate due to multiple comorbidities. The patient was treated with antibiotics and underwent a CT guided percutaneous cholecystostomy. Despite the radiological intervention and antibiotics the patient progressively deteriorated and died peacefully 5 days after admission.

  10. Towards the mechanical characterization of abdominal wall by inverse analysis.

    PubMed

    Simón-Allué, R; Calvo, B; Oberai, A A; Barbone, P E

    2017-02-01

    The aim of this study is to characterize the passive mechanical behaviour of abdominal wall in vivo in an animal model using only external cameras and numerical analysis. The main objective lies in defining a methodology that provides in vivo information of a specific patient without altering mechanical properties. It is demonstrated in the mechanical study of abdomen for hernia purposes. Mechanical tests consisted on pneumoperitoneum tests performed on New Zealand rabbits, where inner pressure was varied from 0mmHg to 12mmHg. Changes in the external abdominal surface were recorded and several points were tracked. Based on their coordinates we reconstructed a 3D finite element model of the abdominal wall, considering an incompressible hyperelastic material model defined by two parameters. The spatial distributions of these parameters (shear modulus and non linear parameter) were calculated by inverse analysis, using two different types of regularization: Total Variation Diminishing (TVD) and Tikhonov (H(1)). After solving the inverse problem, the distribution of the material parameters were obtained along the abdominal surface. Accuracy of the results was evaluated for the last level of pressure. Results revealed a higher value of the shear modulus in a wide stripe along the craneo-caudal direction, associated with the presence of linea alba in conjunction with fascias and rectus abdominis. Non linear parameter distribution was smoother and the location of higher values varied with the regularization type. Both regularizations proved to yield in an accurate predicted displacement field, but H(1) obtained a smoother material parameter distribution while TVD included some discontinuities. The methodology here presented was able to characterize in vivo the passive non linear mechanical response of the abdominal wall.

  11. Quantitative anatomical labeling of the anterior abdominal wall

    NASA Astrophysics Data System (ADS)

    Allen, Wade M.; Xu, Zhoubing; Asman, Andrew J.; Poulose, Benjamin K.; Landman, Bennett A.

    2013-03-01

    Ventral hernias (VHs) are abnormal openings in the anterior abdominal wall that are common side effects of surgical intervention. Repair of VHs is the most commonly performed procedure by general surgeons worldwide, but VH repair outcomes are not particularly encouraging (with recurrence rates up to 43%). A variety of open and laparoscopic techniques are available for hernia repair, and the specific technique used is ultimately driven by surgeon preference and experience. Despite routine acquisition of computed tomography (CT) for VH patients, little quantitative information is available on which to guide selection of a particular approach and/or optimize patient-specific treatment. From anecdotal interviews, the success of VH repair procedures correlates with hernia size, location, and involvement of secondary structures. Herein, we propose an image labeling protocol to segment the anterior abdominal area to provide a geometric basis with which to derive biomarkers and evaluate treatment efficacy. Based on routine clinical CT data, we are able to identify inner and outer surfaces of the abdominal walls and the herniated volume. This is the first formal presentation of a protocol to quantify these structures on abdominal CT. The intra- and inter rater reproducibilities of this protocol are evaluated on 4 patients with suspected VH (3 patients were ultimately diagnosed with VH while 1 was not). Mean surfaces distances of less than 2mm were achieved for all structures.

  12. Abdominal wall endometrioma: Our experience in Vladimir, Russia

    PubMed Central

    Gachabayov, Mahir; Horta, Roman; Afanasyev, Dmitriy; Gilyazov, Timur

    2016-01-01

    Background: Endometriosis is defined as an estrogen-dependent, benign inflammatory disease characterized by the presence of ectopic endometrial implants. Abdominal wall endometrioma (AWE) being a rare entity is a benign tumor defined as ectopic functional, endometrial tissue located in the abdominal wall. Subjects and Methods: A retrospective study of 23 female patients treated with AWE in four departments of three centers in Vladimir city, Russia, from January 2010 to December 2014 was performed. Results: In twenty patients (87%), AWE was symptomatic, and in three patients (13%), AWE was asymptomatic. Esquivel triad presented in 17 patients (74%), and modified Esquivel triad existed in 20 patients (87%). All 23 patients were operated, and AWE excision was performed. Recurrence occurred in 4 cases (17.4%) and was associated with postoperative pain and seroma. Conclusion: Postoperative pain for more than 7 days and seroma (on ultrasonography) seem to be associated with recurrence of AWE. PMID:27942100

  13. [Gas in the abdominal cavity--due to cholecystitis caused by gas-producing bacteria].

    PubMed

    Miettinen, Simo; Hakkarainen, Timo; Reinikainen, Matti; Hakala, Tapio

    2010-01-01

    In most cases, gas in the abdominal cavity indicates perforation of the gastrointestinal wall. We describe a patient, in whom the cause of abdominal gas detected in computed tomography turned out to be emphysematous cholecystitis caused by gas-producing bacteria. It is a rare disease characterized by accumulation of gas into the gall bladder or its wall. The gas can be easily observed in computed tomography. The disease easily becomes complicated and is associated with high mortality. Prompt cholecystectomy and antibiotic therapy are the cornerstones of the treatment.

  14. Management of Complex Abdominal Wall Defects Associated with Penetrating Abdominal Trauma

    DTIC Science & Technology

    2014-05-09

    management of the abdominal wall was determined by a multidisciplinary team of general and plastic surgeons, intensivists and specialist nurses . The...otomy is performed when the patient’s physiology has normalised, usually at 12–72 h after the damage control procedure. Closure of the midline... nurse specialist, microbiology, intensive care, the hos- pital medical director and the orthopaedic surgeons if there was concomitant bony or extremity

  15. Planned ventral hernia. Staged management for acute abdominal wall defects.

    PubMed Central

    Fabian, T C; Croce, M A; Pritchard, F E; Minard, G; Hickerson, W L; Howell, R L; Schurr, M J; Kudsk, K A

    1994-01-01

    OBJECTIVE: Analysis of a staged management scheme for initial and definitive management of acute abdominal wall defects is provided. METHODS: A four-staged scheme for managing acute abdominal wall defects consists of the following stages: stage I--prosthetic insertion; stage II--2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage III--2 to 3 days later, planned ventral hernia (split thickness skin graft [STSG] or full-thickness skin and subcutaneous fat); stage IV--6 to 12 months later, definitive reconstruction. Cases were evaluated retrospectively for benefits and risks of the techniques employed. RESULTS: Eighty-eight cases (39 visceral edema, 27 abdominal sepsis, 22 abdominal wall resection) were managed during 8.5 years. Prostheses included polypropylene mesh in 45 cases, polyglactin 910 mesh in 27, polytetrafluorethylene in 10, and plastic in 6. Twenty-four patients died from their initial disease. The fistula rates associated with prosthetic management was 9%; no wound-related mortality occurred. Most wounds had split thickness skin graft applied after prosthetic removal. Definitive reconstruction was undertaken in 21 patients in the authors' institution (prosthetic mesh in 12 and modified components separation in 9). Recurrent hernias developed in 33% of mesh reconstructions and 11% of the components separation technique. CONCLUSIONS: The authors concluded that 1) this staged approach was associated with low morbidity and no technique-related mortality; 2) prostheses placed for edema were removed with fascial approximation accomplished in half of those cases; 3) absorbable mesh provided the advantages of reasonable durability, ease of removal, and relatively low cost--it has become the prosthesis of choice; and 4) the modified components separation technique of reconstruction provided good results in patients with moderate sized defects. Images Figure 2. Figure 3. Figure 4. Figure 5. PMID:8203973

  16. Distribution of Wall Stress in Abdominal Aortic Aneurysm (AAA)

    NASA Astrophysics Data System (ADS)

    Lasheras, Juan

    2005-11-01

    Abdominal aortic aneurysm (AAA) rupture is believed to occur when the mechanical stress acting on the wall exceeds the strength of the wall tissue. Therefore, knowledge of the AAA wall stress distribution could be useful in assessing its risk of rupture. In our research, a finite element analysis was used to determine the wall stresses both in idealized models and in a real clinical model in which the aorta was considered isotropic with nonlinear material properties and was loaded with a given pressure. In the idealized models, both maximum diameter and asymmetry were found to have substantial influence on the distribution of the wall stress. The thrombus inside the AAA was also found to help protecting the walls from high stresses. Using CT scans of the AAA, the actual geometry of the aneurysm was reconstructed and we found that wall tension increases on the flatter surface (typically corresponds to the posterior surface) and at the inflection points of the bulge. In addition to the static analysis, we also performed simulations of the effect of unsteady pressure wave propagation inside the aneurysm.

  17. Effects of the flexibility of the arterial wall on the wall shear stresses and wall tension in Abdominal Aortic Aneurysms.

    NASA Astrophysics Data System (ADS)

    Salsac, Anne-Virginie; Fernandez, Miguel; Chomaz, Jean-Marc

    2005-11-01

    As an abdominal aortic aneurysm develops, large changes occur in the composition and structure of the arterial wall, which result in its stiffening. So far, most studies, whether experimental or numerical, have been conducted assuming the walls to be rigid. A numerical simulation of the fluid structure interactions is performed in different models of aneurysms in order to analyze the effects that the wall compliance might have on the flow topology. Both symmetric and non-symmetric models of aneurysms are considered, all idealistic in shape. The wall mechanical properties are varied in order to simulate the progressive stiffening of the walls. The spatial and temporal distributions of wall tension are calculated for the different values of the wall elasticity and compared to the results for the rigid walls. In the case of rigid walls, the calculation of the wall shear stresses and pressure compare very well with experimental results.

  18. Abdominal Wall Transplantation: Skin as a Sentinel Marker for Rejection.

    PubMed

    Gerlach, U A; Vrakas, G; Sawitzki, B; Macedo, R; Reddy, S; Friend, P J; Giele, H; Vaidya, A

    2016-06-01

    Abdominal wall transplantation (AWTX) has revolutionized difficult abdominal closure after intestinal transplantation (ITX). More important, the skin of the transplanted abdominal wall (AW) may serve as an immunological tool for differential diagnosis of bowel dysfunction after transplant. Between August 2008 and October 2014, 29 small bowel transplantations were performed in 28 patients (16 male, 12 female; aged 41 ± 13 years). Two groups were identified: the solid organ transplant (SOT) group (n = 15; 12 ITX and 3 modified multivisceral transplantation [MMVTX]) and the SOT-AWTX group (n = 14; 12 ITX and 2 MMVTX), with the latter including one ITX-AWTX retransplantation. Two doses of alemtuzumab were used for induction (30 mg, 6 and 24 h after reperfusion), and tacrolimus (trough levels 8-12 ng/mL) was used for maintenance immunosuppression. Patient survival was similar in both groups (67% vs. 61%); however, the SOT-AWTX group showed faster posttransplant recovery, better intestinal graft survival (79% vs. 60%), a lower intestinal rejection rate (7% vs. 27%) and a lower rate of misdiagnoses in which viral infection was mistaken and treated as rejection (14% vs. 33%). The skin component of the AW may serve as an immune modulator and sentinel marker for immunological activity in the host. This can be a vital tool for timely prevention of intestinal graft rejection and, more important, avoidance of overimmunosuppression in cases of bowel dysfunction not related to graft rejection.

  19. Bioprosthetic Tissue Matrices in Complex Abdominal Wall Reconstruction

    PubMed Central

    Broyles, Justin M.; Abt, Nicholas B.; Sacks, Justin M.

    2013-01-01

    Background: Complex abdominal defects are difficult problems encountered by surgeons in multiple specialties. Although current evidence supports the primary repair of these defects with mesh reinforcement, it is unclear which mesh is superior for any given clinical scenario. The purpose of this review was to explore the characteristics of and clinical relevance behind bioprosthetic tissue matrices in an effort to better clarify their role in abdominal wall reconstruction. Methods: We reviewed the peer-reviewed literature on the use of bioprosthetic mesh in human subjects. Basic science articles and large retrospective and prospective reviews were included in author’s analysis. The clinical performance and characteristics of 13 bioprosthetic tissue matrices were evaluated. Results: The majority of the products evaluated perform well in contaminated fields, where the risk of wound-healing difficulties is high. Clinical outcomes, which included infection, reherniation, and bulge formation, were variable, and the majority of the studies had a mean follow-up of less than 24 months. Conclusions: Although bioprosthetic matrix has a multitude of indications within the growing field of abdominal wall reconstruction, the functionality, regenerative capacity, and long-term fate of these products have yet to be fully established. Furthermore, the clinical performance, indications, and contraindications for each type of matrix need to be fully evaluated in long-term outcome studies. PMID:25289285

  20. Advances in surgery for abdominal wall defects: gastroschisis and omphalocele.

    PubMed

    Islam, Saleem

    2012-06-01

    Abdominal wall defects (AWDs) are a common congenital surgical problem in fetuses and neonates. The incidence of these defects has steadily increased over the past few decades due to rising numbers of gastroschisis. Most of these anomalies are diagnosed prenatally and then managed at a center with available pediatric surgical, neonatology, and high-risk obstetric support. Omphaloceles and gastroschisis are distinct anomalies that have different management and outcomes. There have been a number of recent advances in the care of patients with AWDs, both in the fetus and the newborn, which will be discussed in this article.

  1. Changes in wall shear stresses in abdominal aortic aneurysms with increasing wall stiffness

    NASA Astrophysics Data System (ADS)

    Salsac, Anne-Virginie; Fernandez, Miguel

    2006-11-01

    During the growth of abdominal aortic aneurysms, local changes occur in the composition and structure of the diseased wall, resulting in its stiffening. A numerical simulation of the fluid structure interactions is performed in idealized models of aneurysms using a finite element method. A full coupling of the equations governing the pulsatile blood flow and the deformation of the compliant wall is undertaken. The effect of the progressive stiffening of the wall is analyzed at various stages in the growth of the aneurysm. Increasing the wall stiffness alters the distribution of wall shear stresses and leads to an increase in their magnitude. The wall compliance is shown to have a more pronounced effect on non-axisymmetric aneurysms, which sustain large displacements. The overall movement of the aneurysm models increases the three-dimensionality of the flow.

  2. [Hereditary angioedema: strange cause of abdominal pain].

    PubMed

    Salas-Lozano, Nereo Guillermo; Meza-Cardona, Javier; González-Fernández, Coty; Pineda-Figueroa, Laura; de Ariño-Suárez, Mauricio

    2014-01-01

    Antecedentes: el angioedema hereditario es un trastorno inflamatorio episódico, que se hereda de manera autosómica dominante y se caracteriza por episodios de edema periférico. Los pacientes pueden tener edema de la pared de cualquier víscera hueca, incluido el intestino. Caso clínico: se comunica el caso de un paciente masculino de 33 años de edad, sin antecedentes de importancia, con dolor abdominal, localizado en el epigastrio, irradiado al cuadrante inferior derecho, acompañado de 5 vómitos. La tomografía abdominal mostró engrosamiento de la pared de la segunda y tercera porción del duodeno, con infiltración de grasa y líquido libre. Los exámenes de laboratorio mostraron: concentraciones bajas del complemento C4 (5.5 mg/dL) y actividad del inhibidor de C1 del complemento de 30%. Conclusiones: el angioedema hereditario es consecuencia de la deficiencia (tipo I) o disfunción (tipo II) del inhibidor C1 del complemento. El dolor abdominal asociado con angioedema es de inicio súbito, como dolor cólico, recurrente y de intensidad moderada. En la actualidad existen dos medicamentos aprobados por la Food and Drug Administration para el tratamiento de pacientes con esta afección.

  3. [An example of multi-stage reconstruction of a full-thickness abdominal wall defect].

    PubMed

    Kaczmarzyk, Janusz; Elsaftawy, Ahmed; Jabłecki, Jerzy; Kaczmarzyk, Leszek

    2013-01-01

    Abdominal wall reconstruction is a highly complex procedure that may requires a multiple stages surgical operations. The aim of a such reconstruction is to close the abdominal wall defect and to create a support for the internal organs. It's a challenge for both general and reconstructive surgery. An incomplete thickness defects of the abdominal wall are so much easier to challenge than complete ones. Also the size of the primary defect determines the way and stages of the operation. Such defects can occur in necrotizing fasciitis of the abdominal wall, after abdominal walls tumors removal, in traffic accidents or after "open abdomen" procedures (acute severe pancreatitis). In this paper the authors present a case of 62-yo patient which was operated because of large intestine perforation with various complications of which the most serious was the abdominal wall defect.

  4. [The cutaneous groin flap for coverage of a full-thickness abdominal wall defect].

    PubMed

    Doebler, O; Spierer, R

    2010-08-01

    A full-thickness defect of the abdominal wall is rare and may occur as a complication of extended abdominal surgery procedures. We report about a 69-year-old patient who was presented to our department with a full-thickness abdominal wall defect and a fully exposed collagen-mesh for reconstructive wound closure. 13 operations with resections of necrotic parts of the abdominal wall were performed following a complicated intraabdominal infection. After debridement and mesh explantation, closure of the remaining defect of the lower abdominal region was achieved by a cutaneous groin flap.

  5. An abdominal wall simulator for testing suprapubic urinary catheters.

    PubMed

    Coveney, V A; Gröver, D

    2001-08-01

    Urinary catheters (drainage tubes) are in widespread use. The most common type of long-term catheter is the Foley, which is made from natural or synthetic rubber. Foley catheters are passed into the bladder via the urethra or the suprapubic puncture channel (through the abdominal wall). A simulator for the abdominal wall has been developed to simulate aspects of the interaction between it and a suprapubic catheter. The simulator is based on a slab of ultrasoft elastomer with tensionable reinforcing polyamide filaments. The behaviour of the simulator has been compared with data published. A soft membrane (contact pressure) transducer (SMT) was used and novel instrumented 'tongs' for lateral indentation of the puncture track giving indentation stiffness. Slab materials were used with shear moduli of 0.1 and 0.021 MPa. Two filament-tensioning methods were used: by clamping to a winding mechanism and by weights. The combination of the softer slab material and tensioning by weights gave good conformity to physiological data; other combinations did not.

  6. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance.

    PubMed

    Stensby, J Derek; Baker, Jonathan C; Fox, Michael G

    2016-02-01

    The lateral abdominal wall is comprised of three muscles, each with a different function and orientation. The transversus abdominus, internal oblique, and external oblique muscles span the abdominal cavity between the iliocostalis lumborum and quadratus lumborum posteriorly and the rectus abdominis anteriorly. The lateral abdominal wall is bound superiorly by the lower ribs and costal cartilages and inferiorly by the iliac crest and inguinal ligament. The lateral abdominal wall may be acutely or chronically injured in a variety of athletic endeavors, with occasional acute injuries in the setting of high-energy trauma such as motor vehicle collisions. Injuries to the lateral abdominal wall may result in lumbar hernia formation, unique for its high incarceration rate, and also Spigelian hernias. This article will review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries.

  7. [Postoperative necrotizing fasciitis of the anterior abdominal wall].

    PubMed

    Fichev, G; Poromanski, I; Marina, M

    1995-01-01

    Postoperative necrotizing fasciitis of the anterior abdominal wall is a serious and life-endangering complication of an acute progressive synergistic infective process. There is an absolute increase in its incidence rate attributable to a number of situations in modern life. Morphological and clinical studies are carried out on personal case material of 28 patients, followed up over a 3-year period. The presence of aerobic-anaerobic mixed polyinfection, consisting of average 3.75 bacterial species of which 1.43 aerobes and 2.32 anaerobes, is demonstrated microbiologically. Of the latter non-spore-bearing obligate anaerobes predominate among which B fragillis is the most common. As shown by the study, the process is characterized by slow initial course with ensuring rapid spreading by neighbourhood. The process reveals all signs of a mixed aerobic-anaerobic polyinfection, thereby necessitating subordination of both antibiotic therapy and surgical tactics to the latter.

  8. Components separation for abdominal wall reconstruction: the Memphis modification.

    PubMed

    DiCocco, Jennifer M; Fabian, Timothy C; Emmett, Katrina P; Magnotti, Louis J; Goldberg, Steven P; Croce, Martin A

    2012-01-01

    Since the advent of damage control surgery, more patients are left with an open abdomen. Surgeons are then left with the challenge of how to restore continuity of the abdominal wall. Many different techniques have been utilized for reconstruction with widely variable recurrence rates, mainly depending on the length of follow-up. A modification of the components separation technique was developed in Memphis, Tennessee at the Presley Memorial Trauma Center. This modification greatly increased the length gained in the midline. Additionally, many patients can be reconstructed without the use of prosthetics, reducing the infectious complications. The purpose of this manuscript is to describe in detail how to perform a modification of the components separation technique that has been shown to have one of the lowest recurrence rates in the literature.

  9. Abdominal Wall Reconstruction Using Retrorectus Self-adhering Mesh: A Novel Approach

    PubMed Central

    Khansa, Ibrahim

    2016-01-01

    Background: In abdominal wall reconstruction, the retrorectus plane offers an ideal location for mesh placement. Mesh fixation in this plane is often achieved using transfascial sutures, which risks entrapping intercostal nerves and causing significant pain, and takes time to place. A novel alternative is the use of sutureless self-adhering mesh. Although the use of this mesh in inguinal hernias has been well described, studies on its use in abdominal wall reconstruction are lacking. Methods: Consecutive patients who underwent ventral hernia repair with retrorectus mesh were reviewed. This included patients who received transfascially sutured mesh and those who received sutureless self-adhering mesh. All patients were followed up for at least 12 months. The amount of narcotics required by each patient postoperatively was calculated. Surgical-site occurrences (SSOs) and hernia recurrence and bulge were measured. Results: Twenty-six patients underwent abdominal wall reconstruction with retrorectus mesh. This included 12 patients with transfascially sutured mesh and 14 patients with self-adhering mesh. Mean follow-up was 600 days. Baseline characteristics were similar between the 2 groups. Patients receiving self-adhering mesh required significantly less narcotics than patients with transfascially sutured mesh. There were no significant differences in the rate of SSOs between the 2 groups. No hernia recurrences, bulges, or chronic pain occurred in either group. Conclusions: This is the first study to compare the outcomes of retrorectus self-adhering mesh and transfascially sutured mesh in abdominal wall reconstruction. Our results show low rates of SSO, recurrence, and bulge with both options, with significantly less acute pain with self-adhering mesh. PMID:27975037

  10. Resection and Abdominal Wall Reconstruction of a Desmoid Tumor with Endometrioma Features

    PubMed Central

    Majors, Jaqueline; Stoikes, Nathaniel F.; Nejati, Reza

    2016-01-01

    Desmoid tumors are rare, musculoaponeurotic mesenchymal origin tumors arising from the proliferation of well-differentiated fibroblasts. Desmoid tumors may arise from any location with the abdominal cavity, abdominal wall and extremity locations being most frequent. We present the case of a 35-year-old female with a history of endometriosis who presented palpable abdominal mass and cyclic abdominal pain. Resection was performed for a presumed desmoid soft tissue tumor. Final pathology demonstrated desmoid histology admixed with abdominal wall endometriosis (endometrioma). This unique pathologic finding has only been rarely reported and is discussed with a brief review of the literature. PMID:27247824

  11. [Large abdominal wall reconstruction by free flap after recurrence of a dermatofibrosarcoma protuberans].

    PubMed

    Le Fourn, B; Lejeune, F; Sartre, J Y; Loirat, Y; Pannier, M

    1996-12-01

    Based on a case of recurrence of a dermatofibrosarcoma protuberans of the abdominal wall, the authors discuss the need for initial wide resection of this type of skin tumour and the possibilities of repair of extensive full thickness defects of the abdominal wall by means of a latissimus dorsi myocutaneous free flap.

  12. An Abdominal Aorta Wall Extraction for Liver Cirrhosis Classification Using Ultrasonic Images

    NASA Astrophysics Data System (ADS)

    Hayashi, Takaya; Fujita, Yusuke; Mitani, Yoshihiro; Hamamoto, Yoshihiko; Segawa, Makoto; Terai, Shuji; Sakaida, Isao

    2011-06-01

    We propose a method to extract an abdominal aorta wall from an M-mode image. Furthermore, we propose the use of a Gaussian filter in order to improve image quality. The experimental results show that the Gaussian filter is effective in the abdominal aorta wall extraction.

  13. PET/CT detects abdominal wall and port site metastases of colorectal carcinoma.

    PubMed

    Goshen, E; Davidson, T; Aderka, D; Zwas, S T

    2006-07-01

    Abdominal wall metastases from colorectal cancer (CRC) may be resected with curative results. Such lesions, often indicators of additional intra-abdominal lesions, may appear in surgical scars, stomas and port site metastases after laparoscope-assisted surgery (LAS). Post-operative changes, primarily surgical scars, alter local physical findings making early detection of small lesions challenging. The purpose of this study was to retrospectively evaluate the contribution of PET/CT to the diagnosis of recurrent colorectal cancer in the post-operative abdominal wall. 120 patients were referred for PET/CT with suspected recurrent CRC based on clinical, radiological or laboratory findings. All underwent whole body PET/CT imaging. 12 of these 120 (10%), were found to have abdominal wall lesions. A total of 16 abdominal wall lesions were detected, located to surgical scars, stomas, drain and laparoscope ports. Additional findings on PET/CT in this group included liver metastases, intra-abdominal lesions and retroperitoneal lymph node involvement. In general, the patients in this small group were young with high grade tumours presenting in advanced stages. In conclusion, PET/CT appears to be a sensitive tool for the diagnosis of abdominal wall recurrence of CRC. The accuracy of localization afforded by the fused functional and anatomic images makes PET/CT a likely tool for diagnosing abdominal wall lesions, including port site metastases of other aetiologies.

  14. Reconstruction of abdominal wall musculofascial defects with small intestinal submucosa scaffolds seeded with tenocytes in rats.

    PubMed

    Song, Zhicheng; Peng, Zhiyou; Liu, Zhengni; Yang, Jianjun; Tang, Rui; Gu, Yan

    2013-07-01

    The repair of abdominal wall defects following surgery remains a difficult challenge. Although multiple methods have been described to restore the integrity of the abdominal wall, there is no clear consensus on the ideal material for reconstruction. This study explored the feasibility of in vivo reconstruction of a rat model of an abdominal wall defect with a composite scaffold of tenocytes and porcine small intestinal submucosa (SIS). In the current study, we created a 2×1.5 cm abdominal wall defect in the anterolateral abdominal wall of Sprague-Dawley rats, which were assigned into three groups: the cell-SIS construct group, the cell-free SIS scaffold group, and the abdominal wall defect group. Tenocytes were obtained from the tendons of rat limbs. After isolation and expansion, cells (2×10(7)/mL) were seeded onto the three-layer SIS scaffolds and cultured in vitro for 5 days. Cell-SIS constructs or cell-free constructs were implanted to repair the abdominal wall defects. The results showed that the tenocytes could grow on the SIS scaffold and secreted corresponding matrices. In addition, both scaffolds could repair the abdominal wall defects with no hernia recurrence. In comparison to the cell-free SIS scaffold, the composite scaffold exhibited increased vascular regeneration and mechanical strength. Furthermore, following increased time in vivo, the mechanical strength of the composite scaffold became stronger. The results indicate that the composite scaffold can provide increased mechanical strength that may be suitable for repairing abdominal wall defects.

  15. Gas gangrene of the abdominal wall due to late-onset enteric fistula after polyester mesh repair of an incisional hernia.

    PubMed

    Moussi, A; Daldoul, S; Bourguiba, B; Othmani, D; Zaouche, A

    2012-04-01

    The occurrence of enteric fistulae after wall repair using a prosthetic mesh is a serious but, fortunately, rare complication. We report the case of a 66-year-old diabetic man who presented with gas gangrene of the abdominal wall due to an intra-abdominal abscess caused by intestinal erosion six years after an incisional hernia repair using a polyester mesh. The aim of this case report is to illustrate the seriousness of enteric fistula after parietal repair using a synthetic material.

  16. The use of Surgisis for abdominal wall reconstruction in the separation of omphalopagus conjoined twins.

    PubMed

    Dasgupta, Roshni; Wales, Paul W; Zuker, Ronald M; Fisher, David M; Langer, Jacob C

    2007-09-01

    Abdominal wall reconstruction in omphalopagus twins poses a difficult reconstructive challenge, as separation often results in a large abdominal wall defect. A number of options are available for closure, including tissue flaps, expanders and patches made of foreign material. Surgisis is a new biodegradable small intestine scaffolding substrate that permits tissue in-growth and results in a permanent durable scar. We describe its use in abdominal wall reconstruction after separation of a set of conjoined twins. A set of omphalopagus conjoined twins shared liver and abdominal wall. After separation at 6 months of age, Twin A's abdomen could be closed primarily, but Twin B could not. A 4-ply Surgisis mesh was used in the upper abdominal closure, and a skin flap was created, to completely cover the patch. Both twins survived the operation. A small portion of the skin flap over the Surgisis broke down, healing by secondary intention. In follow up of over 18 months post procedure, there have been no wound infections and the abdominal wall is intact with no evidence of a hernia. Surgisis can be successfully used for the reconstruction of complex abdominal wall defects in the pediatric patient, including reconstruction after separation of conjoined twins.

  17. [Reconstruction of an abdominal wall defect with a superior epigastric perforator propeller flap: case report].

    PubMed

    Lepivert, J-C; Alet, J-M; Michot, A; Pélissier, P; Pinsolle, V

    2014-10-01

    Perforators flaps take a special place in reconstructive surgery. These flaps can be dissected and turned as a propeller blade on its pedicule axis. We report the case of a 54-year-old man presenting a recurrence of a dermatofibrosarcoma in the right hypochondrium. Tumor resection caused a large abdominal wall defect taking the anterior aponeurosis of the rectus abdominis. An angioscanner was realized in preoperative to locate the perforators of the deep superior epigastric artery. We realized a propeller flap based on a perforator of the left superior epigastric artery who allowed to cover the wall defect. We set up a patch of Vicryl® to reconstruct the aponeurosis plan at the same operative time. We didn't note any necrosis and complete healing occurred in 2 weeks. The margins were healthy. The cosmetic result and the low morbidity make this flap a good therapeutic option. This flap seems reliable, arteries perforators are constant with good diameter.

  18. Thoraco-abdominal wall reconstruction after surgical debulking of a giant retroperitoneal liposarcoma: a case report.

    PubMed

    Colebunders, B; Colpaert, S D M; Mertens, M; Willemsen, P

    2011-01-01

    A case of a patient with a recurrent dedifferentiated retroperitoneal liposarcoma with extensive invasion of the thoraco-abdominal wall including the skin, requiring reconstructive surgery after debulking of the tumor is reported.

  19. Severe cellulitis and abdominal wall emphysema following laparoscopic colonic surgery: A case report.

    PubMed

    Tanaka, Ryo; Kameyama, Hitoshi; Chida, Tadasu; Kanda, Tatsuo; Kano, Yosuke; Ichikawa, Hiroshi; Hanyu, Takaaki; Ishikawa, Takashi; Kosugi, Shin-Ichi; Wakai, Toshifumi

    2015-05-01

    Abdominal wall emphysema is a common complication of laparoscopic surgery. This condition is usually harmless; however, if an infection occurs, it can develop into a serious condition such as necrotizing fasciitis. We report a case of a 51-year-old woman suffering from severe cellulitis that spread from an area of abdominal wall emphysema after laparoscopic surgery for sigmoid colon cancer. Recognizing this complication, early diagnosis, and prompt treatment are cornerstones for successful management of this potentially fatal disease.

  20. Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestines.

    PubMed

    Amid, P K; Shulman, A G; Lichtenstein, I L; Sostrin, S; Young, J; Hakakha, M

    1994-03-01

    This preliminary study examined the possibility of preventing intestinal adhesions to biomaterials while preserving their incorporation with the abdominal wall. White New Zealand rabbits received intraperitoneal implants of different biomaterials for repair of defects created on the abdominal wall. The following biomaterials were used: polypropylene, polyester, expanded polytetraflueroethylene, polypropylene mesh/polypropylene sheeting (polypropylene mesh covered with polypropylene sheeting on the peritoneal side), polypropylene/silastic, polypropylene/polyglactin, polypropylene/polyglycolic acid, and polypropylene/fibrin. All biomaterials evaluated caused adhesions to the intestines except for polypropylene mesh/polypropylene sheeting and polypropylene mesh/silastic composites. Because adhesion of the intestine to the biomaterial is the first stage of biomaterial-related intestinal fistula, its prevention is logical for the elimination of this complication. Composites with the selective property of adhering to the abdominal wall, yet sparing the viscera, would facilitate thoracic and abdominal wall surgeries, as well as intraperitoneal laparoscopic hernioplasties.

  1. Collagenopathies—Implications for Abdominal Wall Reconstruction: A Systematic Review

    PubMed Central

    Harrison, Bridget; Sanniec, Kyle

    2016-01-01

    Background: The etiology of hernia formation is strongly debated and includes mechanical strain, prior surgical intervention, abnormal embryologic development, and increased intraabdominal pressure. Although the most common inciting cause in ventral hernias is previous abdominal surgery, many other factors contribute. We explore this etiology through an examination of the current literature and existing evidence on patients with collagen vascular diseases, such as Ehlers–Danlos syndrome. Methods: A systematic review of the published literature was performed of all available Spanish and English language PubMed and Cochrane articles containing the key words “collagenopathies,” “collagenopathy,” “Ehlers-Danlos,” “ventral hernia,” and “hernia.” Results: Three hundred fifty-two articles were identified in the preliminary search. After review, 61 articles were included in the final review. Conclusions: Multiple authors suggest a qualitative or quantitative defect in collagen formation as a common factor in hernia formation. High-level clinical data clearly linking collagenopathies and hernia formation are lacking. However, a trend in pathologic studies suggests a link between abnormal collagen production and/or processing that is likely associated with hernia development. PMID:27826465

  2. The surface landmarks of the abdominal wall: a plea for standardization

    PubMed Central

    Cirocchi, Roberto; Boselli, Carlo; Renzi, Claudio; Cagini, Lucio; Boccolini, Andrea; Noya, Giuseppe; Fingerhut, Abe

    2014-01-01

    Despite centuries of anatomical studies, controversies and contradictions still exist in the literature regarding the definition, anatomical terminology and the limits of the abdominal wall. We conducted a systematic research of books published from 1901 until December 2012 in Google Books. After the index screening, 16 remaining books were further assessed for eligibility. We decided to exclude journals. The aim of the study was to focus on surface landmarks and borders of the abdominal cavity. After this revision of the literature, we propose that the surface landmarks of the abdominal wall should be standardized. PMID:25097589

  3. An unusual cause of acute abdominal pain in dengue fever.

    PubMed

    Waseem, Tariq; Latif, Hina; Shabbir, Bilquis

    2014-07-01

    Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. Physicians managing dengue fever come across varied and uncommon complications of dengue fever. We report a case of dengue fever that developed severe right upper quadrant abdominal pain and induration after extreme retching and vomiting for 2 days. A rectus sheath hematoma was confirmed on noncontrast computed tomography (CT). Rectus sheath hematoma as a complication of dengue fever has rarely been reported before and never from this part of the world. Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table).

  4. Pathologic aerophagia: a rare cause of chronic abdominal distension

    PubMed Central

    de Jesus, Lisieux Eyer; Cestari, Ana Beatriz C.S.S.; da Silva, Orli Carvalho; Fernandes, Marcia Antunes; Firme, Livia Honorato

    2015-01-01

    Objective: To describe an adolescent with pathologic aerophagia, a rare condition caused by excessive and inappropriate swallowing of air and to review its treatment and differential diagnoses. Case description: An 11-year-old mentally impaired blind girl presenting serious behavior problems and severe developmental delay with abdominal distension from the last 8 months. Her past history included a Nissen fundoplication. Abdominal CT and abdominal radiographs showed diffuse gas distension of the small bowel and colon. Hirschsprung's disease was excluded. The distention was minimal at the moment the child awoke and maximal at evening, and persisted after control of constipation. Audible repetitive and frequent movements of air swallowing were observed. The diagnosis of pathologic aerophagia associated to obsessive-compulsive disorder and developmental delay was made, but pharmacological treatment was unsuccessful. The patient was submitted to an endoscopic gastrostomy, permanently opened and elevated relative to the stomach. The distention was resolved, while maintaining oral nutrition. Comments: Pathologic aerophagia is a rare self-limiting condition in normal children exposed to high levels of stress and may be a persisting problem in children with psychiatric or neurologic disease. In this last group, the disease may cause serious complications. Pharmacological and behavioral treatments are ill-defined. Severe cases may demand surgical strategies, mainly decompressive gastrostomy. PMID:26100594

  5. [Imperforate hymen can cause abdominal pain and primary amenorrhoea].

    PubMed

    Nielsen, Vibeke; Vyrdal, Christian

    2013-05-20

    Imperforate hymen (HI) is a rare condition caused by the hymen covering the entire opening of the vagina. This prevents the menstruation blood from being drained and the blood fills up the vagina and later the uterus and Fallopian tubes. The produced strain on these organs causes cyclic pain in the lower abdomen. We present two cases where two adolescent girls were diagnosed with HI. It is important to remember HI as a differential diagnosis in young girls with amenorrhoea and lower abdominal pain. In both cases a hymenectomy was performed and the patients recovered afterwards.

  6. Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments

    PubMed Central

    Dong, Ding-Hui; Liu, Wen-Yan; Feng, Hai-Bo; Fu, Yi-Li; Huang, Shi; Xiang, Jun-Xi; Lyu, Yi

    2015-01-01

    Background: Magnetic anchored surgical instruments (MASI), relying on magnetic force, can break through the limitations of the single port approach in dexterity. Individual characteristic abdominal wall thickness (ICAWT) deeply influences magnetic force that determines the safety of MASI. The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT, and then construct an artful method to predict ICAWT, resulting in better safety and feasibility for MASI. Methods: For MASI, ICAWT is referred to the thickness of thickest point in the applied environment. We determined ICAWT through finding the thickest point in computed tomography scans. We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT. Results: Abdominal wall at C point in the middle third lumbar vertebra plane (L3) is the thickest during chosen points. Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness. “BMI-ICAWT” curve was obtained based on abdominal wall thickness of C point in L3 plane, and the expression was as follow: f(x) = P1 × x2 + P2 × x + P3, where P1 = 0.03916 (0.01776, 0.06056), P2 = 1.098 (0.03197, 2.164), P3 = −18.52 (−31.64, −5.412), R-square: 0.99. Conclusions: Abdominal wall thickness of C point at L3 could be regarded as ICAWT. BMI could be a reliable predictor of ICAWT. In the light of “BMI-ICAWT” curve, we may conveniently predict ICAWT by BMI, resulting a better safety and feasibility for MASI. PMID:26228215

  7. Abdominal and scrotal wall emphysema in a patient with severe ulcerative colitis.

    PubMed

    Sharma, Manik; Thandassery, Ragesh Babu; Hilli, Shatha Al; Kaabi, Saad Al

    2014-07-01

    Severe ulcerative colitis can be associated with bowel perforation. Bowel perforation rarely leads on to abdominal wall and scrotal wall emphysema. Bowel perforation in such cases can be spontaneous or iatrogenic (colonoscopy-related). We report a rare scenario where a patient presented with abdominal wall and scrotal emphysema after topical corticosteroid enema-induced traumatic rectal perforation. Topical corticosteroids were stopped immediately after identification of rectal perforation. The patient was managed conservatively with intravenous antibiotics. With this report we intend to sensitise clinicians and topical enema manufacturers regarding this rare complication.

  8. [Approaches to the abdominal cavity and closure of the abdominal wall].

    PubMed

    Dittmar, Y; Rauchfuss, F; Ardelt, M; Settmacher, U

    2011-12-01

    Although minimally invasive approaches to the abdominal cavity are becoming increasingly more important, open surgical techniques are still of essential interest and must be mastered by general and visceral surgeons. The choice of the particular approach depends on the specificity and location of the scheduled procedure. The following article is intended to give an overview on the current literature as well as experiences in the field of open surgical approaches to the abdominal cavity.

  9. Primary closure of the abdominal wall after "open abdomen" situation.

    PubMed

    Kääriäinen, M; Kuokkanen, H

    2013-01-01

    "Open abdomen" is a strategy used to avoid or treat abdominal compartment syndrome. It has reduced mortality both in trauma and non-trauma abdominal catastrophes but also has created a challenging clinical problem. Traditionally, open abdomen is closed in two phases; primarily with a free skin graft and later with a flap reconstruction. A modern trend is to close the abdomen within the initial hospitalization. This requires multi-professional co-operation. Temporary abdominal closure methods, e.g. negative pressure wound therapy alone or combined with mesh-mediated traction, have been developed to facilitate direct fascial closure. Components separation technique, mesh reinforcement or bridging of the fascial defect with mesh and perforator saving skin undermining can be utilized in the final closure if needed. These techniques can be combined. Choice of the treatment depends on the condition of the patient and size of the fascia and skin defect, and the state of the abdominal contents. In this paper we review the literature on the closure of an open abdomen and present the policy used in our institution in the open abdomen situations.

  10. Paragonimiasis mimicking chest cancer and abdominal wall metastaisis: A case report

    PubMed Central

    ZHOU, RONGXING; ZHANG, MINJIA; CHENG, NANSHENG; ZHOU, YONG

    2016-01-01

    Typical human paragonimiasis demonstrates an elevated eosinophil count, positive immunoblot, nodular shadows of the lung and pleural thickening with pleural effusion, and these symptoms may be confused with chest cancer. In the present case, a rare case of human paragonimiasis mimicking chest cancer and abdominal wall metastasis is described, the 39-year-old male patient was admitted in our hospital for cough, weight loss 5 kg and a firm mass in right upper abdominal wall. The laboratory test showed unremarkable hematology and biochemistry results. Chest X-ray, Plain computed tomography of the chest and abdomen showed right pleural effusion, several nodules in right lower lung and a mass in the right upper abdominal wall. The initial diagnosis was lung or chest cancer with abdominal wall metastasis, and the abdominal wall mass was resected for the final diagnosis. The biopsy revealed eosinophilic granuloma with Charcot-Leyden crystal formation infiltrated in the muscular fibers. Subsequent to assessment of the antibodies against parasites, the final diagnosis of paragonimiasis was made. PMID:27313691

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

    PubMed Central

    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

  12. Testicular Ectopia in the Anterior Abdominal Wall of a Neonate: A Rare Site of Ectopic Testis

    PubMed Central

    Siddiqui, Salman Atiq; Marei, Tamer Ibrahim; Al-Makhaita, Ghada

    2016-01-01

    Patient: Male, 3-day Final Diagnosis: Ectopic right testis in anterior abdominal wall Symptoms: — Medication: — Clinical Procedure: Testicular ultrasound and MRI abdomen Specialty: Radiology Objective: Unusual clinical course Background: Abnormal testicular descent can either be undescended or, less commonly, ectopic. Most undescended testes complete the course of descent by the first year of life only if these remain in the normal path of descent. The deviation of the testis may occur to an ectopic location during the transinguinal phase. Of the known ectopic sites, the anterior abdominal wall is the rarest site of testicular ectopia and to our knowledge only 3 cases of this nature have been reported in the available literature to date. Case Report: This rare case of testicular ectopia occurred in a 3-day-old boy in whom the right scrotal sac was empty; on abdominal ultrasound, the right testis was found in the subcutaneous tissues of the right antero-lateral abdominal wall. These findings were confirmed on abdominal MRI, where the right testis was seen beneath the skin between the subcutaneous tissues and external oblique aponeurosis. No aponeurotic or muscular defect was appreciable under the abdominal wall. The neonate underwent orchiopexy at the age of 6 months and remained uneventful postoperatively. Conclusions: Preoperative imaging is recommended to detect and confirm the ectopic site as well as the morphology of testis, thereby increasing the chance of surveillance and preservation of an ectopic testis. Imaging can serve as preoperative road mapping to localize the exact site for surgical exploration of an ectopic testis if there is no apparent or palpable swelling over the anterior abdominal wall. PMID:27411886

  13. Texture analysis improves level set segmentation of the anterior abdominal wall

    PubMed Central

    Xu, Zhoubing; Allen, Wade M.; Baucom, Rebeccah B.; Poulose, Benjamin K.; Landman, Bennett A.

    2013-01-01

    Purpose: The treatment of ventral hernias (VH) has been a challenging problem for medical care. Repair of these hernias is fraught with failure; recurrence rates ranging from 24% to 43% have been reported, even with the use of biocompatible mesh. Currently, computed tomography (CT) is used to guide intervention through expert, but qualitative, clinical judgments, notably, quantitative metrics based on image-processing are not used. The authors propose that image segmentation methods to capture the three-dimensional structure of the abdominal wall and its abnormalities will provide a foundation on which to measure geometric properties of hernias and surrounding tissues and, therefore, to optimize intervention. Methods: In this study with 20 clinically acquired CT scans on postoperative patients, the authors demonstrated a novel approach to geometric classification of the abdominal. The authors’ approach uses a texture analysis based on Gabor filters to extract feature vectors and follows a fuzzy c-means clustering method to estimate voxelwise probability memberships for eight clusters. The memberships estimated from the texture analysis are helpful to identify anatomical structures with inhomogeneous intensities. The membership was used to guide the level set evolution, as well as to derive an initial start close to the abdominal wall. Results: Segmentation results on abdominal walls were both quantitatively and qualitatively validated with surface errors based on manually labeled ground truth. Using texture, mean surface errors for the outer surface of the abdominal wall were less than 2 mm, with 91% of the outer surface less than 5 mm away from the manual tracings; errors were significantly greater (2–5 mm) for methods that did not use the texture. Conclusions: The authors’ approach establishes a baseline for characterizing the abdominal wall for improving VH care. Inherent texture patterns in CT scans are helpful to the tissue classification, and texture

  14. Texture analysis improves level set segmentation of the anterior abdominal wall

    SciTech Connect

    Xu, Zhoubing; Allen, Wade M.; Baucom, Rebeccah B.; Poulose, Benjamin K.; Landman, Bennett A.

    2013-12-15

    Purpose: The treatment of ventral hernias (VH) has been a challenging problem for medical care. Repair of these hernias is fraught with failure; recurrence rates ranging from 24% to 43% have been reported, even with the use of biocompatible mesh. Currently, computed tomography (CT) is used to guide intervention through expert, but qualitative, clinical judgments, notably, quantitative metrics based on image-processing are not used. The authors propose that image segmentation methods to capture the three-dimensional structure of the abdominal wall and its abnormalities will provide a foundation on which to measure geometric properties of hernias and surrounding tissues and, therefore, to optimize intervention.Methods: In this study with 20 clinically acquired CT scans on postoperative patients, the authors demonstrated a novel approach to geometric classification of the abdominal. The authors’ approach uses a texture analysis based on Gabor filters to extract feature vectors and follows a fuzzy c-means clustering method to estimate voxelwise probability memberships for eight clusters. The memberships estimated from the texture analysis are helpful to identify anatomical structures with inhomogeneous intensities. The membership was used to guide the level set evolution, as well as to derive an initial start close to the abdominal wall.Results: Segmentation results on abdominal walls were both quantitatively and qualitatively validated with surface errors based on manually labeled ground truth. Using texture, mean surface errors for the outer surface of the abdominal wall were less than 2 mm, with 91% of the outer surface less than 5 mm away from the manual tracings; errors were significantly greater (2–5 mm) for methods that did not use the texture.Conclusions: The authors’ approach establishes a baseline for characterizing the abdominal wall for improving VH care. Inherent texture patterns in CT scans are helpful to the tissue classification, and texture

  15. Ectodermal Wnt signaling regulates abdominal myogenesis during ventral body wall development.

    PubMed

    Zhang, Lingling; Li, Hanjun; Yu, Jian; Cao, Jingjing; Chen, Huihui; Zhao, Haixia; Zhao, Jianzhi; Yao, Yiyun; Cheng, Huihui; Wang, Lifang; Zhou, Rujiang; Yao, Zhengju; Guo, Xizhi

    2014-03-01

    Defects of the ventral body wall are prevalent birth anomalies marked by deficiencies in body wall closure, hypoplasia of the abdominal musculature and multiple malformations across a gamut of organs. However, the mechanisms underlying ventral body wall defects remain elusive. Here, we investigated the role of Wnt signaling in ventral body wall development by inactivating Wls or β-catenin in murine abdominal ectoderm. The loss of Wls in the ventral epithelium, which blocks the secretion of Wnt proteins, resulted in dysgenesis of ventral musculature and genito-urinary tract during embryonic development. Molecular analyses revealed that the dermis and myogenic differentiation in the underlying mesenchymal progenitor cells was perturbed by the loss of ectodermal Wls. The activity of the Wnt-Pitx2 axis was impaired in the ventral mesenchyme of the mutant body wall, which partially accounted for the defects in ventral musculature formation. In contrast, epithelial depletion of β-catenin or Wnt5a did not resemble the body wall defects in the ectodermal Wls mutant. These findings indicate that ectodermal Wnt signaling instructs the underlying mesodermal specification and abdominal musculature formation during ventral body wall development, adding evidence to the theory that ectoderm-mesenchyme signaling is a potential unifying mechanism for the origin of ventral body wall defects.

  16. Use of a hand-held Doppler to avoid abdominal wall vessels in laparoscopic surgery.

    PubMed Central

    Whiteley, M. S.; Laws, S. A.; Wise, M. H.

    1994-01-01

    Laparoscopy in general surgery is becoming a wide-spread technique. Substantial anterior abdominal wall haemorrhage is a recognised complication of the laparoscopic technique. Ten patients were examined with an 8 MHz hand-held Doppler and the anterior abdominal wall vessels were marked on the skin. Colour flow duplex was used to confirm the presence of vessels found in this way. All 40 epigastric arteries were marked accurately and confirmed; 75 other intramural arteries were identified, although the majority were too small for duplex confirmation. The preoperative use of hand-held Doppler is a quick and non-invasive way to identify the epigastric and larger intramural arteries. Routine use of this technique to mark abdominal wall vessels in the areas of trocar insertion should reduce this complication of laparoscopic surgery. PMID:7661918

  17. Abdominal Wall Endometriosis: Myofibroblasts as a Possible Evidence of Metaplasia: A Case Report.

    PubMed

    Ibrahim, Mohamed Gamal; Delarue, Eleonore; Abesadze, Elene; Haas, Matthias; Sehouli, Jalid; Chiantera, Vito; Mechsner, Sylvia

    2017-01-01

    In this study, we report about a patient with extra-uterine endometriosis (EM) in the abdominal wall muscle with evident metaplasia based on the abundant alpha smooth muscle actin (ASMA)-expressing myofibroblasts. Laparotomy excision of the abdominal wall EM was done following ultrasonographic evidence of a hypodense swelling in the right rectus abdominis, which was confirmed by MRI. Immunohistochemistry staining for ASMA and collagen I was done, with the results confirming that endometriotic stromal cells expressed both. Anterior abdominal wall endometriosis was suspected because of the patient's history of recurrent EM combined with the cyclic nature of symptoms. MRI is useful in determining the extent of the disease. In case of persisting symptoms even under hormonal treatment, surgical excision is mandatory. The expression of both ASMA and collagen I in and around EM lesions supports the notion of the metaplastic process in the course of disease development.

  18. Congenital defects of the abdominal wall. A review of the experience in New Mexico.

    PubMed

    Klein, M D; Kosloske, A M; Hertzler, J H

    1981-04-24

    Omphalocele, umbilical cord hernia, and gastroschisis are surgically correctable defects of the abdominal wall. Each of these defects has a distinct embryologic basis that results in a characteristic clinical picture. Twenty-five infants with congenital defects of the abdominal wall were treated at the University of New Mexico Hospital in the past four years. Six infants had omphalocele, one had umbilical cord hernia, and 18 had gastroschisis. Survival among infants who underwent a corrective operation was as follows: omphalocele, 50%; umbilical cord hernia, 100%; and gastroschisis, 82%. Long-term survival for the entire group was 72% (18/25). Gastroschisis, which had a lower incidence of major associated anomalies, had a better prognosis than omphalocele. The mortality of congenital abdominal wall defects was related to presence of severe associated anomalies and to poor clinical condition on admission. Prompt and informed initial care may increase the chance of survival.

  19. Living donor liver transplantation with abdominal wall reconstruction for hepatocellular carcinoma with needle track seeding

    PubMed Central

    Yang, Horng-Ren; Thorat, Ashok; Gesakis, Kanellos; Li, Ping-Chun; Kiranantawat, Kidakorn; Chen, Hung Chi; Jeng, Long-Bin

    2015-01-01

    Malignant cell seeding in subcutaneous tissues along the needle track and/or percutaneous biliary drainage catheters is rare complication, but pose various technical issues in planning surgical treatment of such patients. If underlying primary hepatic malignancy can be treated, an aggressive resection of subcutaneous tissue bearing cancer cell with subsequent abdominal wall reconstruction has been sporadically reported. But, when hepatic resection is not possible due to underlying advanced cirrhosis, liver transplantation along with abdominal wall resection and subsequent reconstruction remains only feasible option. Herein, we describe our successful experience of living donor liver transplantation for hepatocellular carcinoma with full-thickness abdominal wall resection bearing the tumor seeding followed by reconstruction in single stage surgery. PMID:26722665

  20. Patient-specific models of wall stress in abdominal aortic aneurysm: a comparison between MR and CT

    NASA Astrophysics Data System (ADS)

    de Putter, Sander; Breeuwer, Marcel; van de Vosse, Frans N.; Kose, Ursula; Gerritsen, Frans A.

    2006-03-01

    Finite element method based patient-specific wall stress in abdominal aortic aneurysm (AAA) may provide a more accurate rupture risk predictor than the currently used maximum transverse diameter. In this study, we have investigated the sensitivity of the wall stress in AAA with respect to geometrical variations. We have acquired MR and CT images for four patients with AAA. Three individual users have delineated the AAA vessel wall contours on the image slices. These contours were used to generate synthetic feature images for a deformable model based segmentation method. We investigated the reproducibility and the influence of the user variability on the wall stress. For sufficiently smooth models of the AAA wall, the peak wall stress is reproducible for three out of the four AAA geometries. The 0.99 percentiles of the wall stress show excellent reproducibility for all four AAAs. The variations induced by user variability are larger than the errors caused by the segmentation variability. The influence of the user variability appears to be similar for MR and CT. We conclude that the peak wall stress in AAA is sensitive to small geometrical variations. To increase reproducibility it appears to be best not to allow too much geometrical detail in the simulations. This could be achieved either by using a sufficiently smooth geometry representation or by using a more robust statistical parameter derived from the wall stress distribution.

  1. Abdominal wall reconstruction after extensive abdominal wall necrosis resulting from chevron incision for liver transplant and subsequent Y-shaped incision for re-transplantation--clinical experience and literature review.

    PubMed

    Rieger, Ulrich M; Petschke, Fabian; Djedovic, Gabriel; Engelhardt, Timm O; Biebl, Matthias; Pierer, Gerhard

    2012-03-01

    Extensive Abdominal wall necrosis is a devastating complication. In visceral transplant patients a quick and easy to perform reconstructive technique may be crucial for patient survival. Based on a clinical case a literature review is performed including a thorough analysis of abdominal wall perfusion and surgical options for defect closure are presented and critically appraised.

  2. Wandering spleen torsion causing acute abdominal pain in a child: case report and review of literature.

    PubMed

    Llorens Marina, Carlos I; Cedeño, Alex; Lugo-Vicente, Humberto; Chapel, Cristel; Rivera, Glorimar; Diaz, Antonio

    2014-01-01

    Wandering spleen is a rare occurrence where the spleen normal fixation to the abdominal wall is lost and thus allowed to change in position. We report a case of a child who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. The diagnosis was promptly made using computed tomography and managed with splenectomy.

  3. Aesthetic and functional abdominal wall reconstruction after multiple bowel perforations secondary to liposuction.

    PubMed

    Di Candia, Michele; Malata, Charles M

    2011-04-01

    This report describes a case of aesthetic and functional abdominal wall reconstruction performed to salvage a deformed, scarred, and herniated anterior abdomen after severe peritonitis and partial rectus muscle necrosis secondary to multiple bowel perforations sustained during liposuction performed in a cosmetic clinic. The diagnosis of intestinal perforation was missed intraoperatively and in the immediate postoperative period. The patient was admitted 4 days after the surgery to the intensive therapy unit in septicemic shock. After resuscitation and stabilization, she was treated by debridement of the abdominal wall, bowel resection, and temporary jejunostomy and colostomy (reversed 10 months later). She was referred 18 months after liposuction to the Plastic Surgery Service with a large central midline abdominal incisional hernia presenting with thinned out skin (14 × 11 cm) overlying adherent bowel. A components separation technique was successfully used to reconstruct the abdominal wall, with no recurrent herniation 2 years later. Survivors of bowel perforations sustained during abdominal liposuction may later present with challenging aesthetic and functional problems, as described in this report. These long-term sequelae have not been addressed hitherto in the literature.

  4. Semiautomatic vessel wall detection and quantification of wall thickness in computed tomography images of human abdominal aortic aneurysms

    SciTech Connect

    Shum, Judy; DiMartino, Elena S.; Goldhammer, Adam; Goldman, Daniel H.; Acker, Leah C.; Patel, Gopal; Ng, Julie H.; Martufi, Giampaolo; Finol, Ender A.

    2010-02-15

    Purpose: Quantitative measurements of wall thickness in human abdominal aortic aneurysms (AAAs) may lead to more accurate methods for the evaluation of their biomechanical environment. Methods: The authors describe an algorithm for estimating wall thickness in AAAs based on intensity histograms and neural networks involving segmentation of contrast enhanced abdominal computed tomography images. The algorithm was applied to ten ruptured and ten unruptured AAA image data sets. Two vascular surgeons manually segmented the lumen, inner wall, and outer wall of each data set and a reference standard was defined as the average of their segmentations. Reproducibility was determined by comparing the reference standard to lumen contours generated automatically by the algorithm and a commercially available software package. Repeatability was assessed by comparing the lumen, outer wall, and inner wall contours, as well as wall thickness, made by the two surgeons using the algorithm. Results: There was high correspondence between automatic and manual measurements for the lumen area (r=0.978 and r=0.996 for ruptured and unruptured aneurysms, respectively) and between vascular surgeons (r=0.987 and r=0.992 for ruptured and unruptured aneurysms, respectively). The authors' automatic algorithm showed better results when compared to the reference with an average lumen error of 3.69%, which is less than half the error between the commercially available application Simpleware and the reference (7.53%). Wall thickness measurements also showed good agreement between vascular surgeons with average coefficients of variation of 10.59% (ruptured aneurysms) and 13.02% (unruptured aneurysms). Ruptured aneurysms exhibit significantly thicker walls (1.78{+-}0.39 mm) than unruptured ones (1.48{+-}0.22 mm), p=0.044. Conclusions: While further refinement is needed to fully automate the outer wall segmentation algorithm, these preliminary results demonstrate the method's adequate reproducibility

  5. Abdominal wall injuries: rectus abdominis strains, oblique strains, rectus sheath hematoma.

    PubMed

    Johnson, Rob

    2006-04-01

    Abdominal wall injuries are reported to be less common than actually perceived by sports medicine practitioners. National Collegiate Athletic Association injury statistics for 2004-2005 cite a high of 0.71 abdominal muscle injuries per 1000 player-hours in wrestling competition to a low of 0.01 injuries per 1000 player-hours in autumn football practices. British professional soccer clubs reported an incidence of "torso" injuries of up to 7% of all injuries over the course of several seasons. Injury definition is most likely the explanation for this discrepancy. The abdominal wall muscles (rectus abdominis, external and internal obliques, and transverse abdominis) are injured by direct blows to the abdomen or by sudden or repetitive trunk movement, either rotation or flexion/extension. With the exception of the rare rectus sheath hematoma that does not self-tamponade, the treatment for these problems is nonoperative with symptoms guiding rehabilitation and return to play decisions.

  6. QUALITY OF LIFE OF IN PATIENTS SUBMITTED TO ANTERIOR ABDOMINAL WALL LAPAROSCOPIC HERNIOPLASTY

    PubMed Central

    ABDALLA, Ricardo Zugaib; GARCIA, Rodrigo Biscuola; SAID, Danniel Frade; ABDALLA, Beatrice Martinez Zugaib

    2014-01-01

    Background The laparoscopic ventral hernia repair technique made possible surgeries with smaller skin incisions and smaller dissection of the soft tissue around the hernia, therefore with a better wound, a quicker postoperative recovery and a lower complication rate. Aim To evaluate the applicability of a quality of life survey based on the molds of the American Hernia Society, European Hernia Society and Carolinas Equation for Quality of Life, through telephone in patients submitted to laparoscopic hernioplasty by IPOM technique. Methods A retrospective cohort study was made to evaluate the quality of life of 21 patients that underwent anterior abdominal wall laparoscopic hernioplasty by intraperitoneal onlay mesh technique. Questionnaire was applied through telephone. Results Of the 21 patients, 19% felt that the hernia recurred. Also 19% passed through another abdominal wall surgery, and among these, 75% was related to the previously hernia correction. Finally, 81% of patients did not undergo any other abdominal wall surgery. Conclusion It was possible to apply the quality of life questionnary by telephone on patients who underwent an anterior abdominal wall. The results, in its turn, were satisfactory and showed that patients, in general, were satisfied with the surgical procedure. PMID:24676295

  7. Urinary bladder herniation through a caudoventral abdominal wall defect in a mature cat.

    PubMed

    Neville-Towle, Jack; Sakals, Sherisse

    2015-09-01

    A 16-year-old spayed female domestic shorthair cat with no history of trauma was presented to the Western College of Veterinary Medicine for assessment of urinary incontinence. Diagnostic investigation revealed herniation of the urinary bladder through a caudoventral abdominal wall defect. Clinical signs resolved after surgical reduction of the bladder.

  8. 3-D segmentation and quantitative analysis of inner and outer walls of thrombotic abdominal aortic aneurysms

    NASA Astrophysics Data System (ADS)

    Lee, Kyungmoo; Yin, Yin; Wahle, Andreas; Olszewski, Mark E.; Sonka, Milan

    2008-03-01

    An abdominal aortic aneurysm (AAA) is an area of a localized widening of the abdominal aorta, with a frequent presence of thrombus. A ruptured aneurysm can cause death due to severe internal bleeding. AAA thrombus segmentation and quantitative analysis are of paramount importance for diagnosis, risk assessment, and determination of treatment options. Until now, only a small number of methods for thrombus segmentation and analysis have been presented in the literature, either requiring substantial user interaction or exhibiting insufficient performance. We report a novel method offering minimal user interaction and high accuracy. Our thrombus segmentation method is composed of an initial automated luminal surface segmentation, followed by a cost function-based optimal segmentation of the inner and outer surfaces of the aortic wall. The approach utilizes the power and flexibility of the optimal triangle mesh-based 3-D graph search method, in which cost functions for thrombus inner and outer surfaces are based on gradient magnitudes. Sometimes local failures caused by image ambiguity occur, in which case several control points are used to guide the computer segmentation without the need to trace borders manually. Our method was tested in 9 MDCT image datasets (951 image slices). With the exception of a case in which the thrombus was highly eccentric, visually acceptable aortic lumen and thrombus segmentation results were achieved. No user interaction was used in 3 out of 8 datasets, and 7.80 +/- 2.71 mouse clicks per case / 0.083 +/- 0.035 mouse clicks per image slice were required in the remaining 5 datasets.

  9. Rectus abdominis muscle resection and fascial reconstruction for the treatment of uterine leiomyosarcoma invading the abdominal wall: a case report.

    PubMed

    Yoon, B S; Seong, S J; Song, T; Kim, M L; Kim, M K

    2014-01-01

    The authors present a case of intra-abdominal recurrent leiomyosarcoma invading a large area of the abdominal wall. The patient underwent cytoreductive surgery, including resection of the rectus abdominis muscle, followed by reconstruction of the defect using synthetic mesh. The tumor was surgically removed by en bloc resection, including most of the rectus abdominis muscle and ileum. The abdominal wall defect was repaired using synthetic mesh. The patient underwent radiotherapy and chemotherapy after the surgery and was healthy one year later.

  10. Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications.

    PubMed Central

    Voyles, C R; Richardson, J D; Bland, K I; Tobin, G R; Flint, L M; Polk, H C

    1981-01-01

    The acute replacement of full-thickness abdominal wall has been facilitated by polypropylene mesh (Marlex) (PPM), allowing debridement of nonviable tissue and restoration of abdominal wall integrity without tension. However, no substantial long-term follow-up has been reported on the definitive wound coverage after the use of PPM in open wounds. Since 1976, we have placed PPM in 31 patients; 25 for infectious complication, three for massive bowel distension preventing abdominal closure, and three for shotgun wounds with extensive tissue loss. In 29 of 31 patients, the mesh was placed in heavily contaminated wounds; extensive fasciitis was present in 23 patients and 21 had intra-abdominal abscesses. Following mesh placement, 23 reoperations were required for continuing complications. No patients eviscerated, despite these multiple procedures. Polypropylene mesh was highly effective in restoring abdominal wall continuity. Despite advantages when PPM was used, significant long-term problems developed. Seven patients died from their primary illness in the postoperative period. Nine wounds were closed by granulation and subsequent split-thickness skin grafts. All nine developed mesh extrusion and/or enteric fistulae. Nine wounds healed by secondary intention, six developed enteric fistulae or continuing mesh extrusion. Full-thickness flap coverage after granulation provided the best means of wound closure. Polypropylene mesh had significant early advantages for providing abdominal wall integrity even in the presence of severe infection. However, long-term problems were common when wounds were closed to skin grafts or secondary intention. If the mesh cannot be completely removed, strong consideration should be given to myocutaneous flaps for coverage after the primary illness has resolved. Images Fig. 1. Fig. 2. Fig. 3. PMID:6455099

  11. Abdominal Pain Caused by a Potentially Fatal Attraction.

    PubMed

    Mercurio, Danielle Claire; Scace, Candace; Shah, Bhairav; Weiner, Evan; Prasad, Rajeev

    2016-11-19

    Abdominal pain is a challenging presentation in children. Examination findings and etiology vary greatly, spanning a vast spectrum from flatulence to frank peritonitis with septic shock. Here, we discuss a 10-year-old boy with 24 hours of progressively worsening lower abdominal pain, nausea, and subjective fevers. History and physical examination findings were consistent with appendicitis. However, physicians were surprised when the single-view abdominal radiograph showed an unanticipated, somewhat perplexing discovery.

  12. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

    PubMed

    Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E

    1991-01-01

    There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.

  13. Long-term anisotropic mechanical response of surgical meshes used to repair abdominal wall defects.

    PubMed

    Hernández-Gascón, B; Peña, E; Pascual, G; Rodríguez, M; Bellón, J M; Calvo, B

    2012-01-01

    Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue.

  14. Free tensor fasciae latae flap for abdominal wall reconstruction: overview and new innovation.

    PubMed

    Chalfoun, Charbel T; McConnell, Michael P; Wirth, Garrett A; Brenner, Kevin A; Evans, Gregory R D; Kobayashi, Mark

    2012-03-01

    Extensive abdominal wall defects may result from tumor extirpation, traumatic injury, or soft tissue infections. Extensive traumatic injuries can often disrupt the soft tissue content of the abdomen as well as the bony support provided by the pelvis. Reconstruction of the lower abdomen should aim to recreate dynamic stability. Five patients with extensive lower abdominal wall disruption following traumatic injuries or infection were treated using a novel flap for functional reconstruction. We devised a free neurotized osteomyocutaneous tensor fasciae latae (TFL) flap that would restore bony continuity by providing a vascularized bone graft and simultaneously maintain the integrity of the attachment of the tensor fascia latae muscle to the iliac crest, reestablishing musculofascial continuity. A branch of the superior gluteal nerve was harvested with this composite flap and coapted to an intercostal nerve for reinnervation, thereby creating a dynamic muscle in these patients. All patients underwent successful free tissue reconstruction with 100% flap survival. The lower abdominal wall and bony integrity of the pelvis were successfully reconstructed. Reinnervation has shown clinical signs of maintained dynamic stability. The innervated TFL osteomyocutaneous flap is an ideal option for lower abdominal reconstruction in patients with complex abdominoperineal defects with loss of bony integrity.

  15. Large antigenic skin load in total abdominal wall transplants permits chimerism induction.

    PubMed

    Nasir, Serdar; Bozkurt, Mehmet; Klimczak, Aleksandra; Siemionow, Maria

    2008-11-01

    The application of composite tissue allograft (CTA) transplants in clinical reconstruction is parallel with extended knowledge of anatomy, microsurgical skills and development of transplantation immunology. CTAs are composed of multiple tissues, some of which such as skin are highly immunogenic and cause strong immunologic responses. Strong antigenic nature of skin may be related to Langerhans cells, which are powerful antigen-presenting cells. They are leukocytes found in the epidermis as members of immunologic cascade. Large skin components of CTA transplant may cause higher antigenic load as a result of increased surface area of transplanted skin correlating with increased load of Langerhans cells. In clinical abdominal wall transplants, increased rejection episodes were reported compared with other CTA transplant. This complication may correlate to large skin component of these transplants. To evaluate correlation between large skin island flaps and immunologic responses, CTA models with large skin components should be tested in experimental studies. Here we propose a total abdominal wall (TAW) transplant model in rat to test the feasibility of TAW transplantation in 2 groups: the anatomic study and experimental transplantation group. In anatomic study, TAW flaps were elevated bilaterally on superficial epigastric vessels and replaced. The entire TAW skin islands of all flaps were viable at postoperative day 21. Dye study confirmed that TAW flap was supplied by 2 vascular pedicles. Data in this group demonstrated that this flap is composed of the largest skin island when compared with other CTA transplant models such as full face, hemiface, limb, and groin flap. In experimental group, isograft transplantations were performed between Lewis rats (RT1(1)) while allograft transplantations were performed Lewis (RT1(1)) donors and LBN (RT(1+n)) recipients. All TAW transplants showed viable islands at posttransplant day 200 under cyclosporine A monotherapy protocol

  16. Fluid-structure interaction in abdominal aortic aneurysms: effects of asymmetry and wall thickness

    PubMed Central

    Scotti, Christine M; Shkolnik, Alexander D; Muluk, Satish C; Finol, Ender A

    2005-01-01

    Background Abdominal aortic aneurysm (AAA) is a prevalent disease which is of significant concern because of the morbidity associated with the continuing expansion of the abdominal aorta and its ultimate rupture. The transient interaction between blood flow and the wall contributes to wall stress which, if it exceeds the failure strength of the dilated arterial wall, will lead to aneurysm rupture. Utilizing a computational approach, the biomechanical environment of virtual AAAs can be evaluated to study the affects of asymmetry and wall thickness on this stress, two parameters that contribute to increased risk of aneurysm rupture. Methods Ten virtual aneurysm models were created with five different asymmetry parameters ranging from β = 0.2 to 1.0 and either a uniform or variable wall thickness to study the flow and wall dynamics by means of fully coupled fluid-structure interaction (FSI) analyses. The AAA wall was designed to have a (i) uniform 1.5 mm thickness or (ii) variable thickness ranging from 0.5 – 1.5 mm extruded normally from the boundary surface of the lumen. These models were meshed with linear hexahedral elements, imported into a commercial finite element code and analyzed under transient flow conditions. The method proposed was then compared with traditional computational solid stress techniques on the basis of peak wall stress predictions and cost of computational effort. Results The results provide quantitative predictions of flow patterns and wall mechanics as well as the effects of aneurysm asymmetry and wall thickness heterogeneity on the estimation of peak wall stress. These parameters affect the magnitude and distribution of Von Mises stresses; varying wall thickness increases the maximum Von Mises stress by 4 times its uniform thickness counterpart. A pre-peak systole retrograde flow was observed in the AAA sac for all models, which is due to the elastic energy stored in the compliant arterial wall and the expansion force of the artery

  17. Abdominal wall Type-I complex regional pain syndrome treated effectively with peripheral nerve field stimulation: a case report

    PubMed Central

    Zhou, Linqiu; Chou, Henry; Holder, Eric

    2017-01-01

    Chronic abdominal wall pain is a well-documented complication of abdominal surgery. However, abdominal wall complex regional pain syndrome (CRPS) is a rare medical condition. We present a case of abdominal wall CRPS and its treatment with peripheral nerve field stimulation (PNfS). A 34-year-old female presented with right periumbilical pain for 2 years. She developed burning, sharp and stabbing pain with allodynia (extremely sensitive to wind and light touch) and erythema or pallor 2 weeks after an exploratory appendectomy. The extensive evaluation ruled out the underlining pathology. After she failed conservative therapies, she underwent a 7-day trial of thoracic spinal cord stimulation (SCS) and abdominal wall PNfS. Thoracic SCS failed to provide pain relief; however, PNfS provided significant relief (>90%) of burning sensation. It has now been 5 years since the PNfS was implanted and she continues to demonstrate substantial pain relief. PMID:28044002

  18. Histological characteristics of the abdominal aortic wall in patients with vascular chronic Q fever

    PubMed Central

    Hagenaars, Julia C J P; Koning, Olivier H J; van den Haak, Ronald F F; Verhoeven, Bart A N; Renders, Nicole H M; Hermans, Mirjam H A; Wever, Peter C; van Suylen, Robert Jan

    2014-01-01

    The aim of this study was to describe specific histological findings of the Coxiella burnetii-infected aneurysmal abdominal aortic wall. Tissue samples of the aneurysmal abdominal aortic wall from seven patients with chronic Q fever and 15 patients without evidence of Q fever infection were analysed and compared. Chronic Q fever was diagnosed using serology and tissue PCR analysis. Histological sections were stained using haematoxylin and eosin staining, Elastica van Gieson staining and immunohistochemical staining for macrophages (CD68), T lymphocytes (CD3), T lymphocyte subsets (CD4 and CD8) and B lymphocytes (CD20). Samples were scored by one pathologist, blinded for Q fever status, using a standard score form. Seven tissue samples from patients with chronic Q fever and 15 tissue samples from patients without Q fever were collected. Four of seven chronic Q fever samples showed a necrotizing granulomatous response of the vascular wall, which was characterized by necrotic core of the arteriosclerotic plaque (P = 0.005) and a presence of high numbers of macrophages in the adventitia (P = 0.007) distributed in typical palisading formation (P = 0.005) and surrounded by the presence of high numbers of T lymphocytes located diffusely in media and adventitia. Necrotizing granulomas are a histological finding in the C. burnetii-infected aneurysmal abdominal aortic wall. Chronic Q fever should be included in the list of infectious diseases with necrotizing granulomatous response, such as tuberculosis, cat scratch disease and syphilis. PMID:24953727

  19. Pathological Analysis of the Ruptured Vascular Wall of Hypoperfusion-induced Abdominal Aortic Aneurysm Animal Model.

    PubMed

    Kugo, Hirona; Zaima, Nobuhiro; Tanaka, Hiroki; Hashimoto, Keisuke; Miyamoto, Chie; Sawaragi, Ayaka; Urano, Tetsumei; Unno, Naoki; Moriyama, Tatsuya

    2017-04-04

    Abdominal aortic aneurysm (AAA) is a vascular disease that results in the gradual dilation of the abdominal aorta and has a high rupture-related mortality rate. However, the mechanism of AAA rupture remains unknown. In our previous study, we established a novel AAA animal model (hypoperfusion-induced AAA rat model) with spontaneous AAA rupture. Using the hypoperfusion-induced AAA rat model, we demonstrated that the abnormal appearance of adipocytes in the vascular wall is associated with AAA rupture. However, pathological analysis of the rupture area has not been performed because it is particularly difficult to identify the rupture point. In this study, we succeeded in obtaining samples from the rupture point and performed a histological analysis of the ruptured area in the vascular wall in the hypoperfusion-induced AAA rat model. Adipocytes were observed along the AAA-ruptured area of the vascular wall. In the areas around the adipocytes, macrophage infiltration and protein levels of matrix metalloproteinases 2 and 9 were significantly increased and collagen-positive areas were significantly decreased, as compared with areas without adipocytes. The AAA diameter was correlated with the number of adipocytes in the vascular wall of the hypoperfusion-induced AAA rat model. On the other hand, serum triglyceride levels and serum total cholesterol levels were not correlated with the number of adipocytes in the vascular wall. These results suggest that local adipocyte accumulation in the vascular wall, not serum lipids, has an important role in AAA rupture.

  20. Automated Delineation of Vessel Wall and Thrombus Boundaries of Abdominal Aortic Aneurysms Using Multispectral MR Images

    PubMed Central

    Rodriguez-Vila, B.; Tarjuelo-Gutierrez, J.; Sánchez-González, P.; Verbrugghe, P.; Fourneau, I.; Maleux, G.; Herijgers, P.; Gomez, E. J.

    2015-01-01

    A correct patient-specific identification of the abdominal aortic aneurysm is useful for both diagnosis and treatment stages, as it locates the disease and represents its geometry. The actual thickness and shape of the arterial wall and the intraluminal thrombus are of great importance when predicting the rupture of the abdominal aortic aneurysms. The authors describe a novel method for delineating both the internal and external contours of the aortic wall, which allows distinguishing between vessel wall and intraluminal thrombus. The method is based on active shape model and texture statistical information. The method was validated with eight MR patient studies. There was high correspondence between automatic and manual measurements for the vessel wall area. Resulting segmented images presented a mean Dice coefficient with respect to manual segmentations of 0.88 and a mean modified Hausdorff distance of 1.14 mm for the internal face and 0.86 and 1.33 mm for the external face of the arterial wall. Preliminary results of the segmentation show high correspondence between automatic and manual measurements for the vessel wall and thrombus areas. However, since the dataset is small the conclusions cannot be generalized. PMID:26236390

  1. Recurrent tense pneumoperitoneum due to air influx via abdominal wall stoma of a PEG tube.

    PubMed

    Vijayakrishnan, Rajakrishnan; Adhikari, Deep; Anand, Curuchi P

    2010-07-28

    A 70 years old male on ventilatory and circulatory support for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tube for enteral feeding. Radiography revealed free air in the abdomen and gastrograffin (G) study showed no extravasation into the peritoneum. The G tube was successfully repositioned with mechanical release of air. Imaging showed complete elimination of free air but the patient had a recurrence of pneumoperitoneum. Mechanical release of air with sealing of the abdominal wound was performed. Later, the patient was restarted on tube feeding with no complications. This case demonstrates a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma.

  2. Urinary Bladder Adenocarcinoma Metastatic to the Abdominal Wall: Report of a Case with Cytohistologic Correlation

    PubMed Central

    Baliga, Mithra

    2016-01-01

    We report a case of adenocarcinoma metastatic to the abdominal wall in a 71-year-old man with a history of primary bladder adenocarcinoma. CT-guided core biopsy was performed; imprints and histologic sections showed malignant glands lined by tumor cells with hyperchromatic nuclei and prominent nucleoli, infiltrating through skeletal muscle. Immunohistochemistry revealed positivity for CK7, membranous/cytoplasmic β-catenin, caudal-type homeobox transcription factor 2 (CDX2), and α-methylacyl coenzyme A racemase and negativity for CK20, p63, prostate-specific antigen (PSA), and prostate-specific acid phosphatase (PSAP). These findings were interpreted as metastatic adenocarcinoma, consistent with bladder primary. Primary bladder adenocarcinoma is a rare malignancy arising within glandular metaplasia and is associated with cystitis cystica and cystitis glandularis. Predisposing factors include bladder exstrophy, schistosomiasis, and other causes of chronic bladder irritation. This tumor is divided into intestinal, clear cell, and signet ring cell subtypes. Treatment involves radical cystectomy with pelvic lymph node dissection, and prognosis is unfavorable. Primary bladder adenocarcinoma should be differentiated from urachal adenocarcinoma, which arises from urachal remnants near the bladder dome, and secondary adenocarcinoma, or vesical involvement by adenocarcinoma from a different primary. CK7, CK20, CDX2, thrombomodulin, and β-catenin can help distinguish primary bladder adenocarcinoma from colonic adenocarcinoma; PSA and PSAP can help distinguish primary bladder adenocarcinoma from prostate adenocarcinoma. PMID:27006847

  3. Reconstruction of extensive abdominal wall defect using an eccentric perforator-based pedicled anterolateral thigh flap: a case report.

    PubMed

    Jang, Joonchul; Jeong, Seong-Ho; Han, Seung-Kyu; Kim, Woo-Kyung

    2013-09-01

    Reconstruction of extensive abdominal wall defects is a challenge for reconstructive surgeons. In this report, a case of reconstruction of a large abdominal wall defect using an eccentric perforator-based pedicled anterolateral thigh (ALT) flap is presented. A 30-year-old man presented with recurrent desmoid-type fibromatosis in the abdominal wall. The recurrent tumor was radically excised, and the en bloc excision resulted in a full-thickness, large abdominal wall defect (25 cm × 20 cm). An eccentric perforator-based pedicled ALT flap, including wide fascial extension, was transferred to the abdominal defect; fascial portions were sutured to the remnant abdominal fascia. Plication of the fascia along the sutured portion was performed to relieve the skin tension between the flap and the marginal skin of the abdominal defect. Eight months after surgery, the reconstructed abdomen had an acceptable esthetic appearance without tumor recurrence or hernia. The use of an eccentric perforator-based pedicled ALT flap may be an alternative method for the reconstruction of extensive abdominal wall defects.

  4. Laparoscopic drainage of abdominal wall abscess from spilled stones post-cholecystectomy

    PubMed Central

    Chong, Vincent; Ram, Rishi

    2015-01-01

    We present a case on abdominal wall abscess from spilled stones post-cholecystectomy and describe laparoscopic drainage as our choice of management. Mr M is a 75-year-old male who presented on multiple occasions to the hospital with right upper quadrant pain and fever post-laparoscopic cholecystectomy. He also required multiple courses of antibiotics. Subsequent computed tomography and magnetic resonance imaging scan confirmed a number of retained stone with signs of chronic inflammation. Hence, 6 months after his initial laparoscopic cholecystectomy, he proceeded to an exploratory laparoscopy. We found an abscess cavity measuring 3 × 4 cm over the anterior abdominal wall. The cavity was de-roofed, drained and washed out. The tissue culture grew Klebsiella pneumoniae. Laparoscopic approach is optimal as the abscess cavity can be clearly identified, stones visualized and removed under direct vision. Patient does not require a laparotomy. PMID:26183574

  5. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes.

    PubMed

    Gamba, Piergiorgio; Midrio, Paola

    2014-10-01

    Omphalocele and gastroschisis represent the most frequent congenital abdominal wall defects a pediatric surgeon is called to treat. There has been an increased reported incidence in the past 10 years mainly due to the diffuse use of prenatal ultrasound. The early detection of these malformations, and related associated anomalies, allows a multidisciplinary counseling and planning of delivery in a center equipped with high-risk pregnancy assistance, pediatric surgery, and neonatology. At present times, closure of defects, even in multiple stages, is always possible as well as management of most of cardiac-, urinary-, and gastrointestinal-associated malformations. The progress, herein discussed, in the care of newborns with abdominal wall defects assures most of them survive and reach adulthood. Some aspects of transition of medical care will also be considered, including fertility and cosmesis.

  6. Evidence-Based Abdominal Wall Reconstruction: The Maxi-Mini Approach.

    PubMed

    Janis, Jeffrey E; Khansa, Ibrahim

    2015-12-01

    Complex abdominal wall reconstruction is a high-risk procedure, but it can be performed safely if a systematic approach is followed. In this article, the authors present their evidence-based technique for abdominal wall reconstruction. This approach aims at reducing rates of complications and hernia recurrence, starting with critical patient selection; preoperative patient optimization; adherence to intraoperative principles including preservation of vascular perforators through maintenance of composite tissue with limited undermining; direct supported mesh reinforcement of midline musculofascial reapproximation; use of percutaneous transfascial suture mesh fixation; careful attention to dead space obliteration in any plane; and aggressive soft-tissue resection of marginal, undermined, or tenuous skin and subcutaneous tissue. Postoperative strategies to decrease complications are also used. The authors' surgical technique is described in detail, and pilot data are presented to support the authors' approach.

  7. Desmoid Tumor of the Anterior Abdominal Wall in Female Patients: Comparison with Endometriosis

    PubMed Central

    Krentel, H.; Tchartchian, G.; De Wilde, R. L.

    2012-01-01

    In female patients presenting a tumor of the lower abdominal wall especially after cesarian section, an endometriotic tumor as well as an aggressive desmoid tumor should be considered. Symptoms in correlation with the monthly period can facilitate the presurgical differentiation between endometriosis and fibromatosis. Ultrasound reveals the typical location of both tumors and its remarkable sonographic appearance. In the clinical practice, the desmoid fibromatosis of the lower abdominal wall is a very rare disease. We present a case of a 25-year-old pregnant and discuss diagnostic and therapeutic options by a PubMed literature review. With the knowledge of the prognosis of the desmoid fibromatosis and the respective treatment options including wait and see, complete surgical resection with macroscopically free margins and adjuvant approaches is essential to avoid further interventions and progression of the locally destructive tumor. PMID:22778752

  8. Clostridial Gas Gangrene of the Abdominal Wall After Laparoscopic Cholecystectomy: A Case Report and Review.

    PubMed

    Harmsen, Annelieke M K; van Tol, Erik; Giannakopoulos, Georgios F; de Brauw, L Maurits

    2016-08-01

    Clostridial gas gangrene is a rare, yet severe, complication after laparoscopic cholecystectomy. We present a case report of a 48-year-old man with obesity, coronary artery disease, and diabetes, who developed clostridial gas gangrene of the abdominal wall after an uncomplicated laparoscopic cholecystectomy. Although the diagnosis was missed initially, successful radical surgical debridement was performed and the patient survived. Pathogenesis, symptoms, prognostic factors, and the best treatment are discussed.

  9. [Clostridial sepsis and gas gangrene of the abdominal wall after cholecystectomy].

    PubMed

    Lochman, P; Kabelác, K; Pospísil, I; Dobes, D; Cáp, R

    2007-01-01

    Clostridial sepsis is a rare complication after intraabdominal operations, mostly fatal. According to our knowledge only two papers describing clostridial sepsis as postoperative complication in 4 patients were published in the Czech literature, only one of them survived. Authors present a case report of patient operated on for cholecystolithiasis and obstructive icterus where within 48 hours after cholecystectomy the clostridial sepsis and gas gangrene of the abdominal wall developed and that were successfuly managed.

  10. Extragastrointestinal Stromal Tumor (EGIST) in the abdominal wall: Case report and literature review

    PubMed Central

    Alkhatib, Loiy; Albtoush, Omar; Bataineh, Nesreen; Gharaibeh, Kamal; Matalka, Ismail; Tokuda, Yasuharu

    2011-01-01

    INTRODUCTION Gastro Intestinal Stromal Tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract (GI). GIST that arises primarily outside the GI tract is termed Extragastrointestinal Stromal Tumor (EGIST). To the best of our knowledge, few cases of EGIST in the abdominal wall were reported. PRESENTATION OF CASE We present a rare case of EGIST in the abdominal wall of a 57 year-old female patient. The asymptomatic tumor was located in the superior aspect of the left rectus abdominis muscle, measured 5.4 × cm 5.3 × cm 6.9 cm and was well circumscribed. Histological examination showed an epithelioid cell morphology. The mitotic count was 7/50 HPFs. Immunohistochemistry showed diffuse strong CD117 positivity, focal positivity for S100. The tumor was excised and the margins were free of malignancy. The patient was doing well postoperatively and was discharged on STI-571 regimen. DISCUSSION Although GIST is the most common mesenchymal tumor of the gastrointestinal tract, a case with EGIST in the abdominal wall is rare. Positive immunohistochemical staining for CD117 is a defining feature of GISTs. A great percentage of EGISTs represent a metastasis from a primary GIST. In our case, the clinical and diagnostic work-up have been proved it to be an EGIST. CONCLUSION The existing data on EGIST is insufficient to make a final conclusion regarding the malignant potential and clinicopathological factors of EGISTs that determine patient prognosis. Thus a follow-up for a long period is required. EGISTs should be kept in mind in the differential diagnosis for patients presenting with solid mass of the abdominal wall. PMID:22096744

  11. Evolution of the wall shear stresses during the progressive enlargement of symmetric abdominal aortic aneurysms

    NASA Astrophysics Data System (ADS)

    Salsac, A.-V.; Sparks, S. R.; Chomaz, J.-M.; Lasheras, J. C.

    2006-08-01

    The changes in the evolution of the spatial and temporal distribution of the wall shear stresses (WSS) and gradients of wall shear stresses (GWSS) at different stages of the enlargement of an abdominal aortic aneurysm (AAA) are important in understanding the aetiology and progression of this vascular disease since they affect the wall structural integrity, primarily via the changes induced on the shape, functions and metabolism of the endothelial cells. Particle image velocimetry (PIV) measurements were performed in in vitro aneurysm models, while changing their geometric parameters systematically. It has been shown that, even at the very early stages of the disease, i.e. increase in the diameter ≤ 50%, the flow separates from the wall and a large vortex ring, usually followed by internal shear layers, is created. These lead to the generation of WSS that drastically differ in mean and fluctuating components from the healthy vessel. Inside the AAA, the mean WSS becomes negative along most of the aneurysmal wall and the magnitude of the WSS can be as low as 26% of the value in a healthy abdominal aorta.

  12. Reconstruction of the abdominal wall by using a combination of the human acellular dermal matrix implant and an interpositional omentum flap after extensive tumor resection in patients with abdominal wall neoplasm: A preliminary result

    PubMed Central

    Gu, Yan; Tang, Rui; Gong, Ding-Quan; Qian, Yun-Liang

    2008-01-01

    AIM: To present our trial using a combination of the human acellular dermal matrix (HADM) implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection. METHODS: Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADM and omentum flap. Postoperative morbidities and signs of herniation were monitored. RESULTS: The abdominal wall reconstruction was successful in these three patients, there was no severe morbidity and no signs of herniation in the follow-up period. CONCLUSION: The combination of HADM and omentum flap offers a new, safe and effective alternative to traditional forms in the repair of giant abdominal wall defects. Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique. PMID:18205267

  13. Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report

    PubMed Central

    Kobayashi, Kosuke; Sasaki, Kazuhito; Iijima, Tatsuo; Yoshimi, Fuyo; Nagai, Hideo

    2016-01-01

    Introduction Here, we report the surgical excision of the urachal remnant using the abdominal wall-lift laparoscopy with a camera port in the umbilicus, combined with a small Pfannenstiel incision to optimally treat the bladder apex. Presentation of case A 21-year-old woman presented with periumbilical discharge and pain on urination. Contrast enhanced CT and MRI showed an abscess in the umbilical region that was connected to the bladder via a long tube-like structure. It was diagnosed as an infected urachal sinus. Partial excision of the umbilical fossa followed by dissection of the urachal remnant was easily performed using the abdominal wall-lift laparoscopy from the umbilicus down to the bladder without pneumoperitoneum or additional trocar placement. A Pfannenstiel incision was made above the pubis to get access to the junction between the urachal remnant and the bladder. Under direct vision, we succeeded in accurately dividing the remnant tract, and we adequately closed the bladder opening with absorbable sutures. This method has the advantage of easily closing peritoneal defects after excision of the urachal remnant with direct sutures under a laparoscopic view from the umbilicus. Cosmetic satisfaction was obtained postoperatively. Discussion and conclusion Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures. PMID:27064744

  14. Value-based Clinical Quality Improvement (CQI) for Patients Undergoing Abdominal Wall Reconstruction.

    PubMed

    Stephan, Bradley; Ramshaw, Bruce; Forman, Brandie

    2015-05-01

    Patients with complex ventral/incisional hernias often undergo an abdominal wall reconstruction (AWR). These operations have a high cost of care and often result in a long hospital stay and high complication rates. Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a 3-year period. For consecutive cases of patients undergoing abdominal wall reconstruction, process improvement attempts included the use of a long-term resorbable synthetic mesh (TIGR® Resorbable Matrix, Novus Scientific, Uppsala, Sweden) in place of a biologic mesh, the use of the transversus abdominis release approach in place of an open or endoscopic component separation (external oblique release) technique, and the use of a preoperative transversus abdominis plane (TAP) block using a long-acting local anesthetic (Exparel®, Pacira Pharmaceutical, Parsippany, NJ) as a part of perioperative multi-modal pain management and an enhanced recovery program. After over 60 cases, improvement in materials costs and postoperative outcomes were documented. No mesh-related complications occurred and no mesh removal was required. In this real-world, value-based application of CQI, several attempts at process improvement led to decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral/incisional hernias. Value-based CQI could be a tool for improved health care value globally.

  15. [New abdominal wall reconstruction technique with a plastic-rehabilitative intent (back pain improvement)].

    PubMed

    Palmieri, Beniamino; Grappolini, Simone; Blandini, Daniele; De-Anna, Dino; Savio, Stefano; Ferrari, Paolo; Ferrari, Giovanni; William, Pillosu; Campanini, Isabella; Guido, Vezzosi; Tenchini, Paolo; Benuzzi, Giorgia; Palmieri, Lucia

    2004-01-01

    Many abdominal wall reconstruction techniques have generally failed to pay attention to a number of anatomical considerations concerning the continuity of the thoraco-lumboabdominal fascia that envelops the dorsal and ventral muscles. We have introduced a new surgical technique (round mesh) developed to improve the abdominal wall weakness or pathology (hernia, laparocele) with the aim of restoring the muscular synergy between the anterior and posterior trunk compartments, thus improving sacroiliac stability, posture, and standing effort endurance. One hundred patients of both sexes were enrolled in this investigation. All were affected by abdominal wall impairment, frank hernia or laparocele, and had been complaining of lumbar and sciatic pain for long periods without any definite intervertebral disk pathology. They underwent pre- and postoperative subjective and objective evaluation and insertion of a prefascial polypropylene mesh with a posterior martingale that passes across the spine and paravertebral muscles, ending in two wider rectangles that are criss-crossed ventrally and finally sutured to the iliopubic brim. All the patients improved either subjectively or objectively with the round mesh procedure. This new technique is particularly useful in cases of reduction or impairment of the recti abdominis, transverse and oblique muscles, because simple suture and plication of these muscles is no guarantee of long-term functional restoration.

  16. 11. VIEW, LOOKING WESTNORTHWEST, SHOWING STRUCTURAL BREACH IN WALL CAUSED ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. VIEW, LOOKING WEST-NORTHWEST, SHOWING STRUCTURAL BREACH IN WALL CAUSED BY MARSHY CONDITIONS. SORTED AND ASSEMBLED NATIVE BASALT COBBLES USED FOR BUILDING MATERIAL APPEAR IN BACKGROUND - Rock Wall, North side of Battle Creek Canyon, Shingletown, Shasta County, CA

  17. Intra-abdominal pulmonary secuestration as an exceptional cause of abdominal mass in the adult☆

    PubMed Central

    Moreno-Sanz, C.; Herrero Bogajo, M.L.; Picazo-Yeste, J.; Morandeira Rivas, A.; Manzanera-Diaz, M.; Sedano-Vizcaino, C.

    2013-01-01

    INTRODUCTION Pulmonary sequestration (PS) is an extremely rare malformation defined as a portion of lung tissue isolated from the pulmonary system. PSs are classified into intralobar type and intra-abdominal PS that represents only 2.5% of cases. There are 20 cases of PS reported in adults and only two were managed by laparoscopic approach. We report a case of intra-abdominal PS mimicking a gastroesophageal duplication cyst in an adult. Besides its rarity, this is the first intra-abdominal PS in an adult managed by an anterior laparoscopic approach. PRESENTATION OF CASE A 60-year-old female patient had had epigastric and left upper quadrant pain for several days. Physical examination was normal. Image test were consistent with a gastroesophageal duplication. The patient was taken to the operating room for laparoscopic exploration and resection. The pathological diagnosis was extralobar pulmonary sequestration. DISCUSSION Less than 20 cases of PS have been reported in adults and only two cases were managed by a lateral laparoscopic approach. In contrast to these reports, we used an anterior approach due to the GEJ suspected origin of the mass. CONCLUSION Extralobar intra-abdominal PS is an extremely rare condition during adulthood but this diagnosis should be included in the differential diagnosis of a left-sided suprarenal mass. Due to the difficulty in achieving a definitive preoperative diagnosis, surgery is recommended. Laparoscopic resection is safe and effective but careful preoperative imaging studies are recommended in order to plan the most suitable approach. PMID:24091075

  18. [Indications and results of preventive endoprosthezing of the abdominal wall during operations on organs of the abdominal cavity and retroperitoneal space].

    PubMed

    Sukovatykh, B S; Valuĭskaia, N M; Netiaga, A A; Zhukovskiĭ, V A; Pravednikova, N V; Kas'ianova, M A

    2011-01-01

    Complex examination and treatment of 120 patients with anatomo-functional insufficiency of the abdominal wall was made after operations on organs of the abdominal cavity and retroperitoneal space. In the 1st group (60 patients) the abdominal wall was sutured by traditional methods. In the 2nd group (60 patients) laparotomy was followed by implantation of polypropylene endoprosthesis by over-aponeurotic method, and suturing of the lateral wall--by sub-aponeurotic method. At the long-term postoperative period the postoperative ventral hernias were formed in 21.6% of patients of the 1st group, in the 2nd group of patients hernias were not detected. Physical component of quality of life of the 2nd group was 1.5 times, and mental component 1.7 times higher than in the 1st group.

  19. CLASSICAL AREAS OF PHENOMENOLOGY: Influence of the abdominal wall on the nonlinear propagation of focused therapeutic ultrasound

    NASA Astrophysics Data System (ADS)

    Liu, Zhen-Bo; Fan, Ting-Bo; Zhang, Dong; Gong, Xiu-Fen

    2009-11-01

    This article theoretically studies the influence of inhomogeneous abdominal walls on focused therapeutic ultrasound based on the phase screen model. An inhomogeneous tissue is considered as a combination of a homogeneous medium and a phase aberration screen. Variations of acoustic parameters such as peak positive pressure, peak negative pressure, and acoustic intensity are discussed with respect to the phase screen statistics of human abdominal walls. Results indicate that the abdominal wall can result in energy loss of the sound in the focal plane. For a typical human abdominal wall with correlation length of 7.9 mm and variance of 0.36, the peak acoustic intensity radiated from a 1 MHz transmitter with a radius of 30 mm can be reduced by about 14% at the focal plane.

  20. An uncommon cause of abdominal pain: Mesenteric cyst

    PubMed Central

    Ünlüer, Erden Erol; Ünlüer, Seran; Şahı̇n, Yusuf; Kamer, Kemal Erdı̇nç; Karagöz, Arı̇f; Tan, Gözde Canan

    2016-01-01

    Mesenteric cysts are benign cystic lesions. Here, we present the case of a patient with abdominal pain, which was diagnosed as mesenteric cyst. A 28-year-old male patient was admitted to the emergency department (ED) with abdominal pain and distention. Abdominal palpation revealed a smooth-surfaced mass palpable in the left upper quadrant. Ultrasonography depicted a hypoechoic heterogeneous mass-like structure with a size of 15 × 12 cm. Computerized tomography (CT) showed a well-defined cystic structure with a size of 12 × 12.5 cm near to the duodenum and pancreas. The patient was admitted, and the cystic structure was drained with a percutaneous drainage catheter; then, sclerotherapy was performed using ethyl alcohol with the aid of ultrasonography. The material was sent to the pathology lab and revealed negative results for malignant cell and mucin. The patient underwent a control CT with contrast, which revealed the catheter at the site of the operation and no cystic lesion after procedure. He was discharged 1 week after the procedure. Mesenteric cysts are extremely rare benign lesions of the abdomen, and emergency physicians must consider this disease in the differential diagnosis of abdominal pain. The percutaneous drainage technique performed on our patient is a safe technique for the treatment of selected patients. PMID:28250978

  1. Pedicled fasciocutaneous anterolateral thigh flap for the reconstruction of a large postoncologic abdominal wall resection defect: a case report.

    PubMed

    Nthumba, Peter; Barasa, Jack; Cavadas, Pedro C; Landin, Luis

    2012-02-01

    The anterolateral thigh (ALT) flap has been used to cover defects between the proximal third of the leg and lower abdomen, and with modification, may cover epigastric defects. We used the ALT flap to cover a full-thickness defect of over half the anterior abdominal wall. We conclude that abdominal wall defects of large sizes can be successfully reconstructed using an appropriately designed ALT flap; a simple, single-stage effective reconstruction.

  2. Local influence of calcifications on the wall mechanics of abdominal aortic aneurysm

    NASA Astrophysics Data System (ADS)

    de Putter, Sander; van de Vosse, Frans N.; Breeuwer, Marcel; Gerritsen, Frans A.

    2006-03-01

    Finite element wall stress simulations on patient-specific models of abdominal aortic aneurysm (AAA) may provide a better rupture risk predictor than the currently used maximum transverse diameter. Calcifications in the wall of AAA lead to a higher maximum wall stress and thus may lead to an elevated rupture risk. The reported material properties for calcifications and the material properties actually used for simulations show great variation. Previous studies have focused on simplified modelling of the calcification shapes within a realistic aneurysm shape. In this study we use an accurate representation of the calcification geometry and a simplified model for the AAA. The objective of this approach is to investigate the influence of the calcification geometry, the material properties and the modelling approach for the computed peak wall stress. For four realistic calcification shapes from standard clinical CT images of AAA, we performed simulations with three distinct modelling approaches, at five distinct elasticity settings. The results show how peak wall stress is sensitive to the material properties of the calcifications. For relatively elastic calcifications, the results from the different modelling approaches agree. Also, for relatively elastic calcifications the computed wall stress in the tissue surrounding the calcifications shows to be insensitive to the exact calcification geometry. For stiffer calcifications the different modelling approaches and the different geometries lead to significantly different results. We conclude that an important challenge for future research is accurately estimating the material properties and the rupture potential of the AAA wall including calcifications.

  3. A Novel Rapidly Growing Mycobacterium Species Causing an Abdominal Cerebrospinal Fluid Pseudocyst Infection

    PubMed Central

    Hussain, Cory K.; de Man, Tom J. B.; Toney, Nadege C.; Kamboj, Kamal; Balada-Llasat, Joan-Miquel; Wang, Shu-Hua

    2016-01-01

    Nontuberculous mycobacteria (NTM) are a rare cause of ventriculoperitoneal shunt infections. We describe the isolation and identification of a novel, rapidly growing, nonpigmented NTM from an abdominal cerebrospinal fluid pseudocyst. The patient presented with fevers, nausea, and abdominal pain and clinically improved after shunt removal. NTM identification was performed by amplicon and whole-genome sequencing. PMID:27704004

  4. Imperforate hymen: a cause of abdominal pain in female adolescents

    PubMed Central

    Lardenoije, Céline; Aardenburg, Robert; Mertens, Helen

    2009-01-01

    A 16-year-old girl presented with primary amenorrhea and had had cyclical abdominal pain for almost a year. At examination we observed a painful mass in the lower abdomen and normal secondary sex characteristics. Perineal examination showed a bluish bulging hymen. Transabdominal ultrasonography revealed a dense mass in the pelvis measuring about 12×11 cm. We diagnosed an imperforate hymen with haematocolpos and haematometra. The hymen was opened surgically and a large quantity of menstrual blood was drained from the vagina and uterus. Postoperative recovery was normal without any pain. The patient now menstruates regularly. An imperforate hymen occurs in 0.05% of women. It is important to be aware of this while examining a female adolescent presenting with cyclical abdominal pain and primary amenorrhea. Late discovery of an imperforate hymen may lead to pain, infections, hydronephrosis and endometriosis with subfertility as a possible consequence. PMID:21686660

  5. Metastasectomy of Abdominal Wall Lesions due to Prostate Cancer Detected Through PET/CT Gallium 68-PMSA: First Case Report.

    PubMed

    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.

  6. Carbon nanotubes as VEGF carriers to improve the early vascularization of porcine small intestinal submucosa in abdominal wall defect repair

    PubMed Central

    Liu, Zhengni; Feng, Xueyi; Wang, Huichun; Ma, Jun; Liu, Wei; Cui, Daxiang; Gu, Yan; Tang, Rui

    2014-01-01

    Insufficient early vascularization in biological meshes, resulting in limited host tissue incorporation, is thought to be the primary cause for the failure of abdominal wall defect repair after implantation. The sustained release of exogenous angiogenic factors from a biocompatible nanomaterial might be a way to overcome this limitation. In the study reported here, multiwalled carbon nanotubes (MWNT) were functionalized by plasma polymerization to deliver vascular endothelial growth factor165 (VEGF165). The novel VEGF165-controlled released system was incorporated into porcine small intestinal submucosa (PSIS) to construct a composite scaffold. Scaffolds incorporating varying amounts of VEGF165-loaded functionalized MWNT were characterized in vitro. At 5 weight percent MWNT, the scaffolds exhibited optimal properties and were implanted in rats to repair abdominal wall defects. PSIS scaffolds incorporating VEGF165-loaded MWNT (VEGF–MWNT–PSIS) contributed to early vascularization from 2–12 weeks postimplantation and obtained more effective collagen deposition and exhibited improved tensile strength at 24 weeks postimplantation compared to PSIS or PSIS scaffolds, incorporating MWNT without VEGF165 loading (MWNT–PSIS). PMID:24648727

  7. A simulation framework for estimating wall stress distribution of abdominal aortic aneurysm.

    PubMed

    Qin, Jing; Zhang, Jing; Chui, Chee-Kong; Huang, Wei-Min; Yang, Tao; Pang, Wai-Man; Sudhakar, Venkatesh; Chang, Stephen

    2011-01-01

    Abdominal aortic aneurysm (AAA) rupture is believed to occur when the mechanical stress acting on the wall exceeds the strength of the wall tissue. In endovascular aneurysm repair, a stent-graft in a catheter is released at the aneurysm site to form a new blood vessel and protect the weakened AAA wall from the pulsatile pressure and, hence, possible rupture. In this paper, we propose a framework to estimate the wall stress distribution of non-stented/stented AAA based on fluid-structure interaction, which is utilized in a surgical simulation system (IRAS). The 3D geometric model of AAA is reconstructed from computed tomography angiographic (CTA) images. Based on our experiments, a combined logarithm and polynomial strain energy equation is applied to model the elastic properties of arterial wall. The blood flow is modeled as laminar, incompressible, and non-Newtonian flow by applying Navier-Stokes equation. The obtained pressure of blood flow is applied as load on the AAA meshes with and without stent-graft and the wall stress distribution is calculated by fluid-structure interaction (FSI) solver equipped in ANSYS. Experiments demonstrate that our analytical results are consistent with clinical observations.

  8. Trace elements in the wall of abdominal aortic aneurysms with and without coexisting iliac artery aneurysms.

    PubMed

    Ziaja, Damian; Chudek, Jerzy; Sznapka, Mariola; Kita, Andrzej; Biolik, Grzegorz; Sieroń-Stołtny, Karolina; Pawlicki, Krzysztof; Domalik, Jolanta; Ziaja, Krzysztof

    2015-06-01

    Iliac artery aneurysms (IAA) and abdominal aortic aneurysms (AAA) frequently coexist. It remains unknown whether the content of trace elements in AAA walls depends on the coexistence of IAAs. The aim of this study was to compare the content of selected trace elements in AAA walls depending on the coexistence of IAAs. The content of trace elements was assessed in samples of AAA walls harvested intraoperatively in 19 consecutive patients. In the studied group, coexisting IAAs were diagnosed in 11 out of the 19 patients with AAA. The coexistence of IAAs was associated with a slightly lower content of nickel (0.28 (0.15-0.40) vs. 0.32 (0-0.85) mg/g; p = 0.09) and a significantly higher content of cadmium (0.71 (0.26-1.17) vs. 0.25 (0.20-0.31) mg/g; p = 0.04) in AAA walls. The levels of the remaining studied elements, copper, zinc, manganese, magnesium and calcium, were comparable. The elevated levels of cadmium in the walls of AAA coexisting with IAAs may suggest an impact of the accumulation of this trace element on the greater damage of the iliac artery wall.

  9. Observation of a Flowing Duct in the Abdominal Wall by Using Nanoparticles

    PubMed Central

    Jung, Sharon Jiyoon; Kim, Min-Suk; Lee, Jin-Kyu; Kim, Young-Jae; Soh, Kwang-Sup

    2016-01-01

    The primo vascular system (PVS) is being established as a circulatory system that corresponds to acupuncture meridians. There have been two critical questions in making the PVS accepted as a novel liquid flowing system. The first one was directly to show the flow of liquid in PVS and the second one was to explain why it was not observed in the conventional histological study of animal tissues. Flow in the PVS in the abdominal cavity was previously verified by injecting Alcian blue into a primo node. However, the tracing of the dye to other subsystems of the PVS has not been done. In the current work we injected fluorescent nanoparticles (FNPs) into a primo node and traced them along a primo vessel which was inside a fat tissue in the abdominal wall. Linea alba is a white middle line in the abdominal skin of a mammal and a band of fat tissue is located in parallel to the linea alba in the parietal side of the abdominal wall of a rat. In this fat band a primo vessel runs parallel to the prominent blood vessels in the fat band and is located just inside the parietal peritoneum. About the second question on the reason why the PVS was not in conventional histological study the current work provided the answer. Histological analysis with hematoxyline and eosine, Masson’s trichrome, and Toluidine blue could not discriminate the primo vessel even when we knew the location of the PVS by the trace of the FNPs. This clearly explains why the PVS is hard to observe in conventional histology: it is not a matter of resolution but the contrast. The PVS has very similar structure to the connective tissues that surround the PVS. In the current work we propose a method to find the PVS: Observation of mast cell distribution with toluidine blue staining and the PN has a high density of mast cells, while the lymph node has low density. PMID:26937963

  10. Observation of a Flowing Duct in the Abdominal Wall by Using Nanoparticles.

    PubMed

    Jang, HyunSuk; Yoon, Joohwan; Gil, HyunJi; Jung, Sharon Jiyoon; Kim, Min-Suk; Lee, Jin-Kyu; Kim, Young-Jae; Soh, Kwang-Sup

    2016-01-01

    The primo vascular system (PVS) is being established as a circulatory system that corresponds to acupuncture meridians. There have been two critical questions in making the PVS accepted as a novel liquid flowing system. The first one was directly to show the flow of liquid in PVS and the second one was to explain why it was not observed in the conventional histological study of animal tissues. Flow in the PVS in the abdominal cavity was previously verified by injecting Alcian blue into a primo node. However, the tracing of the dye to other subsystems of the PVS has not been done. In the current work we injected fluorescent nanoparticles (FNPs) into a primo node and traced them along a primo vessel which was inside a fat tissue in the abdominal wall. Linea alba is a white middle line in the abdominal skin of a mammal and a band of fat tissue is located in parallel to the linea alba in the parietal side of the abdominal wall of a rat. In this fat band a primo vessel runs parallel to the prominent blood vessels in the fat band and is located just inside the parietal peritoneum. About the second question on the reason why the PVS was not in conventional histological study the current work provided the answer. Histological analysis with hematoxyline and eosine, Masson's trichrome, and Toluidine blue could not discriminate the primo vessel even when we knew the location of the PVS by the trace of the FNPs. This clearly explains why the PVS is hard to observe in conventional histology: it is not a matter of resolution but the contrast. The PVS has very similar structure to the connective tissues that surround the PVS. In the current work we propose a method to find the PVS: Observation of mast cell distribution with toluidine blue staining and the PN has a high density of mast cells, while the lymph node has low density.

  11. Laparoscopic Treatment of Median Arcuate Ligament Syndrome: A Rare Cause of Chronic Severe Abdominal Pain

    PubMed Central

    Divarci, Emre; Celtik, Ulgen; Dokumcu, Zafer; Celik, Ahmet; Ergun, Orkan

    2017-01-01

    Median arcuate ligament syndrome is a rare disorder characterized by chronic postprandial abdominal pain and weight loss caused by compression on celiac artery. A 17-year-old girl with chronic severe abdominal pain and weight loss was referred to our clinic. Other causes of chronic abdominal pain were investigated and excluded. The compression on celiac artery was detected on Doppler ultrasound and diagnosis was confirmed by computed tomography angiography. The patient underwent laparoscopic release of median arcuate ligament. There were no intraoperative complications; however, partial pain response was observed postoperatively that necessitated para-spinal ganglion blockage. The patient is symptom-free in 1-year follow-up period. PMID:28082779

  12. Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas

    SciTech Connect

    Bossi, Alberto . E-mail: alberto.bossi@uz.kuleuven.ac.be; De Wever, Ivo; Van Limbergen, Erik; Vanstraelen, Bianca

    2007-01-01

    Purpose: Preoperative external-beam radiation therapy (preop RT) in the management of Retroperitoneal Liposarcomas (RPLS) typically involves the delivery of radiation to the entire tumor mass: yet this may not be necessary. The purpose of this study is to evaluate a new strategy of preop RT for RPLS in which the target volume is limited to the contact area between the tumoral mass and the posterior abdominal wall. Methods and Materials: Between June 2000 and Jan 2005, 18 patients with the diagnosis of RPLS have been treated following a pilot protocol of pre-op RT, 50 Gy in 25 fractions of 2 Gy/day. The Clinical Target Volume (CTV) has been limited to the posterior abdominal wall, region at higher risk for local relapse. A Three-Dimensional conformal (3D-CRT) and an Intensity Modulated (IMRT) plan were generated and compared; toxicity was reported following the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events v3.0. Results: All patients completed the planned treatment and the acute toxicity was tolerable: 2 patients experienced Grade 3 and 1 Grade 2 anorexia while 2 patients developed Grade 2 nausea. IMRT allows a better sparing of the ipsilateral and the contralateral kidney. All tumors were successfully resected without major complications. At a median follow-up of 27 months 2 patients developed a local relapse and 1 lung metastasis. Conclusions: Our strategy of preop RT is feasible and well tolerated: the rate of resectability is not compromised by limiting the preop CTV to the posterior abdominal wall and a better critical-structures sparing is obtained with IMRT.

  13. A comparison of prosthetic materials used to repair abdominal wall defects.

    PubMed

    Jenkins, S D; Klamer, T W; Parteka, J J; Condon, R E

    1983-08-01

    A large abdominal wall hernia, not amenable to primary closure, may require insertion of a prosthesis. The ideal prosthesis maintains strength, is incorporated by surrounding tissues, and does not stimulate adhesions. These qualities vary among available synthetic prostheses. We tested tensile strength, bursting strength, and adhesion formation in response to six materials used in repair of abdominal wall hernias. Adult Sprague-Dawley rats (196) were randomly divided into a control group and six experimental groups. A 4 by 4 cm full-thickness resection of abdominal wall was closed with patches of polypropylene mesh (Marlex), polyglactin 910 mesh (Vicryl), expanded polytetrafluoroethylene (Gore-tex), Dacron-reinforced silicone rubber (Silastic), preserved human dura (PHD), or polypropylene mesh overlying gelatin film (Marlex and Gelfilm, respectively). In controls the 4 cm longitudinal full-thickness incisions were closed primarily. Seven rats randomly selected from each group were sacrificed after 1, 2, 4, and 8 weeks; bursting and tensile strength (tensiometer) and adhesion formation were assessed. There were no differences in bursting strength among the experimental groups at each testing period. Although bursting strength increased linearly with time it was significantly weaker than in controls at 1 and 8 weeks (P less than 0.05). Tensiometric data were inconclusive due to wide variability within the experimental groups. Adhesion formation was moderate to maximal at all evaluation periods for Marlex and Gore-tex. Early adhesion formation was minimal to moderate for both PHD and Vicryl, but later increased with PHD and decreased with Vicryl as this prosthesis was absorbed. No adhesions formed with Marlex and Gelfilm until the gelatin dissolved (1 week), after which the adhesion response was similar to that with Marlex alone. No adhesions formed after Silastic implantation, but graft extrusion and evisceration were common (75%). Controls had no adhesions at all

  14. Heavy Metal Bioaccumulation in an Atypical Primitive Neuroectodermal Tumor of the Abdominal Wall.

    PubMed

    Roncati, Luca; Gatti, Antonietta Morena; Capitani, Federico; Barbolini, Giuseppe; Maiorana, Antonio; Palmieri, Beniamino

    2015-01-01

    Heavy metals are able to interfere with the function of vital cellular components. Besides in trace heavy metals, which are essential at low concentration for humans, there are heavy metals with a well-known toxic and oncogenic potential. In this study, for the first time in literature, we report the unique adulthood case of an atypical primitive neuroectodermal tumor of the abdominal wall, diagnosed by histology and immunohistochemistry, with the molecular hybridization support. The neoplasia occurred in a patient chronically exposed to a transdermal delivery of heavy metal salts (aluminum and bismuth), whose intracellular bioaccumulation has been revealed by elemental microanalysis.

  15. Whole abdominal wall segmentation using augmented active shape models (AASM) with multi-atlas label fusion and level set

    NASA Astrophysics Data System (ADS)

    Xu, Zhoubing; Baucom, Rebeccah B.; Abramson, Richard G.; Poulose, Benjamin K.; Landman, Bennett A.

    2016-03-01

    The abdominal wall is an important structure differentiating subcutaneous and visceral compartments and intimately involved with maintaining abdominal structure. Segmentation of the whole abdominal wall on routinely acquired computed tomography (CT) scans remains challenging due to variations and complexities of the wall and surrounding tissues. In this study, we propose a slice-wise augmented active shape model (AASM) approach to robustly segment both the outer and inner surfaces of the abdominal wall. Multi-atlas label fusion (MALF) and level set (LS) techniques are integrated into the traditional ASM framework. The AASM approach globally optimizes the landmark updates in the presence of complicated underlying local anatomical contexts. The proposed approach was validated on 184 axial slices of 20 CT scans. The Hausdorff distance against the manual segmentation was significantly reduced using proposed approach compared to that using ASM, MALF, and LS individually. Our segmentation of the whole abdominal wall enables the subcutaneous and visceral fat measurement, with high correlation to the measurement derived from manual segmentation. This study presents the first generic algorithm that combines ASM, MALF, and LS, and demonstrates practical application for automatically capturing visceral and subcutaneous fat volumes.

  16. Whole Abdominal Wall Segmentation using Augmented Active Shape Models (AASM) with Multi-Atlas Label Fusion and Level Set

    PubMed Central

    Xu, Zhoubing; Baucom, Rebeccah B.; Abramson, Richard G.; Poulose, Benjamin K.; Landman, Bennett A.

    2016-01-01

    The abdominal wall is an important structure differentiating subcutaneous and visceral compartments and intimately involved with maintaining abdominal structure. Segmentation of the whole abdominal wall on routinely acquired computed tomography (CT) scans remains challenging due to variations and complexities of the wall and surrounding tissues. In this study, we propose a slice-wise augmented active shape model (AASM) approach to robustly segment both the outer and inner surfaces of the abdominal wall. Multi-atlas label fusion (MALF) and level set (LS) techniques are integrated into the traditional ASM framework. The AASM approach globally optimizes the landmark updates in the presence of complicated underlying local anatomical contexts. The proposed approach was validated on 184 axial slices of 20 CT scans. The Hausdorff distance against the manual segmentation was significantly reduced using proposed approach compared to that using ASM, MALF, and LS individually. Our segmentation of the whole abdominal wall enables the subcutaneous and visceral fat measurement, with high correlation to the measurement derived from manual segmentation. This study presents the first generic algorithm that combines ASM, MALF, and LS, and demonstrates practical application for automatically capturing visceral and subcutaneous fat volumes. PMID:27127333

  17. Improved surgical mesh integration into the rat abdominal wall with arginine administration.

    PubMed

    Arbos, M A; Ferrando, J M; Quiles, M T; Vidal, J; López-Cano, M; Gil, J; Manero, J M; Peña, J; Huguet, P; Schwartz-Riera, S; Reventós, J; Armengol, M

    2006-02-01

    Prosthetic meshes are used as the standard of care in abdominal wall hernia repair. However, hernia recurrences and side effects remain unsolved problems. The demand by health care providers for increasingly efficient and cost-effective surgery encourages the development of newer strategies to improve devices and outcomes. Here, we evaluated whether l-arginine administration was able to ameliorate long-term polypropylene prostheses incorporation into the abdominal wall of Sprague-Dawley rats. Meshes were placed on-lay and continuous l-arginine was administered. In vivo biocompatibility was studied at 7, 25 and 30 days post-implantation. Effectively, l-arginine administration in combination with mesh triggered subtle changes in ECM composition that impinged on critical biochemical and structural features. Lastly, tensile strength augmented and stiffness decreased over the control condition. This could help to restructure the mechanical load transfer from the implant to the brittle surrounding tissues, i.e., impact load and fatigue load associated with mechanical tensions could be distributed between the mesh and the restored tissue in a more balanced manner, and ultimately help to reduce the incidence of loosening, recurrences, and local wound complications. Since the newly formed tissue is more mechanically stable, this approach could eventually be introduced to human hernia repair.

  18. Invariant-based anisotropic constitutive models of the healthy and aneurysmal abdominal aortic wall.

    PubMed

    Basciano, C A; Kleinstreuer, C

    2009-02-01

    The arterial wall is a complex fiber-reinforced composite. Pathological conditions, such as aneurysms, significantly alter the mechanical response of the arterial wall, resulting in a loss of elasticity, enhanced anisotropy, and increased chances of mechanical failure. Invariant-based models of the healthy and aneurysmal abdominal aorta were constructed based on first principles and published experimental data with implementations for several numerical cases, as well as comparisons to current healthy and aneurysmal tissue data. Inherent limitations of a traditional invariant-based methodology are also discussed and compared to the models' ability to accurately reproduce experimental trends. The models capture the nonlinear and anisotropic mechanical responses of the two arterial sections and make reasonable predictions regarding the effects of alterations in healthy and diseased tissue histology. Additionally, the new models exhibit convex and anisotropic monotonically increasing energy contours (suggesting numerical stability) but have potentially the inherent limitations of a covariant theoretical framework. Although the traditional invariant framework exhibits significant covariance, the invariant terms utilized in the new models exhibited limited covariance and are able to accurately reproduce experimental trends. A streamlined implementation is also possible for future numerical investigations of fluid-structure interactions in abdominal aortic aneurysms.

  19. Vacuum-assisted abdominal wall lift for minimal-access surgery: a porcine model study.

    PubMed

    Udwadia, T E; Kathrani, B K; Bernie, W; Gadgil, U S; Chariar, V M

    2005-08-01

    Carbon dioxide pneumoperitoneum, although used universally in laparoscopy, has several well-documented complications and disadvantages. The authors describe a simple method of creating vacuum between a rigid shell and the abdominal wall in a porcine model to create adequate operative space for minimal-access surgery, which does not requires carbon dioxide, does not raise intraabdominal pressure, and is safe, cost effective, and feasible. The proposed device and method could be useful wherever basic laparoscopic equipment and a vacuum pump are available, including many parts of the developing world. The study was carried out with three groups using individual porcine models for each study. Group 1 was studied for feasibility of abdominal wall lift, adequacy of intraabdominal space, optimal vacuum levels, and safety and efficacy of the procedure. Group 2 was subjected to laparoscopic cholecystectomy and salpingectomy. Group 3 was studied for 2 days and 8 days after the animals were subjected to prolonged, high-level vacuum and monitored every 24 h to establish long-term effects. In all three groups the safety and efficacy of the proposed method were established, as well as the absence of physiological or histological alterations.

  20. A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

    PubMed Central

    Chan, Jeffrey CY; Burugapalli, Krishna; Huang, Yi-Shiang; Kelly, John L; Pandit, Abhay

    2016-01-01

    An animal model that allows for assessment of the degree of stretching or contraction of the implant area and the in vivo degradation properties of biological meshes is required to evaluate their performance in vivo. Adult New Zealand rabbits underwent full thickness subtotal unilateral rectus abdominis muscle excision and were reconstructed with the non-biodegradable Peri-Guard®, Prolene® or biodegradable Surgisis® meshes. Following 8 weeks of recovery, the anterior abdominal wall tissue samples were collected for measurement of the implant dimensions. The Peri-Guard and Prolene meshes showed a slight and obvious shrinkage, respectively, whereas the Surgisis mesh showed stretching, resulting in hernia formation. Surgisis meshes showed in vivo biodegradation and increased collagen formation. This surgical rabbit model for abdominal wall defects is advantageous for evaluating the in vivo behaviour of surgical meshes. Implant area stretching and shrinkage were detected corresponding to mesh properties, and histological analysis and stereological methods supported these findings. PMID:28228932

  1. Probabilistic noninvasive prediction of wall properties of abdominal aortic aneurysms using Bayesian regression.

    PubMed

    Biehler, Jonas; Kehl, Sebastian; Gee, Michael W; Schmies, Fadwa; Pelisek, Jaroslav; Maier, Andreas; Reeps, Christian; Eckstein, Hans-Henning; Wall, Wolfgang A

    2017-02-01

    Multiple patient-specific parameters, such as wall thickness, wall strength, and constitutive properties, are required for the computational assessment of abdominal aortic aneurysm (AAA) rupture risk. Unfortunately, many of these quantities are not easily accessible and could only be determined by invasive procedures, rendering a computational rupture risk assessment obsolete. This study investigates two different approaches to predict these quantities using regression models in combination with a multitude of noninvasively accessible, explanatory variables. We have gathered a large dataset comprising tensile tests performed with AAA specimens and supplementary patient information based on blood analysis, the patients medical history, and geometric features of the AAAs. Using this unique database, we harness the capability of state-of-the-art Bayesian regression techniques to infer probabilistic models for multiple quantities of interest. After a brief presentation of our experimental results, we show that we can effectively reduce the predictive uncertainty in the assessment of several patient-specific parameters, most importantly in thickness and failure strength of the AAA wall. Thereby, the more elaborate Bayesian regression approach based on Gaussian processes consistently outperforms standard linear regression. Moreover, our study contains a comparison to a previously proposed model for the wall strength.

  2. Effectiveness of laparoscopic gonadectomy using abdominal wall lift method on Turner's syndrome patients with 45, X/46, XY mosaicism.

    PubMed

    Nakano, H; Kawashima, M; Okada, S; Igarashi, T; Nakata, M; Ogino, M

    2001-04-01

    We present a Turner's syndrome patient with a 45, X/46, XY mosaicism who underwent a prophylactic laparoscopic gonadectomy using the abdominal wall lift method. The patient was a 14-year-old phenotypic girl who was referred for an examination of primary amenorrhea. She had already been found to have Turner's syndrome with 45, X/46, XY mosaicism. After an extensive discussion with the patient and her family regarding her high risk for developing a gonadoblastoma, a laparoscopic bilateral salpingo-oophorectomy using the abdominal wall-life method was performed. Laparoscopy using the abdominal wall lift method has an advantage over CO2 pneumoperitoneum method for patients with Turner's syndrome when it is difficult to intubate because of a webbed neck or a shortened trachea.

  3. Functional electrical stimulation to the abdominal wall muscles synchronized with the expiratory flow does not induce muscle fatigue

    PubMed Central

    Okuno, Yukako; Takahashi, Ryoichi; Sewa, Yoko; Ohse, Hirotaka; Imura, Shigeyuki; Tomita, Kazuhide

    2017-01-01

    [Purpose] Continuous electrical stimulation of abdominal wall muscles is known to induce mild muscle fatigue. However, it is not clear whether this is also true for functional electrical stimulation delivered only during the expiratory phase of breathing. This study aimed to examine whether or not intermittent electrical stimulation delivered to abdominal wall muscles induces muscle fatigue. [Subjects and Methods] The subjects were nine healthy adults. Abdominal electrical stimulation was applied for 1.5 seconds from the start of expiration and then turned off during inspiration. The electrodes were attached to both sides of the abdomen at the lower margin of the 12th rib. Abdominal electrical stimulation was delivered for 15 minutes with the subject in a seated position. Expiratory flow was measured during stimulus. Trunk flexor torque and electromyography activity were measured to evaluate abdominal muscle fatigue. [Results] The mean stimulation on/off ratio was 1:2.3. The declining rate of abdominal muscle torque was 61.1 ± 19.1% before stimulus and 56.5 ± 20.9% after stimulus, not significantly different. The declining rate of mean power frequency was 47.8 ± 11.7% before stimulus and 47.9 ± 10.2% after stimulus, not significantly different. [Conclusion] It was found that intermittent electrical stimulation to abdominal muscles synchronized with the expiratory would not induce muscle fatigue. PMID:28356636

  4. Functional electrical stimulation to the abdominal wall muscles synchronized with the expiratory flow does not induce muscle fatigue.

    PubMed

    Okuno, Yukako; Takahashi, Ryoichi; Sewa, Yoko; Ohse, Hirotaka; Imura, Shigeyuki; Tomita, Kazuhide

    2017-03-01

    [Purpose] Continuous electrical stimulation of abdominal wall muscles is known to induce mild muscle fatigue. However, it is not clear whether this is also true for functional electrical stimulation delivered only during the expiratory phase of breathing. This study aimed to examine whether or not intermittent electrical stimulation delivered to abdominal wall muscles induces muscle fatigue. [Subjects and Methods] The subjects were nine healthy adults. Abdominal electrical stimulation was applied for 1.5 seconds from the start of expiration and then turned off during inspiration. The electrodes were attached to both sides of the abdomen at the lower margin of the 12th rib. Abdominal electrical stimulation was delivered for 15 minutes with the subject in a seated position. Expiratory flow was measured during stimulus. Trunk flexor torque and electromyography activity were measured to evaluate abdominal muscle fatigue. [Results] The mean stimulation on/off ratio was 1:2.3. The declining rate of abdominal muscle torque was 61.1 ± 19.1% before stimulus and 56.5 ± 20.9% after stimulus, not significantly different. The declining rate of mean power frequency was 47.8 ± 11.7% before stimulus and 47.9 ± 10.2% after stimulus, not significantly different. [Conclusion] It was found that intermittent electrical stimulation to abdominal muscles synchronized with the expiratory would not induce muscle fatigue.

  5. ACUTE TEARING OF THE OBLIQUE ABDOMINAL WALL INSERTION ONTO THE ILIAC CREST IN AN AUSTRALIAN FOOTBALL PLAYER: A CASE REPORT

    PubMed Central

    Stockden, Marshall; Breidahl, Bill

    2016-01-01

    Background Tears of the abdominal obliques have previously been reported in the vicinity of the lower ribs but they have not been reported in the vicinity of the iliac crest. The purpose of this case report is to describe the mechanism of injury and diagnosis of a distal abdominal oblique tear and subsequent rehabilitation programming. Case Description A 21-year-old male Australian football player experienced acute right-sided abdominal pain during a game while performing a commonly executed rotation skill. He was assessed clinically before being further examined with ultrasound and magnetic resonance imaging which revealed a rupture of the abdominal oblique wall at its insertion onto the iliac crest. The player then underwent a structured and graduated rehabilitation program with clear key performance indicators to optimize return to play and prevent recurrence. Outcomes The player was able to return to play at 35 days post injury and had no recurrence or complications at 12 month follow up post injury. Discussion This is the first time an abdominal oblique wall rupture at its insertion onto the iliac crest has been reported. In players with acute abdominal pain following twisting an insertional oblique tear should be considered as a differential diagnosis. A structured rehabilitation program may also help optimize an athlete's return to play after distal abdominal oblique rupture. PMID:27999726

  6. Extensive Abdominal Wall Incisional Heterotopic Ossification Reconstructed with Component Separation and Strattice Inlay

    PubMed Central

    Suleiman, Nergis Nina

    2016-01-01

    Summary: Symptomatic heterotopic ossification of abdominal surgical incisions is a rare occurrence. We present a 67-year-old man with severe discomfort caused by heterotopic ossification extending from the xiphoid to the umbilicus. The patient underwent an abdominal aortic aneurysm repair 3 years before our treatment. A 13 × 3.5 cm ossified lesion was excised. The resulting midline defect was closed using component separation and inlay Strattice. Tension-free midline adaptation of the recti muscles was achieved. A computed tomography scan of the abdomen 6 months after the surgery showed no recurrence or hernias. Heterotopic ossification in symptomatic patients has previously been treated with excision and primary closure. We believe that tension-free repair is important to prevent recurrence. Acellular dermal matrix may add to this effect and also compartmentalize the process. PMID:27536495

  7. [Intra-abdominal hypertension as a consequence of plasty in the abdominal wall defects, the methods of its determination and prophylaxis].

    PubMed

    Vorovs'kyĭ, O O

    2013-09-01

    The results of various methods of investigation of intraabdominal hypertension (IAH) in 186 patients were analyzed. In 134 (27.1%) patients IAH was measured via bladder, in 46 (8.9%)--the investigation using nasogastric probe was added and in 8 (1.6%), in whom the abdominal wall defect coincided with adhesive disease, the measurement was performed immediately via drainages. In 44 (8.9%) patients the IAH measurement while abdominal wall defect closure was performed, using Stryker Intra Compartmental Pressure Monitor apparatus. The data obtained using this apparatus were considered the most informative. For the IAH prophylaxis it is mandatory to prognosticate the intraabdominal pressure raising, so on the stage of the hernia gates edges approximation it must not be bigger than a second degree level.

  8. A Multidisciplinary Approach to Medical Weight Loss Prior to Complex Abdominal Wall Reconstruction: Is it Feasible?

    PubMed

    Rosen, Michael J; Aydogdu, Kasim; Grafmiller, Kevin; Petro, Clayton C; Faiman, Gregg H; Prabhu, Ajita

    2015-08-01

    Obesity is a major risk factor for perioperative morbidity, especially for patients undergoing complex incisional hernia repair. The feasibility and effectiveness of medical weight loss programs prior to complex abdominal wall reconstruction have not been well characterized. Here, we report our experience collaborating with a medical weight loss specialist utilizing a protein sparing modified fast in order to optimize weight loss prior to complex abdominal wall reconstruction. Morbidly obese patients (body mass index (BMI) > 35 kg/m(2)) evaluated by our medical weight loss specialist prior to complex ventral hernia repair were identified within our prospective database. Our primary outcome measure was the amount of weight lost prior to surgical intervention. Our secondary outcome measure was to determine the maintenance of weight loss during long-term follow-up after the surgical intervention. A total of 25 patients with a BMI > 35 kg/m(2) were evaluated by our medical weight loss specialist prior to undergoing a planned incisional hernia repair. The mean weight of the patients preoperatively was 128 kg ± 25 (range 96-205 kg) (mean ± standard deviation), and the mean BMI was 49 kg/m(2) ± 10 (range 36-85). After completion of the preoperative modified protein sparing fast, the mean preoperative weight loss of the group was 24 kg ± 21 (range 2-80 kg). The overall change in BMI for the group prior to surgery was 9 kg/m(2) ± 8 (0.6 to 33). The percentage of excess BMI loss and total BMI loss preoperatively was 37 % ± 23 (2 to 83) and 18 % ± 12 (1 to 43), respectively. Of the 24 patients that initially lost weight in the program preoperatively, 22 (88 %) successfully maintained their weight loss for the entire study period for an average of 18 months. Collaboration with a medical weight loss specialist and a surgeon with a structured approach using a modified protein sparing fast can successfully result in meaningful weight

  9. Evaluation of porcine dermal collagen (Permacol) used in abdominal wall reconstruction.

    PubMed

    Hsu, Patrick W; Salgado, Christopher J; Kent, Kathryn; Finnegan, Matthew; Pello, Mark; Simons, Robert; Atabek, Umur; Kann, Brian

    2009-11-01

    Various methods have been employed to reconstruct complex abdominal wall defects. Structural prosthetic materials such as polypropylene mesh and ePTFE (expanded polytetrafluoroethylene) have been widely used to close these large fascial defects, however, complications with infection and adhesions have led to the recent use of more biocompatible implants. Permacol (acellular porcine dermis) is used as a dermal scaffold, which eventually becomes vascularised and remodelled to reconstruct the abdominal wall in these complex patients. A retrospective review was performed of all patients who underwent consecutive abdominal wall reconstruction with Permacol at our institution in the year 2006. Twenty-eight patients were identified and included in our study. Factors evaluated were: body mass index, relevant co-morbidities, aetiology of hernia, hernia defect size based on CT scan and intraoperative measurement, size of Permacol implant, length of hospital stay, and postoperative complications. Surgical technique was standardised among six surgeons and involved a single layer of acellular porcine dermis as a subfascial 'underlay' graft under moderate tension upon maximal hernia reduction. Tissue expanders were not required for skin closure. Out of 28 patients, 12 were male and 16 were female. Mean intraoperative hernia size was 150 cm(2) (range of 10 cm(2) to 600 cm(2)). Mean age was 55 years with an average body mass index (BMI) of 34 (largest BMI of 61.4). Defects were attributed to either a previous laparotomy incision or open abdomen. Mean hospital stay was 9.67 days. At a mean follow-up of sixteen months, there were three recurrent hernias (10.7%) based on physical examination and postoperative CT scan evaluation. One patient developed a superficial wound dehiscence which was successfully treated with local wound care and one patient developed a cellulitis which was successfully treated with antibiotic therapy. Four patients (14.3%) developed a chronic, non

  10. Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias.

    PubMed

    Lau, Briana; Kim, Hanjoo; Haigh, Philip I; Tejirian, Talar

    2012-10-01

    The current data available describing the relationship of obesity and abdominal wall hernias is sparse. The objective of this study was to investigate the current prevalence of noninguinal abdominal wall hernias and their correlation with body mass index (BMI) and other demographic risk factors. Patients with umbilical, incisional, ventral, epigastric, or Spigelian hernias with or without incarceration were identified using the regional database for 14 hospitals over a 3-year period. Patients were stratified based on their BMI. Univariate and multivariate analyses were performed to distinguish other significant risk factors associated with the hernias. Of 2,807,414 patients, 26,268 (0.9%) had one of the specified diagnoses. Average age of the patients was 52 years and 61 per cent were male. The majority of patients had nonincarcerated umbilical hernias (74%). Average BMI was 32 kg/m2. Compared with patients with a normal BMI, the odds of having a hernia increased with BMI: BMI of 25 to 29.9 kg/m2 odds ratio (OR) 1.63, BMI of 30 to 39.9 kg/m2 OR 2.62, BMI 40 to 49.9 kg/m2 OR 3.91, BMI 50 to 59.9 kg/m2 OR 4.85, and BMI greater than 60 kg/m2 OR 5.17 (P<0.0001). Age older than 50 years was associated with a higher risk for having a hernia (OR, 2.12; 95% [CI], 2.07 to 2.17), whereas female gender was associated with a lower risk (OR, 0.53; 95% CI, 0.52 to 0.55). Those with incarcerated hernias had a higher average BMI (32 kg/m2 vs 35 kg/m2; P<0.0001). Overall, BMI greater than 40 kg/m2 showed an increased chance of incarceration, and a BMI greater than 60 kg/m2 had the highest chance of incarceration, OR 12.7 (P<0.0001). Age older than 50 years and female gender were also associated with a higher risk of incarceration (OR, 1.28; 95% CI, 1.02 to 1.59 and OR, 1.80; CI, 1.45 to 2.24). Increasing BMI and increasing age are associated with a higher prevalence and an increased risk of incarceration of noninguinal abdominal wall hernias.

  11. Spontaneous extraskeletal osteosarcoma with various histological growth patterns in the abdominal wall of an ICR mouse

    PubMed Central

    Ito, Tsuyoshi; Katoh, Yoshitaka; Shimada, Yuko; Ohnuma-Koyama, Aya; Takahashi, Naofumi; Kuwahara, Maki; Harada, Takanori

    2015-01-01

    Extraskeletal osteosarcoma is extremely rare in mice. This case report demonstrates a spontaneous murine extraskeletal osteosarcoma that exhibited various histological growth patterns in an ICR mouse. At necropsy, the tumor mass was located in the abdominal wall and was 45 × 30 × 25 mm in size. Histopathologically, the tumor showed the following four growth patterns: a solid pattern of polygonal cells embedded in an osteoid eosinophilic matrix with calcification, an irregular sheet pattern of short spindle cells accompanying some eosinophilic multinucleated cells, a fascicular pattern of spindle cells and a cystic pattern lined by short spindle cells. Immunohistochemically, most of the tumor cells were positive for vimentin, proliferating cell nuclear antigen and osterix. The multinucleated cells mentioned above were desmin positive and were regarded as regenerative striated muscles but not tumor cells. Since no clear continuity with normal bone tissues was observed, the tumor was diagnosed as an “extraskeletal osteosarcoma.” PMID:26989300

  12. Uncommon Causes of Acute Abdominal Pain – A Pictorial Essay

    PubMed Central

    Hariharan, Mahesh; Balasubramaniam, Rajan; Shetty, Sharath Kumar; Yadavalli, Shanthala; Ahetasham, Mohammed; Devarapalli, Sravya

    2016-01-01

    Acute abdomen is one of the most common clinical conditions requiring a radiological investigation. Ultrasound is the primary modality of choice which can diagnose some of the common causes of acute abdomen. However, sometimes the underlying cause for the pain is far more complicated than expected mandating a high degree of suspicion to suggest further investigation with contrast enhanced computed tomography or magnetic resonance imaging. Here, we have compiled a comprehensive series of selected cases to highlight the conditions which can be easily overlooked unless carefully sought for. This article also emphasizes the importance of multimodality approach to arrive at the final diagnosis with an increased overall diagnostic accuracy which in turn improves patient management and prognosis. PMID:27014500

  13. Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis

    PubMed Central

    Arumugam, Suresh; Al-Hassani, Ammar; El-Menyar, Ayman; Abdelrahman, Husham; Parchani, Ashok; Peralta, Ruben; Zarour, Ahmad; Al-Thani, Hassan

    2015-01-01

    Background: The incidence of abdominal trauma is still underreported from the Arab Middle-East. We aimed to evaluate the incidence, causes, clinical presentation, and outcome of the abdominal trauma patients in a newly established trauma center. Materials and Methods: A retrospective analysis was conducted at the only level I trauma center in Qatar for the patients admitted with abdominal trauma (2008-2011). Patients demographics, mechanism of injury, pattern of organ injuries, associated extra-abdominal injuries, Injury Severity Score (ISS), Abbreviated Injury Scale, complications, length of Intensive Care Unit, and hospital stay, and mortality were reviewed. Results: A total of 6888 trauma patients were admitted to the hospital, of which 1036 (15%) had abdominal trauma. The mean age was 30.6 ± 13 years and the majority was males (93%). Road traffic accidents (61%) were the most frequent mechanism of injury followed by fall from height (25%) and fall of heavy object (7%). The mean ISS was 17.9 ± 10. Liver (36%), spleen (32%) and kidney (18%) were most common injured organs. The common associated extra-abdominal injuries included chest (35%), musculoskeletal (32%), and head injury (24%). Wound infection (3.8%), pneumonia (3%), and urinary tract infection (1.4%) were the frequently observed complications. The overall mortality was 8.3% and late mortality was observed in 2.3% cases mainly due to severe head injury and sepsis. The predictors of mortality were head injury, ISS, need for blood transfusion, and serum lactate. Conclusion: Abdominal trauma is a frequent diagnosis in multiple trauma and the presence of extra-abdominal injuries and sepsis has a significant impact on the outcome. PMID:26604524

  14. "Abdominal crunch"-induced rhabdomyolysis presenting as right upper quadrant pain.

    PubMed

    Haas, D C; Bohnker, B K

    1999-02-01

    A young, active duty sailor presented with right upper quadrant abdominal pain. History, physical, and laboratory findings initially suggested cholecystitis or related disease. Further evaluation found myoglobinuria and a recently increased exercise program, leading to the diagnosis of exercise-induced right upper abdominal wall rhabdomyolysis. Although not a common cause of abdominal pain, this diagnosis should be considered in the patient with abdominal pain and a recently increased exercise program, particularly exercises of the abdominal wall such as "abdominal crunches."

  15. Effects of arterial blood flow on walls of the abdominal aorta: distributions of wall shear stress and oscillatory shear index determined by phase-contrast magnetic resonance imaging.

    PubMed

    Sughimoto, Koichi; Shimamura, Yoshiaki; Tezuka, Chie; Tsubota, Ken'ichi; Liu, Hao; Okumura, Kenichiro; Masuda, Yoshitada; Haneishi, Hideaki

    2016-07-01

    Although abdominal aortic aneurysms (AAAs) occur mostly inferior to the renal artery, the mechanism of the development of AAA in relation to its specific location is not yet clearly understood. The objective of this study was to evaluate the hypothesis that even healthy volunteers may manifest specific flow characteristics of blood flow and alter wall shear or oscillatory shear stress in the areas where AAAs commonly develop. Eight healthy male volunteers were enrolled in this prospective study, aged from 24 to 27. Phase-contrast magnetic resonance imaging (MRI) was performed with electrocardiographic triggering. Flow-sensitive four-dimensional MR imaging of the abdominal aorta, with three-directional velocity encoding, including simple morphological image acquisition, was performed. Information on specific locations on the aortic wall was applied to the flow encodes to calculate wall shear stress (WSS) and oscillatory shear index (OSI). While time-framed WSS showed the highest peak of 1.14 ± 0.25 Pa in the juxtaposition of the renal artery, the WSS plateaued to 0.61 Pa at the anterior wall of the abdominal aorta. The OSI peaked distal to the renal arteries at the posterior wall of the abdominal aorta of 0.249 ± 0.148, and was constantly elevated in the whole abdominal aorta at more than 0.14. All subjects were found to have elevated OSI in regions where AAAs commonly occur. These findings indicate that areas of constant peaked oscillatory shear stress in the infra-renal aorta may be one of the factors that lead to morphological changes over time, even in healthy individuals.

  16. [Case of abdominal wall malignant peripheral nerve sheath tumor which is difficult to distinguish from a urachal disease].

    PubMed

    Tatenuma, Tomoyuki; Sakata, Ryoko; Sugiura, Shinpei; Tajiri, Takehiro; Gondo, Toshikazu; Kitami, Kazuo

    2013-09-01

    Malignant peripheral nerve sheath tumors (MPNST) are highly malignant soft tissue sarcomas. It is very rare for MPNST to arise in the abdominal wall. We report a case of abdominal wall MPNST that was difficult to distinguish from a urachal disease. A 72-year-old woman found a mass of the umbilicus in October 2011. She visited a digestive surgery department in November because it gradually enlarged. Diagnostic imaging suggested a urachal tumor. She was then referred to our clinic. Contrast enhanced CT showed that the 5-cm cystic tumor extended from the umbilicus to abdominal wall. The tumor showed low uptake value in PET-CT. We diagnosed her with a urachal cyst, but could not deny urachal carcinoma. Therefore, we performed surgical resection in January 2012. The pathological diagnosis was MPNST. She has not experienced recurrence for 9 months. MPNST mostly occur in the retroperitoneum close to the spine, extremities, head, and neck. It is very rare for them to occur in the abdominal wall. This is the sixth case including overseas reports. In addition, this is the first case in which it was difficult to distinguish from a urachal disease.

  17. Isotropic 3D Black Blood MRI of Abdominal Aortic Aneurysm Wall and Intraluminal Thrombus

    PubMed Central

    Zhu, Chengcheng; Haraldsson, Henrik; Faraji, Farshid; Owens, Christopher; Gasper, Warren; Ahn, Sinyeob; Liu, Jing; Laub, Gerhard; Hope, Michael D.; Saloner, David

    2015-01-01

    Introduction The aortic wall and intraluminal thrombus (ILT) have been increasingly studied as potential markers of progressive disease with abdominal aortic aneurysms (AAAs). Our goal was to develop a high resolution, 3D black blood MR technique for AAA wall and ILT imaging within a clinically acceptable scan time. Methods Twenty two patients with AAAs (maximal diameter 4.3±1.0cm), along with five healthy volunteers, were imaged at 3T with a 3D T1-weighted fast-spin-echo sequence using variable flip angle trains (SPACE) with a preparation pulse (DANTE) for suppressing blood signal. Volunteers and ten patients were also scanned with SPACE alone for comparison purposes. The signal to noise ratio (SNR) and the aortic wall/ILT to lumen contrast to noise ratio (CNR) were measured. Qualitative image scores (1–4 scale) assessing the inner lumen and outer wall boundaries of AAA were performed by two blinded reviewers. In patients with ILT, the ratio of ILT signal intensity (ILTSI) over psoas muscle SI (MuscleSI) was calculated, and the signal heterogeneity of ILT was quantified as standard deviation (SD) over the mean. Results All subjects were imaged successfully with an average scan time of 7.8±0.7 minutes. The DANTE preparation pulse for blood suppression substantially reduced flow artifacts in SPACE with lower lumen SNR (8.8 vs. 21.4, p<0.001) and improved the wall/ILT to lumen CNR (9.9 vs. 6.3, p<0.001) in patients. Qualitative assessment showed improved visualization of lumen boundaries (73% higher scores on average, p=0.01) and comparable visualization of outer wall boundary (p>0.05). ILT was present in ten patients, with relatively high signal and a wide SD (average ILTSI/MuscleSI 1.42±0.48 (range 0.75–2.11) ) and with SD/mean of 27.7%±6.6% (range 19.6% – 39.4%). Conclusion High resolution, 3D black blood MRI of AAAs can be achieved in a clinical accepted scan time with reduction of flow artifacts using the DANTE preparation pulse. Signal characteristics

  18. Abdominal wall reconstruction by a regionally distinct biocomposite of extracellular matrix digest and a biodegradable elastomer.

    PubMed

    Takanari, Keisuke; Hong, Yi; Hashizume, Ryotaro; Huber, Alexander; Amoroso, Nicholas J; D'Amore, Antonio; Badylak, Stephen F; Wagner, William R

    2016-09-01

    Current extracellular matrix (ECM) derived scaffolds offer promising regenerative responses in many settings, however in some applications there may be a desire for more robust and long lasting mechanical properties. A biohybrid composite material that offers both strength and bioactivity for optimal healing towards native tissue behavior may offer a solution to this problem. A regionally distinct biocomposite scaffold composed of a biodegradable elastomer (poly(ester urethane)urea) and porcine dermal ECM gel was generated to meet this need by a concurrent polymer electrospinning/ECM gel electrospraying technique where the electrosprayed component was varied temporally during the processing. A sandwich structure was achieved with polymer fiber rich upper and lower layers for structural support and an ECM-rich inner layer to encourage cell ingrowth. Increasing the upper and lower layer fiber content predictably increased tensile strength. In a rat full thickness abdominal wall defect model, the sandwich scaffold design maintained its thickness whereas control biohybrid scaffolds lacking the upper and lower fiber-rich regions failed at 8 weeks. Sandwich scaffold implants also showed higher collagen content 4 and 8 weeks after implantation, exhibited an increased M2 macrophage phenotype response at later times and developed biaxial mechanical properties better approximating native tissue. By employing a processing approach that creates a sheet-form scaffold with regionally distinct zones, it was possible to improve biological outcomes in body wall repair and provide the means for further tuning scaffold mechanical parameters when targeting other applications. Copyright © 2013 John Wiley & Sons, Ltd.

  19. Combined Use of an Anterolateral Thigh Flap and Superficial Inferior Epigastric Artery Flap for Reconstruction of an Extensive Abdominal Wall Defect

    PubMed Central

    Kagaya, Yu; Arikawa, Masaki; Kobayashi, Eisuke

    2016-01-01

    Summary: Reconstruction of large abdominal wall defects is challenging. We herein report the successful reconstruction of an extensive abdominal wall defect using a novel combination of flaps after sarcoma resection. A 74-year-old man presented with a dedifferentiated liposarcoma on his abdominal wall. He underwent excision of the tumor, which resulted in an extensive abdominal wall defect. The defect was reconstructed with a pedicled anterolateral thigh flap with an iliotibial tract and a pedicled superficial inferior epigastric artery flap. No skin graft was necessary. The wounds healed successfully, and no herniation occurred. The combination of an anterolateral thigh flap and a superficial inferior epigastric artery flap is a versatile option for reconstruction of extensive abdominal wall defects. PMID:27975026

  20. [A case of fixing an anastomotic site to the abdominal wall out of the abdominal cavity for a small intestinal perforation during chemotherapy].

    PubMed

    Takahashi, Kazutaka; Harano, Masao; Kato, Takuya; Yoshida, Kazuhiro; Sato, Daisuke; Choda, Yasuhiro; Tokumoto, Noriaki; Kanazawa, Takashi; Matsukawa, Hiroyoshi; Ojima, Yasutomo; Idani, Hitoshi; Shiozaki, Shigehiro; Okajima, Masazumi; Ninomiya, Motoki

    2014-11-01

    A 53-year-old man presented with a continuous high fever and was diagnosed with diffuse large B-cell lymphoma with metastasis to the lung, spleen, and mesenterium. He was treated with cyclophosphamide and prednisolone followed by administration of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy 20 days later. Two days after initiation of CHOP therapy, the patient complained of severe abdominal pain. Perforative peritonitis was diagnosed using abdominal computed tomography. A perforation of the small intestine approximately 160 cm distal to the Treitz ligament was uncovered during emergency laparotomy. The risk of leakage was considered too high for anastomosis of the small intestine to be performed. Further, construction of an intestinal stoma could result in a high-output syndrome that could lead to difficulty in resuming chemotherapy. Based on these considerations, we fixed the anastomotic region to the abdominal wall using a technique similar to construction of an intestinal stoma. Post-operative anastomotic leakage did not occur. Nine days later, a perineal hernia was noted near the anastomotic site and a second operation was performed. The anastomotic site was placed back into the abdominal cavity during this operation. CHOP therapy was resumed 16 days after the first operation.

  1. Anisakiasis ('herring worm disease') as a cause of acute abdominal crisis.

    PubMed

    Kark, A E; McAlpine, J C

    1994-01-01

    A hazard associated with eating raw fish is presented. The larval nematode Anisakis marina ('herring worm') is a recognised public health problem in Japan, and cases have been reported in the UK. The intestinal burrowing of the larval form causes acute abdominal symptoms clinically resembling acute appendicitis. Operation is required; no antiparasitic agent is available.

  2. Jejunal choristoma: a very rare cause of abdominal pain in children.

    PubMed

    Olajide, T A; Agodirin, S O; Ojewola, R W; Akanbi, O O; Solaja, T O; Odesanya, Johnson Oluremi; Ariyibi, O O

    2014-01-01

    Choristoma is development of a normal tissue in an aberrant location. This report describes jejunal salivary choristoma (JSC) causing recurring episodes of abdominal discomfort in a 5-year-old girl. Exploratory laporatomy revealed a pale yellow subserosal jejunal lesion. Wedge resection of the lesion and repair of the bowel were performed. The child did well postoperatively and has since that time been free of pain at follow-up. Histopathological examination of the resected lesion revealed salivary gland choriostoma. Literature review (PUBMED search engine) revealed no previous report of this rare clinicopathologic entity. We conclude that choriostoma should be considered a possible differential when evaluating abdominal complaint in children.

  3. Biomechanical and morphological study of a new elastic mesh (Ciberlastic) to repair abdominal wall defects.

    PubMed

    Calvo, B; Pascual, G; Peña, E; Pérez-Khöler, B; Rodríguez, M; Bellón, J M

    2016-06-01

    The aim of this study was to conduct a preclinical evaluation of the behaviour of a new type of abdominal LW prosthesis (Ciberlastic), which was designed with a non-absorbable elastic polyurethane monofilament (Assuplus, Assut Europe, Italy) to allow greater adaptability to mechanical area requirements and higher bio-mimicking with the newly formed surrounding tissues. Our hypothesis was that an increase in the elasticity of the mesh filament could improve the benefits of LW prostheses. To verify our hypothesis, we compared the short- and long-term behaviour of Ciberlastic and Optilene(®) elastic commercial meshes by repairing the partially herniated abdomen in New Zealand White rabbits. The implanted meshes were mechanically and histologically assessed at 14 and 180 days post-implant. We mechanically characterized the partially herniated repaired muscle tissue and also determined mesh shrinkage at different post-implant times. This was followed by a histological study in which the tissue incorporation process was analysed over time. The new prosthesis designed by our group achieved good behaviour that was similar to that of Optilene(®), one of the most popular LW prostheses on the market, with the added advantage of its elastic property. The mechanical properties are significantly lower than those of the polypropylene Optilene(®) mesh, and the new elastic mesh meets the basic mechanical requirements for positioning in the abdominal wall, which was also demonstrated by the absence of recurrences after implantation in the experimental model. We found that the growth of a connective tissue rich in collagen over the hernial defect and the proper deposit of the collagen fibres in the regenerated tissue substantially modified the original properties of the mesh, thereby increasing its biomechanical strength and making the whole tissue/mesh stiffer.

  4. A new technique for minimally invasive abdominal wall reconstruction of complex incisional hernias: totally laparoscopic component separation and incisional hernia repair.

    PubMed

    Moazzez, Ashkan; Mason, Rodney J; Katkhouda, Namir

    2010-10-01

    Since Ramirez et al. presented the first case of component separation for abdominal wall hernias in 1990, it has undergone multiple modifications. This technique, which has been mainly used for large hernias where primary closure of the abdominal wall is not feasible, or for staged management of patients with open abdomens, results in multiple wound complications. In 2007, Rosen et al. reported on the laparoscopic approach to component separation that is associated with less subcutaneous dissection and the consequent advantage of a decreased risk of flap necrosis and wound infection. Here we discuss our totally laparoscopic approach to abdominal wall reconstruction. A minimally invasive abdominal wall reconstruction consists of a bilateral component separation, an intra-abdominal adhesiolysis, primary approximation of rectus muscles, and placement of an intraperitoneal mesh for reinforcing the repair, all performed laparoscopically. Patient-selection criteria, detailed operative technique, tips in preventing and managing the potential pitfalls, and postoperative care are discussed.

  5. Intra-Abdominal Abscess and Primary Peritonitis Caused by Streptococcus anginosus

    PubMed Central

    Terzi, Huseyin Agah; Demiray, Tayfur; Koroglu, Mehmet; Cakmak, Guner; Hakki Ciftci, Ihsan; Ozbek, Ahmet; Altindis, Mustafa

    2016-01-01

    Introduction The Streptococcus anginosus group of bacteria are low-virulence bacteria existing as commensals in the oral flora and gastrointestinal tracts of humans. S. anginosus may spread to the blood in individuals with poor oral hygiene in cases of oral infections, such as gingivitis and tooth abscesses, that develop following the loss of mucosal unity. This may lead to infections in the whole body, primarily as brain and liver abscesses. Case Presentation A 32-year-old male patient presented with complaints of nausea, vomiting, and diffuse abdominal pain. Diffuse abdominal tenderness and rebound tenderness were detected particularly in the epigastrium and right upper quadrant. Laboratory assessment revealed a leukocyte count of 20,500/mm3. Free fluid around the liver and heterogeneous areas of abscess formation in the right lateral gallbladder were revealed on abdominal computed tomography. Diffuse adhesions between the bowel and seropurulent free liquid in the abdomen were detected on surgical exploration, and a sample was taken for cultures. The patient was discharged without complications on the sixth postoperative day and his antibiotic course was completed with 4 weeks of oral treatment. We reviewed the literature for similar cases of disseminated pyogenic infections caused by the S. anginosus group. Conclusions It should be kept in mind that the oral flora bacterium S. anginosus may cause transient bacteremia and deep-seated organ abscesses in immunodeficient patients with poor oral hygiene. Such patients with intra-abdominal abscesses should be treated with antibiotics and surgery. PMID:27630763

  6. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs.

    PubMed

    Roje, Zdravko; Roje, Zeljka; Matić, Dario; Librenjak, Davor; Dokuzović, Stjepan; Varvodić, Josip

    2011-12-23

    Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other

  7. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

    PubMed Central

    2011-01-01

    Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other

  8. Case report of traumatic abdominal wall hernia following blunt motorcycle handlebar injury and review of the literature.

    PubMed

    Ogundiran, T O; Obamuyide, H A; Adesina, M A; Ademola, A F

    2012-01-01

    A 25-year-old man, riding a motorcycle, rammed into a moving car at a T junction and sustained a blunt lower-right abdominal injury with the handlebar of his motorbike. He developed a swelling at the point of impact for which he presented in hospital 10 days later. Clinical assessment revealed a healthy young man with a soft, nontender reducible swelling over the lateral half of the right inguinal area. A diagnosis of acute traumatic hernia was made. Abdominal ultrasonography revealed a wide-necked defect in the anterior abdominal wall over the right inguinal area with protruding bowel loops beneath an intact skin. He was planned for herniorrhaphy but has defaulted since then.

  9. Temporary feeding inhibition caused by artificial abdominal distension in the bedbug, Cimex lectularius.

    PubMed

    Wintle, Kenneth; Reinhardt, Klaus

    2008-07-01

    Abdominal distension of haematophagous insects caused by ingested blood has been recognised as an important contributor to triggering meal termination, feeding inhibition and further susceptibility to host signals. Factors that regulate feeding behaviour of the common bedbug, Cimex lectularius, are poorly understood. By injecting air directly into the body cavity of virgin female C. lectularius we artificially induced abdominal distension without providing chemical cues of the blood meal and without applying gut distension. Body length increased to 138% after feeding and 147% after inflation. The early decline in body volume is similar in blood-fed bugs but after between 8 and 24h became faster in inflated than fed bedbugs. Artificially inflated individuals remained feeding-inhibited at lower abdominal distensions than those that terminate blood ingestion (to ca. 135% initial body length, or up to about 5h). Feeding activity resumed earlier in inflated than blood-fed bugs. These results suggest that artificial abdominal distension has an inhibitory effect on feeding but is not the sole mechanism in preventing further feeding.

  10. An Unusual Cause of Abdominal Pain: Three Lead Pellets within the Appendix Vermiformis

    PubMed Central

    Muderris, Vecdi; Yagmurkaya, Orhan; Yalkin, Omer; Celebi, Fehmi

    2015-01-01

    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. PMID:26106500

  11. Successful Treatment of Mesenteric Varices After Living Donor Liver Transplantation with Retrograde Transvenous Obliteration Via an Abdominal Wall Vein

    SciTech Connect

    Ikeda, Osamu Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki; Okajima, Hideaki; Asonuma, Katsuhiro; Inomata, Yukihiro

    2010-06-15

    Balloon-occluded retrograde transvenous obliteration is an established treatment for gastric varices; it has been used more rarely to treat mesenteric varices. We report a 12-year-old girl who had received a living donor liver transplant and suffered melena due to ruptured mesenteric varices. We addressed treatment of the mesenteric varices by retrograde transvenous obliteration of an abdominal wall collateral vein detected by superior mesenteric arteriography.

  12. Gasless laparoscopic surgery plus abdominal wall lifting for giant hiatal hernia-our single-center experience.

    PubMed

    Yu, Jiang-Hong; Wu, Ji-Xiang; Yu, Lei; Li, Jian-Ye

    2016-12-01

    Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.

  13. Surgically placed abdominal wall catheters on postoperative analgesia and outcomes after living liver donation.

    PubMed

    Khan, James; Katz, Joel; Montbriand, Janice; Ladak, Salima; McCluskey, Stuart; Srinivas, Coimbatore; Ko, Raynauld; Grant, David; Bradbury, Ashleene; LeManach, Yannick; Clarke, Hance

    2015-04-01

    Living donor liver resections are associated with significant postoperative pain. Epidural analgesia is the gold standard for postoperative pain management, although it is often refused or contraindicated. Surgically placed abdominal wall catheters (AWCs) are a novel pain modality that can potentially provide pain relief for those patients who are unable to receive an epidural. A retrospective review was performed at a single center. Patients were categorized according to their postoperative pain modality: intravenous (IV) patient-controlled analgesia (PCA), AWCs with IV PCA, or patient-controlled epidural analgesia (PCEA). Pain scores, opioid consumption, and outcomes were compared for the first 3 postoperative days. Propensity score matches (PSMs) were performed to adjust for covariates and to confirm the primary analysis. The AWC group had significantly lower mean morphine-equivalent consumption on postoperative day 3 [18.1 mg, standard error (SE)=3.1 versus 28.2 mg, SE=3.0; P=0.02] and mean cumulative morphine-equivalent consumption (97.2 mg, SE=7.2 versus 121.0 mg, SE=9.1; P=0.04) in comparison with the IV PCA group; the difference in cumulative-morphine equivalent remained significant in the PSMs. AWC pain scores were higher than those in the PCEA group and were similar to the those in the IV PCA group. The AWC group had a lower incidence of pruritus and a shorter hospital stay in comparison with the PCEA group and had a lower incidence of sedation in comparison with both groups. Time to ambulation, nausea, and vomiting were comparable among all 3 groups. The PSMs confirmed all results except for a decrease in the length of stay in comparison with PCEA. AWCs may be an alternative to epidural analgesia after living donor liver resections. Randomized trials are needed to verify the benefits of AWCs, including the safety and adverse effects.

  14. Sir Ganga Ram Hospital classification of groin and ventral abdominal wall hernias

    PubMed Central

    Chowbey, Pradeep K; Khullar, Rajesh; Mehrotra, Magan; Sharma, Anil; Soni, Vandana; Baijal, Manish

    2006-01-01

    Background: Numerous classifications for groin and ventral hernias have been proposed over the past five to six decades. The old, simple classification of groin hernia in to direct, inguinal and femoral components is no longer adequate to understand the complex pathophysiology and management of these hernias. The most commonly followed classification for ventral hernias divide them into congenital, acquired, incisional and traumatic, which also does not convey any information regarding the predicted level of difficulty. Aim: All the previous classification systems were based on open hernia repairs and have their own fallacies particularly for uncommon hernias that cannot be classified in these systems. With the advent of laparoscopic/ endoscopic approach, surgical access to the hernia as well as the functional anatomy viewed by the surgeon changed. This change in the surgical approach and functional anatomy opened the doors for newer classifications. The authors have thus proposed a classification system based on the expected level of intraoperative difficulty for endoscopic hernia repair. Classification: In the proposed classification higher grades signify increasing levels of expected intraoperative difficulty. This functional classification grades groin hernias according to the: a) Pre -operative predictive level of difficulty of endoscopic surgery, and b) Intraoperative factors that lead to a difficult repair. Pre operative factors include multiple or pantaloon hernias, recurrent hernias, irreducible and incarcerated hernias. Intraoperative factors include reducibility at operation, degree of descent of the hernial sac and previous hernia repairs. Hernial defects greater than 7 cm in diameter are categorized one grade higher. Conclusion: Though there have been several classification systems for groin or inguinal hernias, none have been described for total classification of all ventral hernias of the abdomen. The system proposed by us includes all abdominal wall

  15. A successful early gore-tex reconstruction of an abdominal wall defect in a neonate with Cantrell pentalogy: a case report and literature review

    PubMed Central

    Divkovic, Dalibor; Kvolik, Slavica; Sipl, Mirna; Sego, Krunoslav; Puseljic, Silvija; Rakipovic-Stojanovic, Andreja; Kovacic, Borna

    2015-01-01

    Key Clinical Message A surgical technique, materials used for abdominal wall reconstruction, and postoperative care are important for patient outcomes. We report the first case of neonate with Cantrell's pentalogy surviving early reconstruction of abdominal, diaphragmal and pericardial defects. Several recent investigations suggest that intraabdominal pressure monitoring may improve outcomes in this patient category. PMID:25678967

  16. Clinical anatomy of the inferior epigastric artery with special relevance to invasive procedures of the anterior abdominal wall

    PubMed Central

    Joy, Praisy; Prithishkumar, Ivan James; Isaac, Bina

    2017-01-01

    INTRODUCTION: Injury to the inferior epigastric artery (IEA) has been reported following lower abdominal wall surgical incisions, abdominal peritoneocentesis and trocar placements at laparoscopic port sites, resulting in the formation of abdominal wall haematomas that may expand considerably due to lack of tissue resistance. The aim of this study was to localise its course in relation to standard anatomic landmarks and suggest safe areas for performance of invasive procedures. MATERIALS AND METHODS: Sixty IEAs of 30 adult cadavers (male = 19; female = 11) were dissected and the course of the IEA noted in relation to the mid-inguinal point, anterior superior iliac spine (ASIS) and umbilicus. RESULTS: The mean distance of the IEA from the midline was 4.45 ± 1.42 cm at the level of the mid-inguinal point, 4.10 ± 1.15 cm at the level of ASIS and 4.49 ± 1.15 cm at the level of umbilicus. There was an average of 3.3 branches per IEA with more branches arising from its lateral aspect. The IEA was situated within one-third (32%) of the distance between the midline and the sagittal plane through ASIS at all levels. CONCLUSION: To avoid injury to IEA, trocars can be safely inserted 5.5 cm [mean + 1 standard deviation (SD)] away from the midline (or) slightly more than one-third of the distance between the midline and a sagittal plane running through ASIS. These findings may be useful not only for laparoscopic procedures but also for image-guided biopsy, abdominal paracentesis, and placement of abdominal drains. PMID:27251822

  17. An unusual cause of abdominal distension: intraperitoneal bladder perforation secondary to intermittent self-catheterisation.

    PubMed

    Martin, Jennifer; Convie, Liam; Mark, David; McClure, Mark

    2015-02-25

    We report a strikingly unusual case of traumatic intraperitoneal perforation of an augmented bladder from clean intermittent self-catheterisation (CISC), which presented a unique diagnostic challenge. This case describes a 48-year-old T1 level paraplegic, who had undergone clamshell ileocystoplasty for detrusor overactivity, presenting with abdominal distension, vomiting and diarrhoea. Initial investigations were suggestive of disseminated peritoneal malignancy with ascitic fluid collections, but the ascitic fluid was found to be intraperitoneal urine from a perforation of the urinary bladder. This was associated with an inflammatory response in the surrounding structures causing an appearance of colonic thickening and omental disease. Although the diagnostic process was complex due to this patient's medical history, the treatment plan initiated was non-operative, with insertion of an indwelling urinary catheter and radiologically guided drainage of pelvic and abdominal collections. Overdistension perforations of augmented urinary bladders have been reported, but few have described perforation from CISC.

  18. Effects of the Transient Blood Flow-Wall Interaction on the Wall Stress Distribution in Abdominal Aortic Aneurysm (AAA)

    NASA Astrophysics Data System (ADS)

    Tang, Rubing; Geindreau, Christian; Lasheras, Juan

    2006-11-01

    Our static finite element analysis (FEA) of both idealized and real clinical models has shown that the maximum diameter and asymmetry have substantial influence on the AAA wall stress distribution. The thrombus inside the AAA was also found to reduce the magnitude of the wall stresses. To achieve a better understanding of the wall stress distribution in real AAAs, a dynamic FEA was also performed. We considered models, both symmetric and non-symmetric, in which the aorta is assumed isotropic with nonlinear material properties. For the limiting case of rigid walls, the evolution of the flow pattern and the wall shear stresses due to fluid flow at different stages of cardiac cycle predicted by our simulations are compared with experimental results obtained in in-vitro models. A good agreement is found between both results. Finally, we have extended the analysis to the physiologically correct case of deformable walls and characterized the transient effects on the wall stresses.

  19. Dynamic reconstruction of full-thickness abdominal wall defects using free innervated vastus lateralis muscle flap combined with free anterolateral thigh flap.

    PubMed

    Iida, Takuya; Mihara, Makoto; Narushima, Mitsunaga; Todokoro, Takeshi; Hara, Hisako; Yoshimatu, Hidehiko; Koshima, Isao; Kadono, Takafumi

    2013-03-01

    Reconstruction of full-thickness abdominal wall defects remains a difficult surgical challenge. Although various reconstructive methods, including artificial mesh, pedicled and free flaps, have been reported, most reported reconstruction of only the fascia layer, leaving the resected rectus abdominis muscle unreconstructed. However, recent studies suggested the importance of dynamic reconstruction with functional muscle in preventing abdominal hernia in the long-term. According to the principle of reconstructive surgery, "replace lost tissue with similar tissue," a functionally and aesthetically ideal reconstruction is to reconstruct all components of the abdominal wall structure, including skin, subcutaneous fat, fascia, and muscle. We present 2 cases with full-thickness abdominal wall defects in the upper abdominal region, which we reconstructed with a free innervated vastus lateralis muscle flap combined with a free anterolateral thigh flap. The motor nerve of the vastus lateralis muscle was sutured with the intercostal nerve, and reinnervation was confirmed by electromyography. This method allows reconstruction of all components of the abdominal wall with a single flap, and dynamic reconstruction is achieved which will reduce the risk of postoperative hernia. We believe this method can be a good option for reconstruction of full-thickness abdominal wall defects with long-term stability.

  20. Delayed primary closure of contaminated abdominal wall defects with non-crosslinked porcine acellular dermal matrix compared with conventional staged repair: a retrospective study

    PubMed Central

    2014-01-01

    Introduction Synthetic mesh has been used traditionally to repair abdominal wall defects, but its use is limited in the case of bacterial contamination. New biological materials are now being used successfully for delayed primary closure of contaminated abdominal wall defects. The costs of biological materials may prevent surgeons from using them. We compared the conventional staged repair of contaminated abdominal wall defects with a single-stage procedure using a non-crosslinked porcine acellular dermal matrix. Methods A total of 14 cases with Grade 3 contaminated abdominal wall defects underwent delayed primary closure of the abdomen using a non-crosslinked porcine acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA). The results were compared with a group of 14 patients who had received conventional treatment for the repair of contaminated abdominal wall defects comprising a staged repair during two separate hospital admissions employing synthetic mesh. Treatment modalities, outcomes, and costs were compared. Results In all cases treated with delayed primary closure employing non-crosslinked porcine acellular dermal matrix, there were no complications related to its use. Two patients died due to unrelated events. Although treatment costs were estimated to be similar in the two groups, the patients treated with porcine acellular dermal matrix spent less time as an inpatient than those receiving conventional two-stage repair. Conclusions Delayed primary closure of contaminated abdominal wall defects using a non-crosslinked porcine acellular dermal matrix may be a suitable alternative to conventional staged repair. In our patients, it resulted in early restoration of abdominal wall function and shorter hospitalization. The costs for treating contaminated abdominal wall defects using porcine acellular dermal matrix during a single hospital admission were not higher than costs for conventional two-stage repair

  1. The effects of modified wall squat exercises on average adults' deep abdominal muscle thickness and lumbar stability.

    PubMed

    Cho, Misuk

    2013-06-01

    [Purpose] The purpose of this study was to compare the effects of bridge exercises applying the abdominal drawing-in method and modified wall squat exercises on deep abdominal muscle thickness and lumbar stability. [Subjects] A total of 30 subjects were equally divided into an experimental group and a control group. [Methods] The experimental group completed modified wall squat exercises, and the control group performed bridge exercises. Both did so for 30 minutes three times per week over a six-week period. Both groups' transversus abdominis (Tra), internal oblique (IO), and multifidus muscle thickness were measured using ultrasonography, while their static lumbar stability and dynamic lumbar stability were measured using a pressure biofeedback unit. [Results] A comparison of the pre-intervention and post-intervention measures of the experimental group and the control group was made; the Tra and IO thicknesses were significantly different in both groups. [Conclusion] The modified wall squat exercise and bridge exercise affected the thicknesses of the Tra and the IO muscles. While the bridge exercise requirs space and a mattress to lie on, the modified wall squat exercise can be conveniently performed anytime.

  2. Endovascular treatment of a small infrarenal abdominal aortic aneurysm causing duodenal obstruction: Case report and literature review.

    PubMed

    Esposito, Andrea; Menna, Danilo; Mansour, Wassim; Sirignano, Pasqualino; Capoccia, Laura; Speziale, Francesco

    2015-06-01

    Duodenal obstruction caused by abdominal aortic aneurysm was first described by Osler in 1905 and is named "aortoduodenal syndrome." This condition has always been treated by open surgical repair. We report the first case of aortoduodenal syndrome successfully treated by endovascular aneurysm repair. A 74-year-old male patient referred to our hospital complaining postprandial vomit, reporting a consistent weight loss in the latest weeks. Enhanced computed tomography scans showed a small saccular abdominal aortic aneurysm compressing duodenum and inferior vena cava without any other evident pathological finding. As the patient underwent a successful endovascular treatment of the abdominal aortic aneurysm, symptoms immediately resolved so that he started back to feed and progressively gained body weight. Despite aortoduodenal syndrome is generally caused by large abdominal aortic aneurysm, this condition has to be suspected also in case of small abdominal aortic aneurysm. Differently from what has been reported in literature, endovascular aneurysm repair could be effective in the treatment of aortoduodenal syndrome.

  3. Expression of matrix metalloproteinases, their tissue inhibitors, and osteopontin in the wall of thoracic and abdominal aortas with dilatative pathology.

    PubMed

    Lesauskaite, Vaiva; Epistolato, Maria Carmela; Castagnini, Marta; Urbonavicius, Sigitas; Tanganelli, Piero

    2006-08-01

    Matrix metalloproteinases (MMPs) degrade extracellular matrix and may play a central role in the pathogenesis of aortic aneurysms. We studied 2 groups of patients: 15 with dilatative pathology of the ascending thoracic aorta and 17 with aneurysm of the abdominal aortic wall (AAA). We compared the expression of MMPs, tissue inhibitors of matrix metalloproteinases (TIMPs), and osteopontin in the wall of thoracic and abdominal aneurysms. In AAA, MMP-9 and TIMP-1 expression in inflammatory cells was higher than in smooth muscle cells (SMCs) (median score: 3.5 versus 1, P < .0001; 2 versus 1, P < .04, respectively), whereas MMP-2 demonstrated higher expression in SMCs than in inflammatory cells (median score: 0 versus 4, P < .0001). In ATA, MMP-2, MMP-9, TIMP-1, TIMP-2, TIMP-3, and osteopontin expression in SMCs was higher than in inflammatory cells (median score: 3 versus 0, P < .0001; 4 versus 1, P < .0005; 2 versus 0, P < .001; 5 versus 2, P < .0001; 2 versus 0, P < .005; and 5 versus 1.5, P < .0001, respectively), when both inflammatory cells of the media and the adventitia were considered together. The cellular expression of MMP-9 and their tissue inhibitors TIMP-1, TIMP-2, and TIMP-3 differs in the dilatative pathology of abdominal and thoracic aortas, so the hypothetical model of morphogenesis of AAA cannot completely explain the formation of dilatative pathology of the ascending thoracic aorta.

  4. Critical analysis of Strattice performance in complex abdominal wall reconstruction: intermediate-risk patients and early complications.

    PubMed

    Patel, Ketan M; Albino, Frank P; Nahabedian, Maurice Y; Bhanot, Parag

    2013-01-01

    The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m(2)). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1-24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.

  5. Increased Expression of Lamin A/C Correlate with Regions of High Wall Stress in Abdominal Aortic Aneurysms

    PubMed Central

    Malkawi, Amir; Pirianov, Grisha; Torsney, Evelyn; Chetter, Ian; Sakalihasan, Natzi; Loftus, Ian M.; Nordon, Ian; Huggins, Christopher; Charolidi, Nicoletta; Thompson, Matt; Xu, Xie Yun; Cockerill, Gillian W.

    2015-01-01

    Background Since aortic diameter is the most ­significant risk factor for rupture, we sought to identify stress-dependent changes in gene expression to illuminate novel molecular processes in aneurysm rupture. Materials and Methods We constructed finite element maps of abdominal computerized tomography scans (CTs) of seven abdominal aortic aneurysm (AAA) patients to map wall stress. Paired biopsies from high- and low-stress areas were collected at surgery using vascular landmarks as coordinates. Differential gene expression was evaluated by Illumina Array analysis, using the whole genome DNA-mediated, annealing, selection, extension, and ligation (DASL) gene chip (n = 3 paired samples). Results The sole significant candidate from this analysis, Lamin A/C, was validated at the protein level, using western blotting. Lamin A/C expression in the inferior mesenteric vein (IMV) of AAA patients was compared to a control group and in aortic smooth muscle cells in culture in response to physiological pulsatile stretch. ­Areas of high wall stress (n = 7) correlate to those ­regions which have the thinnest walls [778 µm (585–1120 µm)] in comparison to areas of lowest wall stress [1620 µm (962–2919 µm)]. Induced expression of Lamin A/C ­correlated with areas of high wall stress from AAAs but was not significantly induced in the IMV from AAA patients compared to controls (n = 16). Stress-induced expression of Lamin A/C was mimicked by exposing aortic smooth muscle cells to prolonged pulsatile stretch. Conclusion Lamin A/C protein is specifically increased in areas of high wall stress in AAA from patients, but is not increased on other vascular beds of aneurysm patients, suggesting that its elevation may be a compensatory response to the pathobiology leading to aneurysms. PMID:27175366

  6. Abdominal wall reconstruction after resection of an enterocutaneous fistula with an island pedicled anterolateral thigh perforator flap. Case report.

    PubMed

    Ali, F; Safawi, E B; Zakaria, Z; Basiron, N

    2013-01-01

    Entero-cutaneous fistula resulting from a locally invasive large bowel carcinoma is a difficult surgical challenge. En-bloc resection of the involved organs and the entero-cutaneous fistula tract with a healthy tissue margin will result in a composite abdominal wall defect that requires closure. Reconstructive surgical options include primary closure, components separation and the use of local, regional or free flaps with or without prosthetic mesh. We report a case of an abdominal enterocutaneous fistula secondary to a locally invasive sigmoid carcinoma, which was reconstructed with a pedicled antero-lateral thigh perforator (ALT) flap. To our knowledge, this is the first case of a malignant entero-cutaneous fistula, which was reconstructed with an ALT flap.

  7. [Abdominal approaches and drainages of the abdominal cavity].

    PubMed

    Hagel, C; Schilling, M

    2006-04-01

    Appropriate access to the abdominal cavity is the first and crucial step for successful abdominal surgical intervention. In planning the incision, several variables have to be considered, such as anatomy of the abdominal wall, localization of the target organ, and individual conditions (previous incisions, minimal access surgery, etc). Medial laparotomy is the preferred incision for emergency cases and ill-defined pathologies, allowing access and hence exploration to all quadrants. Transverse laparotomies give superior access to the dorsal and right aspects of the liver and cause less pain in patients unfit for regional anesthetic procedures. Draining of the abdominal cavity is used after various resective and reconstructive procedures, but there is little evidence for its use in a number of operations such as gastric, hepatic, and colorectal resections. Advantages and disadvantages of different abdominal wall incisions and drainages are discussed.

  8. Preparation of poly(L-lactic acid)-modified polypropylene mesh and its antiadhesion in experimental abdominal wall defect repair.

    PubMed

    Zhang, Zhigang; Zhang, Tianzhu; Li, Junsheng; Ji, Zhenling; Zhou, Hemei; Zhou, Xuefeng; Gu, Ning

    2014-01-01

    A new type of polypropylene (PP) hernia mesh, modified with poly(L-lactic acid) (PLLA), was developed and used to repair rat abdominal wall defect. The PP mesh was first treated with oxygen plasma and then grafted with PLLA in phosphorus pentachloride (PCl5 ) solution in dichloride methane. The water contact angle changed during the procedure, and the coverage percentage of PLLA on the PP was about 80%. ATR-FTIR spectroscopy measurements showed the existence of carbonyl group absorption peak (1756.9 cm(-1) ), and atomic force microscope and scanning electron microscope morphological observation indicated that the surface of the PP mesh was covered with PLLA graft. X-ray photoelectron spectroscopy spectra was used to probe chemical group changes and confirmed that the PLLA was grafted onto the PP. A total of 36 Sprague-Dawley rats were randomly divided into six groups, and they received either modified meshes (experimental groups) or PP meshes (control groups) to repair abdominal wall defects. All animals survived until the end of the experiment. Rats in each group were dissected after the operation (after 1 week, 2 weeks, and 1 month, respectively), and the adhesion effects were evaluated. Sections of the mesh parietal peritoneum overlap were examined histologically and graded for inflammation reaction. Compared with the control groups, the experimental groups showed a better ability to resist peritoneal cavity adhesions (P < 0.05), and there was no increase in inflammation formation (P > 0.05). This new type of PLLA-modified PP mesh displayed an additional property of antiadhesion in animal abdominal wall defect repair.

  9. Automatic identification and validation of planar collagen organization in the aorta wall with application to abdominal aortic aneurysm.

    PubMed

    Polzer, Stanislav; Gasser, T Christian; Forsell, Caroline; Druckmüllerova, Hana; Tichy, Michal; Staffa, Robert; Vlachovsky, Robert; Bursa, Jiri

    2013-12-01

    Arterial physiology relies on a delicate three-dimensional (3D) organization of cells and extracellular matrix, which is remarkably altered by vascular diseases like abdominal aortic aneurysms (AAA). The ability to explore the micro-histology of the aorta wall is important in the study of vascular pathologies and in the development of vascular constitutive models, i.e., mathematical descriptions of biomechanical properties of the wall. The present study reports and validates a fast image processing sequence capable of quantifying collagen fiber organization from histological stains. Powering and re-normalizing the histogram of the classical fast Fourier transformation (FFT) is a key step in the proposed analysis sequence. This modification introduces a powering parameter w, which was calibrated to best fit the reference data obtained using classical FFT and polarized light microscopy (PLM) of stained histological slices of AAA wall samples. The values of w = 3 and 7 give the best correlation (Pearson's correlation coefficient larger than 0.7, R 2 about 0.7) with the classical FFT approach and PLM measurements. A fast and operator independent method to identify collagen organization in the arterial wall was developed and validated. This overcomes severe limitations of currently applied methods like PLM to identify collagen organization in the arterial wall.

  10. First Clinical Judgment by Primary Care Physicians Distinguishes Well Between Nonorganic and Organic Causes of Abdominal or Chest Pain

    PubMed Central

    Martina, Benedict; Bucheli, Bruno; Stotz, Martin; Battegay, Edouard; Gyr, Niklaus

    1997-01-01

    OBJECTIVE To evaluate the accuracy of a preliminary diagnosis based solely on patient history and physical examination in medical outpatients with abdominal or chest pain. DESIGN Prospective observational study. setting General medical outpatient clinic in a university teaching hospital. participants One hundred ninety new, consecutive patients with a mean age of 44 years (SD = 14 years, range 30–58 years) with a main complaint of abdominal or chest pain. measurements and main results The preliminary diagnosis, established on the basis of patient history and physical examination, was compared with a final diagnosis, obtained after workup at completion of the chart. A nonorganic cause was established in 66 (59%) of 112 patients with abdominal pain and in 65 (83%) of 78 with chest pain. The preliminary diagnosis of “nonorganic” versus “organic” causes was correct in 79% of patients with abdominal pain and in 88% of patients with chest pain. An “undoubted” preliminary diagnosis predicted a correct assessment in all patients with abdominal pain and in all but one patient with chest pain. Overall, only 4 patients (3%) were initially incorrectly diagnosed as having a nonorganic cause of pain rather than an organic cause. In addition, final nonorganic diagnosis (n = 131) was compared with long-term follow-up by obtaining information from patients and, if necessary, from treating physicians. Follow-up information, obtained for 71% of these patients after a mean of 29 months (range 18–56 months) identified three other patients that had been misdiagnosed as having abdominal pain of nonorganic causes. Compared with follow-up, the diagnostic accuracy for nonorganic abdominal and chest pain at chart completion was 93% and 98%, respectively. conclusions A preliminary diagnosis of nonorganic versus organic abdominal or chest pain based on patient history and physical examination proved remarkably reliable. Accuracy was almost complete in patients with an

  11. Giant Cutaneous Leiomyosarcoma Originating From the Abdominal Wall: A Case Report

    PubMed Central

    Eken, Huseyin; Karagul, Servet; Topgül, Koray; Yoruker, Savaş; Ozen, Necati; Gun, Seda; Balci, Mecdi Gurhan; Somuncu, Erkan; Cimen, Orhan; Soyturk, Mehmet; Karavas, Erdal

    2016-01-01

    Patient: Male, 44 Final Diagnosis: Cutaneous Leiomyosarcoma Symptoms: Abdominal mass Medication: — Clinical Procedure: Surgery Specialty: Surgery Objective: Rare disease Background: Leiomyosarcoma, a rare type of tumor, accounts for 5–10% of all soft tissue tumors. Case Report: A 44-year-old male patient was admitted to the emergency service of our medical faculty with the complaints of fatigue and abdominal mass. Conclusions: The pathology result was leiomyosarcoma. Leiomyosarcoma of the skin is rare and our case is the largest such lesion reported in the literature. PMID:26787636

  12. The behavior of different types of polytetrafluoroethylene (PTFE) prostheses in the reparative scarring process of abdominal wall defects.

    PubMed

    Buján, J; Contreras, L A; Carrera-San Martín, A; Bellón, J M

    1997-07-01

    Currently one of the most widely used prosthetic materials in the repair of abdominal wall defects, is expanded polytetrafluoroethylene (ePTFE). It has been suggested that its behavior with respect to the reparative process may depend on its structure. The aim of the present study was to evaluate the effect of the structure of 3 ePTFE prostheses on the scarring process in an abdominal-wall-defect experimental model. The prostheses employed were the Soft Tissue Patch (STP) which is laminar in structure, Mycro Mesh (MM) which is multilaminar with perforations, and the Dual Mesh (DM) prosthesis which has one non-porous surface. Abdominal wall defects (7 x 5 cm) were created in 36 New Zealand rabbits and repaired using fragments of STP, MM and DM. Follow-up periods were 14, 30, 60 and 90 days post-implant. At these times prostheses were macroscopically examined for the presence of infection and/or rejection and the formation of adhesions to abdominal viscera. Specimens were also taken for microscopic analysis (optical and scanning electron) and for immunohistochemical analysis using the rabbit macrophage-specific monoclonal antibody RAM-11. Labelled macrophage counts were performed at each follow-up session. No cases of infection or rejection were found. Loose adhesions between prosthesis and underlying viscera were observed in 2 of the STP, 4 of the MM and 2 of the DM implants. STP and DM implants were progressively encapsulated by organized connective tissue on both peritoneal and subcutaneous surfaces. Cellular colonization was observed on both STP surfaces and on the porous surface of the DM although no more than a third of the biomaterial was penetrated by cells in either case. Colonization was very slight at prosthesis anchorage points. MM implants differed only in the formation of connective tissue bridges in perforated areas, and cellular infiltration in interlaminar spaces. Macrophage response was similar in the 3 prostheses with a reduction in RAM-11 labelled

  13. Diagnostic Accuracy of Abdominal wall Ultrasonography and Local Wound Exploration in Predicting the Need for Laparotomy following Stab Wound

    PubMed Central

    Vafaei, Ali; Heidari, Kamran; Saboorizadeh, Afshin; shams akhtari, Amin

    2017-01-01

    Introduction: Screening of patients with anterior abdominal penetrating trauma in need for laparotomy is an important issue in management of these cases. This study aimed to compare the accuracy of abdominal wall ultrasonography (AWU) and local wound exploration (LWE) in this regard. Methods: This diagnostic accuracy study was conducted on ≥ 18 year-old patients presenting to emergency department with anterior abdominal stab wound and stable hemodynamics, to compare the characteristics of AWU and LWE in screening of patients in need of laparotomy. Results: 50 cases with the mean age of 28.44 ± 7.14 years were included (80% male). Sensitivity, specificity and area under the receiver operating characteristic (ROC) curve of AWU were 70.58 (95% CI: 44.04 – 88.62), 93.33 (95% CI: 76.49 – 98.83), and 81.96 (95% CI: 69.91 – 94.01), respectively. These measures were 88.23 (62.25 – 97.93), 93.33 (76.49 – 98.83), and 90.78 (95% CI: 81.67 – 99.89) for LWE, respectively. The difference in overall accuracy of the two methods was not statistically significant (p = 0.0641). Conclusion: Based on the findings of the present study, AWU and LWE had the same specificity but different sensitivities in screening of anterior abdominal stab wound patients in need of laparotomy. The overall accuracy of LWE was slightly higher (91.48% versus 85.1%). PMID:28286841

  14. Reproducibility of The Abdominal and Chest Wall Position by Voluntary Breath-Hold Technique Using a Laser-Based Monitoring and Visual Feedback System

    SciTech Connect

    Nakamura, Katsumasa . E-mail: nakam@radiol.med.kyushu-u.ac.jp; Shioyama, Yoshiyuki; Nomoto, Satoru; Ohga, Saiji; Toba, Takashi; Yoshitake, Tadamasa; Anai, Shigeo; Terashima, Hiromi; Honda, Hiroshi

    2007-05-01

    Purpose: The voluntary breath-hold (BH) technique is a simple method to control the respiration-related motion of a tumor during irradiation. However, the abdominal and chest wall position may not be accurately reproduced using the BH technique. The purpose of this study was to examine whether visual feedback can reduce the fluctuation in wall motion during BH using a new respiratory monitoring device. Methods and Materials: We developed a laser-based BH monitoring and visual feedback system. For this study, five healthy volunteers were enrolled. The volunteers, practicing abdominal breathing, performed shallow end-expiration BH (SEBH), shallow end-inspiration BH (SIBH), and deep end-inspiration BH (DIBH) with or without visual feedback. The abdominal and chest wall positions were measured at 80-ms intervals during BHs. Results: The fluctuation in the chest wall position was smaller than that of the abdominal wall position. The reproducibility of the wall position was improved by visual feedback. With a monitoring device, visual feedback reduced the mean deviation of the abdominal wall from 2.1 {+-} 1.3 mm to 1.5 {+-} 0.5 mm, 2.5 {+-} 1.9 mm to 1.1 {+-} 0.4 mm, and 6.6 {+-} 2.4 mm to 2.6 {+-} 1.4 mm in SEBH, SIBH, and DIBH, respectively. Conclusions: Volunteers can perform the BH maneuver in a highly reproducible fashion when informed about the position of the wall, although in the case of DIBH, the deviation in the wall position remained substantial.

  15. The quasi-static failure properties of the abdominal aortic aneurysm wall estimated by a mixed experimental-numerical approach.

    PubMed

    Forsell, Caroline; Swedenborg, Jesper; Roy, Joy; Gasser, T Christian

    2013-07-01

    Assessing the risk for abdominal aortic aneurysm (AAA) rupture is critical in the management of aneurysm patients and an individual assessment is possible with the biomechanical rupture risk assessment. Such an assessment could potentially be improved by a constitutive AAA wall model that accounts for irreversible damage-related deformations. Because of that the present study estimated the elastic and inelastic properties of the AAA wall through a mixed experimental-numerical approach. Specifically, finite element (FE) models of bone-shaped tensile specimens were used to merge data from failure testing of the AAA wall with their measured collagen orientation distribution. A histo-mechanical constitutive model for collagen fibers was employed, where plastic fibril sliding determined not only remaining deformations but also weakening of the fiber. The developed FE models were able to replicate the experimentally recorded load-displacement property of all 16 AAA wall specimens that were investigated in the study. Tensile testing in longitudinal direction of the AAA defined a Cauchy strength of 569(SD 411) kPa that was reached at a stretch of 1.436(SD 0.118). The stiffness and strength of specimens decreased with the wall thickness and were elevated (p = 0.018; p = 0.030) in patients with chronic obstructive pulmonary disease (COPD). Smoking affected the tissue parameters that were related to the irreversible deformation response, and no correlation with gender and age was found. The observed effects on the biomechanical properties of the AAA wall could have long-term consequences for the management of aneurysm patients, i.e., specifically they might influence future AAA rupture risk assessments. However, in order to design appropriate clinical validation studies our findings should firstly be verified in a larger patient cohort.

  16. Perforation of the gallbladder: a rare cause of acute abdominal pain.

    PubMed

    Ponten, Joep B; Selten, Jasmijn; Puylaert, Julien B C M; Bronkhorst, Maarten W G A

    2015-02-08

    An 82-year-old woman without any previous medical history arrived in the emergency department with severe pain in the entire abdomen since 5 h. Blood tests showed, apart from a CRP of 28 mg/l, no abnormalities. We decided to perform an abdominal ultrasound, which showed an easily compressible gallbladder, containing a small, mobile gallstone and free fluid in the abdomen. During ultrasound-guided punction of this fluid, bile is aspirated. We performed laparoscopy and confirmed a large amount of intraperitoneal bile. Upon inspecting the gallbladder a perforation is seen in the anti-hepatic side of the gallbladder. After performing a cholecystectomy, we opened the gallbladder and detected a dissection-like lesion, which provided access to the peritoneal cavity. The confirmed diagnosis was acute onset free perforation of the gallbladder. The perforation was probably caused by the small obstructing gallstone seen on ultrasound or by another small stone, which could not be visualized.

  17. Avoiding Complications in Abdominal Wall Surgery: A Mathematical Model to Predict the Course of the Motor Innervation of the Rectus Abdominis.

    PubMed

    Tessone, Ariel; Nava, Maurizio; Blondeel, Phillip; Spano, Andrea

    2016-02-01

    Ever since its introduction, the transverse rectus abdominis myocutaneous flap has become the mainstay of autologous breast reconstruction. However, concerns regarding donor site morbidity due to the breach of abdominal wall musculature integrity soon followed. Muscle-sparing techniques, eventually eliminating the muscle from the flap all-together with the deep inferior epigastric artery perforator flap, did not eliminate the problem of abdominal wall weakness. This led to the conclusion that motor innervation might be at fault. Studies have shown that even in the presence of an intact rectus abdominis muscle, and an intact anterior rectus sheath, denervation of the rectus abdominis muscle results in significant abdominal wall weakness leading to superior and inferior abdominal bulges, and abdominal herniation. Our aim was to establish a mathematical model to predict the location of the motor innervation to the rectus abdominis muscle, and thus provide surgeons with a tool that will allow them to reduce abdominal morbidity during deep inferior epigastric artery perforator and free muscle-sparing transverse rectus abdominis myocutaneous surgery. We dissected 42 cadaveric hemiabdomens and mapped the course of the thoracolumbar nerves. We then standardized and analyzed our findings and presented them as a relative map which can be adjusted to body type and dimensions. Our dissections show that the motor innervation is closely related to the lateral vascular supply. Thus, when possible, we support the preferred utilization of the medial vascular supply, and the preservation of the lateral supply and motor innervation.

  18. Reconstruction of a four-quadrant full-thickness abdominal wall defect after removal and debridement of an infected mesh hernioplasty.

    PubMed

    Schmitz, C; Schramm, S; Hankiss, J

    2011-02-01

    This case-report shows our experience with a patient, who underwent mesh hernioplasty followed by infection of the mesh and full-thickness loss of the abdominal wall after debridement due to necrosis. The anamnesis included generalised arteriosclerosis, chronic nicotine and alcohol abuse and recurring wound-healing disorders after surgical procedures. The initial infection was treated by radical debridement, targeted antibiotics and V.A.C.(®) Therapy. After this, a staged plastic reconstructive procedure with four pedicled flaps was performed. The functional integrity of the abdominal wall was completely re-established. The patient was able to continue her occupation as a facility manager. Although the use of free flaps is very common in modern plastic and reconstructive surgery, procedures such as pedicled flaps still have their significance for special indications. In this case, a full recovery of the abdominal wall with autologous tissue was successful under difficult vascular conditions by using local flaps.

  19. Reconstruction of Abdominal Wall Defects Using a Pedicled Anterolateral Thigh Flap including the Vastus Lateralis Muscle: A Report of Two Cases

    PubMed Central

    Fujioka, Masaki; Ishiyama, Satoko

    2016-01-01

    The purpose of abdominal wall reconstruction is to prevent hernias and protect the abdominal viscera. In cases involving full-thickness defects of the rectus abdominis muscle, the muscle layer should be repaired. We present 2 cases in which full-thickness lower rectus abdominis muscle defects were reconstructed using vastus lateralis-anterolateral thigh flaps. The pedicled vastus lateralis-anterolateral thigh flap provides skin, fascia, and muscle tissue. Furthermore, it has a long neurovascular pedicle and can reach up to the periumbilical area and cover large defects. We consider that this muscle flap is a good option for repairing full-thickness lower abdominal defects. PMID:28074168

  20. Treatment of a chronic vesicocutaneous fistula and abdominal wall defect after resection of a soft tissue sarcoma using a bipedicled latissimus dorsi and serratus anterior free flap.

    PubMed

    Ludolph, Ingo; Apel, Hendrik; Horch, Raymund E; Beier, Justus P

    2014-11-01

    We present a surgical treatment for bladder reconstruction in a case of chronic vesicocutaneous radiation-induced fistula and reconstruction of the abdominal wall after resection of a liposarcoma in the rectus abdominis muscle. Fistulas are sequelae after radiotherapy. To regain bladder function and reconstitute abdominal wall stability, a microsurgical flap approach should be considered. A male patient underwent resection of a liposarcoma in the rectus abdominis muscle with adjuvant radiotherapy, suffering from a chronic vesicocutaneous fistula. A bipedicled combined latissimus dorsi and serratus anterior flap was carried out after resection of the fistula for reconstruction of the urine bladder and the abdominal wall. Ascending urethrography 4 weeks postoperatively showed no leakage. In the 4-month follow-up period, no signs of recurrence of the fistula or herniation occurred. A bipedicled flap allowed reconstruction of the urine bladder and the abdominal wall. Using non-irradiated, well-perfused intra-abdominal muscle tissue over the urine bladder prevented recurrence of the fistula.

  1. Novel superhydrophilic poly(l-lactic acid-co-ε-caprolactone)/fibrinogen electrospun patch for rat abdominal wall reconstruction.

    PubMed

    Liu, Zhang; Li, Shaojie; Su, Ling; Sun, Kang; Wu, Xujun; Wu, Feng; Huang, Weihong; Yang, Li; Tang, Jianxiong; He, Hongbing

    2015-08-01

    A novel superhydrophilic hybrid scaffold was created by electrospinning a mixture of poly(l-lactic acid-co-ε-caprolactone) and formulated fibrinogen. The hybrid scaffolds possess the combined benefits of each individual component, such as moderate mechanical strength and excellent biocompatibility. In vitro studies also revealed that endothelial cells seeded on the hybrid scaffolds achieved a relatively high level of cell attachment after three days of culture and a significant increase in the proliferation rate after seven days of culture, compared with pure fibrinogen or poly(l-lactic acid-co-ε-caprolactone) scaffolds. A comparative study of hybrid and pure poly(l-lactic acid-co-ε-caprolactone) patches was performed in an abdominal wall defect model in rats. In both groups, implants degraded by six months, but muscle reconstruction was only observed in the hybrid patch group.

  2. [Results of partial splenic resection and transposition to the lateral abdominal wall in portal hypertension in childhood].

    PubMed

    Bennek, J; Tröbs, R B; Mühlig, K; Richter, T

    1996-01-01

    Between 1977 and 1995, 19 children with portal hypertension (nine extrahepatic, ten intrahepatic) were treated by transpositioning the spleen into the left abdominal wall. Among the patients with intrahepatic portal hypertension three died. Two patients underwent secondary diminuition of the transposed spleen due to relapsed hypersplenism. In one of our first patients the transposed spleen atrophied after tangential resection. All surviving patients except one preserved hepatic function. The serum colloid osmotic pressure was stable. Plasma ammonia levels were normal. Serum immunoglobulins (IgG, IgM, IgA and IgG subclasses) and complement components (C3c, C4) were analyzed. After transposition patients had normal or slightly elevated values of these proteins compared with controls.

  3. Changes in the Frequencies of Abdominal Wall Hernias and the Preferences for Their Repair: A Multicenter National Study From Turkey

    PubMed Central

    Şeker, Gaye; Kulacoglu, Hakan; Öztuna, Derya; Topgül, Koray; Akyol, Cihangir; Çakmak, Atıl; Karateke, Faruk; Özdoğan, Mehmet; Ersoy, Eren; Gürer, Ahmet; Zerbaliyev, Elbrus; Seker, Duray; Yorgancı, Kaya; Pergel, Ahmet; Aydın, İbrahim; Ensari, Cemal; Bilecik, Tuna; Kahraman, İzzettin; Reis, Erhan; Kalaycı, Murat; Canda, Aras Emre; Demirağ, Alp; Kesicioğlu, Tuğrul; Malazgirt, Zafer; Gündoğdu, Haldun; Terzi, Cem

    2014-01-01

    Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%.1–3 As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world.4 Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic),5,6 the ideal anesthesia (general, local, or regional),7,8 and the ideal mesh (standard polypropylene or newer meshes).9,10 PMID:25216417

  4. Behaviour of a New Composite Mesh for the Repair of Full-Thickness Abdominal Wall Defects in a Rabbit Model

    PubMed Central

    Pascual, Gemma; Sotomayor, Sandra; Rodríguez, Marta; Bayon, Yves; Bellón, Juan M.

    2013-01-01

    Introduction Composite biomaterials designed for the repair of abdominal wall defects are composed of a mesh component and a laminar barrier in contact with the visceral peritoneum. This study assesses the behaviour of a new composite mesh by comparing it with two latest-generation composites currently used in clinical practice. Methods Defects (7x5cm) created in the anterior abdominal wall of New Zealand White rabbits were repaired using a polypropylene mesh and the composites: PhysiomeshTM; VentralightTM and a new composite mesh with a three-dimensional macroporous polyester structure and an oxidized collagen/chitosan barrier. Animals were sacrificed on days 14 and 90 postimplant. Specimens were processed to determine host tissue incorporation, gene/protein expression of neo-collagens (RT-PCR/immunofluorescence), macrophage response (RAM-11-immunolabelling) and biomechanical resistance. On postoperative days 7/14, each animal was examined laparoscopically to quantify adhesions between the visceral peritoneum and implant. Results The new composite mesh showed the lowest incidence of seroma in the short term. At each time point, the mesh surface covered with adhesions was greater in controls than composites. By day 14, the implants were fully infiltrated by a loose connective tissue that became denser over time. At 90 days, the peritoneal mesh surface was lined with a stable mesothelium. The new composite mesh induced more rapid tissue maturation than PhysiomeshTM, giving rise to a neoformed tissue containing more type I collagen. In VentralightTM the macrophage reaction was intense and significantly greater than the other composites at both follow-up times. Tensile strengths were similar for each biomaterial. Conclusions All composites showed optimal peritoneal behaviour, inducing good peritoneal regeneration and scarce postoperative adhesion formation. A greater foreign body reaction was observed for VentralightTM. All composites induced good collagen deposition

  5. Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms

    PubMed Central

    Goodney, Philip P.; Tavris, Dale; Lucas, F. Lee; Gross, Thomas; Fisher, Elliott S.; Finlayson, Samuel R. G.

    2017-01-01

    Introduction Several reports suggest unexpectedly high rates of late abdominal aortic aneurysm (AAA) rupture occur after endovascular AAA repair (EVAR). However, a population-based study examining causes of late death after EVAR vs open surgical repair has not been performed. Methods We performed a retrospective cohort study of patients undergoing infrarenal AAA repair using information from the Medicare inpatient hospital discharge records (MedPAR files), physician claim files (Part B files, 20% sample), and Medicare Denominator Files for the years 2001 to 2004. Using the Social Security Death Index, we identified all “late” deaths, defined as deaths occurring >30 days and after hospital discharge. We used the National Death Index to identify cause of death information; in particular, those deaths that were likely caused by late rupture. We compared causes of late death and survival between EVAR and open repair using Wilcoxon log-rank and rank-sum tests. Results Between 2001 and 2004, 13,971 patients underwent AAA repair (6119 EVAR, 7852 open repair). After a mean follow-up of 1.6 years in the EVAR cohort and 1.9 years in the open cohort, mortality rates were similar across repair type (15.4% EVAR, 15.9% open repair), with an adjusted odds ratio for death after open repair of 0.98 (95% confidence interval, 0.90–1.07). Of the 2194 documented deaths, 523 occurred before discharge or ≤30 days, and 1671 occurred >30 days and after hospital discharge. Cause of death information for the 1671 late deaths was available from the National Death Index for 1515 (91%). The 15 most common codes for causes of late death were dominated by cardiac disease (atherosclerotic heart disease, acute myocardial infarction) and pulmonary disease (lung cancer, respiratory failure). Causes of late death with specific mention of aneurysm were identified in 37 patients (2.4% of all deaths), but this event was not more common in EVAR or open repair (15 [0.3%] in the EVAR group, 22 [0

  6. Application of a Silicone Sheet in Negative-Pressure Wound Therapy to Treat an Abdominal Wall Defect after Necrotizing Fasciitis

    PubMed Central

    Shin, Jin Su

    2017-01-01

    Necrotizing fasciitis (NF) is an aggressive soft-tissue infection involving the deep fascia and is characterized by extensive deterioration of the surrounding tissue. Immediate diagnosis and intensive treatment, including debridement and systemic antibiotics, represent the most important factors influencing the survival of NF patients. In this report, we present a case of NF in the abdomen due to an infection caused by a perforated small bowel after abdominal liposuction. It was successfully treated using negative-pressure wound therapy, in which a silicone sheet functioned as a barrier between the sponge and internal organs to protect the small bowel. PMID:28194352

  7. Changes in the wall shear stresses (WSS) during the enlargement of Abdominal Aortic Aneurysms (AAA)

    NASA Astrophysics Data System (ADS)

    Salsac, Anne-Virginie; Sparks, Steven R.; Chomaz, Jean-Marc; Lasheras, Juan C.

    2004-11-01

    The changes in the evolution of the spatial and temporal distribution of the WSS and gradients of WSS at different stages of the enlargement of AAAs are important to understand the etiology and progression of this vascular disease, since they affect the wall structural integrity, primarily via the changes induced on the shape, functions and metabolism of the endothelial cells. PIV measurements were performed in aneurysm models, while changing systematically their geometric parameters. We show that, even at very early stages of the disease (dilatation > 30%), the flow separates from the wall and the formation of a large vortex ring followed by internal shear layers leads to the generation of WSS that drastically differ from the healthy vessel. Inside the AAA, the mean WSS decreases to zero and the magnitude of the WSS can be as low as 26% of the value in a healthy vessel. Two regions with distinct patterns of WSS were identified. The region of flow detachment, with oscillatory WSS of very low mean, and the region of flow reattachment, located distally, where large, negative WSS and sustained gradients of WSS are produced as a result of the impact of the vortex ring on the wall.

  8. Giant abdominal osteosarcoma causing intestinal obstruction treated with resection and adjuvant chemotherapy

    PubMed Central

    Diamantis, Alexandros; Christodoulidis, Grigorios; Vasdeki, Dionysia; Karasavvidou, Foteini; Margonis, Evangelos; Tepetes, Konstantinos

    2017-01-01

    Extraskeletal osteosarcoma (ESOS) is an uncommon tumor that accounts for 1% of all soft tissue sarcomas and 4% of all osteosarcomas. Its presentation may be atypical, while pain has been described as the most common symptom. Radiological findings include a large mass in the soft-tissues with massive calcifications, but no attachment to the adjacent bone or periosteum. We present the case of a 73-year-old gentle man who presented with a palpable, tender abdominal mass and symptoms of bowel obstruction. Computer tomography images revealed a large space-occupying heterogeneous, hyper dense soft tissue mass involving the small intestine. Explorative laparotomy revealed a large mass in the upper mesenteric root of the small intestine, measuring 22 cm × 12 cm × 10 cm in close proximity with the cecum, which was the cause of the bowel obstruction. Pathology confirmed the diagnosis of an ESOS. ESOS is an uncommon malignant soft tissue tumor with poor prognosis and a 5-year survival rate of less than 37%. Regional recurrence and distant metastasis to lungs, regional lymph nodes and liver can occur within the first three years of diagnosis in a high rate (45% and 65% respectively). Wide surgical resection of the mass followed by adjuvant chemotherapy or radiotherapy has been the treatment of choice. PMID:28289512

  9. Antenatal Diagnosis of a Large Immature Abdominal Wall Teratoma by 2D-3D Ultrasound Using HDlive and Magnetic Resonance Imaging.

    PubMed

    Werner, Heron; Mocarzel, Carolina; Sá, Renato Augusto; Tonni, Gabriele; Novoa Y Novoa, Victoria Arruga; Avvad-Portari, Elyzabeth; Bonasoni, Paola; Araujo Júnior, Edward

    2016-01-01

    We describe the first case of prenatally detected teratoma of the fetal abdomen wall using ultrasound and fetal magnetic resonance imaging (MRI). A heterogeneous mass, partly solid and cystic, originating from the anterior abdominal wall of the fetus close to an omphalocele sac was detected by means of 2D/3D ultrasound and MRI. Amniodrainage was performed and due to sign of impending fetal risk, an emergency Cesarean section was performed. A bulky, crumbly and bleeding tumoral mass was confirmed at delivery. Ligation of the supplying artery to the tumor was complicated by uncontrollable hemorrhage and early neonatal death. Pathology identified the tumor as an immature teratoma of the anterior fetal abdominal wall. 2D/3D ultrasound, especially using HDlive application and MRI demonstrated accurate detection and characterization of this congenital tumor.

  10. Indications and Outcomes of the Components Separation Technique in the Repair of Complex Abdominal Wall Hernias: Experience From the Cambridge Plastic Surgery Department

    PubMed Central

    Adekunle, Shola; Pantelides, Nicholas M.; Hall, Nigel R.; Praseedom, Raaj; Malata, Charles M.

    2013-01-01

    Objectives: The components separation technique (CST) is a widely described abdominal wall reconstructive technique. There have, however, been no UK reports of its use, prompting the present review. Methods: Between 2008 and 2012, 13 patients who underwent this procedure by a single plastic surgeon (C.M.M.) were retrospectively evaluated. The indications, operative details, and clinical outcomes were recorded. Results: There were 7 women and 6 men in the series with a mean age of 53 years (range: 30-80). Patients were referred from a variety of specialties, often as a last resort. The commonest indication for CST was herniation following abdominal surgery. All operations except 1 were jointly performed with general surgeons (for bowel resection, stoma reversal, and hernia dissection). The operations lasted a mean of 5 hours (range: 3-8 hours). There were no major intra- and postoperative problems, except in 1 patient who developed intra-abdominal compartment syndrome, secondary to massive hemorrhage. All patients were satisfied with the cosmetic improvement in their abdominal contours. None of the patients have developed a clinical recurrence after a mean follow-up of 16 months (range: 3-38 months). Conclusions: The components separation technique is an effective method of treating large recalcitrant hernias but appears to be underutilized in the United Kingdom. The management of large abdominal wall defects requires a multidisciplinary approach, with input across a variety of specialities. Liaison with plastic surgery teams should be encouraged at an early stage and the CST should be more widely considered when presented with seemingly intractable abdominal wall defects. PMID:24058718

  11. Initial experience with the use of porcine acellular dermal matrix (Strattice) for abdominal wall reinforcement after transverse rectus abdominis myocutaneous flap breast reconstruction.

    PubMed

    Cicilioni, Orlando; Araujo, Gerson; Mimbs, Nancy; Cox, Matthew D

    2012-03-01

    Reestablishing anterior rectus fascial integrity remains a clinical challenge after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The main concerns include herniation and bulging due to abdominal weakness. Mesh-assisted closure of the fascial defect has improved bulging and herniation rates but infection, extrusion, and encapsulation are serious concerns with mesh use. Biologic tissue matrices may overcome some of these mesh-related complications. The initial experience of using Strattice for fascial closure after TRAM flap procedure is described in this article. Strattice was in-lain and sutured between the anterior and posterior layers of the rectus fascia, at the rectus muscle donor site. The abdominal wall was closed with progressive tension sutures. Postoperative complications at the donor site were assessed. A total of 16 unilateral and 9 bilateral reconstructions were performed in 25 patients. Length of hospital stay was 2 to 3 days which is shorter than with mesh repair (typically 4-5 days). During a mean follow-up period of 14.0 months, complications occurred in 7 patients (28%): seroma formation (2), minor skin separation (2), superficial skin infection (2), and superficial wound dehiscence (1). Complications were not directly related to Strattice and all, except one (superficial skin infection), were resolved without surgical intervention. In all patients, routine abdominal functions were restored 4 months postoperatively. Strattice is a safe, alternative option to synthetic mesh for fascial repair following TRAM flap breast reconstruction. When used in conjunction with progressive tension suture closure of the abdominal wall, dynamic reconstruction of the abdominal wall with resumption of abdominal function is possible with Strattice.

  12. Superthin Abdominal Wall Glove-Like Flap Combined With Vacuum-Assisted Closure Therapy for Soft Tissue Reconstruction in Severely Burned Hands or With Infection.

    PubMed

    Wang, Fei; Liu, Sheng; Qiu, Le; Ma, Ben; Wang, Jian; Wang, Yong-Jie; Peszel, April; Chen, Xu-Lin

    2015-12-01

    Severe burn and infection to hands always involves the deep structures, such as tendons, joints, and bones. These wounds cannot be closed immediately and therefore creates a high risk for complication. We presented 9 cases with deep dermal burns to the dorsal of the hand (6 electrical burns and 3 thermal crush injuries) with wound infections in 2 cases. The vacuum-assisted closure system was used continuously until the flap reconstruction was performed. A random pattern and superthin abdominal wall skin flap-like glove was designed. The flap was transferred to the defected portion of the dorsum of the hand and resected from the abdominal wall about 3 weeks later. The flaps in 8 of the patients treated by this technique survived completely and partial necrosis of the distal flap occurred in 1 patient. The defect resolved after operative treatment and the function of the hands and fingers were successfully salvaged. All patients resulted in having a satisfactory aesthetic outcome with no or minor discomfort at the abdominal donor area. Integration of the vacuum-assisted closure system and the superthin abdominal wall glove-like flap reconstruction appeared to be successful and should be considered in patients with severely burned hands.

  13. Abdominal obesity modifies the risk of hypertriglyceridemia for all-cause and cardiovascular mortality in hemodialysis patients.

    PubMed

    Postorino, Maurizio; Marino, Carmen; Tripepi, Giovanni; Zoccali, Carmine

    2011-04-01

    Hypertriglyceridemia is the most prevalent lipid alteration in end-stage renal disease, and we studied the relationship between serum triglycerides and all-cause and cardiovascular death in these patients. Since abdominal fat modifies the effect of lipids on atherosclerosis, we analyzed the interaction between serum lipids and waist circumference (WC) as a metric of abdominal obesity. In a cohort of 537 hemodialysis patients, 182 died, 113 from cardiovascular causes, over an average follow-up of 29 months. In Cox models that included traditional and nontraditional risk factors, there were significant strong interactions between triglycerides and WC to both all-cause and cardiovascular death. A fixed (50 mg/dl) excess in triglycerides was associated with a progressive lower risk of all-cause and cardiovascular mortality in patients with threshold WC <95 cm but with a progressive increased risk in those above this threshold. A significant interaction between cholesterol and WC with all-cause and cardiovascular death emerged only in models excluding the triglycerides-WC interaction. Neither high-density lipoprotein (HDL) nor non-HDL cholesterol or their interaction terms with WC were associated with study outcomes. Thus, the predictive value of triglycerides and cholesterol for survival and atherosclerotic complications in hemodialysis patients is critically dependent on WC. Hence, intervention studies in end-stage renal disease should specifically target patients with abdominal obesity and hyperlipidemia.

  14. Free-breathing black-blood CINE fast-spin echo imaging for measuring abdominal aortic wall distensibility: A feasibility study.

    PubMed

    Lin, Jyh-Miin; Patterson, Andrew; Chao, Tzu-Cheng; Zhu, Chengcheng; Chang, Hing-Chiu; Mendes, Jason; Chung, Hsiao-Wen; Gillard, Jonathan; Graves, Martin

    2017-03-22

    The paper reports a free-breathing black-blood CINE fast-spin echo (FSE) technique for measuring abdominal aortic wall motion. The free-breathing CINE FSE includes the following MR techniques: 1) variable-density sampling with fast iterative reconstruction; 2) inner-volume imaging; and 3) a blood-suppression preparation pulse. The proposed technique was evaluated in eight healthy subjects. The inner-volume imaging significantly reduced the intraluminal artifacts of respiratory motion (p = 0.015). The quantitative measurements were a diameter of 16.3 ± 2.8 mm and wall distensibility of 2.0 ± 0.4 mm (12.5 ± 3.4%) and 0.7 ± 0.3 mm (4.1 ± 1.0%) for the anterior and posterior walls, respectively. The cyclic cross-sectional distensibility was 35 ± 15% greater in the systolic phase than in the diastolic phase. In conclusion, we developed a feasible CINE FSE method to measure the motion of the abdominal aortic wall, which will enable clinical scientists to study the elasticity of the abdominal aorta.

  15. Techniques for Abdominal Wall Closure after Damage Control Laparotomy: From Temporary Abdominal Closure to Early/Delayed Fascial Closure—A Review

    PubMed Central

    Huang, Qian; Li, Jieshou; Lau, Wan-yee

    2016-01-01

    Open abdomen (OA) has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient's physiological condition allows. PMID:26819597

  16. A reduced-order model for wall shear stress in abdominal aortic aneurysms by proper orthogonal decomposition.

    PubMed

    Chang, Gary Han; Schirmer, Clemens M; Modarres-Sadeghi, Yahya

    2017-03-21

    In this paper, we introduce a method to construct a Reduced-Order Model (ROM) to study the physiological flow and the Wall Shear Stress (WSS) conditions in Abdominal Aortic Aneurysms (AAA). We start the process by running a training case using Computational Fluid Dynamics (CFD) simulations with time-varying flow parameters, such that these parameters cover the range of parameters that we would like to consider in our ROM. We use the inflow angle as the variable parameter in the current study. Then we use the snapshot Proper Orthogonal Decomposition (POD) to construct the reduced-order bases, which are subsequently enhanced using a QR-factorization technique to satisfy the relevant fluid boundary conditions. The resulting ROM enables us to study the flow pattern and the WSS distribution over a range of system parameters computationally very efficiently. We have used this method to show how the WSS varies significantly for an AAA with a simplified geometry, over a range of inflow angles usually considered mild in clinical terms. We have validated the ROM results with CFD results. This approach enables comprehensive analysis of the model system across a range of inflow angles and frequencies without the need to re-compute the simulation for small changes.

  17. Reconstruction of large-size abdominal wall defect using biodegradable poly-p-dioxanone mesh: an experimental canine study

    PubMed Central

    2014-01-01

    Background Reconstruction of large-size abdominal wall defect (AWDs) is a huge challenge faced in current surgical practice. In this study, we aimed to evaluate the effectiveness and safety of biodegradable poly-p-dioxanone (PDO) mesh for reconstructing large-size AWDs in an experimental canine model. Methods Eighteen experimental canines were randomly and equally divided into three groups, namely, a PDO group, a Marlex group and a control group (n = 6 each). Following the creation of a 6 cm × 5.5 cm AWD, PDO mesh and Marlex mesh were used to reconstruct the defect in the PDO and Marlex groups, respectively. The defect was closed using relaxation sutures alone in the control group. Animals were killed 24 weeks after surgery, and reconstruction outcomes were evaluated using radiography, histology and biomechanical testing. Results All animals except those in the control group survived the experiment. The PDO group showed no wound dehiscence, herniation or infection, whereas the animals in the Marlex group exhibited marked foreign body reactions. The PDO group had less intraabdominal adhesion than the Marlex group. As shown by radiography, histology and biomechanical testing, PDO mesh exhibited complete degradation and favorable biochemical strength at 24 weeks postsurgery. Conclusions PDO mesh implantation is an effective, safe treatment modality for reconstructing large-size AWDs. PMID:24625138

  18. Risk factors associated with early failure in complex abdominal wall reconstruction: a 5 year single surgeon experience.

    PubMed

    Wink, Jason D; Wes, Ari M; Fischer, John P; Nelson, Jonas A; Stranksy, Carrie; Kovach, Stephen J

    2015-04-01

    Complex abdominal wall reconstruction (AWR) is commonly performed, but with a significant rate of surgical complications and hernia recurrence. The aim of this experiential review is to assess risk factors for hernia recurrence after complex AWR. A retrospective review of AWR patients from 2007-2012 was performed. Rates of hernia recurrence were assessed. Univariate analyses and subsequent multivariate logistic regression analysis was used to assess independent predictors of early hernia recurrence. One hundred and thirty-four consecutive cases of AWR were performed over a 5-year period. Hernia recurrence developed in 14 (10.4%) patients. Hernias derived from trauma (OR = 19.76, p = 0.011) and those who experienced postoperative wound infections (OR = 18.81, p = 0.004) were at increased risk for hernia recurrence. In conclusion, increased vigilance must be paid to patients presenting after trauma with massive loss of domain and those who experience postoperative infection, as these cohorts are at added risk for failed reconstruction.

  19. CRITICAL ANALYSIS OF EXPERIMENTAL MODEL FOR STUDY OF ADHESIONS AFTER INCISIONAL HERNIAS INDUCED IN RATS’ AND REPAIR OF ABDOMINAL WALL WITH DIFFERENT BIOMATERIALS

    PubMed Central

    SERIGIOLLE, Leonardo Carvalho; BARBIERI, Renato Lamounier; GOMES, Helbert Minuncio Pereira; RODRIGUES, Daren Athiê Boy; STUDART, Sarah do Valle; LEME, Pedro Luiz Squilacci

    2015-01-01

    Background: Adhesions induced by biomaterials experimentally implanted in the abdominal cavity are basically studied by primary repair of different abdominal wall defects or by the correction of incisional hernias previously performed with no precise definition of the most appropriate model. Aim: To describe the adhesions which occur after the development of incisional hernias, before the prosthesis implantation, in an experimental model to study the changes induced by different meshes. Methods: Incisional hernias were performed in 10 rats with hernia orifices of standardized dimensions, obtained by the median incision of the abdominal wall and eversion of the defect edges. Ten days after the procedure adhesions of abdominal structures were found when hernias were repaired with different meshes. Results: The results showed hernia sac well defined in all rats ten days after the initial procedure. Adhesions of the greater omentum occurred in five animals of which two also showed adhesions of small bowel loops besides the omentum, and another two showed liver adhesions as well as the greater omentum, numbers with statistical significance by Student's t test (p<0.05). Conclusion: Although it reproduces the real clinical situation, the choice of experimental model of incisional hernia repair previously induced implies important adhesions, with possible repercussions in the evaluation of the second operation, when different implants of synthetic materials are used. PMID:26537141

  20. Pedicled full-thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn.

    PubMed

    Zhao, Jing-Chun; Xian, Chun-Jing; Yu, Jia-Ao; Shi, Kai

    2015-02-01

    Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full-thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad-spectrum antibiotics to reduce infection, a pedicled full-thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required.

  1. Reconstruction of the Abdominal Wall in Anatomical Plans. Pre- and Postoperative Keys in Repairing “Cold” Incisional Hernias

    PubMed Central

    POPA, FLORINA; ROSCA, OANA; GEORGESCU, ALEXANDRU; CANNISTRA, CLAUDIO

    2016-01-01

    Background and aims The clinical results of the vertical “vest-over-pants” Mayo repair were evaluated, and the risk factors for incisional hernia recurrence were studied. The purpose of this study is to point out the importance of reducing pre and post operative risk factors in the incisional hernia repair process in order to achieve a physiologically normal abdominal wall. Methods Twenty patients diagnosed with incisional hernia underwent an abdominal reconstruction procedure using the Mayo (Paletot) technique at Bichat Claude Bernard Hospital between 2005 and 2015. All procedures were performed by a single surgeon and all patients were pre-operatively prepared, identifying all coexisting conditions and treating them accordingly before undergoing surgery. Results All patients underwent at least one surgical operation before the hernia repair procedure and a quarter had experienced at least three, prior to this one. Nine patients had a body mass index of >30 kg/m2. Additional risk factors and comorbidities included obesity in 45%, diabetes mellitus in 10%, smoking in 55%, and high blood pressure in 40%. Hernia defect width was from 3 cm (25% F) to 15 cm (5% M) of which nine patients (45%) had a 10 cm defect. Most of the patients had an average hospitalization of 7 days. The patients were carefully monitored and were called on periodic consultations after 3, 6, and 12 months from the moment of the procedure. Patient feedback regarding hernia recurrence and complaints about the scar were noted. Physical examination is essential in determining the hernia recurrence therefore the scar was examined for any abnormalities that may have occurred, which was defined as any palpable or detected fascial defect located within seven centimeters of the hernia repair. Post-operative complications: seroma formation, wound hematoma, superficial and deep wound infection, recurrences and chronic pain were followed and no complications were registered during the follow-up period

  2. [Influence of mydocalm on the degree of intra-abdominal hypertension and local blood circulation in the intestinal wall in experiment].

    PubMed

    Sapegin, V I; Sapegin, I D; Il'chenko, F N

    2014-01-01

    The effect of mydocalm (tolperison, 5 mg/kg single dose) on the dynamics of intra-abdominal hypertension (IAH), blood circulation regulation, and oxygen balance in the tissues of intestinal wall were studied in acute experiments on rabbits. Using a special stand of original design, the initial IAH level was modeled at 200 mm H2O with the subsequent stopping of further receipt of liquid during 3 hours in an elastic container in the abdominal cavity. During 3-h observation without drug administration, no changes in IAH due to the tone of muscles of the frontal abdominal wall takes place, but there is progressive deceleration of local blood flow (-35.33 + 0.99%, p < 0.01), suppressed dilation (-20.02 + 0.54%, p < 0.01) and constriction (-60.45 + 1.17%, p < 0.01) reactivity of vessels, and decreased oxygen tension (-47.18 + 0.75%, p < 0.01) in the intestinal wall at the end of experiment. The introduction of mydocalm reduces the tone of muscles of the frontal abdominal wall, which leads to a decrease in IAH (maximum effect after 1.5 hours, -20.81 + 0.84%, p < 0.01) and prevents decrease in the local blood flow (-26.77 + 0.41%, p < 0.01), suppression of dilation (-16.51 + 0.34%, p < 0.01) and constriction (-37.85 + 0.61%, p < 0.01) reactivity of vessels, and reduction in oxygen tension (-36.60 + 1.18%, p < 0.01) at the end of experiment. The administration of mydocalm can extend the limits of application of a conservative therapy for patients with IAH and to improve the results.

  3. Salt stress causes cell wall damage in yeast cells lacking mitochondrial DNA

    PubMed Central

    Gao, Qiuqiang; Liou, Liang-Chun; Ren, Qun; Bao, Xiaoming; Zhang, Zhaojie

    2014-01-01

    The yeast cell wall plays an important role in maintaining cell morphology, cell integrity and response to environmental stresses. Here, we report that salt stress causes cell wall damage in yeast cells lacking mitochondrial DNA (ρ0). Upon salt treatment, the cell wall is thickened, broken and becomes more sensitive to the cell wall-perturbing agent sodium dodecyl sulfate (SDS). Also, SCW11 mRNA levels are elevated in ρ0 cells. Deletion of SCW11 significantly decreases the sensitivity of ρ0 cells to SDS after salt treatment, while overexpression of SCW11 results in higher sensitivity. In addition, salt stress in ρ0 cells induces high levels of reactive oxygen species (ROS), which further damages the cell wall, causing cells to become more sensitive towards the cell wall-perturbing agent. PMID:28357227

  4. [Dientamoeba fragilis infection as cause of severe abdominal discomfort and flatulence].

    PubMed

    Halkjær, Sofie; Stensvold, Christen Rune; Petersen, Andreas Munk

    2015-01-26

    The clinical significance of Dientamoeba fragilis infection is controversial. We describe a case-history of a 16-year-old patient, who had suffered severe abdominal discomfort and flatulence through his lifetime. He was eventually diagnosed with D. fragilis infection, and eradication of D. fragilis with high-dose metronidazole kept him without symptoms for one year. Recurrence of the symptoms and recurrence of the D. fragilis infection was thereafter treated successfully with paromomycin.

  5. An unusual cause of abdominal pain in an HIV-positive man

    PubMed Central

    Saing, Chit; Yoganathan, Kathir G

    2015-01-01

    We report a case of an HIV-positive man on antiretroviral therapy (ART) who developed abdominal pain due to acute-on-chronic intestinal ischaemia secondary to superior mesenteric vein thrombosis (SMVT) requiring emergency surgery. He was found to have persistently low levels of protein C on thrombophilia screening. To the best of our knowledge, the association linking SMVT to protein C deficiency in an HIV-infected patient has never been reported in the literature. PMID:25819818

  6. Examinations of a new long-term degradable electrospun polycaprolactone scaffold in three rat abdominal wall models.

    PubMed

    Jangö, Hanna; Gräs, Søren; Christensen, Lise; Lose, Gunnar

    2017-02-01

    Alternative approaches to reinforce native tissue in reconstructive surgery for pelvic organ prolapse are warranted. Tissue engineering combines the use of a scaffold with the regenerative potential of stem cells and is a promising new concept in urogynecology. Our objective was to evaluate whether a newly developed long-term degradable polycaprolactone scaffold could provide biomechanical reinforcement and function as a scaffold for autologous muscle fiber fragments. We performed a study with three different rat abdominal wall models where the scaffold with or without muscle fiber fragments was placed (1) subcutaneously (minimal load), (2) in a partial defect (partial load), and (3) in a full-thickness defect (heavy load). After 8 weeks, no animals had developed hernia, and the scaffold provided biomechanical reinforcement, even in the models where it was subjected to heavy load. The scaffold was not yet degraded but showed increased thickness in all groups. Histologically, we found a massive foreign body response with numerous large giant cells intermingled with the fibers of the scaffold. Cells from added muscle fiber fragments could not be traced by PKH26 fluorescence or desmin staining. Taken together, the long-term degradable polycaprolactone scaffold provided biomechanical reinforcement by inducing a marked foreign-body response and attracting numerous inflammatory cells to form a strong neo-tissue construct. However, cells from the muscle fiber fragments did not survive in this milieu. Properties of the new neo-tissue construct must be evaluated at the time of full degradation of the scaffold before its possible clinical value in pelvic organ prolapse surgery can be evaluated.

  7. Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls

    PubMed Central

    Lu, Yueh-Feng; Lin, Yu-Chin; Chen, Kuo-Hsin; Shueng, Pei-Wei; Yeh, Hsin-Pei; Hsieh, Chen-Hsi

    2016-01-01

    Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT); however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT) has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm3. The percent of lung volume receiving at least 20 Gy (V20) was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity developed during treatment or follow-up. Concurrent HT with or without systemic treatment could be a safe salvage therapy for chemorefractory locally advanced breast cancer patients with extensive cutaneous metastasis. PMID:27284253

  8. Evaluation of side effects of radiofrequency capacitive hyperthermia with magnetite on the blood vessel walls of tumor metastatic lesion surrounding the abdominal large vessels: an agar phantom study

    PubMed Central

    2014-01-01

    Background Magnetite used in an 8-MHz radiofrequency (RF) capacitive heating device can increase the temperature of a specific site up to 45°C. When treating a metastatic lesion around large abdominal vessels via hyperthermia with magnetite, heating-induced adverse effects on these vessels need to be considered. Therefore, this study examined hyperthermia-induced damage to blood vessel walls in vitro. Methods A large agar phantom with a circulatory system consisting of a swine artery and vein connected to a peristaltic pump was prepared. The blood vessels were placed on the magnetite-containing agar piece. Heating was continued for 30 min at 45°C. After heating, a histological study for injury to the blood vessels was performed. Results The inner membrane temperature did not reach 45°C due to the cooling effect of the blood flow. In the heated vessels, vascular wall collagen degenerated and smooth muscle cells were narrowed; however, no serious changes were noted in the vascular endothelial cells or vascular wall elastic fibers. The heated vessel wall was not severely damaged; this was attributed to cooling by the blood flow. Conclusions Our findings indicate that RF capacitive heating therapy with magnetite may be used for metastatic lesions without injuring the surrounding large abdominal vessels. PMID:25114787

  9. [Abdominal pain].

    PubMed

    Gschossmann, J M; Holtmann, G; Netzer, P; Essig, M; Balsiger, B M; Scheurer, U

    2005-10-01

    Abdominal pain can result from a variety of different intra- and extra-abdominal disorders. Given the wide variety of etiological triggers for this pain, the primary task during the first stage of the diagnostic work-up is to determine as soon as possible the underlying cause and the degree of emergency. The aim of this evaluation is to adapt the therapeutic measures which are necessary for a causal treatment to the individual situation. Contrary to somatic causes of abdominal pain, the availability of such a causal therapy for functional bowel disorders is still very limited. Given this dilemma, the therapeutic focus of abdominal pain associated with these functional syndromes has to be placed on symptom-oriented treatment.

  10. Traumatic abdominal hernia complicated by necrotizing fasciitis.

    PubMed

    Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa

    2014-11-01

    Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption.

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

    PubMed Central

    Barut, Ibrahim; Yazkan, Rasih

    2016-01-01

    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. PMID:28018700

  12. Intra-Abdominal Hypertension Causes Bacterial Growth in Lungs: An Animal Study

    PubMed Central

    Papakrivou, Eleni; Manoulakas, Efstratios; Mitroudi, Magda; Tepetes, Konstantinos; Papazoglou, Konstantinos; Zakynthinos, Epaminondas

    2017-01-01

    To study the effect of intra-abdominal hypertension (IAH) on the frequency of pneumonia with an experimental study, thirteen Sprague-Dawley rats were included. Eight out of thirteen animals were randomly assigned to receive 10 ml of benzalkonium chloride 0.2% (megacolon group) and five animals received 10 ml NaCl 0.9% (controls). Animals were anaesthetized by intramuscular delivery of ketamine. The incidence of positivity for bacteria lung tissue cultures and mesenteric lymph node cultures was assessed at the 21st day after animals' sacrification, or before in case of death. All megacolon group animals presented progressive increase of the abdomen and increased IAP (≥10 mmHg) whereas the frequency of their evacuations was almost eliminated. Controls presented normal evacuations, no sign of abdominal distention, and normal IAP. In megacolon group animals, there was evidence of significant amount of bacteria in lung cultures. In contrast, no bacteria were found in control animals. PMID:28357400

  13. Squamous cell carcinoma of unknown primary site presenting with an abdominal wall lesion as the primary symptom: A case report and review of the literature

    PubMed Central

    ZHANG, YINGLI; CHEN, BO; ZHU, JIANQING; CHEN, LU

    2015-01-01

    Squamous cell carcinoma of unknown primary site (SC CUP) is a rare malignant tumor, and its histogenesis and appropriate treatment are unclear. To the best of our knowledge, this type of carcinoma with abdominal wall lesions as the primary presenting symptom 3 months after laparoscopic surgery, has not been previously described in the literature. In the present study, a postmenopausal 54-year-old female patient was diagnosed with pain from the right abdominal puncture site 3 months after laparoscopic unilateral left salpingo-oophorectomy at a local hospital, at which time the left ovary and Fallopian tube were free of malignant tumor. Computed tomography (CT) imaging showed a subcutaneous nodule with a size of 6.2×3.3 cm. A wide excision of the lesion with safety margins and repair of the abdominal wall was performed, and the histopathological results and various investigations lead to the diagnosis of metastatic well-differentiated SC CUP. The patient underwent three surgeries and eight cycles of Taxol and cisplatin/carboplatin chemotherapy, and received a total of 10.8 Gy palliative radiation. However, the patient succumbed to intestinal bleeding, thrombocytopenia and multiple organ failure with pelvic recurrence and liver metastases at 10 months post-diagnosis. The prognosis of SC CUP, particularly with multiple metastases, is extremely poor. Although chemotherapy, surgery and radiotherapy have a certain role in the treatment, no regimen has been established as a standard therapy and palliative care could be recommended. PMID:26622812

  14. [Malabsorption of fermentable oligo-, di-, or monosaccharides and polyols (FODMAP) as a common cause of unclear abdominal discomfort].

    PubMed

    Goebel-Stengel, M; Mönnikes, H

    2014-06-01

    Carbohydrate malabsorption is a frequent but underestimated cause of unexplained gastrointestinal symptoms like meteorism, flatulence, pain and diarrhea. By means of hydrogen and/or methane breath test after ingestion of the respective carbohydrate it can be identified and diagnosed easily, fast and reliably by successful nutritional therapy. Besides the well known complaints caused by lactose and fructose malabsorption, other fermentable oligo-, di-, or monosaccharides and polyols (akronym: FODMAP) can cause abdominal discomfort and IBS-like symptoms. In addition to lactose (dairy products) and fructose (apples, pears, mango, watermelon), FODMAPs comprise galactans (legumes), fructans (wheat, onions, garlic, artichoke) and the artificial sweeteners sorbitol, mannitol, maltitol and xylitol (sugar free candy, light products). A general restriction of all FODMAP components can be beneficial in relieving symptoms and improving quality of life in patients with functional gastrointestinal complaints.

  15. Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Caused by Sigmoid Sinus Wall Dehiscence: A Single-Center Experience

    PubMed Central

    Liu, Zhao-Hui; Liang, Xi-Hong; Zhao, Peng-Fei; Wang, Zhen-Chang; Gong, Shu-Sheng

    2016-01-01

    Objective To evaluate clinical characteristics and present surgical outcomes of PT caused by sigmoid sinus wall dehiscence (SSWD) Methods This study retrospectively reviewed 34 patients with PT who were diagnosed with SSWD in our institution between December 2008 and July 2013. Among them, 27 patients underwent sigmoid sinus wall reconstruction (surgery group) and 7 patients refused surgery (non-surgery group). Preoperative data were obtained from the patients’ medical records. All patients were followed up regularly for at least 25 months. Preoperative and postoperative computed tomography angiography (CTA) images were compared. Student’s t-tests were used to compare age, body mass index (BMI) and preoperative Tinnitus Handicap Inventory (THI) scores between the surgery and the non-surgery groups and to compare pre- and follow-up THI scores. Results There was no significant difference in age, body mass index, or preoperative THI scores between groups. Following surgery, 14 patients had complete resolution, 5 had partial resolution, 7 experienced no change and PT was aggravated in 1 patient. The difference between preoperative and postoperative THI scores was significant. No severe complications were found postoperatively. Comparison of the preoperative and postoperative CTA images revealed that remnant unrepaired dehiscences were the cause of unsatisfactory outcomes following surgery. In the non-surgery group, PT remained largely unchanged. Conclusions Sigmoid sinus wall reconstruction is an effective and safe treatment for PT caused by SSWD. It is imperative that all regions of the dehiscence are sufficiently exposed and resurfaced during surgery. PMID:27736970

  16. CLOSTRIDIAL PARAPROCTITIS WITH GAS GANGRENE OF FRONT-LATERAL ABDOMINAL WALLS AND NECROTIC FASCIO-MYOSITIS (CASE REPORT).

    PubMed

    Didbaridze, N; Lomidze, N; Abuladze, T; Qiliptari, G; Didbaridze, T; Gvasalia, I; Mkervalishvili, Z; Gogokhia, N

    2016-09-01

    Anaerobic clostridial infection is the most severe form of paraproctitis. The incubation period is very short, from 3 to 6 hours, sometimes lasting for 1-2 days. Clostridial infection spreads rapidly and induces gas gangrene, causes destruction of cells and other intermediate substances, and impedes blood circulation. This paper presents a case study of an extremely severe form of anaerobic infection with spontaneous gas gangrene, cellulitis, fasciomyositic necrosis, severe intoxication and septic shock on the abdominal front and lateral surfaces. This patient presented as infected with Clostridium septicum, a rare and highly toxic Gram-positive, spore-forming, obligate anaerobic bacillus that progresses and migrates rapidly, affecting all soft tissues (muscle, fascia), and produces four toxins which cause gas gangrene, intravascular hemolysis, tissue necrosis, and septic shock. The mortality rate is typically 80%. In this case study, a positive clinical outcome was achieved by aggressive identification of the microbe, appropriate and immediate therapy, and vigorous surgical intervention. Specifically, immediate surgery was conducted to ensure a wide excision of damaged tissues, necrectomy, curettage, wide drainage, readjustment, oxygenation through drainages, further additional surgical corrections through CT control with wide bandages in the operating area. Further, the diagnostic workup was thorough, identifying the microbe through a properly constructed diagnostic algorithm, ultrasound and CT studies, infectious agent assessments, and bacteriological monitoring carried out on the 1st-2nd-5th-7th-12th-15th-21st-25th days. Rational antibiotic therapy with permanent susceptibility testing informed the selection of an appropriate agent. Finally, markers for the evaluation of severity (Apache scale) were assessed, as they were for stage of infection (prokalcitonin), inflammation (CRP) and other indicators.

  17. Spontaneous Rupture of a Leiomyoma Causing Life-Threatening Intra-Abdominal Hemorrhage

    PubMed Central

    Powell, Kristin

    2017-01-01

    Background. Uterine fibroids are common benign tumors in women. Clinical manifestations are well known. Acute complications necessitating emergent surgical intervention are rare. Case. We report a case of a 53-year-old woman with a history of uterine fibroids presenting with acute-onset severe abdominal pain. Imaging indicated massive free fluid and a large partially solid uterine mass. Vitals were consistent with hypovolemic shock. Examination revealed a surgical abdomen. She underwent an emergent laparotomy and total hysterectomy. Surgery revealed 4.5 L of hemoperitoneum and a 15 cm degenerated uterine fibroid with active bleeding. Pathology was consistent with intraoperative findings. She required transfusion of numerous blood products perioperatively. Her postoperative course was uncomplicated. Conclusion. It is rare for a uterine fibroid to spontaneously rupture. However, prompt recognition of this severe complication is critical for expeditious, life-saving surgical management. PMID:28127487

  18. [Lead poisoning. A surprising cause of constipation, abdominal pain and anemia].

    PubMed

    Hoffmanová, Iva; Kačírková, Petra; Kučerová, Irena; Ševčík, Rudolf; Sánchez, Daniel

    2016-02-01

    This article reports on patient that has been presented with sudden onset of constipation, abdominal pain and normocytic anemia. Gastroscopy and colonoscopy ruled out an organic diseases. In peripheral blood and bone marrow aspirates mears, coarse basophilic stippling of erythrocyte (and erythroblasts) point out a possibility of heavy metal poisoning. The level of plumbemia exceeded 8.4 times the maximal permitted value for common (non-professional) population. A source of poisoning was indentified from a glaze on a ceramic jug, from which the patient had drank tea with lemon for three months. A lead concentration in the tea extract was 227 mg/kg. In developed countries, lead poisoning is a rare diagnosis. As the symptoms are nonspecific, missed diagnoses could occur, especially in sporadic, non-occupational exposure. However, a microscopic evaluation of the peripheral bloods mear with finding of predominantly coarse basophilic stippling of erythrocyte mayle ad to suspicion of lead poisoning.

  19. Hepatic toxocariasis: a rare cause of right upper abdominal pain in the emergency department.

    PubMed

    Coşkun, Figen; Akıncı, Emine

    2013-01-01

    Toxocara canis and Toxocara cati are common helminths that reside in the intestinal tract of cats and dogs. Toxocariasis and, commonly, T. canis, is a disease commonly seen in children, which is characterised by hypereosinophilia, hepatomegaly, fever, transient pulmonary infiltration, and hypergammaglobulinaemia. Humans, who are not the actual host for these parasitic worms, are infected following oral intake of the infective eggs. Radiological differentiation of hepatic toxocariasis can be difficult, as liver lesions, which present as multiple hypoechoic lesions with regular borders, can look like a tumour, an infarction or an infection. We report on a case that presented to our emergency department (ED) with abdominal pain. During the initial review, the pathology in the liver was thought to be an infarction or an infection; however, the patient was diagnosed with hepatic toxocariasis following further evaluation.

  20. Fourier Transform Infrared Spectroscopic Imaging-Derived Collagen Content and Maturity Correlates with Stress in the Aortic Wall of Abdominal Aortic Aneurysm Patients.

    PubMed

    Cheheltani, Rabee; Pichamuthu, Joseph E; Rao, Jayashree; Weinbaum, Justin S; Kiani, Mohammad F; Vorp, David A; Pleshko, Nancy

    2017-03-01

    Abdominal aortic aneurysm (AAA) is a degenerative disease of the aorta characterized by severe disruption of the structural integrity of the aortic wall and its major molecular constituents. From the early stages of disease, elastin in the aorta becomes highly degraded and is replaced by collagen. Questions persist as to the contribution of collagen content, quality and maturity to the potential for rupture. Here, using our recently developed Fourier transform infrared imaging spectroscopy (FT-IRIS) method, we quantified collagen content and maturity in the wall of AAA tissues in pairs of specimens with different wall stresses. CT scans of AAAs from 12 patients were used to create finite element models to estimate stress in different regions of tissue. Each patient underwent elective repair of the AAA, and two segments of the AAA tissues from anatomic regions more proximal or distal with different wall stresses were evaluated by histology and FT-IRIS after excision. For each patient, collagen content was generally greater in the tissue location with lower wall stress, which corresponded to the more distal anatomic regions. The wall stress/collagen ratio was greater in the higher stress region compared to the lower stress region (1.01 ± 1.09 vs. 0.55 ± 0.084, p = 0.02). The higher stress region also corresponded to the location with reduced intraluminal thrombus thickness. Further, collagen maturity tended to decrease with increased collagen content (p = 0.068, R = 0.38). Together, these results suggest that an increase in less mature collagen content in AAA patients does not effectively compensate for the loss of elastin in the aortic wall, and results in a reduced capability to endure wall stresses.

  1. Omental infarction and its mimics: imaging features of acute abdominal conditions presenting with fat stranding greater than the degree of bowel wall thickening.

    PubMed

    Tonerini, Michele; Calcagni, Francesca; Lorenzi, Silvia; Scalise, Paola; Grigolini, Alessandro; Bemi, Pietro

    2015-08-01

    The segmental omental infarction is a rare self-limited disorder presenting with aspecific clinical symptoms that may mimic several acute abdominal conditions. Therefore, a correct noninvasive diagnosis is important because treatment approaches range from monitoring to surgery. As omental infarction results in an important fat stranding that is much greater than the degree of bowel wall thickening, it suggests a narrower differential diagnosis: appendicitis, diverticulitis, epiploic appendagitis, and mesenteric panniculitis. In this pictorial essay, we point out the importance of imaging in identifying this typical sign allowing alternate diagnoses such as segmental omental infarction that can be conservatively managed.

  2. Severe Abdominal Pain Caused by Lead Toxicity without Response to Oral Chelators: A Case Report

    PubMed Central

    Vossoughinia, Hassan; Pourakbar, Ali; Esfandiari, Samaneh; Sharifianrazavi, Masoud

    2016-01-01

    A 19-year-old woman was referred to the Emergency Surgery Department with severe abdominal pain, icterus, and anemia. The patient’s clinical and paraclinical findings in addition to her occupational and social history, convinced us to assay blood lead level (BLL), which was 41/5 μg/dL. Therefore toxicology consult was performed to treat lead toxicity. Recheck of the BLL showed the level as 53/7 μg/dL. So oral chelator with succimer was started. Despite consumption of oral chelator, there was no response and the pain continued. Because our repeated evaluations were negative, we decided to re-treat lead poisoning by intravenous and intramuscular chelators. Dimercaprol (BAL) + calcium EDTA was started, and after 5 days, the pain relieved dramatically and the patient was discharged. We recommend more liberal lead poisoning therapy in symptomatic patients, and also suggest parenteral chelator therapy, which is more potent, instead of oral chelators in patients with severe symptoms. PMID:26933485

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

    PubMed Central

    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

  4. A rare cause of lower abdominal and pelvic mass, primary tuberculous psoas abscess: a case report

    PubMed Central

    2009-01-01

    Introduction Tuberculous psoas abscess was usually associated to complicate Pott's disease, but it can also be secondary to direct extension from other adjacent structures or haematogenous spread from an occult source. However, the occurrence of this entity as the presenting manifestation of tuberculosis, without evidence of active infection elsewhere, has been seldom reported. Case Presentation We report a clinical case of a 64-year-old immunocompetent female that presented with left lower abdominal pain and a soft tissue mass over the left iliac fossa and inguinal regions due to a primary tuberculous psoas abscess. Early diagnosis and prompt treatment with percutaneous drainage guided by ultrasound along with antituberculous drugs, lead to a satisfactory outcome. Conclusion The purpose of this case report is to point out attention to the diagnostic challenge of tuberculous psoas abscess in the absence of tuberculosis in other organs or a predisposing condition. A brief review of the literature about its epidemiology, etiology, clinical features and management is discussed over the text. PMID:19946492

  5. Severe Abdominal Pain Caused by Lead Toxicity without Response to Oral Chelators: A Case Report.

    PubMed

    Vossoughinia, Hassan; Pourakbar, Ali; Esfandiari, Samaneh; Sharifianrazavi, Masoud

    2016-01-01

    A 19-year-old woman was referred to the Emergency Surgery Department with severe abdominal pain, icterus, and anemia. The patient's clinical and paraclinical findings in addition to her occupational and social history, convinced us to assay blood lead level (BLL), which was 41/5 μg/dL. Therefore toxicology consult was performed to treat lead toxicity. Recheck of the BLL showed the level as 53/7 μg/dL. So oral chelator with succimer was started. Despite consumption of oral chelator, there was no response and the pain continued. Because our repeated evaluations were negative, we decided to re-treat lead poisoning by intravenous and intramuscular chelators. Dimercaprol (BAL) + calcium EDTA was started, and after 5 days, the pain relieved dramatically and the patient was discharged. We recommend more liberal lead poisoning therapy in symptomatic patients, and also suggest parenteral chelator therapy, which is more potent, instead of oral chelators in patients with severe symptoms.

  6. Oxidative stress in the brain of mice caused by translocated nanoparticulate TiO2 delivered to the abdominal cavity.

    PubMed

    Ma, Linglan; Liu, Jie; Li, Na; Wang, Jue; Duan, Yanmei; Yan, Jinying; Liu, Huiting; Wang, Han; Hong, Fashui

    2010-01-01

    In order to study the mechanisms underlying the effects of TiO(2) nanoparticles on the brain, ICR mice were injected with nanoparticulate anatase TiO(2) (5 nm) of various doses into the abdominal cavity daily for 14 days. We then examined the coefficient of the brain, the brain pathological changes and oxidative stress-mediated responses, and the accumulation of nanoparticulate anatase TiO(2) and levels of neurochemicals in the brain. The results showed that high-dose nanoparticulate anatase TiO(2) could induce some neurons to turn into filamentous shapes and others into inflammatory cells. The concentration of nanoparticulate anatase TiO(2) in the brain was increased as increases in nanoparticulate anatase TiO(2) dosages used. The oxidative stress and injury of the brain occurred as nanoparticulate anatase TiO(2) appeared to trigger a cascade of reactions such as lipid peroxidation, the decreases of the total anti-oxidation capacity and activities of antioxidative enzymes, the excessive release of nitric oxide, the reduction of glutamic acid, and the downregulated level of acetylcholinesterase activities. We concluded that TiO(2) nanoparticles injected at the abdominal cavity could be translocated into the brain and in turn caused the brain injury.

  7. Abdominal Aortic Aneurysm (AAA)

    MedlinePlus

    ... Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis or plaque buildup causes the ... weak and bulge outward like a balloon. An AAA develops slowly over time and has few noticeable ...

  8. Intestinal injury mechanisms after blunt abdominal impact.

    PubMed

    Cripps, N P; Cooper, G J

    1997-03-01

    Intestinal injury is frequent after non-penetrating abdominal trauma, particularly after modern, high-energy transfer impacts. Under these circumstances, delay in the diagnosis of perforation is a major contributor to morbidity and mortality. This study establishes patterns of intestinal injury after blunt trauma by non-penetrating projectiles and examines relationships between injury distribution and abdominal wall motion. Projectile impacts of variable momentum were produced in 31 anaesthetised pigs to cause abdominal wall motion of varying magnitude and velocity. No small bowel injury was observed at initial impact velocity of less than 40 m/s despite gross abdominal compression. At higher velocity, injury to the small bowel was frequent, irrespective of the degree of abdominal compression (P = 0.00044). Large bowel injury was observed at all impact velocities and at all degrees of abdominal compression. This study confirms the potential for intestinal injury in high velocity, low momentum impacts which do not greatly compress the abdominal cavity and demonstrates apparent differences in injury mechanisms for the small bowel and colon. Familiarity with injury mechanisms may reduce delays in the diagnosis of intestinal perforation in both military and civilian situations.

  9. The hypertrophy of the lateral abdominal wall and quadratus lumborum is sport-specific: an MRI segmental study in professional tennis and soccer players.

    PubMed

    Sanchis-Moysi, Joaquin; Idoate, Fernando; Izquierdo, Mikel; Calbet, Jose A; Dorado, Cecilia

    2013-03-01

    The aim was to determine the volume and degree of asymmetry of quadratus lumborum (QL), obliques, and transversus abdominis; the last two considered conjointly (OT), in tennis and soccer players. The volume of QL and OT was determined using magnetic resonance imaging in professional tennis and soccer players, and in non-active controls (n = 8, 14, and 6, respectively). In tennis players the hypertrophy of OT was limited to proximal segments (cephalic segments), while in soccer players it was similar along longitudinal axis. In tennis players the hypertrophy was asymmetric (18% greater volume in the non-dominant than in the dominant OT, p = 0.001), while in soccer players and controls both sides had similar volumes (p > 0.05). In controls, the non-dominant QL was 15% greater than that of the dominant (p = 0.049). Tennis and soccer players had similar volumes in both sides of QL. Tennis alters the dominant-to-non-dominant balance in the muscle volume of the lateral abdominal wall. In tennis the hypertrophy is limited to proximal segments and is greater in the non-dominant side. Soccer, however, is associated to a symmetric hypertrophy of the lateral abdominal wall. Tennis and soccer elicit an asymmetric hypertrophy of QL.

  10. [Moisture and mold on the inner walls of prefabricated building slabs--investigating a strange cause].

    PubMed

    Kaufhold, T; Fiedler, K; Jung, G; Lindner, M; Gassel, R P

    1997-04-01

    Reasons for indoor-moisture beyond the normal level can be caused by penetrating dampness, condensation-water, and apartment misuse. A fall in the air temperature below the dew point in connection with moulding inside buildings becomes evident mostly at places like badly insulated outer-walls or room-corners. In a number of houses built between 1980 and 1983 in the so called "Plattenbauweise" (prefabricated slabs), exclusively the inner-walls were covered in mould around cracks in the walls. Examinations showed connections between the apartment and the outer-corridor with a slight exchange of air through the cracks. Warm, wet air escaped from the apartment into the outer-corridor, and cold air entered the apartment from the outer-corridor. This temporary fall below the dewpoint caused by suitable variation of temperature probably resulted in the building materials and wallpapers becoming damp, as well as the growth of mould.

  11. L'appendagite épiploïque primitive: une cause rare de douleur abdominal

    PubMed Central

    Yazough, Issam; El bouhadouti, Hecham; Mazaz, Khalid

    2015-01-01

    Les appendagites sont une cause rare de douleur abdominale chez l'adulte, elles simulent souvent le tableau d'une appendicite aiguë ou une sigmoïdite, le diagnostic est souvent poser par une TDM ou lors d'un acte chirurgicale, le traitement est essentiellement médicale. PMID:26113913

  12. On the Likelihood of Single-Walled Carbon Nanotubes Causing Adverse Marine Ecological Effects

    EPA Science Inventory

    This brief article discusses the ecological effects of single-walled carbon nanotubes (SWNTs)in the marine environment. Based on new research and a review of the scientific literature, the paper concludes that SWNTs are unlikely to cause adverse ecological effects in the marine ...

  13. Restrictive glycosylphosphatidylinositol anchor synthesis in cwh6/gpi3 yeast cells causes aberrant biogenesis of cell wall proteins.

    PubMed Central

    Vossen, J H; Müller, W H; Lipke, P N; Klis, F M

    1997-01-01

    We previously reported that the defects in the Saccharomyces cerevisiae cwh6 Calcofluor white-hypersensitive cell wall mutant are caused by a mutation in SPT14/GPI3, a gene involved in glycosylphosphatidylinositol (GPI) anchor biosynthesis. Here we describe the effect of cwh6/spt14/gpi3 on the biogenesis of cell wall proteins. It was found that the release of precursors of cell wall proteins from the endoplasmic reticulum (ER) was retarded. This was accompanied by proliferation of ER structures. The majority of the cell wall protein precursors that eventually left the ER were not covalently incorporated into the cell wall but were secreted into the growth medium. Despite the inefficient incorporation of cell wall proteins, there was no net effect on the protein level in the cell wall. It is postulated that the availability of GPI-dependent cell wall proteins determines the rate of cell wall construction and limits growth rate. PMID:9079905

  14. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    PubMed Central

    Ochieng, Vincent; Hendrickx, Leo; Valk, Jody

    2016-01-01

    Background The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. Summary The unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. Conclusion This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP. PMID:27107305

  15. Adhesions to Mesh after Ventral Hernia Mesh Repair Are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain

    PubMed Central

    Langbach, Odd; Holmedal, Stein Harald; Grandal, Ole Jacob

    2016-01-01

    Aim. The aim of the present study was to perform MRI in patients after ventral hernia mesh repair, in order to evaluate MRI's ability to detect intra-abdominal adhesions. Materials and Methods. Single-center long term follow-up study of 155 patients operated for ventral hernia with laparoscopic (LVHR) or open mesh repair (OVHR), including analyzing medical records, clinical investigation with patient-reported pain (VAS-scale), and MRI. MRI was performed in 124 patients: 114 patients (74%) after follow-up, and 10 patients referred for late complaints after ventral mesh repair. To verify the MRI-diagnosis of adhesions, laparoscopy was performed after MRI in a cohort of 20 patients. Results. MRI detected adhesions between bowel and abdominal wall/mesh in 60% of the patients and mesh shrinkage in 20–50%. Adhesions were demonstrated to all types of meshes after both LVHR and OVHR with a sensitivity of 70%, specificity of 75%, positive predictive value of 78%, and negative predictive value of 67%. Independent predictors for formation of adhesions were mesh area as determined by MRI and Charlson index. The presence of adhesions was not associated with more pain. Conclusion. MRI can detect adhesions between bowel and abdominal wall in a fair reliable way. Adhesions are formed both after open and laparoscopic hernia mesh repair and are not associated with chronic pain. PMID:26819601

  16. Constitutive activation of ectodermal β-catenin induces ectopic outgrowths at various positions in mouse embryo and affects abdominal ventral body wall closure.

    PubMed

    Zhu, Xuming; Huang, Sixia; Zhang, Lingling; Wu, Yumei; Chen, Yingwei; Tao, Yixin; Wang, Yushu; He, Shigang; Shen, Sanbing; Wu, Ji; Li, Baojie; Guo, Xizhi; He, Lin; Ma, Gang

    2014-01-01

    Vertebrate limbs originate from the lateral plate mesoderm (LPM) and the overlying ectoderm. While normal limb formation in defined regions has been well studied, the question of whether other positions retain limb-forming potential has not been fully investigated in mice. By ectopically activating β-catenin in the ectoderm with Msx2-cre, we observed that local tissue outgrowths were induced, which either progressed into limb-like structure within the inter-limb flank or formed extra tissues in other parts of the mouse embryo. In the presumptive abdominal region of severely affected embryos, ectopic limb formation was coupled with impaired abdominal ventral body wall (AVBW) closure, which indicates the existence of a potential counterbalance of limb formation and AVBW closure. At the molecular level, constitutive β-catenin activation was sufficient to trigger, but insufficient to maintain the ectopic expression of a putative limb-inducing factor, Fgf8, in the ectoderm. These findings provide new insight into the mechanism of limb formation and AVBW closure, and the crosstalk between the Wnt/β-catenin pathway and Fgf signal.

  17. Surgical management of a large peritoneal pseudocyst causing acute kidney injury secondary to abdominal compartment syndrome in a rare case of congenital absence of omentum during pregnancy.

    PubMed

    Jones, Benjamin P; Hunjan, Tia; Terry, Jayne

    2016-09-01

    Complete congenital absence of the omentum is very rare with only one previously reported case. We present a unique case of the management of a pregnant woman with a large pelvic pseudocyst caused by complications related to congenital absence of omentum, resulting in acute kidney injury, likely secondary to acute compartment syndrome. This case highlights the importance of considering acute compartment syndrome in critically unwell pregnant women and reiterates the need to measure intra-abdominal pressure when clinically indicated. Given that pregnancy is in itself a state of intra-abdominal hypertension, obstetricians should maintain a high index of suspicion in the context of additional risk factors.

  18. [Anesthetic management of a patient with aortocaval fistula caused by rupture of a huge abdominal aortic aneurysm into the inferior vena cava].

    PubMed

    Tanaka, Motonari; Kawashima, Akira; Kuremoto, Yoshito; Tanada, Kazuko

    2013-12-01

    Aortocaval fistula is a rare complication of ruptured abdominal aortic aneurysm. We report anesthetic management of a patient with aortocaval fistula caused by rupture of a huge abdominal aortic aneurysm into the inferior vena cava. A 51-year-old man who had complained of low back pain and general fatigue was referred to our hospital because of his liver damage. Aortocaval fistula due to rupture of a huge abdominal aortic aneurysm was diagnosed from physical examination, enhanced computed tomography and color Doppler ultrasonography. Anesthesia was induced with propofol and rocuronium, and was maintained with sevoflurane and remifentanil. After induction of anesthesia, the central venous pressure and cardiac index showed remarkably high values because of arteriovenous shunt. When the aneurysm was incised after the clamping of the abdominal aorta, massive venous bleeding occurred from the fistula and caused severe hypotension. Blood pressure recovered by digital compression of the bleeding point and the use of an autotransfusion device. After the repair of the aortocaval fistula, the hemodynamics became stable. The patient had a high output but a good cardiac function in preoperative examination. Therefore anesthesia was managed successfully without worsening high-output heart failure.

  19. Recurrent incisional hernia, enterocutaneous fistula and loss of the substance of the abdominal wall: plastic with organic prosthesis, skin graft and VAC therapy. Clinical case.

    PubMed

    Nicodemi, Sara; Corelli, Sergio; Sacchi, Marco; Ricciardi, Edoardo; Costantino, Annarita; Di Legge, Pietro; Ceci, Francesco; Cipriani, Benedetta; Martellucci, Annunziata; Santilli, Mario; Orsini, Silvia; Tudisco, Antonella; Stagnitti, Franco

    2015-01-01

    Surgical wounds dehiscence is a serious post-operatory complication, with an incidence between 0.4% and 3.5%. Mortality is more than 45%. Complex wounds treatment may require a multidisciplinary management. VAC Therapy could be an alternative treatment regarding complex wound. VAC therapy has been recently introduced on skin's graft tissue management reducing skin graft rejection. The use of biological prosthesis has been tested in a contaminated field, better than synthetic meshes, which often need to be removed. The Permacol is more resistant to degradation by proteases due to its cross-links. Surgery is still considered the best treatment for digestive fistula. A 58 years old obese woman come to our attention, she was operated for an abdominal hernia. She had a post-operatory entero-cutaneous fistula. She was submitted to bowel resection, the anastomosis has been tailored and the hernia of the abdominal wall has been repaired with biological mesh for managing such condition. She had a wound dehiscence with loss of substance and the exposure of the biological prosthesis, nearly 20 cm diameter. She was treated first with antibiotic therapy and simple medications. In addiction, antibiotic therapy was necessary late associated to 7 months with advanced medications allowed a small reduction's defect. Because of its, treatment went on for two more months using VAC therapy. Antibiotic's therapy was finally suspended. The VAC therapy allowed the reduction of the gap, between skin and subcutaneous tissue, and the defect's size preparing a suitable ground for the skin graft. The graft, managed with the vac therapy, was necessary to complete the healing process.

  20. Prior Distributions of Material Parameters for Bayesian Calibration of Growth and Remodeling Computational Model of Abdominal Aortic Wall.

    PubMed

    Seyedsalehi, Sajjad; Zhang, Liangliang; Choi, Jongeun; Baek, Seungik

    2015-10-01

    For the accurate prediction of the vascular disease progression, there is a crucial need for developing a systematic tool aimed toward patient-specific modeling. Considering the interpatient variations, a prior distribution of model parameters has a strong influence on computational results for arterial mechanics. One crucial step toward patient-specific computational modeling is to identify parameters of prior distributions that reflect existing knowledge. In this paper, we present a new systematic method to estimate the prior distribution for the parameters of a constrained mixture model using previous biaxial tests of healthy abdominal aortas (AAs). We investigate the correlation between the estimated parameters for each constituent and the patient's age and gender; however, the results indicate that the parameters are correlated with age only. The parameters are classified into two groups: Group-I in which the parameters ce, ck1, ck2, cm2,Ghc, and ϕe are correlated with age, and Group-II in which the parameters cm1, Ghm, G1e, G2e, and α are not correlated with age. For the parameters in Group-I, we used regression associated with age via linear or inverse relations, in which their prior distributions provide conditional distributions with confidence intervals. For Group-II, the parameter estimated values were subjected to multiple transformations and chosen if the transformed data had a better fit to the normal distribution than the original. This information improves the prior distribution of a subject-specific model by specifying parameters that are correlated with age and their transformed distributions. Therefore, this study is a necessary first step in our group's approach toward a Bayesian calibration of an aortic model. The results from this study will be used as the prior information necessary for the initialization of Bayesian calibration of a computational model for future applications.

  1. Epidemiology and antimicrobial susceptibility of Gram-negative aerobic bacteria causing intra-abdominal infections during 2010-2011.

    PubMed

    Hawser, Stephen; Hoban, Daryl J; Badal, Robert E; Bouchillon, Samuel K; Biedenbach, Douglas; Hackel, Meredith; Morrissey, Ian

    2015-02-01

    The study for monitoring antimicrobial resistance trends (SMART) surveillance program monitors the epidemiology and trends in antibiotic resistance of intra-abdominal pathogens to currently used therapies. The current report describes such trends during 2010-2011. A total of 25,746 Gram-negative clinical isolates from intra-abdominal infections were collected and classified as hospital-associated (HA) if the hospital length of stay (LOS) at the time of specimen collection was ≥48 hours, community-associated (CA) if LOS at the time of specimen collection was <48 hours, or unknown (no designation given by participating centre). A total of 92 different species were collected of which the most common was Escherichia coli: 39% of all isolates in North America to 55% in Africa. Klebsiella pneumoniae was the second most common pathogen: 11% of all isolates from Europe to 19% of all isolates from Asia. Isolates were from multiple intra-abdominal sources of which 32% were peritoneal fluid, 20% were intra-abdominal abscesses, and 16.5% were gall bladder infections. Isolates were further classified as HA (55% of all isolates), CA (39% of all isolates), or unknown (6% of all isolates). The most active antibiotics tested were imipenem, ertapenem, amikacin, and piperacillin-tazobactam. Resistance rates to all other antibiotics tested were high. Considering the current data set and high-level resistance of intra-abdominal pathogens to various antibiotics, further monitoring of the epidemiology of intra-abdominal infections and their susceptibility to antibiotics through SMART is warranted.

  2. Insufficient Lymph Drainage Causes Abnormal Lipid Accumulation and Vein Wall Degeneration

    PubMed Central

    Tanaka, Hiroki; Yamamoto, Naoto; Suzuki, Minoru; Mano, Yuuki; Sano, Masaki; Zaima, Nobuhiro; Sasaki, Takeshi; Setou, Mitsutoshi

    2016-01-01

    Objective: Previously, we analyzed human varicose veins (VV) using imaging mass spectrometry (IMS) and detected the abnormal accumulation of lipid molecules in the walls of VV, possibly due to insufficient lipid drainage by the lymphatic vessels. In this study, we created an animal model of lymphatic insufficiency to investigate the effects of insufficient lymph drainage on vein walls. Methods: In rats, the lymphatic collecting vessels surrounding the femoral vein were ligated on one side (the model tissue), which caused the local retention of lymphatic fluid in the perivascular tissue. The equivalent contralateral tissue was used as a control. A histological study of the femoral vein and the surrounding perivascular tissue was conducted. IMS was used to analyze the distribution of lipid molecules in the perivascular tissue. Results: Fourteen days after the procedure, the lymphatic vessels in the model tissue were significantly dilated. Furthermore, IMS revealed that the composition of the lipid molecules in the perivascular regions of the model tissue had altered. Compared with the control tissue, the model tissue exhibited marked perivascular accumulation of lysophosphatidylcholine (1-acyl 16:0), phosphatidylcholine (16:0/20:4), and triglycerides (52:2). Interestingly, the walls of the femoral veins running through the model tissue were 3.4-fold thicker than those of the femoral veins running through the control tissue. The number of tumor necrosis factor α-positive adipocytes was increased in the perivascular regions of the model tissue. Conclusion: The findings of this study indicated that the accumulation of lymphatic fluid due to insufficient lymph drainage changes the structure of vein walls, and such changes might be associated with chronic venous insufficiency. (This is a translation of Jpn J Phlebol 2015; 26: 227–235.) PMID:28018498

  3. Remodeling characteristics and collagen distribution in synthetic mesh materials explanted from human subjects after abdominal wall reconstruction: an analysis of remodeling characteristics by patient risk factors and surgical site classifications

    PubMed Central

    Cavallo, Jaime A.; Roma, Andres A.; Jasielec, Mateusz S.; Ousley, Jenny; Creamer, Jennifer; Pichert, Matthew D.; Baalman, Sara; Frisella, Margaret M.; Matthews, Brent D.

    2014-01-01

    Background The purpose of this study was to evaluate the associations between patient characteristics or surgical site classifications and the histologic remodeling scores of synthetic meshes biopsied from their abdominal wall repair sites in the first attempt to generate a multivariable risk prediction model of non-constructive remodeling. Methods Biopsies of the synthetic meshes were obtained from the abdominal wall repair sites of 51 patients during a subsequent abdominal re-exploration. Biopsies were stained with hematoxylin and eosin, and evaluated according to a semi-quantitative scoring system for remodeling characteristics (cell infiltration, cell types, extracellular matrix deposition, inflammation, fibrous encapsulation, and neovascularization) and a mean composite score (CR). Biopsies were also stained with Sirius Red and Fast Green, and analyzed to determine the collagen I:III ratio. Based on univariate analyses between subject clinical characteristics or surgical site classification and the histologic remodeling scores, cohort variables were selected for multivariable regression models using a threshold p value of ≤0.200. Results The model selection process for the extracellular matrix score yielded two variables: subject age at time of mesh implantation, and mesh classification (c-statistic = 0.842). For CR score, the model selection process yielded two variables: subject age at time of mesh implantation and mesh classification (r2 = 0.464). The model selection process for the collagen III area yielded a model with two variables: subject body mass index at time of mesh explantation and pack-year history (r2 = 0.244). Conclusion Host characteristics and surgical site assessments may predict degree of remodeling for synthetic meshes used to reinforce abdominal wall repair sites. These preliminary results constitute the first steps in generating a risk prediction model that predicts the patients and clinical circumstances for which non

  4. “Toxic Pancreatitis with an Intra-Abdominal Abscess which was Caused by Organophosphate Poisoning (OP)”

    PubMed Central

    L, Venugopal; Rao V, Dharma; Rao M, Srinivas; Y, Mallikarjuna

    2013-01-01

    Organophosphate insecticides are the potent inhibitors of the acetylcholinesterase enzyme which lead to an increased acetylcholine activity, which are responsible for symptoms such as abdominal pain, diarrhoea, vomiting and hypersalivation. We are reporting on a young male with acute organophosphate poisoning, who presented with unusual complications like toxic pancreatitis with an intraabdominal abscess. PMID:23543622

  5. [Abdominal actinomycosis with IUD].

    PubMed

    Kamprath, S; Merker, A; Kühne-Heid, R; Schneider, A

    1997-01-01

    We report a case of abdominal actinomycosis in a 54 year old woman using an intrauterine device for a period of 8 years. The most important finding was a tuboovarialabscess at the left pelvic side with involvement of the serosa of the jejunum, ileum, sigma, and omentum majus. Intraoperative exploration showed a solid retroperitoneal infiltration between the pelvic side wall and sigma. Another infiltration was found on the left side of the abdominal wall. The diagnosis was confirmed by histopathological examination and the patient was treated by a combination of Aminopenicillin and Metronidazol. After a period of three months we observed a complete regression of the clinical and the MRI findings.

  6. Cryptogenia multifocal ulcerous stenosing enteritis: an entity on its own as a cause of abdominal pain, iron deficiency anemia and protein-losing enteropathy.

    PubMed

    Guisado Vasco, P; Fraile Rodríguez, G

    2014-01-01

    We studied a patient with edema secondary to protein losing enteropathy, and recurrent bouts of bloating and abdominal pain secondary to intestinal subocclusion episodes. After the clinical study, the patient was diagnosed of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), that is a rare disease, probably caused by mutations in the gene PLA2G4A, and characterized by multiple short stenosis of the small bowel with superficial ulcers, which do not exceed the submucosa layer. Inflammatory bowel disease (Chron's disease), intestinal tuberculosis and intestinal ulcers secondary to non-steroidal anti-inflammatory drugs are the main differential diagnosis. To sum up, physicians should included CMUSE in the differential diagnosis of recurrent abdominal pain, iron deficiency anaemia, occult intestinal bleeding, edema and protein losing enteropathy.

  7. BOTULINUM TOXIN A INDUCED PARALYSIS OF THE LATERAL ABDOMINAL WALL AFTER DAMAGE CONTROL LAPAROTOMY: A MULTIINSTITUTIONAL, PROSPECTIVE, RANDOMIZED, PLACEBO CONTROLLED PILOT STUDY

    PubMed Central

    Zielinski, Martin D.; Kuntz, Melissa; Zhang, Xiaoming; Zagar, Abigail E.; Khasawneh, Mohammad A.; Zendejas, Benjamin; Polites, Stephanie F.; Ferrara, Michael; Harmsen, William S.; Ballman, Karla S.; Park, Myung S.; Schiller, Henry J.; Dries, David; Jenkins, Donald H.

    2015-01-01

    INTRODUCTION Damage control laparotomy (DCL) is a life-saving operation used in critically ill patients; however, interval primary fascial closure remains a challenge. We hypothesized that flaccid paralysis of the lateral abdominal wall musculature induced by Botulinum Toxin A (BTX), would improve of rates of primary fascial closure, decrease duration of hospital stay (LOS), and enhance pain control. METHODS Consenting adults who had undergone a DCL at two institutions were prospectively randomized to receive ultrasound-guided injections of their external oblique, internal oblique, and transversus abdominus muscles with either BTX (150cc, 2units/cc) or placebo (150cc 0.9%NaCl). Patients were excluded if they had a BMI>50, remained unstable or coagulopathic, were home O2 dependent or had an existing neuromuscular disorder. Outcomes were assessed in a double-blinded manner. Univariate and Kaplan Meier estimates of cumulative probability of abdominal closure were performed. RESULTS We randomized 46 patients (24 BTX, 22 placebo). There were no significant differences in demographics, comorbidities, and physiological status. Injections were performed on average 1.8 ± 2.8 days after DCL (range 0-14). The 10-day cumulative probability of primary fascial closure was similar between groups: 96% for BTX (95% CI 72%-99%) and 93% for placebo (95% CI 61%-99%); HR =1.0 (95% CI 0.5-1.8). No difference between BTX and placebo groups was observed for LOS (37 vs 26 days, p=0.30) or intensive care unit stay (17 vs 11 days, p=0.27). There was no difference in median morphine equivalents following DCL. The overall complication rate was similar (63% vs 68%, p=0.69), with 2 deaths in the placebo group and 0 in the BTX group. No BTX or injection procedure complications were observed. CONCLUSION Use of BTX after DCL was safe but did not appear to affect primary fascial closure, LOS, or pain modulation after DCL. Given higher than expected rates of primary fascial closure, type II error

  8. [Sudden death caused by a less lethal weapon chest-wall injury (Commotio cordis)].

    PubMed

    Contargyris, C; Peytel, E

    2012-05-01

    Less lethal weapons, like Flashball, are more and more used since 1995 in law enforcement, even by the local police to neutralize combative individuals and to disperse riot crowds. This gun fires large rubber bullets and has been incriminated many times in cases of face injuries with functional consequences. In this case report, we mention a case of sudden death from cardiac arrest due to low energy chest wall impact of a rubber bullet shot with the Flashball. Commotio cordis is potentialized by a lethal set of three including, a certain impact velocity, an exact location of the hit over the cardiac silhouette, and a precise timing 15 m/s prior to the peak of the T-wave. This case report highlights the fact that such impacts can cause significant injury to internal organs, in particular circonstances, implying the necessity of a raising awareness of the medical staff, in ordre to not underestimate the severity of such injuries.

  9. A population-level analysis of abdominal wall reconstruction by component separation in the morbidly obese patient: can it be performed safely?

    PubMed

    Nelson, Jonas A; Fischer, John P; Wink, Jason D; Kovach, Stephen J

    2014-10-01

    Morbid obesity is increasing at an alarming rate and a significant portion of patients presenting for complex abdominal wall reconstruction (AWR) and component separation fall into this category, creating added medical and surgical challenges to an already difficult operation. The goal of this study was to utilise the Nationwide 2005-2010 American College of Surgeons National Surgical Quality Improvement database (ACS-NSQIP) to perform a population level analysis of the role of morbid obesity on 30-day perioperative morbidity with the hope of improving patient care, counselling and risk stratification. Morbidly obese patients (BMI > 40 kg/m(2)) were compared to non-obese patients (BMI < 30 kg/m(2)). Outcome variables assessed included major surgical complications, major medical complications, major renal complications, major wound complications, return to OR (ROR), and venous thromboembolism (VTE). Significant variables in a univariate analysis were included in a multivariate logistic regression controlling for patient characteristics (p < 0.05). In total, 1695 patients undergoing AWR were identified in the ACS-NSQIP database. Of these, 614 patients were non-obese (average BMI = 25.7 ± 3.0 kg/m(2)) and 314 were morbidly obese (average BMI = 45.9 ± 5.8 kg/m(2)). Multivariate analyses determined that morbid obesity did not significantly contribute to major surgical, medical, renal or wound complications. However, it was significantly associated with ROR (OR = 2.8, p < 0.001) and VTE (OR = 5.2, p = 0.04). Morbid obesity is an independent risk factor for ROR and VTE related complications, in the 30 day post-operative period. Additional perioperative care is warranted to decrease such early re-operations and for preventable complications.

  10. Abdominal ultrasound

    MedlinePlus

    ... Kidney - blood and urine flow Abdominal ultrasound References Chen L. Abdominal ultrasound imaging. In: Sahani DV, Samir ... the Health on the Net Foundation (www.hon.ch). The information provided herein should not be used ...

  11. Abdominal tap

    MedlinePlus

    ... tap; Cirrhosis - abdominal tap; Malignant ascites - abdominal tap Images Digestive system Peritoneal sample References Garcia-Tiso G. ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  12. Gibberellin reactivates and maintains ovary-wall cell division causing fruit set in parthenocarpic Citrus species.

    PubMed

    Mesejo, Carlos; Yuste, Roberto; Reig, Carmina; Martínez-Fuentes, Amparo; Iglesias, Domingo J; Muñoz-Fambuena, Natalia; Bermejo, Almudena; Germanà, M Antonietta; Primo-Millo, Eduardo; Agustí, Manuel

    2016-06-01

    Citrus is a wide genus in which most of the cultivated species and cultivars are natural parthenocarpic mutants or hybrids (i.e. orange, mandarin, tangerine, grapefruit). The autonomous increase in GA1 ovary concentration during anthesis was suggested as being the stimulus responsible for parthenocarpy in Citrus regardless of the species. To determine the exact GA-role in parthenocarpic fruit set, the following hypothesis was tested: GA triggers and maintains cell division in ovary walls causing fruit set. Obligate and facultative parthenocarpic Citrus species were used as a model system because obligate parthenocarpic Citrus sp (i.e. Citrus unshiu) have higher GA levels and better natural parthenocarpic fruit set compared to other facultative parthenocarpic Citrus (i.e. Citrus clementina). The autonomous activation of GA synthesis in C. unshiu ovary preceded cell division and CYCA1.1 up-regulation (a G2-stage cell cycle regulator) at anthesis setting a high proportion of fruits, whereas C. clementina lacked this GA-biosynthesis and CYCA1.1 up-regulation failing in fruit set. In situ hybridization experiments revealed a tissue-specific expression of GA20ox2 only in the dividing tissues of the pericarp. Furthermore, CYCA1.1 expression correlated endogenous GA1 content with GA3 treatment, which stimulated cell division and ovary growth, mostly in C. clementina. Instead, paclobutrazol (GA biosynthesis inhibitor) negated cell division and reduced fruit set. Results suggest that in parthenocarpic citrus the specific GA synthesis in the ovary walls at anthesis triggers cell division and, thus, the necessary ovary growth rate to set fruit.

  13. [Myxofibrosarcoma in the abdominal cavity].

    PubMed

    Janů, F

    2016-01-01

    A number of benign and malignant tumors may develop in the abdominal cavity. Sarcomas are rather rare tumors of the abdominal cavity. They are often diagnosed at advanced growth stages as their local growth can cause clinical problems to the patients. The author presents a case report of myxofibrosarcoma in the abdominal cavity.Key words: myxofibrosarcoma.

  14. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  15. Abdominal Pain

    MedlinePlus

    ... call your doctor. In Spanish— Dolor abdominal en niños menores de 12 años What is recurrent abdominal ... Functional abdominal pain (FAP) typically affects kids ages 4-12, and is quite common, affecting up to ...

  16. Abdominal Pain Syndrome

    MedlinePlus

    ... or cancer Infection of the tubes (salpingitis) Ectopic pregnancy Fibroid tumors of the uterus (womb) Malignant tumors of the uterus or cervix Endometriosis Adhesions (scars) Screening and Diagnosis How is the cause of abdominal pain determined? ...

  17. A prospective, controlled evaluation of the abdominal reapproximation anchor abdominal wall closure system in combination with VAC therapy compared with VAC alone in the management of an open abdomen.

    PubMed

    Long, Kristin L; Hamilton, David A; Davenport, Daniel L; Bernard, Andrew C; Kearney, Paul A; Chang, Phillip K

    2014-06-01

    Dramatic increases in damage control and decompressive laparotomies and a significant increase in patients with open abdominal cavities have resulted in numerous techniques to facilitate fascial closure. We hypothesized addition of the abdominal reapproximation anchor system (ABRA) to the KCI Abdominal Wound Vac™ (VAC) or KCI ABThera™ would increase successful primary closure rates and reduce operative costs. Fourteen patients with open abdomens were prospectively randomized into a control group using VAC alone (control) or a study group using VAC plus ABRA (VAC-ABRA). All patients underwent regular VAC changes; patients receiving VAC-ABRA also underwent concomitant daily elastomer adjustment of the ABRA system. Primary end points included abdominal closure, number of operating room (OR) visits, and OR time use. Eight patients were included in the VAC-ABRA group and six patients in the control group. Primary closure rates between groups were not statistically different; however, the number of trips to the OR and OR time use were different. Despite higher Acute Physiology and Chronic Health Evaluation II scores, larger starting wound size, and higher rates of abdominal compartment syndrome, closure rates in the VAC-ABRA group were similar to VAC alone. Importantly, however, fewer OR trips and less OR time were required for the VAC-ABRA group.

  18. Structural ordering of multi-walled carbon nanotubes (MWCNTs) caused by gamma (γ)-ray irradiation

    SciTech Connect

    Silambarasan, D. Vasu, V.; Iyakutti, K.; Asokan, K.

    2015-06-24

    Multi-walled carbon nanotubes (MWCNTs) were irradiated by Gamma (γ)-rays in air with absorbed doses of 25 and 50 kGy. As a result of γ-ray irradiation, the inter-wall distance of MWCNTs was decreased and their graphitic order was improved. The reduction in inter-wall distance and structural ordering was improved with the increasing dosage of irradiation. Experimental evidences are provided by powder XRD and micro-Raman analyses.

  19. Renal infarction due to spontaneous dissection of the renal artery: an unusual cause of non-visceral type abdominal pain

    PubMed Central

    Kang, James H-E; Kang, Jin-Yong; Morgan, Robert

    2013-01-01

    A 44-year-old man presented with very severe right upper quadrant pain of sudden onset. This was exacerbated by movement but unaffected by food or defaecation. It was continuous—day and night —but resolved over a 1-week period. The physical examination was normal at presentation, by which time the pain had resolved. His white cell count, alanine transaminase and C reactive protein were elevated but normalised after 10 days. An abdominal CT showed low density lesions in the right kidney consistent with segmental infarcts. CT angiogram showed a dissection of the right renal artery. The patient remained asymptomatic and normotensive when reviewed 1 month later. PMID:24049091

  20. Parasitic Infection of the Gallbladder: Cystoisospora belli Infection as a Cause of Chronic Abdominal Pain and Acalculous Cholecystitis.

    PubMed

    Martelli, Matthew G; Lee, Johnathan Y

    2016-06-01

    Herein we describe two cases of Cystoisospora belli infection of the gallbladder in patients with chronic abdominal pain and review the published literature to date. C. belli is an intracellular protozoan parasite that typically infects the small bowel of immunocompromised hosts. Little is known of the significance of C. belli infection of the gallbladder at this point as only four cases have been reported as yet, only one of which occurred in an immunocompetent patient. It is often treatable with antibiotics, and the patient's immune status, including HIV testing, should be investigated. Neither of the patients at our institution was found to be immunocompromised, and HIV-1/2 antibody testing was non-reactive in both.

  1. Onset of pulsatile pressure causes transiently increased filtration through artery wall.

    PubMed

    Alberding, Jonathan P; Baldwin, Ann L; Barton, Jennifer K; Wiley, Elizabeth

    2004-05-01

    Convective fluid motion through artery walls aids in the transvascular transport of macromolecules. Although many measurements of convective filtration have been reported, they were all obtained under constant transmural pressure. However, arterial pressure in vivo is pulsatile. Therefore, experiments were designed to compare filtration under steady and pulsatile pressure conditions. Rabbit carotid arteries were cannulated and excised from male New Zealand White rabbits anesthetized with pentobarbitol sodium (30 mg/kg i.v. administered). Hydraulic conductance was measured in cannulated excised rabbit carotid arteries at steady pressure. Next, pulsatile pressure trains were applied within the same vessels, and, simultaneously, arterial distension was monitored using Optical coherence tomography (OCT). For each pulse train, the volume of fluid lost through filtration was measured (subtracting volume change due to residual distension) and compared with that predicted from steady pressure measurements. At 60- and 80-mmHg baseline pressures, the experimental filtration volumes were significantly increased compared with those predicted for steady pressure (P < 0.05). OCT demonstrated that the excess fluid volume loss was significantly greater than the volume that would be lost through residual distension (P < 0.05). After 30 s, the magnitude of the excess of fluid loss was reduced. These results suggest that sudden onset of pulsatile pressure may cause changes in arterial interstitial hydration.

  2. [Abdominal paracentesis].

    PubMed

    Glauser, Frédéric; Barras, Anne-Catherine; Pache, Isabelle; Monti, Matteo

    2008-10-29

    Abdominal paracentesis is frequently performed in the clinical setting. Every newly developed ascites need to be investigated by abdominal paracentesis. Any clinical or biological deterioration in patients with chronic ascites also requires a new paracentesis. Therapeutically abdominal paracentesis is performed for refractory or symptomatic ascites. As other invasive procedures, it is critical to master its indications, contra-indications and complications. The aim of this article is to review the basics of abdominal paracentesis in order to help physicians to carry out this technical skill.

  3. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Mikami, Y; Kyogoku, M

    1994-08-01

    Inflammatory abdominal aortic aneurysm (IAAA) is a distinct clinicopathological entity, characterized by: (1) clinical presentation, such as back pain, weight loss, and increased ESR, (2) patchy and/or diffuse lymphoplasmacytic infiltration, and (3) marked periaortic fibrosis resulting in thickening of the aneurysmal wall and occasional retroperitoneal fibrosis. Its pathogenesis is unknown, but some authors support the theory that IAAA is a subtype of atherosclerotic abdominal aortic aneurysm because of close relationship between IAAA and atherosclerotic change. In this article, we describe clinical and histological features of IAAA on the basis of the literature and our review of 6 cases of IAAA, emphasizing the similarity and difference between IAAA and atherosclerotic abdominal aortic aneurysm. Our review supports that marked lamellar fibrosis completely replacing the media and adventitia, patchy lymphocytic infiltration (mostly B cells) and endarteritis obliterans are characteristic features of IAAA.

  4. [Abdominal bloating: an up-to-date].

    PubMed

    Ducrotté, P

    2009-10-01

    Bloating is a common symptom, especially in women. In the clinical practice, it remains a therapeutic challenge. Since recently, its pathophysiology is better understood: an impaired transit of gas (particularly in the small bowel) or a visceral hypersensitivity leading to the induction of an abdominal discomfort despite a normal volume of gas are two of the main causes, far more frequent than an excessive production of gas. Moreover, bloating can be related to abnormal viscera-somatic reflexes promoting both an abdomino-phrenic dyssynergia and the relaxation of the muscles of the abdominal wall. From a therapeutic point of view, the efficacy of the gas absorbants remains to be more documented. Besides the treatment of a constipation and the avoidance of nutrients either highly fermentable or rich in fructose, other therapeutic options include prokinetics and drugs acting on visceral sensitivity. Probiotics are another promising option. In some centers, a non pharmacological therapeutic approach, mainly based on hypnosis, is discussed.

  5. Adventitial vasa vasorum arteriosclerosis in abdominal aortic aneurysm.

    PubMed

    Tanaka, Hiroki; Zaima, Nobuhiro; Sasaki, Takeshi; Hayasaka, Takahiro; Goto-Inoue, Naoko; Onoue, Kenji; Ikegami, Koji; Morita, Yoshifumi; Yamamoto, Naoto; Mano, Yuuki; Sano, Masaki; Saito, Takaaki; Sato, Kohji; Konno, Hiroyuki; Setou, Mitsutoshi; Unno, Naoki

    2013-01-01

    Abdominal aortic aneurysm (AAA) is a common disease among elderly individuals. However, the precise pathophysiology of AAA remains unknown. In AAA, an intraluminal thrombus prevents luminal perfusion of oxygen, allowing only the adventitial vaso vasorum (VV) to deliver oxygen and nutrients to the aortic wall. In this study, we examined changes in the adventitial VV wall in AAA to clarify the histopathological mechanisms underlying AAA. We found marked intimal hyperplasia of the adventitial VV in the AAA sac; further, immunohistological studies revealed proliferation of smooth muscle cells, which caused luminal stenosis of the VV. We also found decreased HemeB signals in the aortic wall of the sac as compared with those in the aortic wall of the neck region in AAA. The stenosis of adventitial VV in the AAA sac and the malperfusion of the aortic wall observed in the present study are new aspects of AAA pathology that are expected to enhance our understanding of this disease.

  6. Reaction wood – a key cause of variation in cell wall recalcitrance in willow

    PubMed Central

    2012-01-01

    Background The recalcitrance of lignocellulosic cell wall biomass to deconstruction varies greatly in angiosperms, yet the source of this variation remains unclear. Here, in eight genotypes of short rotation coppice willow (Salix sp.) variability of the reaction wood (RW) response and the impact of this variation on cell wall recalcitrance to enzymatic saccharification was considered. Results A pot trial was designed to test if the ‘RW response’ varies between willow genotypes and contributes to the differences observed in cell wall recalcitrance to enzymatic saccharification in field-grown trees. Biomass composition was measured via wet chemistry and used with glucose release yields from enzymatic saccharification to determine cell wall recalcitrance. The levels of glucose release found for pot-grown control trees showed no significant correlation with glucose release from mature field-grown trees. However, when a RW phenotype was induced in pot-grown trees, glucose release was strongly correlated with that for mature field-grown trees. Field studies revealed a 5-fold increase in glucose release from a genotype grown at a site exposed to high wind speeds (a potentially high RW inducing environment) when compared with the same genotype grown at a more sheltered site. Conclusions Our findings provide evidence for a new concept concerning variation in the recalcitrance to enzymatic hydrolysis of the stem biomass of different, field-grown willow genotypes (and potentially other angiosperms). Specifically, that genotypic differences in the ability to produce a response to RW inducing conditions (a ‘RW response’) indicate that this RW response is a primary determinant of the variation observed in cell wall glucan accessibility. The identification of the importance of this RW response trait in willows, is likely to be valuable in selective breeding strategies in willow (and other angiosperm) biofuel crops and, with further work to dissect the nature of RW

  7. Effect of alpha lipoic acid co-administration on structural and immunohistochemical changes in subcutaneous tissue of anterior abdominal wall of adult male albino rat in response to polypropylene mesh implantation.

    PubMed

    Mazroa, Shireen A; Asker, Samar A; Asker, Waleed; Abd Ellatif, Mohamed

    2015-06-01

    Polypropylene mesh is commonly used in the treatment of abdominal hernia. Different approaches were addressed to improve their tissue integration and consequently reduce long-term complications. This study aimed to investigate the effect of alpha-lipoic acid (ALA) co-administration on structural and immunohistochemical (IHC) changes in the subcutaneous tissues of the anterior abdominal wall of the adult rat in response to polypropylene mesh implantation. Forty adult male albino rats were divided into: group I (control), group II (receiving ALA), group III (polypropylene mesh implantation) and group IV (mesh implantation + ALA co-administration). After 4 weeks, subcutaneous tissue samples were prepared for light microscopy and IHC study of CD34 as a marker for angiogenesis. In groups I and II rats, positive CD34 expression was demonstrated by IHC reaction, localized to endothelial cells lining small blood vessels. Group III showed an excess inflammatory reaction, deposition of both regular and irregularly arranged collagen fibres around mesh pores and few elastic fibres. CD34-positive was detected not only in cells lining small blood vessels but also in other cells scattered in the connective tissue indicating angiogenesis. In group IV, ALA co-administration resulted in less inflammatory reaction, regular collagen deposition, enhanced elastic fibres synthesis and a significant increase in CD34-positive cells and small blood vessels reflecting improved angiogenesis. ALA co-administration with polypropylene mesh implantation controlled the inflammatory reaction, helped regular collagen deposition, enhanced elastic fibres synthesis and improved angiogenesis in the subcutaneous tissue of anterior abdominal wall of adult albino rats, suggesting a possible role of ALA in optimizing mesh integration in subcutaneous tissue.

  8. Effect of alpha lipoic acid co-administration on structural and immunohistochemical changes in subcutaneous tissue of anterior abdominal wall of adult male albino rat in response to polypropylene mesh implantation

    PubMed Central

    Mazroa, Shireen A; Asker, Samar A; Asker, Waleed; Abd Ellatif, Mohamed

    2015-01-01

    Polypropylene mesh is commonly used in the treatment of abdominal hernia. Different approaches were addressed to improve their tissue integration and consequently reduce long-term complications. This study aimed to investigate the effect of alpha-lipoic acid (ALA) co-administration on structural and immunohistochemical (IHC) changes in the subcutaneous tissues of the anterior abdominal wall of the adult rat in response to polypropylene mesh implantation. Forty adult male albino rats were divided into: group I (control), group II (receiving ALA), group III (polypropylene mesh implantation) and group IV (mesh implantation + ALA co-administration). After 4 weeks, subcutaneous tissue samples were prepared for light microscopy and IHC study of CD34 as a marker for angiogenesis. In groups I and II rats, positive CD34 expression was demonstrated by IHC reaction, localized to endothelial cells lining small blood vessels. Group III showed an excess inflammatory reaction, deposition of both regular and irregularly arranged collagen fibres around mesh pores and few elastic fibres. CD34-positive was detected not only in cells lining small blood vessels but also in other cells scattered in the connective tissue indicating angiogenesis. In group IV, ALA co-administration resulted in less inflammatory reaction, regular collagen deposition, enhanced elastic fibres synthesis and a significant increase in CD34-positive cells and small blood vessels reflecting improved angiogenesis. ALA co-administration with polypropylene mesh implantation controlled the inflammatory reaction, helped regular collagen deposition, enhanced elastic fibres synthesis and improved angiogenesis in the subcutaneous tissue of anterior abdominal wall of adult albino rats, suggesting a possible role of ALA in optimizing mesh integration in subcutaneous tissue. PMID:25891652

  9. Abdominal pain

    MedlinePlus

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

  10. Acute incarcerated external abdominal hernia

    PubMed Central

    Yang, Xue-Fei

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  11. Mitigation of Adverse Effects Caused by Shock Wave Boundary Layer Interactions Through Optimal Wall Shaping

    NASA Technical Reports Server (NTRS)

    Liou, May-Fun; Lee, Byung Joon

    2013-01-01

    It is known that the adverse effects of shock wave boundary layer interactions in high speed inlets include reduced total pressure recovery and highly distorted flow at the aerodynamic interface plane (AIP). This paper presents a design method for flow control which creates perturbations in geometry. These perturbations are tailored to change the flow structures in order to minimize shock wave boundary layer interactions (SWBLI) inside supersonic inlets. Optimizing the shape of two dimensional micro-size bumps is shown to be a very effective flow control method for two-dimensional SWBLI. In investigating the three dimensional SWBLI, a square duct is employed as a baseline. To investigate the mechanism whereby the geometric elements of the baseline, i.e. the bottom wall, the sidewall and the corner, exert influence on the flow's aerodynamic characteristics, each element is studied and optimized separately. It is found that arrays of micro-size bumps on the bottom wall of the duct have little effect in improving total pressure recovery though they are useful in suppressing the incipient separation in three-dimensional problems. Shaping sidewall geometry is effective in re-distributing flow on the side wall and results in a less distorted flow at the exit. Subsequently, a near 50% reduction in distortion is achieved. A simple change in corner geometry resulted in a 2.4% improvement in total pressure recovery.

  12. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher

    PubMed Central

    Kato, Kinshi; Yabuki, Shoji; Otani, Koji; Nikaido, Takuya; Otoshi, Ken-ichi; Watanabe, Kazuyuki; Kikuchi, Shin-ichi; Konno, Shin-ichi

    2016-01-01

    Abstract Symptomatic thoracic disc herniation is clinically rare. There are few cases of disc herniation of the thoracic spine in top athletes described in the literature. We herein present a rare case of chest wall pain due to thoracic disc herniation in a professional baseball pitcher. A 30-year-old, left-handed pitcher complained of left-sided chest wall pain in the region of his lower ribs during a game. Neurological examination revealed hypoesthesia of the left side of the chest at the level of the lower thoracic spine. Magnetic resonance imaging (MRI) of the thoracic spine showed a left-sided paramedian disc herniation at the T9-T10 level. The player was initially prescribed rest, administration of pregabalin (150 mg twice a day), and subsequent physical rehabilitation. He was able to resume full training and pitching without medication 6 months after the onset. A follow-up MRI of the thoracic spine showed a reduction in the size of the herniated disc compared to the initial findings. Though relatively rare, thoracic disc herniation should be considered in cases of chest wall pain in athletes. PMID:26983590

  13. [The effect of ionizing radiation on the blood plasma and erythrocytes and on the wall of the abdominal aorta of rats].

    PubMed

    Nikulin, A A; Pustovalov, A P; Voronkov, I F

    1988-01-01

    On days 7 and 15 after gamma-irradiation (4 Gy) changes were noted in the temperature dependence of the erythrocyte suspension viscosity coefficient, in the electrolyte composition of the abdominal aorta, plasma, and erythrocytes, in Na, K- and Mg-ATPase activity, and in the intensity of fluorescence of 1.8 ANS of erythrocyte ghost of albino rats. The changes were a function of the stage of radiation sickness and were more pronounced on the 15th day following irradiation.

  14. Catastrophic necrotizing fasciitis after blunt abdominal trauma with delayed recognition of the coecal rupture--case report.

    PubMed

    Pecic, Vanja; Nestorovic, Milica; Kovacevic, Predrag; Tasic, Dragan; Stanojevic, Goran

    2014-03-01

    Necrotizing fasciitis (NF) is a rare bacterial infection with dramatic course, characterized by widespread necrosis of the skin, subcutaneous tissue, and superficial fascia which can often lead to death. We present a case of a 27-year-old male with NF. One day after experiencing blunt abdominal trauma caused by falling over bike handlebars, the patient was admitted to a regional hospital and treated for diffuse abdominal pain and large hematoma of the anterior abdominal wall. Due to worsening of general condition, he was referred to our hospital the following day and operated on urgently. Surgery revealed rupture of the coecum with peritonitis and abdominal wall infection. After surgery, fulminant necrotizing fasciitis developed. Antibiotics were prescribed according to wound cultures and subsequent necrectomies were performed. After 25 days, reconstruction of the abdominal wall with skin grafts was obtained. Despite all resuscitation measures including fluids, blood transfusions, and parenteral nutrition, lung infection and MODS caused death 42 days after initial operation. Blunt abdominal trauma can cause the rupture of intestine, and if early signs of peritoneal irritation should present, emergency laparotomy should be performed. Disastrous complication are rare but lethal.

  15. Abdominal Sepsis.

    PubMed

    De Waele, Jan J

    2016-08-01

    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy.

  16. [Differential surgical treatment of victims with damage to the small and large intestines in a closed abdominal injury combined, depending on the prediction of traumatic disease course and morphological changes of the intestinal wall].

    PubMed

    Zaruts'kyĭ, Ia L; Denysenko, V M; Khomenko, I P; Levkivskyĭ, R H

    2013-08-01

    Use of differentiated surgical approach to the management of surgical treatment, depending on the degree of violation of systemic hemodynamics, the timing and volume of surgical procedures, depending on the prognosis of traumatic disease course of cardiac index, interventions in the small and large intestine depending on morphological changes of the intestinal wall by cardiac and stroke indexes, put method extra-enteric anastomosis in patients with damage to the small intestine and colon combined with closed abdominal injury permitted to reduce the rate of postoperative complications from 22.2 to 10.1%, mortality at 2.1 times in shock period (from 19.3 to 9.2%) and the overall mortality from 33.3 to 21.1%.

  17. Sex Differences in Somatotrope Dependency on Leptin Receptors in Young Mice: Ablation of LEPR Causes Severe Growth Hormone Deficiency and Abdominal Obesity in Males

    PubMed Central

    Odle, Angela; Haney, Anessa; Childs, Gwen

    2015-01-01

    Leptin receptor (LEPR) signaling controls appetite and energy expenditure. Somatotrope-specific deletion of the LEPRb signaling isoform causes GH deficiency and obesity. The present study selectively ablated Lepr exon 1 in somatotropes, which removes the signal peptide, causing the loss of all isoforms of LEPR. Excision of Lepr exon 1 was restricted to the pituitary, and mutant somatotropes failed to respond to leptin. Young (2–3 mo) males showed a severe 84% reduction in serum GH levels and more than 60% reduction in immunolabeled GH cells compared with 41%–42% reductions in GH and GH cells in mutant females. Mutant males (35 d) and females (45 d) weighed less than controls and males had lower lean body mass. Image analysis of adipose tissue by magnetic resonance imaging showed that young males had a 2-fold increase in abdominal fat mass and increased adipose tissue density. Young females had only an overall increase in adipose tissue. Both males and females showed lower energy expenditure and higher respiratory quotient, indicating preferential carbohydrate burning. Young mutant males slept less and were more restless during the dark phase, whereas the opposite was true of females. The effects of a Cre-bearing sire on his non-Cre-recombinase bearing progeny are seen by increased respiratory quotient and reduced litter sizes. These studies elucidate clear sex differences in the extent to which somatotropes are dependent on all isoforms of LEPR. These results, which were not seen with the ablation of Lepr exon 17, highlight the severe consequences of ablation of LEPR in male somatotropes. PMID:26168341

  18. Ultrasonic Measurement of Transient Change in Stress-Strain Property of Radial Arterial Wall Caused by Endothelium-Dependent Vasodilation

    NASA Astrophysics Data System (ADS)

    Ikeshita, Kazuki; Hasegawa, Hideyuki; Kanai, Hiroshi

    2008-05-01

    The endothelial dysfunction is considered to be an initial step of atherosclerosis. Additionally, it was reported that the smooth muscle, which constructs the media of the artery, changes its characteristics owing to atherosclerosis. Therefore, it is essential to develop a method for assessing the regional endothelial function and mechanical property of the arterial wall. There is a conventional technique of measuring the transient change in the diameter of the brachial artery caused by flow-mediated dilation (FMD) after the release of avascularization. For more sensitive and regional evaluation, we developed a method of measuring the change in the elasticity of the radial artery due to FMD. In this study, the transient change in the mechanical property of the arterial wall was further revealed by measuring the stress-strain relationship during each heartbeat. The minute change in the thickness (strain) of the radial arterial wall during a cardiac cycle was measured by the phased tracking method, together with the waveform of blood pressure which was continuously measured with a sphygmometer at the radial artery. The transient change in stress-strain relationship during a cardiac cycle was obtained from the measured changes in wall thickness and blood pressure to show the transient change in instantaneous viscoelasticity. From the in vivo experimental results, the stress-strain relationship shows the hysteresis loop. The slope of the loop decreased owing to FMD, which shows that the elastic modulus decreased, and the increasing area of the loop depends on the ratio of the loss modulus (depends on viscosity) to the elastic modulus when the Voigt model is assumed. These results show a potential of the proposed method for the thorough analysis of the transient change in viscoelasticity due to FMD.

  19. Comparative study of the microvascular blood flow in the intestinal wall, wound contraction and fluid evacuation during negative pressure wound therapy in laparostomy using the V.A.C. abdominal dressing and the ABThera open abdomen negative pressure therapy system.

    PubMed

    Lindstedt, Sandra; Malmsjö, Malin; Hlebowicz, Joanna; Ingemansson, Richard

    2015-02-01

    This study aimed to compare the changes in microvascular blood flow in the small intestinal wall, wound contraction and fluid evacuation, using the established V.A.C. abdominal dressing (VAC dressing) and a new abdominal dressing, the ABThera open abdomen negative pressure therapy system (ABThera dressing), in negative pressure wound therapy (NPWT). Midline incisions were made in 12 pigs that were subjected to treatment with NPWT using the VAC or ABThera dressing. The microvascular blood flow in the intestinal wall was measured before and after the application of topical negative pressures of −50, −75 and −125mmHg using laser Doppler velocimetry. Wound contraction and fluid evacuation were also measured. Baseline blood flow was defined as 100% in all settings. The blood flow was significantly reduced to 64·6±6·7% (P <0·05) after the application of −50mmHg using the VAC dressing, and to 65·3±9·6% (P <0·05) after the application of −50mmHg using the ABThera dressing. The blood flow was significantly reduced to 39·6±6·7% (P <0·05) after the application of −125mmHg using VAC and to 40·5±6·2% (P <0·05) after the application of −125mmHg using ABThera. No significant difference in reduction in blood flow could be observed between the two groups. The ABThera system afforded significantly better fluid evacuation from the wound, better drainage of the abdomen and better wound contraction than the VAC dressing.

  20. Abdominal Adhesions

    MedlinePlus

    ... Adhesions 1 Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. Journal of Surgical Research. 2011;165(1):91–111. Seek Help for ... and how to participate, visit the NIH Clinical Research Trials and You website ... Foundation for Functional Gastrointestinal Disorders 700 West Virginia ...

  1. Repair of Large Abdominal Wall Defects Using Total Anterior Aponeurotic Flap: Anatomical Feasibility Study and Comparison with Ramirez’s Technique

    PubMed Central

    Assalino, Michela; Morel, Philippe; Fasel, Jean H. D.; Stimec, Bojan V.; Tobalem, Mickael

    2016-01-01

    Summary: In this cadaveric study, we explored the feasibility of a maximal mobilization of the superficial abdominal fascia, in a continuous flap, to achieve a tension-free covering of midline defects. The aponeurosis of the external oblique muscle was incised along the anterior axillary line and then detached up to the anterior rectus sheath. The latter was opened between the external and the internal oblique aponeurosis while keeping the continuity with the external oblique fascia. The obtained flap was solid and uninterrupted. The width gain reached 15 ± 3 cm on each sides, providing tissue advancement 60% longer than Ramirez’s technique (n = 8). The described technique allows large covering with respect to the anatomical planes. Further clinical tests should evaluate the validity of such concept in the repair of giant and asymmetrical hernias.

  2. A Point Mutation in Myh10 Causes Major Defects in Heart Development and Body Wall Closure

    PubMed Central

    Ma, Xuefei; Adelstein, Robert S.

    2014-01-01

    Background The three isoforms of nonmuscle myosin II (NMII-A, NMII-B and NMII-C) play various roles during mouse embryonic development. Previous work, using knockout and hypomorphic mice, showed that MYH10 encoding myosin heavy chain II-B is critical for cardiac and brain development. Ablating or decreasing NMII-B by 80% results in cardiac (ventricular septal defect, double outlet of the right ventricle) and brain defects but not midline fusion defects. Neither NMII-A nor II-C appear to play roles in early myocardial development. Methods and Results We had previously generated point mutant knock-in mice and now report novel findings due to expressing motor deficient NMII-B at wild-type levels. Homozygous mice die at E14.5 in cardiac failure exhibiting abnormalities not seen in NMII-B null and hypomorphic mice: a failure in midline fusion resulting in a cleft palate, ectopia cordis, and a large omphalocele. Fusion of the sternum and endocardial cushions is impaired in the mutant mice associated with a failure in apoptosis of the mesenchyme cells. Failure to disassemble myocyte cell-cell adhesions during cardiac outflow tract development contributes to impaired outflow tract myocardialization and displacement of the aorta to the right ventricle. Conclusions Expression of motor impaired NMII-B disrupts normal ventral body wall closure, due to a dominant negative effect. This is not due to the loss of NMII-B function but rather to a gain-of-function resulting from prolonged crosslinking of NMII-B to actin-filaments thereby interfering with the dynamics of actomyosin cytoskeletal structure. Moreover impaired NMII-B motor activity inhibits outflow tract myocardialization leading to mis-localization of the aorta. PMID:24825879

  3. Successful Resolution of Gastric Outlet Obstruction Caused by Pancreatic Pseudocyst or Walled-Off Necrosis After Acute Pancreatitis

    PubMed Central

    Zhang, Yun; Zhang, Shao-Yang; Gao, Shun-Liang; Liang, Zhong-Yan; Yu, Wen-Qiao; Liang, Ting-Bo

    2015-01-01

    Objective Delayed gastric emptying (DGE) in patients with acute pancreatitis (AP) can be caused by gastroparesis or gastric outlet obstruction, which may occur when pancreatic pseudocyst (PP) or walled-off necrosis (WON) compresses the stomach. The aim of the study was to explore a proper surgical treatment. Methods From June 2010 to June 2013, 25 of 148 patients with AP suffered DGE. Among them, 12 were caused by gastroparesis, 1 was a result of obstruction from a Candida albicans plug, and 12 were gastric outlet obstruction (GOO) compressed by PP (n = 8) or WON (n = 4), which were treated by percutaneous catheter drainage (PCD). Results All 12 cases of compressing GOO achieved resolution by PCD after 6 [1.86] and 37.25 [12.02] days for PP and WON, respectively. Five cases developed intracystic infection, 3 cases had pancreatic fistulae whereas 2 achieved resolution and 1 underwent a pseudocyst jejunostomy. Conclusions Gastric outlet obstruction caused by a PP or WON is a major cause of DGE in patients with AP. Percutaneous catheter drainage with multiple sites, large-bore tubing, and lavage may be a good therapy due to high safety and minimal invasiveness. PMID:26465954

  4. Staged endourologic and endovascular repair of an infrarenal inflammatory abdominal aortic aneurysm presenting with forniceal rupture.

    PubMed

    Edmonds, Rebecca D; Tomaszewski, Jeffrey J; Jackman, Stephen V; Chaer, Rabih A

    2008-11-01

    We present the case of a 79-year-old female who presented with severe left flank pain and a pulsatile abdominal mass. She was diagnosed with left peripelvic urinary extravasation and forniceal rupture secondary to an intact infrarenal inflammatory abdominal aortic aneurysm with extensive periaortic fibrosis. Successful operative repair was performed with staged ureteral and endovascular stenting with subsequent resolution of periaortic inflammation and ureteral obstruction, and shrinkage of the aneurysm sac. Inflammatory abdominal aortic aneurysms (IAAAs) represent 5% to 10% of all abdominal aortic aneurysms. The distinguishing features of inflammatory aneurysms include thickening of aneurysm wall, retroperitoneal fibrosis, and adhesions to adjacent retroperitoneal structures. The most commonly involved adjacent structures are the duodenum, left renal vein, and ureter. Adhesions to the urinary system can cause hydronephrosis or hydroureter and result in obstructive uropathy. An unusual case of IAAA presenting with forniceal rupture is presented, with successful endovascular and endourologic repair.

  5. The reverse abdominal reduction and the 'waistcoating' procedure for the correction of the fixated Pfannenstiel incision.

    PubMed

    Harrison, Douglas H

    2016-05-01

    The principles of a standard abdominal reduction are well understood; this technique has been used for many years. However, a reverse abdominal reduction may be considered in some cases, for example, continued weight loss, and thus skin redundancy on the upper abdomen in patients who have already undergone abdominal reduction and upper abdomen improvement in patients requiring a mastopexy or breast reduction simultaneously. Reverse abdominal reduction is rarely mentioned in the medical literature, but it can prove successful; although the scar across the lower sternum has often been considered to be unsatisfactory, often it does not prove to be so. Thus, this procedure can be proven to be successful in suitable cases. Secondly, the Pfannenstiel incision, if not satisfactorily repaired in the first instance, can become fixated to the abdominal wall; this fixation along with the inevitable migration of skin and fat at its cephalic edge causes a rather displeasing contour defect when wearing tight-fitting swimwear. The principle of the waistcoating procedure is essentially to chamfer the fat cephalically; this procedure is employed for removing the Pfannenstiel scar from the abdominal wall. The principle is simple and effective and can be applied in cases with fixated scars. These two aforementioned principles are not commonly used, but they can prove particularly effective in suitable cases. We illustrate the principles.

  6. Retrospective analysis of a VACM (vacuum-assisted closure and mesh-mediated fascial traction) treatment manual for temporary abdominal wall closure - results of 58 consecutive patients.

    PubMed

    Beltzer, Christian; Eisenächer, Alexander; Badendieck, Steffen; Doll, Dietrich; Küper, Markus; Lenz, Stefan; Krapohl, Björn Dirk

    2016-01-01

    Einleitung: Das optimale Behandlungskonzept eines temporären Bauchdeckenverschlusses (temporary abdominal closure, TAC) bei kritisch kranken viszeralchirurgischen Patienten mit offenem Abdomen („open abdomen“, OA) ist weiterhin unklar. Durch eine VACM-Therapie (vacuum-assisted closure and mesh-mediated fascial traction) scheinen sich gegenüber anderen Verfahren des TAC höhere Faszienverschlussraten (delayed primary fascial closure rate, FCR) realisieren zu lassen. Material und Methoden: Patienten unserer Klinik (n=58), welche in den Jahren 2005 bis 2008 mittels eines VAC/VACM-Behandlungsmanuals behandelt wurden, wurden retrospektiv analysiert. Ergebnisse: Die FCR aller Patienten betrug insgesamt 48,3% (95%-Konfidenzintervall: 34,95–61,78). Bei Patienten, bei denen im Verlauf ein Vicryl-Netz auf Faszienebene implantiert wurde (VACM-Therapie), konnte eine FCR von 61,3% realisiert werden. Die Letalität der mittels VACM therapierten Patienten betrug 45,2% (95%-KI: 27,32–63,97).Schlussfolgerung: Die Ergebnisse der eigenen Untersuchung bestätigen bisherige Studienergebnisse, die eine akzeptable FCR bei non-trauma-Patienten durch Anwendung der VACM-Therapie zeigen konnten. Die VACM-Therapie scheint aktuell Therapiekonzept der ersten Wahl bei Patienten mit OA und Indikation zum TAC zu sein.

  7. [Rupture of the free wall of the heart as cause of death in acute myocardial infarct].

    PubMed

    Hurtado Buen Abad, L; De la Ree, R; Contreras, M; González-Hermosillo, J A; Salinas, L; Cárdenas, M

    1978-01-01

    Twenty four cases with myocardial rupture among 259 patients with autopsy after death due to myocardial infarction, were compared with patients with acute myocardial infarction and death secondary to other causes. Myocardial rupture occured during the first 72 hours in 58% of the patients and all cases within the first five days. Two thirds of the patients were males and 46% were 70 years of age. There were 24 myocardial ruptures (9.5%). Previous history of arterial hypertension and un-remittent anginal pain were predisposing factors for rupture (p=0.05). Other previously reported bad prognostic factors such as persistent hipertension after acute infarction, severe exercise before infarction and history of Diabetes Mellitus were not statistically significant in this study. Ruptured myocardium was not influenced by a previous history of myocardial infarction, hospitalization delay in the C.C.U., administration of anticoagulants, digitalis or pressor amines. There was no significant difference among the groups compared in enzyme curves or magnitude of leucocytosis. Electromechanic dissociation, sinus bradycardia, nodal rhythm followed by idioventricular rhythm and asystole, were observed following myocardial rupture.

  8. Effects of the changes in the wall shear stresses (WSS) acting on endothelial cells (EC) during the enlargement of Abdominal Aortic Aneurysms (AAA)

    NASA Astrophysics Data System (ADS)

    Salsac, Anne-Virginie

    2005-03-01

    The changes in the spatial and temporal distribution of the WSS and gradients of WSS during the enlargement of AAAs are important to understand the etiology and progression of this vascular disease, since they affect the wall structural integrity, primarily via the changes induced on the shape, functions and metabolism of the endothelial cells. PIV measurements were performed in aneurysm models, while changing systematically their size and geometry. Two regions with distinct patterns of WSS were identified. The region of flow detachment extends over the proximal half and is characterized by oscillatory WSS of very low mean. The region of flow reattachment, located distally, is dominated by large, negative WSS and sustained gradients of WSS that result from the impact of the vortex ring on the wall. Cultured EC were subjected to these two types of stimuli in vitro. The permeability of the endothelium was found to be largely increased in the flow detachment region. Endothelium cell-cell adhesion, proliferation and apoptosis were also affected by the high gradients of WSS.

  9. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Siebenmann, R; Schneider, K; von Segesser, L; Turina, M

    1988-06-11

    348 cases of abdominal aortic aneurysm were reviewed for typical features of inflammatory aneurysm (IAAA) (marked thickening of aneurysm wall, retroperitoneal fibrosis and rigid adherence of adjacent structures). IAAA was present in 15 cases (14 male, 1 female). When compared with patients who had ordinary aneurysms, significantly more patients complained of back or abdominal pain (p less than 0.01). Erythrocyte sedimentation rate was highly elevated. Diagnosis was established in 7 of 10 computed tomographies. 2 patients underwent emergency repair for ruptured aneurysm. Unilateral ureteral obstruction was present in 4 cases and bilateral in 1. Repair of IAAA was performed by a modified technique. Histological examination revealed thickening of the aortic wall, mainly of the adventitial layer, infiltrated by plasma cells and lymphocytes. One 71-year-old patient operated on for rupture of IAAA died early, and another 78-year-old patient after 5 1/2 months. Control computed tomographies revealed spontaneous regression of inflammatory infiltration after repair. Equally, hydronephrosis due to ureteral obstruction could be shown to disappear or at least to decrease. IAAA can be diagnosed by computed tomography with high sensitivity. Repair involves low risk, but modification of technique is necessary. The etiology of IAAA remains unclear.

  10. Delayed bleeding and pelvic haematoma after low-energy osteoporotic pubic rami fracture in a warfarin patient: an unusual cause of abdominal pain.

    PubMed

    Sandri, Andrea; Regis, Dario; Bizzotto, Nicola

    2014-01-01

    Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED) with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with "benign" osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications.

  11. Abdominal cavity myolipoma presenting as an enlarging incisional hernia.

    PubMed

    Moore, Mark O; Richardson, Michael L; Rubin, Brian P; Baird, Geoffrey S

    2006-01-01

    We present a case of an abdominal cavity myolipoma which herniated through a low transverse abdominal (Pfannenstiel) incision, and presented as an enlarging abdominal wall mass. Magnetic resonance imaging (MRI) prior to surgery demonstrated an encapsulated solid tumor mass demonstrating fat signal and and increased T2-weighted signal. Postsurgical histological tissue diagnosis was myolipoma. Recognition of the intra- and extraperitoneal location of this abdominal tumor was essential for accurate surgical planning.

  12. A bizarre abdominal cystic lesion.

    PubMed

    Zucchini, Giorgia; Pezzilli, Raffaele; Ricci, Claudio; Casadei, Riccardo; Santini, Donatella; Calculli, Lucia; Corinaldesi, Roberto

    2010-09-06

    In spite of careful intraoperative precautions and gauze counts, mistakes can still occur during surgery. In the case reported, a retained gauze leaved during a surgical approach for removing a solid-cystic papillary tumor localized in the pancreatic tail, caused both persistent abdominal discomfort and the presence of an abdominal cystic lesion at imaging techniques. When a previous operative history is present, a foreign body should be taken into account in the differential diagnosis of a patient with an intra-abdominal cystic mass. Finally, radio-opaque marker should be routinely used by surgeons in order to reach a correct diagnosis in operated patients having retained gauze.

  13. Disruption of the microtubule network alters cellulose deposition and causes major changes in pectin distribution in the cell wall of the green alga, Penium margaritaceum

    PubMed Central

    Domozych, David S.

    2014-01-01

    Application of the dintroaniline compound, oryzalin, which inhibits microtubule formation, to the unicellular green alga Penium margaritaceum caused major perturbations to its cell morphology, such as swelling at the wall expansion zone in the central isthmus region. Cell wall structure was also notably altered, including a thinning of the inner cellulosic wall layer and a major disruption of the homogalacturonan (HG)-rich outer wall layer lattice. Polysaccharide microarray analysis indicated that the oryzalin treatment resulted in an increase in HG abundance in treated cells but a decrease in other cell wall components, specifically the pectin rhamnogalacturonan I (RG-I) and arabinogalactan proteins (AGPs). The ring of microtubules that characterizes the cortical area of the cell isthmus zone was significantly disrupted by oryzalin, as was the extensive peripheral network of actin microfilaments. It is proposed that the disruption of the microtubule network altered cellulose production, the main load-bearing component of the cell wall, which in turn affected the incorporation of HG in the two outer wall layers, suggesting coordinated mechanisms of wall polymer deposition. PMID:24285826

  14. Is the great attractor really a great wall?. [late-time cosmological phase transition producing coherent velocity caused by relic domain wall repulsive effect

    NASA Technical Reports Server (NTRS)

    Stebbins, Albert; Turner, Michael S.

    1989-01-01

    Some of the cosmological consequences of a late-time phase transition which produces light domain walls are discussed. The observed peculiar velocity field of the universe and the observed isotropy of the microwave backgroud radiation severely constrain the wall surface density in such as scenario: G(omega) less than about 0.0001 H0 (H0 is the present value of the Hubble parameter). The most interesting consequence of such a phase transition is the possibility that the local, coherent streaming motion of about 600 km/s reported by Dressler et al (1987) could be explained by the repulsive effect of a relic domain wall within the Hubble volume provided that G(omega)/H0 = 0.0001.

  15. [Drainage as a rare cause of intestinal incarceration].

    PubMed

    Kadija, Sasa; Sparić, Radmila; Zizić, Vojislav; Stefanović, Aleksandar

    2005-01-01

    Silicone drains are often placed in the abdominal cavity for prophylactic reasons. One complication resulting from drainage includes visceral herniation at the drain site of the abdominal wall defect. An 82-year-old woman underwent a laparotomy for a large pelvic mass. After the operation, she developed small bowel incarceration, which was caused by aggressive drain extraction. Subsequent surgical treatment resulted in the patient's full recovery. This case emphasises the unusual causative mechanism of intestinal obstruction. Drains should be placed carefully in the abdominal cavity in strictly selected cases, only when it is reasonable to do so.

  16. Abdominal tuberculosis.

    PubMed Central

    Kapoor, V. K.

    1998-01-01

    Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 PMID:9926119

  17. Functional Abdominal Pain in Children

    MedlinePlus

    ... the child’s mood and emotions, and in turn cause depression and anxiety. Screening/Diagnosis Detailed information regarding the location of abdominal pain, the frequency (number of times per week) and ... about the cause, and will guide further testing. Other important pieces ...

  18. [Deviation of the abdominal aorta and common iliac arteries due to aging and kidney dystopia].

    PubMed

    Zhelobtsov, P M

    1982-12-01

    A specific peculiarity in the relief changeability and position of the abdominal aorta, the common iliac arteries is a segmentary deformity occurring in aged persons as a result of atherosclerotic alterations in their walls. A congenital homolateral dystopia, horseshoe and double kidney are rather seldom developmental anomalies in mature persons. In newborns, however, they are found 6-7 times more often and together with other congenital defects of the kidneys make evidently an often cause of the fetal and infantile death.

  19. Functional abdominal pain

    PubMed Central

    Matthews, P; Aziz, Q

    2005-01-01

    Functional abdominal pain or functional abdominal pain syndrome (FAPS) is an uncommon functional gut disorder characterised by chronic or recurrent abdominal pain attributed to the gut but poorly related to gut function. It is associated with abnormal illness behaviour and patients show psychological morbidity that is often minimised or denied in an attempt to discover an organic cause for symptoms. Thus the conventional biomedical approach to the management of such patients is unhelpful and a person's symptom experience is more usefully investigated using a biopsychosocial evaluation, which necessarily entails a multidisciplinary system of healthcare provision. Currently the pathophysiology of the disorder is poorly understood but is most likely to involve a dysfunction of central pain mechanisms either in terms of attentional bias, for example, hypervigilance or a failure of central pain modulation/inhibition. Although modern neurophysiological investigation of patients is promising and may provide important insights into the pathophysiology of FAPS, current clinical management relies on an effective physician-patient relationship in which limits on clinical investigation are set and achievable treatment goals tailored to the patient's needs are pursued. PMID:15998821

  20. The effects of nicotine administration on the pathophysiology of rat aortic wall.

    PubMed

    Kugo, H; Zaima, N; Tanaka, H; Urano, T; Unno, N; Moriyama, T

    2017-01-01

    Abdominal aortic aneurysm (AAA) is the progressive dilation of the abdominal aorta. Nicotine is reported to be associated with the development and rupture of AAA, but the pathological effects of nicotine on normal rat aorta have not been determined. We investigated pathological changes in the aortic wall of rats caused by the administration of nicotine. Nicotine administration weakened the vascular wall, increased gelatinolytic activity and promoted the destruction of elastin and collagen in the rat abdominal aorta. There were no differences in the areas positive for matrix metalloproteinase (MMP)-2 and MMP-9 between the control and nicotine treated groups. The areas positive for MMP-12 in the nicotine group were significantly greater than for the control group. Gelatinolytic activity in the aortic wall was increased significantly in the nicotine group. Our findings suggest that MMP-12 is sensitive to nicotine exposure in rats.

  1. Abdominal sounds

    MedlinePlus

    ... may be a sign of early bowel obstruction. Causes Most of the sounds you hear in your stomach and intestines are ... a list of more serious conditions that can cause abnormal bowel sounds. Hyperactive, hypoactive, or missing bowel sounds may be ...

  2. Common abdominal emergencies in children.

    PubMed

    D'Agostino, James

    2002-02-01

    Because young children often present to EDs with abdominal complaints, emergency physicians must have a high index of suspicion for the common abdominal emergencies that have serious sequelae. At the same time, they must realize that less serious causes of abdominal symptoms (e.g., constipation or gastroenteritis) are also seen. A gentle yet thorough and complete history and physical examination are the most important diagnostic tools for the emergency physician. Repeated examinations and observation are useful tools. Physicians should listen carefully to parents and their children, respect their concerns, and honor their complaints. Ancillary tests are inconsistent in their value in assessing these complaints. Abdominal radiographs can be normal in children with intussusception and even malrotation and early volvulus. Unlike the classic symptoms seen in adults, young children can display only lethargy or poor feeding in cases of appendicitis or can appear happy and playful between paroxysmal bouts of intussusception. The emergency physician therefore, must maintain a high index of suspicion for serious pathology in pediatric patients with abdominal complaints. Eventually, all significant abdominal emergencies reveal their true nature, and if one can be patient with the child and repeat the examinations when the child is quiet, one will be rewarded with the correct diagnosis.

  3. Assessment of the patient with acute abdominal pain.

    PubMed

    Cole, Elaine; Lynch, Antonia; Cugnoni, Helen

    Abdominal pain has many causes, from simple to complex presentations. Patients with abdominal pain may have a number of physiological and psychological needs. Nurses have a key role to play in patient assessment, history talking and management.

  4. Endovascular Repair of a Perforation of the Vena Caval Wall Caused by the Retrieval of a Gunther Tulip Filter After Long-Term Implantation

    SciTech Connect

    Morishita, Hiroyuki; Yamagami, Takuji; Matsumoto, Tomohiro; Takeuchi, Yoshito; Sato, Osamu; Nishimura, Tsunehiko

    2011-02-15

    Symptomatic penetration of the inferior vena cava (IVC) wall reportedly occurs in 0.3% of patients in whom a filter has been implanted, and it causes injury to the adjacent structures (Bogue et al. in Pediatr Radiol 39(10):1110-1113, 1; Brzezinski et al. in Burns 32(5):640-643, 2). We succeeded in the endovascular repair of perforation of the IVC wall occurring during the retrieval of a penetrated Gunther tulip vena cava filter (Cook, Bjaeverskov, Denmark) after long-term implantation.

  5. Abdominal bloating

    MedlinePlus

    ... Some other medicines or foods containing lactulose or sorbitol, may cause bloating. More serious disorders that may ... from foods with high levels of fructose or sorbitol. Avoid foods that can produce gas, such as ...

  6. Abdominal rigidity

    MedlinePlus

    Rigidity of the abdomen ... is a sore area inside the belly or abdomen, the pain will get worse when a hand ... Causes can include: Abscess inside the abdomen Appendicitis ... small intestine, large bowel, or gallbladder ( gastrointestinal ...

  7. Abdominal mass

    MedlinePlus

    ... lumpy mass in the right upper quadrant. Liver enlargement (hepatomegaly) can cause a firm, irregular mass below ... the kidney (usually only affects one kidney). Spleen enlargement (splenomegaly) can sometimes be felt in the left- ...

  8. The preventive effect of fish oil on abdominal aortic aneurysm development.

    PubMed

    Kugo, Hirona; Zaima, Nobuhiro; Mouri, Youhei; Tanaka, Hiroki; Yanagimoto, Kenichi; Urano, Tetsumei; Unno, Naoki; Moriyama, Tatsuya

    2016-06-01

    Abdominal aortic aneurysm (AAA) is a vascular disease involving gradual dilation of the abdominal aorta and high rupture-related mortality rates. AAA is histologically characterized by oxidative stress, chronic inflammation, and extracellular matrix degradation in the vascular wall. We previously demonstrated that aortic hypoperfusion could cause the vascular inflammation and AAA formation. However, the preventive method for hypoperfusion-induced AAA remains unknown. In this study, we evaluated the effect of fish oil on AAA development using a hypoperfusion-induced AAA animal model. Dilation of the abdominal aorta in the fish oil administration group was smaller than in the control group. Collagen destruction and oxidative stress were suppressed in the fish oil administration group than in the control group. These results suggested that fish oil could prevent the development of AAA induced by hypoperfusion.

  9. [Diagnostic imaging and acute abdominal pain].

    PubMed

    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.

  10. [Gallstone ileus. Abdominal CT usefulness].

    PubMed

    Sukkarieh, F; Brasseur, P; Bissen, L

    2004-06-01

    The authors report the case of a 93-year old woman referred to the emergency department and presenting with an intestinal obstruction. Abdominal CT reveals a biliary ileus caused by the migration and the impaction of a 3 cm gallstone in the small bowel. Surgical treatment by enterolithotomy was successful. In over 90% of cases, gallstone ileus is a complication of cholelithiasis and accounts for 25% of intestinal obstruction in patients over 65 years. To reduce morbidity and mortality, early diagnosis and prompt treatment are essential. Abdominal CT-scan is the gold standard technique.

  11. Abdominal Migraine in a Middle-aged Woman

    PubMed Central

    Kunishi, Yosuke; Iwata, Yuri; Ota, Mitsuyasu; Kurakami, Yuichi; Matsubayashi, Mao; Kanno, Masatomo; Kuboi, Yoriko; Yoshie, Koichiro; Kato, Yoshio

    2016-01-01

    A 52-year-old woman presented with recurrent, severe abdominal pain. Laboratory tests and imaging were insignificant, and treatment for functional dyspepsia was ineffective. The poorly localized, dull, and severe abdominal pain, associated with anorexia, nausea, and vomiting, was consistent with abdominal migraine. The symptoms were relieved by loxoprofen and lomerizine, which are used in the treatment of migraine. We herein report a case of abdominal migraine in a middle-aged woman. Abdominal migraine should be considered as a cause of abdominal pain as it might easily be relieved by appropriate treatment. PMID:27725538

  12. Gender Differences in Abdominal Aortic Aneurysms

    PubMed Central

    Hannawa, Kevin K.; Eliason, Jonathan L.; Upchurch, Gilbert R.

    2010-01-01

    Abdominal aortic aneurysms (AAAs) comprise the 10th leading cause of death in Caucasian males 65–74 years of age, and accounted for nearly 16,000 deaths overall in the year 2000. Therefore, understanding the pathophysiology of AAAs is an important undertaking. Clinically, multiple risk factors are associated with the development of AAAs, including increasing age, positive smoking history, and hypertension. Male gender is also a well-established risk factor for the development of an AAA with a 4:1 male to female ratio. The reason for this gender disparity is unknown. The pathogenesis of AAAs formation is complex and multifactorial. Histologically, AAAs are characterized by early chemokine driven leukocyte infiltration into the aortic wall. Subsequent destruction of elastin and collagen in the media and adventitia ensues due to excessive local production of matrix degrading enzymes, and is accompanied by smooth muscle cell loss and thinning of the aortic wall. At present, there are no medical therapies available to treat patients with aortic aneurysms, using only the crude measurement of aortic diameter as a threshold for which patients must undergo life-threatening and costly surgery. Defining the early mechanisms underlying gender-related differences in AAA formation are critical, as understanding differences in disease patterns based on gender may allow us to develop new translational approaches to the prevention and treatment of patients with aortic aneurysms. PMID:19426607

  13. Lateral abdominal muscle size at rest and during abdominal drawing-in manoeuvre in healthy adolescents.

    PubMed

    Linek, Pawel; Saulicz, Edward; Wolny, Tomasz; Myśliwiec, Andrzej; Kokosz, Mirosław

    2015-02-01

    Lateral abdominal wall muscles in children and adolescents have not been characterised to date. In the present report, we examined the reliability of the ultrasound measurement and thickness of the oblique external muscle (OE), oblique internal muscle (OI) and transverse abdominal muscle (TrA) at rest and during abdominal drawing-in manoeuvre (ADIM) on both sides of the body in healthy adolescents. We also determined possible differences between boys and girls and defined any factors-such as body mass, height and BMI-that may affect the thickness of the abdominal muscles. B-mode ultrasound was used to assess OE, OI and TrA on both sides of the body in the supine position. Ultrasound measurements at rest and during ADIM were reliable in this age group (ICC3,3 > 0.92). OI was always the thickest and TrA the thinnest muscle on both sides of the body. In this group, an identical pattern of the contribution of the individual muscles to the structure of the lateral abdominal wall (OI > OE > TrA) was observed. At rest and during ADIM, no statistically significant side-to-side differences were demonstrated in either gender. The body mass constitutes between 30% and <50% of the thickness differences in all muscles under examination at rest and during ADIM. The structure of lateral abdominal wall in adolescents is similar to that of adults. During ADIM, the abdominal muscles in adolescents react similarly to those in adults. This study provided extensive information regarding the structure of the lateral abdominal wall in healthy adolescents.

  14. A Case of Infective Abdominal Aortic Aneurysm due to Haemophilus influenzae Type B

    PubMed Central

    Sato, Toshimitsu; Kobayashi, Masayoshi

    2012-01-01

    Infective abdominal aortic aneurysm (IAAA) is relatively rare, but a case which is caused by Haemophilus influenzae type B is very rare. We experienced one IAAA case due to H. influenzae type B. The patient was 69-year-old man presenting with severe abdominal and back pain and elevated C-reactive protein (CRP), as inflammatory marker. The patient was found to have saccular aneurysm infrarenal aorta on computed tomography scanning. First, we started to treat him with antibiotic agent and second, we operated him at day 8 after admission with expanded polytetrafluoroethylene graft. Revascularization was made in situ reconstruction. As the result of culture with aneurysm wall, we found that the cause of this aneurysm was the infection of H. influenzae type B. As far as we know, this bacterium is scarcely reported as the cause of infective aortic aneurysms. We reported this IAAA case with the review of the English literature. PMID:23997558

  15. A Case of Infective Abdominal Aortic Aneurysm due to Haemophilus influenzae Type B.

    PubMed

    Sato, Toshimitsu; Kobayashi, Masayoshi

    2012-09-01

    Infective abdominal aortic aneurysm (IAAA) is relatively rare, but a case which is caused by Haemophilus influenzae type B is very rare. We experienced one IAAA case due to H. influenzae type B. The patient was 69-year-old man presenting with severe abdominal and back pain and elevated C-reactive protein (CRP), as inflammatory marker. The patient was found to have saccular aneurysm infrarenal aorta on computed tomography scanning. First, we started to treat him with antibiotic agent and second, we operated him at day 8 after admission with expanded polytetrafluoroethylene graft. Revascularization was made in situ reconstruction. As the result of culture with aneurysm wall, we found that the cause of this aneurysm was the infection of H. influenzae type B. As far as we know, this bacterium is scarcely reported as the cause of infective aortic aneurysms. We reported this IAAA case with the review of the English literature.

  16. Partial splenectomy, transposition of the spleen to the abdominal wall or splenohepatoplasty in portal hypertensive rats. Effects on portal venous pressure and homeostasis--microscopical appearance of the transposed spleen.

    PubMed

    Tröbs, R B; Bennek, J

    1998-06-01

    Reduction of the splenic volume by partial resection and collateral development after transposition are of potential value in the elective treatment of esophageal varices, hypersplenism and ascites. A study was performed on young Wistar rats. A simple animal model of extrahepatic portal hypertension was used, narrowing the portal vein to an outer diameter of one millimeter (PVS). One day, three weeks and seven weeks after this operation the portal venous pressure was elevated as compared with the sham-operated controls. The portal hypertension was statistically significant at week three (1.31 +/- 0.04 vs. 0.72 +/- 0.18 kPa, p = 0.01). Portocaval pressure gradient after partial resection of the spleen (SR) and intramuscular transposition (IMTrans) was compared with the pressure gradient after graded portal vein stenosis. Three weeks after intramuscular transposition portocaval pressure gradient was reduced (1.46 +/- 0.38 vs. 1.74 +/- 0.13 kPa, n.s.). This data supports the hypothesis that the portal venous high-pressure compartment and the systemic venous low-pressure compartment are maintained after development of natural shunts to the systemic circulation. In the following experiment different types of splenic transposition were tested and compared to each other and a normal control group or to rats with protal vein stenosis (PVS), respectively. After PVS, the animals were reoperated, an SR was performed and the wound surface of the spleen was transposed into the left abdominal wall subcutaneously (SCTrans) or intramuscularly (IMTrans) or to the left liver lobe (splenohepatoplasty, SHP), respectively. After three weeks the animals underwent measurements of organ weights, collections of blood samples and the spleen was investigated histologically. Blood cell counts were nearly normal but total serum protein, albumin and the colloid osmotic pressure were slightly diminished or significantly reduced (COP in the groups PVS + SR + IMTrans or SCTrans, p < 0.05) compared

  17. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC)123456

    PubMed Central

    Ward, Heather A; Norat, Teresa; Luan, Jian’an; May, Anne M; Weiderpass, Elisabete; Sharp, Stephen J; Overvad, Kim; Østergaard, Jane Nautrup; Tjønneland, Anne; Johnsen, Nina Føns; Mesrine, Sylvie; Fournier, Agnès; Fagherazzi, Guy; Trichopoulou, Antonia; Lagiou, Pagona; Trichopoulos, Dimitrios; Li, Kuanrong; Kaaks, Rudolf; Ferrari, Pietro; Licaj, Idlir; Jenab, Mazda; Bergmann, Manuela; Boeing, Heiner; Palli, Domenico; Sieri, Sabina; Panico, Salvatore; Tumino, Rosario; Vineis, Paolo; Peeters, Petra H; Monnikhof, Evelyn; Bueno-de-Mesquita, H Bas; Quirós, J Ramón; Agudo, Antonio; Sánchez, María-José; Huerta, José María; Ardanaz, Eva; Arriola, Larraitz; Hedblad, Bo; Wirfält, Elisabet; Sund, Malin; Johansson, Mattias; Key, Timothy J; Travis, Ruth C; Khaw, Kay-Tee; Brage, Søren; Wareham, Nicholas J; Riboli, Elio

    2015-01-01

    Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear. Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures. Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Center-specific PAF associated with inactivity, body mass index (BMI; in kg/m2) (>30), and WC (≥102 cm for men, ≥88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures. Results: Significant interactions (PA × BMI and PA × WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16–30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity. Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which

  18. [Abdominal pregnancy care. Case report].

    PubMed

    Morales Hernández, Sara; Díaz Velázquez, Mary Flor; Puello Tamara, Edgardo; Morales Hernández, Jorge; Basavilvazo Rodríguez, Maria Antonia; Cruz Cruz, Polita del Rocío; Hernández Valencia, Marcelino

    2008-10-01

    Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.

  19. Abdominal aortic aneurysm

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/000162.htm Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  20. [Inflammatory aneurysms of the abdominal aorta].

    PubMed

    Tovar Martín, E; Acea Nebril, B

    1993-01-01

    Approximately 10 per cent of abdominal aneurysms have an excessively thick wall that sometimes involve duodenum, cava or colon by an inflammatory process. Between February 1986 and December 1992, 147 patients with abdominal aortic aneurysm (AAA) were treated surgically and in 13 (8.8%) the aneurysms were found to be inflammatory. Their mean age was 67.3 years (70.1 years in non inflammatory group) and all were symptomatics initially (abdominal pain in 53%, rupture in 23%, mass in 15%). The operative mortality for elective resection was 37% in patients with inflammatory abdominal aortic aneurysms (IAAA) decreasing to 9% in the AAA group without inflammatory involvement. We conclude that surgery is indicated in these patients to prevent rupture and to hasten the subsidense of inflammatory process ever with postoperative morbi-mortality increased.

  1. Fertility after abdominal myomectomy.

    PubMed

    Connolly, G; Doyle, M; Barrett, T; Byrne, P; De Mello, M; Harrison, R F

    2000-07-01

    This study aimed to evaluate the morbidity and pregnancy outcome of myomectomy in infertile women with uterine fibroids. This was a cross-sectional study. Records were reviewed for 100 consecutive women in the Rotunda Hospital who underwent myomectomy in the years 1995-1996. A questionnaire regarding subsequent fertility was sent. The study was carried out in the infertility unit at the Rotunda Hospital, Dublin, Ireland. Seventy-five women responded. Multiple myomectomy was performed in 52 (70%). Mean fibroid size was 6.8 cm (range 2-14.5 cm). Nine women (12%) developed complications; five had menstrual problems, two had wound discomfort and two had abdominal discomfort. Twenty-five women (33%) became pregnant. Seven (28%) were IVF pregnancies. Overall six (24%) miscarried. In 19 of 25, pregnancy occurred where fibroids were the only identifiable cause of infertility. We conclude that abdominal myomectomy is associated with a favourable outcome in infertile women particularly if no other confounding variable is present.

  2. In Vitro Activity of Ceftazidime-Avibactam against Isolates in a Phase 3 Open-Label Clinical Trial for Complicated Intra-Abdominal and Urinary Tract Infections Caused by Ceftazidime-Nonsusceptible Gram-Negative Pathogens.

    PubMed

    Stone, Gregory G; Bradford, Patricia A; Newell, Paul; Wardman, Angela

    2017-02-01

    The in vitro activity of ceftazidime-avibactam was evaluated against 341 Gram-negative isolates from 333 patients in a randomized, phase 3 clinical trial of patients with complicated urinary tract or intra-abdominal infections caused by ceftazidime-nonsusceptible pathogens (NCT01644643). Ceftazidime-avibactam MIC90 values against Enterobacteriaceae and Pseudomonas aeruginosa (including several class B or D enzyme producers that avibactam does not inhibit) were 1 and 64 μg/ml, respectively. Overall, the ceftazidime-avibactam activity against ceftazidime-nonsusceptible isolates was comparable to the activity of ceftazidime-avibactam previously reported against ceftazidime-susceptible isolates. (This study has been registered at ClinicalTrials.gov under identifier NCT01644643.).

  3. Intra-abdominal bleeding in appendicitis.

    PubMed

    Thongprayoon, C; Pasa-Arj, S

    1991-08-01

    A 34-year-old woman, gravida 6 with 10 weeks of gestation was admitted because of abdominal pain and fainting. On physical examination she had hypotension, was pale with abdominal tenderness and guarding. Culdocentesis yielded unclotted blood. Immediate laparotomy was performed, because a diagnosis of ectopic pregnancy was made. About 2,500 ml of fresh blood was found in the abdominal cavity. Appendicular artery tear caused active arterial bleeding. The torn appendicular artery was observed to be the consequence of perforated appendicitis, which, in turn, was caused by a faecalith. Appendectomy was performed and she made a good recovery.

  4. Limb body wall complex, amniotic band sequence, or new syndrome caused by mutation in IQ Motif containing K (IQCK)?

    PubMed Central

    Kruszka, Paul; Uwineza, Annette; Mutesa, Leon; Martinez, Ariel F; Abe, Yu; Zackai, Elaine H; Ganetzky, Rebecca; Chung, Brian; Stevenson, Roger E; Adelstein, Robert S; Ma, Xuefei; Mullikin, James C; Hong, Sung-Kook; Muenke, Maximilian

    2015-01-01

    Limb body wall complex (LBWC) and amniotic band sequence (ABS) are multiple congenital anomaly conditions with craniofacial, limb, and ventral wall defects. LBWC and ABS are considered separate entities by some, and a continuum of severity of the same condition by others. The etiology of LBWC/ABS remains unknown and multiple hypotheses have been proposed. One individual with features of LBWC and his unaffected parents were whole exome sequenced and Sanger sequenced as confirmation of the mutation. Functional studies were conducted using morpholino knockdown studies followed by human mRNA rescue experiments. Using whole exome sequencing, a de novo heterozygous mutation was found in the gene IQCK: c.667C>G; p.Q223E and confirmed by Sanger sequencing in an individual with LBWC. Morpholino knockdown of iqck mRNA in the zebrafish showed ventral defects including failure of ventral fin to develop and cardiac edema. Human wild-type IQCK mRNA rescued the zebrafish phenotype, whereas human p.Q223E IQCK mRNA did not, but worsened the phenotype of the morpholino knockdown zebrafish. This study supports a genetic etiology for LBWC/ABS, or potentially a new syndrome. PMID:26436108

  5. Substantiation of causes for damage of water-wall tubes of an external salt compartment of a high-pressure boiler

    NASA Astrophysics Data System (ADS)

    Fedorov, A. I.

    2014-10-01

    The damageability for water-wall tubes of an external salt compartment of a TPE-208 boiler is analyzed. The general cause for tube damage is the intensive underslime corrosion of the inner surface, which is caused by a local increase in the salt concentration in boiler water. The experiment-calculated method showed that continuous bleeding from an external cyclone being the first in water downstream causes a substantial increase in the concentration of salts (more than by a factor of three) and scale-forming agents within a contour of the loop of a distant cyclone in comparison with the variant of bleeding from a loop being the second in water downstream.

  6. Advancements in identifying biomechanical determinants for abdominal aortic aneurysm rupture.

    PubMed

    Kontopodis, Nikolaos; Metaxa, Eleni; Papaharilaou, Yannis; Tavlas, Emmanouil; Tsetis, Dimitrios; Ioannou, Christos

    2015-02-01

    Abdominal aortic aneurysms are a common health problem and currently the need for surgical intervention is determined based on maximum diameter and growth rate criteria. Since these universal variables often fail to predict accurately every abdominal aortic aneurysms evolution, there is a considerable effort in the literature for other markers to be identified towards individualized rupture risk estimations and growth rate predictions. To this effort, biomechanical tools have been extensively used since abdominal aortic aneurysm rupture is in fact a material failure of the diseased arterial wall to compensate the stress acting on it. The peak wall stress, the role of the unique geometry of every individual abdominal aortic aneurysm as well as the mechanical properties and the local strength of the degenerated aneurysmal wall, all confer to rupture risk. In this review article, the assessment of these variables through mechanical testing, advanced imaging and computational modeling is reviewed and the clinical perspective is discussed.

  7. Low temperature caused modifications in the arrangement of cell wall pectins due to changes of osmotic potential of cells of maize leaves (Zea mays L.).

    PubMed

    Bilska-Kos, Anna; Solecka, Danuta; Dziewulska, Aleksandra; Ochodzki, Piotr; Jończyk, Maciej; Bilski, Henryk; Sowiński, Paweł

    2017-03-01

    The cell wall emerged as one of the important structures in plant stress responses. To investigate the effect of cold on the cell wall properties, the content and localization of pectins and pectin methylesterase (PME) activity, were studied in two maize inbred lines characterized by different sensitivity to cold. Low temperature (14/12 °C) caused a reduction of pectin content and PME activity in leaves of chilling-sensitive maize line, especially after prolonged treatment (28 h and 7 days). Furthermore, immunocytohistological studies, using JIM5 and JIM7 antibodies, revealed a decrease of labeling of both low- and high-methylesterified pectins in this maize line. The osmotic potential, quantified by means of incipient plasmolysis was lower in several types of cells of chilling-sensitive maize line which was correlated with the accumulation of sucrose. These studies present new finding on the effect of cold stress on the cell wall properties in conjunction with changes in the osmotic potential of maize leaf cells.

  8. Hypovolemic shock in children: abdominal CT manifestations.

    PubMed

    Taylor, G A; Fallat, M E; Eichelberger, M R

    1987-08-01

    The authors describe a "hypoperfusion complex," seen on abdominal computed tomography, which consists of marked, diffuse dilatation of the intestine with fluid; abnormally intense contrast enhancement of the bowel wall, mesentery, kidneys, and/or pancreas; decreased caliber of the abdominal aorta and inferior vena cava; and moderate to large peritoneal fluid collections. This complex was present in three patients less than 2 years of age and was associated with severe injury and a poor outcome. Recognition of this constellation of findings may help direct attention to the patient's serious hemodynamic abnormality as much as to individual organ defects.

  9. [Intraabdominal hypertension and abdominal compartment syndrome].

    PubMed

    Sonne, Morten; Hillingsø, Jens

    2008-02-11

    Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are rare conditions with high mortality. IAH is an intraabdominal pressure (IAP) above 12 mmHg and ACS an IAP above 20 mmHg with evidence of organ dysfunction. IAP is measured indirectly via the bladder or stomach. Various medical and surgical conditions increase the intraabdominal volume. When the content exceeds the compliance of the abdominal wall, the IAP rises. Increased IAP affects the functioning of the brain, lungs, circulation, kidneys, and bowel. The treatment of ACS is a reduction of IAP.

  10. [Dirofilaria in the abdominal cavity].

    PubMed

    Révész, Erzsébet; Markovics, Gabriella; Darabos, Zoltán; Tóth, Ildikó; Fok, Eva

    2008-10-01

    Number of cases of filariasis have been recently reported in the Hungarian medical literature, most of them caused by Dirofilaria repens . Dirofilaria repens is a mosquito-transmitted filarioid worm in the subcutaneous tissue of dogs and cats. Human infection manifests as either subcutaneous nodules or lung parenchymal disease, which may even be asymptomatic. The authors report a human Dirofilaria repens infection of the abdominal cavity in a 61-year-old man,who underwent laparotomy for acute abdomen. Intraoperatively, local peritonitis was detected caused by a white nemathhelminth, measured 8 cm in size. Histocytology confirmed that the infection was caused by Dirofilaria repens.

  11. [Abdominal pregnancy, institutional experience].

    PubMed

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q

    1998-07-01

    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy.

  12. Desmoid tumor following abdominally-based free flap breast reconstruction

    PubMed Central

    Oh, Christine; Hammoudeh, Ziyad S.

    2017-01-01

    Desmoid tumors are fibroblastic connective tissue tumors that most commonly develop within the anterior abdominal wall. The etiology of desmoid tumors has not been well defined; however, hereditary, hormonal, traumatic, and surgery-related causes have been implicated. Desmoid tumors are believed to arise from musculoaponeurotic structures. Development in the breast is very rare. Several reports of desmoid tumors arising in the vicinity of the fibrous capsule of a breast implant have been described, but to date, the authors are not aware of any published cases following autologous breast reconstruction. This report describes a desmoid tumor developing after a muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction and subsequent surgical management. PMID:28210557

  13. A Novel FC116/BC10 Mutation Distinctively Causes Alteration in the Expression of the Genes for Cell Wall Polymer Synthesis in Rice

    PubMed Central

    Zhang, Mingliang; Wei, Feng; Guo, Kai; Hu, Zhen; Li, Yuyang; Xie, Guosheng; Wang, Yanting; Cai, Xiwen; Peng, Liangcai; Wang, Lingqiang

    2016-01-01

    We report isolation and characterization of a fragile culm mutant fc116 that displays reduced mechanical strength caused by decreased cellulose content and altered cell wall structure in rice. Map-based cloning revealed that fc116 was a base substitution mutant (G to A) in a putative beta-1,6-N-acetylglucosaminyltransferase (C2GnT) gene (LOC_Os05g07790, allelic to BC10). This mutation resulted in one amino acid missing within a newly-identified protein motif “R, RXG, RA.” The FC116/BC10 gene was lowly but ubiquitously expressed in the all tissues examined across the whole life cycle of rice, and slightly down-regulated during secondary growth. This mutant also exhibited a significant increase in the content of hemicelluloses and lignins, as well as the content of pentoses (xylose and arabinose). But the content of hexoses (glucose, mannose, and galactose) was decreased in both cellulosic and non-cellulosic (pectins and hemicelluloses) fractions of the mutant. Transcriptomic analysis indicated that the typical genes in the fc116 mutant were up-regulated corresponding to xylan biosynthesis, as well as lignin biosynthesis including p-hydroxyphenyl (H), syringyl (S), and guaiacyl (G). Our results indicate that FC116 has universal function in regulation of the cell wall polymers in rice. PMID:27708650

  14. Hypoperfusion of the Adventitial Vasa Vasorum Develops an Abdominal Aortic Aneurysm.

    PubMed

    Tanaka, Hiroki; Zaima, Nobuhiro; Sasaki, Takeshi; Sano, Masaki; Yamamoto, Naoto; Saito, Takaaki; Inuzuka, Kazunori; Hayasaka, Takahiro; Goto-Inoue, Naoko; Sugiura, Yuki; Sato, Kohji; Kugo, Hirona; Moriyama, Tatsuya; Konno, Hiroyuki; Setou, Mitsutoshi; Unno, Naoki

    2015-01-01

    The aortic wall is perfused by the adventitial vasa vasorum (VV). Tissue hypoxia has previously been observed as a manifestation of enlarged abdominal aortic aneurysms (AAAs). We sought to determine whether hypoperfusion of the adventitial VV could develop AAAs. We created a novel animal model of adventitial VV hypoperfusion with a combination of a polyurethane catheter insertion and a suture ligation of the infrarenal abdominal aorta in rats. VV hypoperfusion caused tissue hypoxia and developed infrarenal AAA, which had similar morphological and pathological characteristics to human AAA. In human AAA tissue, the adventitial VV were stenotic in both small AAAs (30-49 mm in diameter) and in large AAAs (> 50 mm in diameter), with the sac tissue in these AAAs being ischemic and hypoxic. These results indicate that hypoperfusion of adventitial VV has critical effects on the development of infrarenal AAA.

  15. [Secretory activity of the stomach during modeling of increased filling of abdominal veins].

    PubMed

    Afonin, B V; Goncharova, N P

    2009-01-01

    Determination of the stomach secretory activity and ultrasonic investigation of the gastroduodenal organs and vessels were performed in test-subjects tilted at -12 degrees and -15 degrees. Short HDT(12-24 hrs.) as a hypokinesia factor was minimized which caused enlargement of the parenchymatous and thickening of walls of the hollow organs. Increased filling of the abdominal veins was paralleled by rise in pepsinogen levels in blood and urine, and increase in the intravitelline content in fasting subjects. Elevated tone of the pylorus and retarded evacuation from the stomach indicated active hydrochloric acid secretion. Concurrently, bile and pancreas juices were secreted more profusely and intestinal content in the duodenum increased. It was shown that modeled increase of abdominal vein filling stimulates secretion as by fasting stomach so by the liver and pancreas.

  16. Distribution of extended-spectrum β-lactamases, AmpC β-lactamases, and carbapenemases among Enterobacteriaceae isolates causing intra-abdominal infections in the Asia-Pacific region: results of the study for Monitoring Antimicrobial Resistance Trends (SMART).

    PubMed

    Sheng, Wang-Huei; Badal, Robert E; Hsueh, Po-Ren

    2013-07-01

    The increasing trend of β-lactam resistance among Enterobacteriaceae is a worldwide threat. Enterobacteriaceae isolates causing intra-abdominal infections (IAI) from the Study for Monitoring Antimicrobial Resistance Trends (SMART) collected in 2008 and 2009 from the Asia-Pacific region were investigated. Detection of extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, and carbapenemases was performed by multiplex PCR. A total of 699 Enterobacteriaceae isolates with positive genotypic results, included Escherichia coli (n = 443), Klebsiella pneumoniae (n = 187), Enterobacter cloacae (n = 45), Klebsiella oxytoca (n = 9), Citrobacter freundii (n = 5), Proteus mirabilis (n = 3), Enterobacter aerogenes (n = 2), Morganella morganii (n = 2), and one each of Enterobacter asburiae, Proteus vulgaris, and Providencia rettgeri were analyzed. Nearly 20% of these β-lactamase-producing Enterobacteriaceae isolates were from community-associated IAI. CTX-M (588 isolates, including 428 [72.8%] with CTX-M-15) was the most common ESBL, followed by SHV (n = 59) and TEM (n = 4). CMY (n = 110, including 102 [92.7%] with CMY-2) was the most common AmpC β-lactamase, followed by DHA (n = 46) and ACT/MIR (n = 40). NDM (n = 65, including 62 [95.4%] with NDM-1) was the most common carbapenemase, followed by IMP (n = 7) and OXA (n = 7). Isolates from hospital-associated IAI had more complicated β-lactamase combinations than isolates from the community. Carbapenemases were all exclusively detected in Enterobacteriaceae isolates from India, except that IMP β-lactamases were also detected in Philippines and Australia. CTX-M β-lactamases were the predominant ESBLs produced by Enterobacteriaceae causing IAI in the Asia-Pacific region. Emergence of CTX-M-15-, CMY-2-, and NDM-1-producing Enterobacteriaceae isolates is of major concern and highlights the need for further surveillance in this area.

  17. Reconstruction of the Lower Abdominal Region Using Bilateral Pedicled Anterolateral Thigh Flaps Combined With Poly-Surgical Mesh: A Case Report.

    PubMed

    Zhou, Bo; Zhou, Xiao; Li, Zan; Chen, Ju-Ying; Peng, Xiao-Wei; Yang, Li-Chang; Lv, Chun-Liu

    2015-12-01

    The en-bloc resection of neoplasms on the abdominal wall often causes extensive defects that are difficult to manage. The anterolateral thigh (ALT) flap is a widely used flap in reconstructive surgery of defects. In this article, we present a case using bilateral pedicle anterolateral thigh flaps combined with a surgical polymesh to repair a large defect (22 cm × 18 cm) caused by dissection of a recurrent fibromatosis with good functional and aesthetic effects. There were no obvious morbidities or complications during a 6-month follow-up period.We conclude that the bilateral pedicle anterolateral thigh flap is a good choice for reconstruction of large lower abdominal wall defects. It can afford sufficient soft tissue coverage without obvious donor site morbidity.

  18. Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease

    PubMed Central

    Oguejiofor, Njideka; Al-Abayechi, Sarah; Njoku, Emmanuel

    2017-01-01

    Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003). This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms. PMID:28299215

  19. Effect of carbodiimide-derivatized hyaluronic acid gelatin on preventing postsurgical intra-abdominal adhesion formation and promoting healing in a rat model.

    PubMed

    Yuan, Fang; Lin, Long-Xiang; Zhang, Hui-Hui; Huang, Dan; Sun, Yu-Long

    2016-05-01

    Adhesions often occur after abdominal surgery. It could cause chronic pelvic pain, intestinal obstruction, and infertility. A hydrogel biomaterial, carbodiimide-derivatized hyaluronic acid gelatin (cd-HA gelatin), has been successfully used to reduce adhesion formation after flexor tendon grafting. This study investigated the efficacy of cd-HA gelatin in preventing postsurgical peritoneal adhesions in a rat model. The surgical traumas were created on the underlying muscle of the abdominal wall and the serosal layer of the cecum. The wounds were covered with or without cd-HA gelatin. Animals were euthanized at day 14 after surgery. Adhesion formation was assessed with adhesion degree and adhesion breaking strength. The healing of abdominal wall was evaluated with biomechanical testing and histological analysis. The adhesions occurred in all rats (n = 12) without cd-HA gelatin treatment. The application of cd-HA gelatin significantly reduced the adhesion rate from 100% to 58%. The decrease of adhesion breaking strength also manifested that cd-HA gelatin could reduce postsurgical intra-abdominal adhesion formation. Moreover, it was found that cd-HA gelatin was a safe material and could promote tissue healing. The cd-HA gelatin hydrogel could reduce the formation of intra-abdominal adhesions without adversely effects on wound healing.

  20. Maintaining end-expiratory transpulmonary pressure prevents worsening of ventilator-induced lung injury caused by chest wall constriction in surfactant-depleted rats

    PubMed Central

    Loring, Stephen H.; Pecchiari, Matteo; Valle, Patrizia Della; Monaco, Ario; Gentile, Guendalina; D'Angelo, Edgardo

    2014-01-01

    Objective To see whether in acute lung injury (ALI) 1) compression of the lungs caused by thoracoabdominal constriction degrades lung function and worsens ventilator-induced lung injury (VILI), and 2) maintaining end-expiratory transpulmonary pressure (Pl) by increasing positive end-expiratory pressure (PEEP) reduces the deleterious effects of chest wall constriction. Design Experimental study in rats. Setting Physiology laboratory. Interventions ALI was induced in 3 groups of 9 rats by saline lavage. Nine animals immediately sacrificed served as control group. Group L had lavage only, group LC had the chest wall constricted with an elastic binder, and group LCP had the same chest constriction but with PEEP raised to maintain end-expiratory Pl. After lavage, all groups were ventilated with the same pattern for 1½ hr. Measurements and Main Results Pl, measured with an esophageal balloon-catheter, lung volume changes, arterial blood gasses and pH were assessed during mechanical ventilation (MV). Lung wet-to-dry ratio (W/D), albumin, TNF-α, IL-1β, IL-6, IL-10, and MIP-2 in serum and bronchoalveolar lavage fluid (BALF), and serum E-selectin and von Willebrand Factor (vWF) were measured at the end of MV. Lavage caused hypoxemia and acidemia, increased lung resistance and elastance, and decreased end-expiratory lung volume. With prolonged MV, lung mechanics, hypoxemia, and W/D were significantly worse in group LC. Pro-inflammatory cytokines except E-selectin were elevated in serum and BALF in all groups, with significantly greater levels of TNF-α, IL-1β, and IL-6 in group LC, which also exhibited significantly worse bronchiolar injury and greater heterogeneity of airspace expansion at a fixed Pl than other groups. Conclusions Chest wall constriction in ALI reduces lung volume, worsens hypoxemia, and increases pulmonary edema, mechanical abnormalities, pro-inflammatory mediator release, and histological signs of VILI. Maintaining end-expiratory Pl at preconstriction

  1. [What do general, abdominal and vascular surgeons need to know on plastic surgery - aspects of plastic surgery in the field of general, abdominal and vascular surgery].

    PubMed

    Damert, H G; Altmann, S; Stübs, P; Infanger, M; Meyer, F

    2015-02-01

    There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options.

  2. The Relationship Between Pulsatile Flow Impingement and Intraluminal Thrombus Deposition in Abdominal Aortic Aneurysms.

    PubMed

    Lozowy, Richard J; Kuhn, David C S; Ducas, Annie A; Boyd, April J

    2017-03-01

    Direct numerical simulations were performed on four patient-specific abdominal aortic aneurysm (AAA) geometries and the resulting pulsatile blood flow dynamics were compared to aneurysm shape and correlated with intraluminal thrombus (ILT) deposition. For three of the cases, turbulent vortex structures impinged/sheared along the anterior wall and along the posterior wall a zone of recirculating blood formed. Within the impingement region the AAA wall was devoid of ILT and remote to this region there was an accumulation of ILT. The high wall shear stress (WSS) caused by the impact of vortexes is thought to prevent the attachment of ILT. WSS from impingement is comparable to peak-systolic WSS in a normal-sized aorta and therefore may not damage the wall. Expansion occurred to a greater extent in the direction of jet impingement and the wall-normal force from the continuous impact of vortexes may contribute to expansion. It was shown that the impingement region has low oscillatory shear index (OSI) and recirculation zones can have either low or high OSI. No correlation could be identified between OSI and ILT deposition since different flow dynamics can have similar OSI values.

  3. [The abdominal catastrophe].

    PubMed

    Seiler, Christian A

    2011-08-01

    Patients with an abdominal catastrophe are in urgent need of early, interdisciplinary medical help. The treatment plan should be based on medical priorities and clear leadership. First priority should be given to achieve optimal oxygenation of blood and stabilization of circulation during all treatment-phases. The sicker the patient, the less invasive the (surgical) treatment should to be, which means "damage control only". This short article describes 7 important, pragmatic rules that will help to increase the survival of a patient with an abdominal catastrophe. Preexisting morbidity and risk factors must be included in the overall risk-evaluation for every therapeutic intervention. The challenge in patients with an abdominal catastrophe is to carefully balance the therapeutic stress and the existing resistance of the individual patient. The best way to avoid abdominal disaster, however, is its prevention.

  4. Abdominal ultrasound (image)

    MedlinePlus

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  5. Acute abdominal pain.

    PubMed

    Stone, R

    1998-01-01

    Abdominal pain is among the most frequent ailments reported in the office setting and can account for up to 40% of ailments in the ambulatory practice. Also, it is in the top three symptoms of patients presenting to emergency departments (ED) and accounts for 5-10% of all ED primary presenting ailments. There are several common sources for acute abdominal pain and many for subacute and chronic abdominal pain. This article explores the history-taking, initial evaluation, and examination of the patient presenting with acute abdominal pain. The goal of this article is to help differentiate one source of pain from another. Discussion of acute cholecystitis, pancreatitis, appendicitis, ectopic pregnancy, diverticulitis, gastritis, and gastroenteritis are undertaken. Additionally, there is discussion of common laboratory studies, diagnostic studies, and treatment of the patient with the above entities.

  6. Abdominal and Pelvic CT

    MedlinePlus Videos and Cool Tools

    ... as ulcerative colitis or Crohn's disease , pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries and bladder as well as ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal organs in cases of ...

  7. Abdominal involvement in tuberculosis.

    PubMed

    Neyman, Edward G; Georgiades, Christos S; Fishman, Elliot K

    2002-10-01

    Rising incidence of disseminated and extrapulmonary tuberculosis (TB), especially in immunocompromised hosts and patients with multi-drug-resistant tuberculosis, has resulted in an increase of unusual clinical and radiographic presentations of TB. With CT being a common part of emergency room (ER) evaluation of abdominal pain, it is imperative that radiologists be able to recognize abdominal presentations of TB. We discuss and illustrate typical and less common CT manifestations of tuberculosis in the abdomen to help ER radiologists in this task.

  8. Inflammatory abdominal aortic aneurysm.

    PubMed

    Savarese, R P; Rosenfeld, J C; DeLaurentis, D A

    1986-05-01

    Between January 1976 and December 1982, 181 patients with abdominal aortic aneurysms were treated surgically, and in 13 patients the aneurysms were found to be inflammatory. Inflammatory aneurysms of the abdominal aorta (IAAA) share important characteristics with typical atherosclerotic abdominal aortic aneurysms. Diagnosis and surgical management of IAAA are distinctive which suggests that IAAA should be considered separately, as a varient of typical abdominal aortic aneurysms. IAAA occur predominantly in males. The presenting symptoms are often idiosyncratic and include severe abdominal or back pain, or both, and ureteral obstruction; the diagnosis of IAAA should be considered when these symptoms are present. Although grossly and microscopically, the perianeurysmal fibrosis resembles idiopathic retroperitoneal fibrosis, the two conditions can be differentiated. At the present time, ultrasonography and computed tomography appear to offer reliable means for diagnosing IAAA. The presence of IAAA, whether established preoperatively or discovered unexpectedly at operation, necessitate certain modifications in the surgical approach, in order to avoid injuring the duodenum and the venous structures. Most patients can be successfully treated by resection and graft replacement. Rupture of the aneurysm in IAAA appears to be less frequent than in typical atherosclerotic abdominal aortic aneurysm.

  9. Abdominal emergencies in pediatrics.

    PubMed

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

    2016-05-01

    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  10. Duodenal perforation as result of blunt abdominal trauma in childhood.

    PubMed

    Hartholt, Klaas Albert; Dekker, Jan Willem T

    2015-12-23

    Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended.

  11. Isotope ratios of (235)U/(238)U and (137)Cs/(235)U in black rain streaks on plaster wall caused by fallout of the Hiroshima atomic bomb.

    PubMed

    Shizuma, Kiyoshi; Endo, Satoru; Fujikawa, Yoko

    2012-02-01

    Radiological investigations of fallout from the atomic bomb detonated over Hiroshima city on 6 August 1945 are important to estimate doses for inhabitants. The authors have analyzed the concentrations of (137)Cs, (235)U, and (238)U in streaks of black rain caused by the atomic bomb using gamma-ray spectroscopy and the ICP-QMS method. The black rain streaks were deposited on a plaster wall of a house located 3.7 km west of the hypocenter that has been kept in the same condition as after the rainfall. Cesium-137 ((137)Cs) was detected from black streak samples. Concentration of (137)Cs in the black rain streaks is twice as high as fallout deposition on the ground in this area. A (235)U/(238)U atom ratio of 0.00887 was found, which is higher than the natural ratio, reflecting the fact that the atomic bomb "Little Boy" used enriched uranium as fuel. The ratio (137)Cs/(235)U was determined to be 0.0091, which is about eight times higher than the estimated ratio of 0.00113 based on the fission yield.

  12. [Albert Einstein and his abdominal aortic aneurysm].

    PubMed

    Cervantes Castro, Jorge

    2011-01-01

    The interesting case of Albert Einstein's abdominal aortic aneurysm is presented. He was operated on at age 69 and, finding that the large aneurysm could not be removed, the surgeon elected to wrap it with cellophane to prevent its growth. However, seven years later the aneurysm ruptured and caused the death of the famous scientist.

  13. Mycotic Aneurysm Caused by Bacteroides fragilis in an Elderly Immunosuppressed Patient

    PubMed Central

    Fukuchi, Takahiko; Kawasaki, Sadao; Hayashi, Hiroki; Koreeda, Daisuke; Ashikawa, Takahiro

    2016-01-01

    An 82-year-old Japanese man, who presented with a fever and abdominal pain, was admitted to our hospital. According to enhanced computed tomography images, the probable diagnosis was abdominal aortic mycotic aneurysm. Eight sets of blood cultures obtained from the patient were negative. Despite administering treatment with vancomycin and ceftriaxone, the aneurysm progressively enlarged. He underwent open debridement surgery and in situ replacement because of an aneurysmal rupture. Bacteroides fragilis was isolated from the tissue culture of the aortic wall. Metronidazole was administered and discontinued without any infection relapse. When faced with similar cases, rare pathogens should thus be considered as possible causes of mycotic aneurysms. PMID:27904124

  14. Comparative study of abdominal and thoracic aortic aneurysms: their pathogenesis and a gingival fibroblasts-based ex vivo treatment.

    PubMed

    Cherifi, Hafida; Gogly, Bruno; Loison-Robert, Ludwig-Stanislas; Couty, Ludovic; Ferré, François Côme; Nassif, Ali; Lafont, Antoine; Fournier, Benjamin Pj

    2015-01-01

    Aortic aneurysms (AAs) consist of slow proteolysis and loss of both collagen and elastin matrix in the aorta wall, leading to wall dilation, weakening and rupture in well-advanced lesions. This can occur in both abdominal aorta (Abdominal Aortic Aneurysm: AAA) and thoracic aorta (Thoracic Aortic Aneurysm: TAA). To date, no non-surgical therapy has been proposed to slow or stop AA progression. Previously published preclinical studies from our team using an aneurysm rabbit model showed a promising concept for treatment of AAs with gingival fibroblast (GFs) which are readily available cells. In this study, we investigated the possible tissue repair of human AAAs and TAAs using ex vivo models co-cultured with GFs. Histological analysis showed that TAA and AAA are two distinct pathologies. Both lesions presented destruction of the aorta wall, highly evidenced in AAA samples. The results have confirmed the presence of the bacterial Porphyromonas gingivalis (Pg) protein in all AAA samples, but not in TAA samples, indicating the possible role of an infectious factor in the developing and progression of AAA lesions compared to TAA. The co-culture of GFs with AA lesions shows increased expression of TIMP-1, the inhibitor of the aneurysm severity marker MMP-9. Our study indicates that GFs might ameliorate aorta wall reestablishment in both AA types by their regenerative and immunomodulatory capacities. It also demonstrates the possible infectious cause of AAA compared with TAA that may explain their different behavior.

  15. Mouse bladder wall injection.

    PubMed

    Fu, Chi-Ling; Apelo, Charity A; Torres, Baldemar; Thai, Kim H; Hsieh, Michael H

    2011-07-12

    Mouse bladder wall injection is a useful technique to orthotopically study bladder phenomena, including stem cell, smooth muscle, and cancer biology. Before starting injections, the surgical area must be cleaned with soap and water and antiseptic solution. Surgical equipment must be sterilized before use and between each animal. Each mouse is placed under inhaled isoflurane anesthesia (2-5% for induction, 1-3% for maintenance) and its bladder exposed by making a midline abdominal incision with scissors. If the bladder is full, it is partially decompressed by gentle squeezing between two fingers. The cell suspension of interest is intramurally injected into the wall of the bladder dome using a 29 or 30 gauge needle and 1 cc or smaller syringe. The wound is then closed using wound clips and the mouse allowed to recover on a warming pad. Bladder wall injection is a delicate microsurgical technique that can be mastered with practice.

  16. Ultrasound and differential diagnosis of fetal abdominal cysts

    PubMed Central

    Tu, Chang-Yu

    2017-01-01

    The present study aimed to investigate the use of ultrasound and differential diagnosis to diagnose a fetal abdominal cyst. A retrospective analysis of 41 cases of fetal abdominal cyst, which included ovarian cysts, choledochal cysts, intestinal duplication and mesenteric cysts, was performed. Imaging characteristics of various types of cysts were summarized, compared and discussed. Among 41 fetal abdominal cyst cases, there were 21 cases of ovarian cysts, 11 cases of bile duct cyst, six cases of intestinal duplication and three cases of mesenteric cyst. Each type of fetal cyst had its own distinctive characteristics on abdominal ultrasound examination. Ovarian cysts were located at one side of the bladder, round-shaped and observed in female fetuses; choledochal cysts were located in the hilar, were oblong- or oval-shaped and connected to the bile duct; intestinal duplication was located in the middle of abdomen, close to the intestine, and presented as an intestinal wall-like structure; mesenteric cysts were round-shaped with thin tensionless wall, presented with multiple chambers, and were easily deformable on compression. The findings of the present study demonstrated that a comprehensive analysis of the association between the cyst and its adjacent location, shape, wall thickness, motility and other aspects of dynamic changes via ultrasonography may provide a differential diagnosis of different types of fetal abdominal cysts. PMID:28123506

  17. Ultrasound and differential diagnosis of fetal abdominal cysts.

    PubMed

    Tu, Chang-Yu

    2017-01-01

    The present study aimed to investigate the use of ultrasound and differential diagnosis to diagnose a fetal abdominal cyst. A retrospective analysis of 41 cases of fetal abdominal cyst, which included ovarian cysts, choledochal cysts, intestinal duplication and mesenteric cysts, was performed. Imaging characteristics of various types of cysts were summarized, compared and discussed. Among 41 fetal abdominal cyst cases, there were 21 cases of ovarian cysts, 11 cases of bile duct cyst, six cases of intestinal duplication and three cases of mesenteric cyst. Each type of fetal cyst had its own distinctive characteristics on abdominal ultrasound examination. Ovarian cysts were located at one side of the bladder, round-shaped and observed in female fetuses; choledochal cysts were located in the hilar, were oblong- or oval-shaped and connected to the bile duct; intestinal duplication was located in the middle of abdomen, close to the intestine, and presented as an intestinal wall-like structure; mesenteric cysts were round-shaped with thin tensionless wall, presented with multiple chambers, and were easily deformable on compression. The findings of the present study demonstrated that a comprehensive analysis of the association between the cyst and its adjacent location, shape, wall thickness, motility and other aspects of dynamic changes via ultrasonography may provide a differential diagnosis of different types of fetal abdominal cysts.

  18. Abdominal exploration - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100049.htm Abdominal exploration - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  19. Imaging the Abdominal Manifestations of Cystic Fibrosis

    PubMed Central

    McDermott, S.; Chan, V. O.; Ridge, C. A.

    2017-01-01

    Cystic fibrosis (CF) is a multisystem disease with a range of abdominal manifestations including those involving the liver, pancreas, and kidneys. Recent advances in management of the respiratory complications of the disease has led to a greater life expectancy in patients with CF. Subsequently, there is increasing focus on the impact of abdominal disease on quality of life and survival. Liver cirrhosis is the most important extrapulmonary cause of death in CF, yet significant challenges remain in the diagnosis of CF related liver disease. The capacity to predict those patients at risk of developing cirrhosis remains a significant challenge. We review representative abdominal imaging findings in patients with CF selected from the records of two academic health centres, with a view to increasing familiarity with the abdominal manifestations of the disease. We review their presentation and expected imaging findings, with a focus on the challenges facing diagnosis of the hepatic manifestations of the disease. An increased familiarity with these abdominal manifestations will facilitate timely diagnosis and management, which is paramount to further improving outcomes for patients with cystic fibrosis. PMID:28250993

  20. Functional bowel disorders and functional abdominal pain

    PubMed Central

    Thompson, W; Longstreth, G; Drossman, D; Heaton, K; Irvine, E; Muller-Lissner, S

    1999-01-01

    The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominal pain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient's pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.


Keywords: functional bowel disorder; functional constipation; functional diarrhea; irritable bowel syndrome; functional abdominal pain; functional abdominal bloating; Rome II PMID:10457044

  1. Incision for abdominal laparoscopy (image)

    MedlinePlus

    Abdominal laparoscopy is a useful aid in diagnosing disease or trauma in the abdominal cavity with less scarring than ... as liver and pancreatic resections may begin with laparoscopy to exclude the presence of additional tumors (metastatic ...

  2. Ultrasonographic abdominal anatomy of healthy captive caracals (Caracal caracal).

    PubMed

    Makungu, Modesta; du Plessis, Wencke M; Barrows, Michelle; Koeppel, Katja N; Groenewald, Hermanus B

    2012-09-01

    Abdominal ultrasonography was performed in six adult captive caracals (Caracal caracal) to describe the normal abdominal ultrasonographic anatomy. Consistently, the splenic parenchyma was hyperechoic to the liver and kidneys. The relative echogenicity of the right kidney's cortex was inconsistent to the liver. The gall bladder was prominent in five animals and surrounded by a clearly visualized thin, smooth, regular echogenic wall. The wall thickness of the duodenum measured significantly greater compared with that of the jejunum and colon. The duodenum had a significantly thicker mucosal layer compared with that of the stomach. Such knowledge of the normal abdominal ultrasonographic anatomy of individual species is important for accurate diagnosis and interpretation of routine health examinations.

  3. Thoraco-abdominal Ectopia Cordis in Southwest Cameroon

    PubMed Central

    Chishugi, John B; Franke, Trixy J

    2014-01-01

    Ectopia cordis is a rare congenital defect where the heart is completely displaced outside the chest wall. Cantrell's pentalogy is an embryologic anomaly with five classic midline deficiencies often associated with ectopia cordis. Here we present a case of thoraco-abdominal ectopia cordis, brief literature review, and possible implications for changes in antenatal care. PMID:25404984

  4. Thoraco-abdominal ectopia cordis in southwest Cameroon.

    PubMed

    Chishugi, John B; Franke, Trixy J

    2014-01-01

    Ectopia cordis is a rare congenital defect where the heart is completely displaced outside the chest wall. Cantrell's pentalogy is an embryologic anomaly with five classic midline deficiencies often associated with ectopia cordis. Here we present a case of thoraco-abdominal ectopia cordis, brief literature review, and possible implications for changes in antenatal care.

  5. Mechanical ventilation in abdominal surgery.

    PubMed

    Futier, E; Godet, T; Millot, A; Constantin, J-M; Jaber, S

    2014-01-01

    One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEP<5cmH2O) or no PEEP, may cause alveolar overdistension and repetitive tidal recruitment leading to ventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery.

  6. Why Do Abdominal Muscles Sometimes Separate during Pregnancy?

    MedlinePlus

    ... Lifestyle Pregnancy week by week Why do abdominal muscles sometimes separate during pregnancy? Answers from Roger W. ... D. During pregnancy, the growing uterus stretches the muscles in the abdomen. This can cause the two ...

  7. Unique Presentation of Intra-Abdominal Testis: Small Bowel Obstruction

    PubMed Central

    Bassiouny, Ibrahim E.; Abbas, Tariq O.; Alansari, Amani N.; Ali, Mansour A.

    2011-01-01

    We describe here a two-year-old male who required urgent laparotomy to relieve a strangulated small bowel caused by internal herniation around an intra-abdominal testis. This clinical presentation has not been reported previously. PMID:22084802

  8. Ultrasound Screening for Abdominal Aortic Aneurysm

    PubMed Central

    2006-01-01

    Executive Summary Objective The aim of this review was to assess the effectiveness of ultrasound screening for asymptomatic abdominal aortic aneurysm (AAA). Clinical Need Abdominal aortic aneurysm is a localized abnormal dilatation of the aorta greater than 3 cm. In community surveys, the prevalence of AAA is reported to be between 2% and 5.4%. Abdominal aortic aneurysms are found in 4% to 8% of older men and in 0.5% to 1.5% of women aged 65 years and older. Abdominal aortic aneurysms are largely asymptomatic. If left untreated, the continuing extension and thinning of the vessel wall may eventually result in rupture of the AAA. Often rupture may occur without warning, causing acute pain. Rupture is always life threatening and requires emergency surgical repair of the ruptured aorta. The risk of death from ruptured AAA is 80% to 90%. Over one-half of all deaths attributed to a ruptured aneurysm take place before the patient reaches hospital. In comparison, the rate of death in people undergoing elective surgery is 5% to 7%; however, symptoms of AAA rarely occur before rupture. Given that ultrasound can reliably visualize the aorta in 99% of the population, and its sensitivity and specificity for diagnosing AAA approaches 100%, screening for aneurysms is worth considering as it may reduce the incidence of ruptured aneurysms and hence reduce unnecessary deaths caused by AAA-attributable mortality. Review Strategy The Medical Advisory Secretariat used its standard search strategy to retrieve international health technology assessments and English-language journal articles from selected databases to determine the effectiveness of ultrasound screening for abdominal aortic aneurysms. Case reports, letters, editorials, nonsystematic reviews, non-human studies, and comments were excluded. Questions asked: Is population-based AAA screening effective in improving health outcomes in asymptomatic populations? Is AAA screening acceptable to the population? Does this affect the

  9. Abdominal pain – learning when not to intervene!

    PubMed Central

    Tachamo, Niranjan; Timilsina, Bidhya; Nazir, Salik; Lohani, Saroj

    2016-01-01

    Epiploic appendagitis (EA) is an uncommon cause of abdominal pain. It is a benign condition but may mimic other serious causes of acute abdomen such as appendicitis, diverticulitis, and gynecological emergency in severe cases. Knowledge of this condition in the differential diagnosis of abdominal pain can save unnecessary hospital admission, antibiotics, and surgery. In this article, we present the case of a 43-year-old female who presented to our hospital with a 2-day history of right lower quadrant abdominal pain and diarrhea. She was diagnosed with EA with computed tomography of abdomen with contrast and was managed conservatively with good outcome. PMID:27987280

  10. Ruptured abdominal aortic aneurysm.

    PubMed

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  11. The Abdominal Circulatory Pump

    PubMed Central

    Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellacà, Raffaele L.; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T.

    2009-01-01

    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50–75 ml with an ejection fraction of 4–6% and an output of 750–1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61±0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57±0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart. PMID:19440240

  12. [Abdominal catastrophe--surgeon's view].

    PubMed

    Vyhnánek, F

    2010-07-01

    Abdominal catastrophe is a serious clinical condition, usually being a complication arising during treatment of intraabdominal nontraumatic disorders or abdominal injuries. Most commonly, inflamation- secondary peritonitis, is concerned. Abdominal catastrophe also includes secondary signs of sepsis, abdominal compartment syndrome and enterocutaneous fistules. Most septic abdominal disorders which show signs of abdominal catastrophy, require surgical intervention and reinterventions--planned or "on demand" laparotomies. During the postoperative period, the patient requires intensive care management, including steps taken to stabilize his/hers condition, management of sepsis and metabolic and nutritional support measures, as well as adequate indication for reoperations. New technologies aimed at prevention of complications in laparostomies and to improve conditions for final laparotomy closure are used in phase procedures for surgical management of intraabdominal infections. Despite the new technologies, abdominal catastrophe has higher morbidity and lethality risk rates.

  13. Abdominal SPECT imaging

    SciTech Connect

    Van Heertum, R.L.; Brunetti, J.C.; Yudd, A.P.

    1987-07-01

    Over the past several years, abdominal single photon emission computed tomography (SPECT) imaging has evolved from a research tool to an important clinical imaging modality that is helpful in the diagnostic assessment of a wide variety of disorders involving the abdominal viscera. Although liver-spleen imaging is the most popular of the abdominal SPECT procedures, blood pool imaging is becoming much more widely utilized for the evaluation of cavernous hemangiomas of the liver as well as other vascular abnormalities in the abdomen. Adjunctive indium leukocyte and gallium SPECT studies are also proving to be of value in the assessment of a variety of infectious and neoplastic diseases. As more experience is acquired in this area, SPECT should become the primary imaging modality for both gallium and indium white blood cells in many institutions. Renal SPECT, on the other hand, has only recently been used as a clinical imaging modality for the assessment of such parameters as renal depth and volume. The exact role of renal SPECT as a clinical tool is, therefore, yet to be determined. 79 references.

  14. Abdominal emergencies during pregnancy.

    PubMed

    Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B

    2015-12-01

    Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.

  15. Decompressive laparotomy for abdominal compartment syndrome

    PubMed Central

    Kimball, E.; Malbrain, M.; Nesbitt, I.; Cohen, J.; Kaloiani, V.; Ivatury, R.; Mone, M.; Debergh, D.; Björck, M.

    2016-01-01

    Background The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes. Methods This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28‐day and 1‐year all‐cause mortality. Changes in intra‐abdominal pressure (IAP) and organ function, and laparotomy‐related morbidity were secondary endpoints. Results Thirty‐three patients were included in the study (20 men). Twenty‐seven patients were surgical admissions treated for abdominal conditions. The median (i.q.r.) Acute Physiology And Chronic Health Evaluation (APACHE) II score was 26 (20–32). Median IAP was 23 (21–27) mmHg before decompressive laparotomy, decreasing to 12 (9–15), 13 (8–17), 12 (9–15) and 12 (9–14) mmHg after 2, 6, 24 and 72 h. Decompressive laparotomy significantly improved oxygenation and urinary output. Survivors showed improvement in organ function scores, but non‐survivors did not. Fourteen complications related to the procedure developed in eight of the 33 patients. The abdomen could be closed primarily in 18 patients. The overall 28‐day mortality rate was 36 per cent (12 of 33), which increased to 55 per cent (18 patients) at 1 year. Non‐survivors were no different from survivors, except that they tended to be older and on mechanical ventilation. Conclusion Decompressive laparotomy reduced IAP and had an immediate effect on organ function. It should be considered in patients with abdominal compartment syndrome. PMID:26891380

  16. Decreasing methylation of pectin caused by nitric oxide leads to higher aluminium binding in cell walls and greater aluminium sensitivity of wheat roots.

    PubMed

    Sun, Chengliang; Lu, Lingli; Yu, Yan; Liu, Lijuan; Hu, Yan; Ye, Yiquan; Jin, Chongwei; Lin, Xianyong

    2016-02-01

    Nitric oxide (NO) is an important bioactive molecule involved in cell wall metabolism, which has been recognized as a major target of aluminium (Al) toxicity. We have investigated the effects of Al-induced NO production on cell wall composition and the subsequent Al-binding capacity in roots of an Al-sensitive cultivar of wheat (Triticum aestivum L. cv. Yang-5). We found that Al exposure induced NO accumulation in the root tips. Eliminating NO production with an NO scavenger (cPTIO) significantly alleviated the Al-induced inhibition of root growth and thus reduced Al accumulation. Elimination of NO, however, did not significantly affect malate efflux or rhizosphere pH changes under Al exposure. Levels of cell wall polysaccharides (pectin, hemicelluloses 1, and hemicelluloses 2) and pectin methylesterase activity, as well as pectin demethylation in the root apex, significantly increased under Al treatment. Exogenous cPTIO application significantly decreased pectin methylesterase activity and increased the degree of methylation of pectin in the root cell wall, thus decreasing the Al-binding capacity of pectin. These results suggest that the Al-induced enhanced production of NO decreases cell wall pectin methylation, thus increasing the Al-binding capacity of pectin and negatively regulating Al tolerance in wheat.

  17. Abdominal tumors in children

    PubMed Central

    Oh, Chaeyoun; Youn, Joong Kee; Han, Ji-Won; Kim, Hyun-Young; Jung, Sung-Eun

    2016-01-01

    Abstract The use of minimally invasive surgery (MIS) in pediatric patients has been steadily increasing in recent years. However, its use for diagnosing and treating abdominal tumors in children is still limited compared with adults, especially when malignancy is a matter of debate. Here, we describe the experience at our center with pediatric abdominal tumors to show the safety and feasibility of MIS. Based on a retrospective review of patient records, we selected for study those pediatric patients who had undergone diagnostic exploration or curative resection for abdominal tumors at a single center from January 2010 through August 2015. Diagnostic exploration for abdominal tumors was performed in 32 cases and curative resection in 173 cases (205 operations). MIS was performed in 11 cases of diagnostic exploration (34.4%) and 38 cases of curative resection (21.9%). The mean age of the children who underwent MIS was 6.09 ± 5.2 years. With regard to diagnostic exploration, patient characteristics and surgical outcomes were found to be similar for MIS and open surgery. With regard to curative resection, however, the mean age was significantly lower among the patients who underwent open surgery (4.21 ± 4.20 vs 6.02 ± 4.99 for MIS, P = 0.047), and the proportion of malignancies was significantly higher (80% vs 39.4% for MIS, P < 0.001). MIS compared favorably with open surgery with respect to the rate of recurrence (6.7% vs 35.1%, P = 0.035), the rate of intraoperative transfusions (34.2% vs 58.5%, P = 0.01), the median amount of blood transfused (14 vs 22 mL/kg, P = 0.001), and the mean number of hospital days (4.66 ± 2.36 vs 7.21 ± 5.09, P < 0.001). Complication rates did not differ significantly between the MIS and open surgery groups. The operation was converted to open surgery in 3 cases (27.2%) of diagnostic MIS and in 5 cases (13.1%) of curative MIS. MIS was found to be both feasible and effective for the

  18. Haemodynamic and abdominal motor reflexes elicited by neurotensin in anaesthetized guinea-pigs.

    PubMed Central

    Rioux, F.; Lemieux, M.

    1992-01-01

    1. Single intraperitoneal (i.p.) injections of neurotensin (NT) (0.14- 140 nmol kg-1) in anaesthetized guinea-pigs were found to trigger transient abdominal wall contractions (TAWC) accompanied by relatively sustained increases of systemic blood pressure (BP) and heart rate (HR). The modification of the latter NT effects by various drugs and surgical manipulations was examined to obtain some insight into the nature of, and possible relationship between, these responses. 2. The abdominal motor response (i.e. TAWC) to i.p. NT (14 nmol kg-1) was inhibited by prior i.v. injection of the guinea-pigs with pancuronium (0.27 mumol kg-1), morphine (1.5 and 15 mumol kg-1), clonidine (0.34 mumol kg-1), by concomitant i.p. injection of procaine 2% w/v, or by acute spinalization. It was potentiated by naloxone (2.8 and 28 mumol kg-1), but not affected by i.v. injection of autonomic drugs (i.e. pentolinium, prazosin, yohimbine and atropine), by capsaicin desensitization, or by acute bilateral cervical vagotomy. In spinalized animals a sustained abdominal wall contraction (SAWC) was unmasked, which was resistant to i.v. morphine, clonidine or baclofen but suppressed by i.v. pancuronium or i.p. lignocaine 2% w/v. 3. Haemodynamic responses to i.p. NT were not affected by i.v. pancuronium, morphine, naloxone, atropine, or by vagotomy. They were inhibited by i.v. pentolinium or clonidine (BP, HR), i.v. prazosin (BP), i.p. procaine 2% w/v (BP, HR), capsaicin desensitization or acute spinalization (BP, HR). Yohimbine (i.v.) potentiated BP and HR increases caused by i.p. NT.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1504727

  19. Patient with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas.

    PubMed

    Kanehiro, Tetsuya; Tsumura, Hiroaki; Ichikawa, Toru; Hino, Yuji; Murakami, Yoshiaki; Sueda, Taijiro

    2008-01-01

    We report an 84-year-old man with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas. The patient was admitted for abdominal pain, abdominal swelling, and consciousness disorder 18 days after the onset. Abdominal computed tomography (CT) revealed emphysema in the gallbladder and a small amount of intraperitoneal free gas. Intraoperative findings suggested gangrenous cholecystitis. The gallbladder wall was perforated, and an abscess involving the right subphrenic region, the periphery of the liver and gallbladder, and the right paracolonic groove, was detected. The flare on the body surface may have reflected abscess formation in the right abdominal cavity. Emphysematous cholecystitis induces necrosis and perforation in many patients, and immediate strategies such as emergency surgery are important.

  20. Management of a chest-wall soft-tissue tumor caused by an infection with the larval tapeworm pathogen Taenia crassiceps.

    PubMed

    Roesel, Christian; Welter, Stefan; Stamatis, Georgios; Theegarten, Dirk; Tappe, Dennis

    2014-09-01

    A chest-wall lesion of an immunocompetent patient was initially suspicious for a malignant tumor. Histopathological and polymerase chain reaction examinations revealed an infection with the larval stage of the tapeworm Taenia crassiceps. Curative resection of the tumorous lesion was performed. Treatment options for immunocompromised patients and patients without known immune defect are discussed, because most of the infections occur in immunocompromised individuals.

  1. A comparison of abdominal and vaginal hysterectomies in Benghazi, Libya.

    PubMed

    Agnaeber, K; Bodalal, Z

    2013-08-01

    We performed a comparative study between abdominal and vaginal hysterectomies using clinical data from Al-Jamhouria hospital (one of the largest maternity hospitals in Eastern Libya). Various parameters were taken into consideration: the rates of each type (and their subtypes); average age of patients; indications; causes; postoperative complications; and duration of stay in the hospital afterwards. Conclusions and recommendations were drawn from the results of this study. In light of the aforementioned parameters, it was found that: (1) abdominal hysterectomies were more common than vaginal hysterectomies (p < 0.001); (2) patients admitted for abdominal hysterectomies are younger than those admitted for vaginal hysterectomies (p < 0.001); (3) the most common indication for an abdominal hysterectomy was menstrual disturbances, while for vaginal hysterectomies it was vaginal prolapse; (4) the histopathological cause for abdominal and vaginal hysterectomies were observed and the most common were found to be leiomyomas and atrophic endometrium; (5) there was no significant difference between the two routes in terms of postoperative complications; (6) patients who were admitted for abdominal hysterectomies spent a longer amount of time in the hospital (p < 0.01). It was concluded that efforts should be made to further pursue vaginal and laparoscopic hysterectomies as a viable option to the more conventional abdominal route.

  2. Abdominal perfusion computed tomography.

    PubMed

    Ogul, Hayri; Bayraktutan, Ummugulsum; Kizrak, Yesim; Pirimoglu, Berhan; Yuceler, Zeynep; Sagsoz, M Erdem; Yilmaz, Omer; Aydinli, Bulent; Ozturk, Gurkan; Kantarci, Mecit

    2013-02-01

    The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis.

  3. Abdominal Perfusion Computed Tomography

    PubMed Central

    Ogul, Hayri; Bayraktutan, Ummugulsum; Kizrak, Yesim; Pirimoglu, Berhan; Yuceler, Zeynep; Sagsoz, M. Erdem; Yilmaz, Omer; Aydinli, Bulent; Ozturk, Gurkan; Kantarci, Mecit

    2013-01-01

    The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis. PMID:25610249

  4. Malignant peritoneal mesothelioma after remote abdominal radiation

    SciTech Connect

    Gilks, B.; Hegedus, C.; Freeman, H.; Fratkin, L.; Churg, A.

    1988-05-15

    Peritoneal mesothelioma in a 61-year-old man, occurred 26 years after abdominal radiotherapy for a testicular seminoma. The patient had no history of asbestos exposure. After asbestos, radiation is the second most frequent defined cause of mesothelioma in North America, but the number of well-documented cases is small; this case represents only the fifth example of peritoneal mesothelioma after therapeutic irradiation of the abdomen. 16 references.

  5. Erysipelothrix rhusiopathiae intra-abdominal abscess.

    PubMed

    Feasi, Marcello; Bacigalupo, Lorenzo; Cappato, Stefano; Pontali, Emanuele; Usiglio, David; Rollandi, Gian Andrea; Filauro, Marco; Mori, Marco; Cassola, Giovanni

    2010-01-01

    Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is infrequently responsible for infections in humans. Most human cases present as localized or generalized cutaneous infections. An invasive septic form, usually associated with endocarditis, has rarely been described. We report here an invasive infection caused by E. rhusiopathiae without endocardium involvement. To our knowledge, this is the first report of an intra-abdominal abscess due to this pathogen.

  6. Recurrent pneumothorax following abdominal paracentesis.

    PubMed Central

    Stafford, P. J.

    1990-01-01

    A 62 year old man presented with abdominal ascites, without pleural effusion, due to peritoneal mesothelioma. He had chronic obstructive airways disease and a past history of right upper lobectomy for tuberculosis. On two occasions abdominal paracentesis was followed within 72 hours by pneumothorax. This previously unreported complication of abdominal paracentesis may be due to increased diaphragmatic excursion following the procedure and should be considered in patients with preexisting lung disease. PMID:2385561

  7. Abdominal Tuberculosis in Cairo, Egypt

    DTIC Science & Technology

    1994-01-01

    COW 03 PUBLICATION REPORT 94-30227 * ABDOMINAL TUBERCULOSIS IN CAIRO, BY RWIavni 0. IHibbs6 M. Kuanmm ad Z. Fun .Y .~ ... W I Form ApprovedREPORT...Leave blank) 2. REPORT DATE 3. REPORT TYPE AND DATES COVERED 8 April 1993 4. TITLE AND SUBTITLE S. FUNDING NUMBERS Abdominal Tuberculosis in Cairo...abdominal tuberculosis patients seen at Abbassia Fever Hospital in Cairo, Egypt from January 1990 to August 1992 are described; their mean age was 21.5

  8. Abdominal pregnancy- a case report.

    PubMed

    Okafor, Ii; Ude, Ac; Aderibigbe, Aso; Amu, Oc; Udeh, Pe; Obianyo, Nen; Ani, Coc

    2011-01-01

    A case of abdominal pregnancy in a 39 year old female gravida 4, para 0(+3) is presented. Ultrasonography revealed a viable abdominal pregnancy at 15 weeks gestational age. She was initially managed conservatively. Surgical intervention became necessary at 20 weeks gestational age following Ultrasound detection of foetal demise. The maternal outcome was favourable. This case is presented to highlight the dilemma associated with diagnosis and management of abdominal pregnancy with a review of literature.

  9. Fournier's gangrene secondary to intra-abdominal processes.

    PubMed

    Gerber, G S; Guss, S P; Pielet, R W

    1994-11-01

    We report 2 cases of necrotizing fasciitis of the perineum, perianal area, and male genitalia (Fournier's gangrene) that arose secondary to intra-abdominal infectious processes (ruptured appendicitis and diverticulitis). Management consisted of immediate debridement of necrotic tissue, exploratory laparotomy, and diverting colostomy. The presence of an acute abdominal process was not immediately evident on initial evaluation of either patient. This demonstrates the critical importance of considering intra-abdominal infection in patients with Fournier's gangrene when the more commonly seen urinary tract, perirectal, and traumatic causes are not readily apparent.

  10. [Intra-abdominal mycoses].

    PubMed

    Boos, C; Kujath, P; Bruch, H-P

    2005-01-01

    The incidence of invasive mycoses in patients undergoing abdominal surgery amounts to approximately 8% and shows an upward trend in epidemiological studies. The lethality of these systemic mycoses, which are mostly based on Candida infections constitutes up to 60%. The development of a sytemic mycosis is marked by exogenic, endogenic and iatrogenic risk factors and typically displays tissue invasion after an initial fungal contamination or systemic dissemination via fungal sepsis. Fungal peritonitis is generally a monoinfection with Candida spp., where Candida albicans outweighs in 70% of cases. Aspergillus spp. are only detected abdominally in rare cases. The histological verification of a fungal invasion is regarded as proof of the existence of an invasive mycosis, but typical macroscopic findings with corresponding cultural findings can also confirm the diagnosis. Systemic mycosis requires an early initiation of a consistent antimycotic therapy as well as definitive surgical eradication of the focus in order to reduce high lethal rate. Resistances or incorrect dosages can be validated objectively by means of histological monitoring of the antimycotic therapy, thus affording early recognition of the need to change the substance class.

  11. A report of three cases and review of the literature on rectal disruption following abdominal seatbelt trauma

    PubMed Central

    El Kafsi, J; Kraus, R; Guy, R

    2016-01-01

    Seatbelt associated blunt trauma to the rectum is a rare but well recognised injury. The exact mechanism of hollow visceral injury in blunt trauma is unclear. Stress and shear waves generated by abdominal compression may in part account for injury to gas containing structures. A ‘seatbelt sign’ (linear ecchymosis across the abdomen in the distribution of the lap belt) should raise the suspicion of hollow visceral injuries and can be more severe with disruption of the abdominal wall musculature. Three consecutive cases of rectal injury following blunt abdominal trauma, requiring emergency laparotomy and resection, are described. Lumbar spine injury occurred in one case and in the other two cases, there was injury to the iliac wing of the pelvis; all three cases sustained significant abdominal wall contusion or muscle disruption. Abdominal wall reconstruction and closure posed a particular challenge, requiring a multidisciplinary approach. The literature on this topic is reviewed and potential mechanisms of injury are discussed. PMID:26741660

  12. Management of a Chest-Wall Soft-Tissue Tumor Caused by an Infection with the Larval Tapeworm Pathogen Taenia crassiceps

    PubMed Central

    Roesel, Christian; Welter, Stefan; Stamatis, Georgios; Theegarten, Dirk; Tappe, Dennis

    2014-01-01

    A chest-wall lesion of an immunocompetent patient was initially suspicious for a malignant tumor. Histopathological and polymerase chain reaction examinations revealed an infection with the larval stage of the tapeworm Taenia crassiceps. Curative resection of the tumorous lesion was performed. Treatment options for immunocompromised patients and patients without known immune defect are discussed, because most of the infections occur in immunocompromised individuals. PMID:24914004

  13. Deficient sucrose synthase activity in developing wood does not specifically affect cellulose biosynthesis, but causes an overall decrease in cell wall polymers.

    PubMed

    Gerber, Lorenz; Zhang, Bo; Roach, Melissa; Rende, Umut; Gorzsás, András; Kumar, Manoj; Burgert, Ingo; Niittylä, Totte; Sundberg, Björn

    2014-09-01

    The biosynthesis of wood in aspen (Populus) depends on the metabolism of sucrose, which is the main transported form of carbon from source tissues. The largest fraction of the wood biomass is cellulose, which is synthesized from UDP-glucose. Sucrose synthase (SUS) has been proposed previously to interact directly with cellulose synthase complexes and specifically supply UDP-glucose for cellulose biosynthesis. To investigate the role of SUS in wood biosynthesis, we characterized transgenic lines of hybrid aspen with strongly reduced SUS activity in developing wood. No dramatic growth phenotypes in glasshouse-grown trees were observed, but chemical fingerprinting with pyrolysis-GC/MS, together with micromechanical analysis, showed notable changes in chemistry and ultrastructure of the wood in the transgenic lines. Wet chemical analysis showed that the dry weight percentage composition of wood polymers was not changed significantly. However, a decrease in wood density was observed and, consequently, the content of lignin, hemicellulose and cellulose was decreased per wood volume. The decrease in density was explained by a looser structure of fibre cell walls as shown by increased wall shrinkage on drying. The results show that SUS is not essential for cellulose biosynthesis, but plays a role in defining the total carbon incorporation to wood cell walls.

  14. Mechanics, Mechanobiology, and Modeling of Human Abdominal Aorta and Aneurysms

    PubMed Central

    Humphrey, J.D.; Holzapfel, G.A.

    2011-01-01

    Biomechanical factors play fundamental roles in the natural history of abdominal aortic aneurysms (AAAs) and their responses to treatment. Advances during the past two decades have increased our understanding of the mechanics and biology of the human abdominal aorta and AAAs, yet there remains a pressing need for considerable new data and resulting patient-specific computational models that can better describe the current status of a lesion and better predict the evolution of lesion geometry, composition, and material properties and thereby improve interventional planning. In this paper, we briefly review data on the structure and function of the human abdominal aorta and aneurysmal wall, past models of the mechanics, and recent growth and remodeling models. We conclude by identifying open problems that we hope will motivate studies to improve our computational modeling and thus general understanding of AAAs. PMID:22189249

  15. Obstructive ileus caused by phlebosclerotic colitis

    PubMed Central

    Lee, Seung Hyun; Park, Se Jin; Heo, Ju Yeol; Paik, Woo Hyun; Bae, Won Ki; Kim, Nam-Hoon; Kim, Kyung-Ah; Lee, June Sung

    2016-01-01

    A 57-year-old man with chronic kidney disease and a history of using numerous herbal medications visited Inje University Ilsan Paik Hospital for abdominal pain and vomiting. An abdominal radiograph showed diffuse small bowel distension containing multiple air-fluid levels and extensive calcifications along the colon. Computed tomography showed colon wall thickening with diffuse calcification along the colonic mesenteric vein and colonic wall. Colonoscopy, performed without bowel preparation, showed bluish edematous mucosa from the transverse to the distal sigmoid colon, with multiple scar changes. At the mid transverse colon, a stricture was noted and the scope could not pass through. A biopsy of the stricture site revealed nonspecific changes. The patient was diagnosed with phlebosclerotic colitis. After the colonoscopy, the obstructive ileus spontaneously resolved, and the patient was discharged without an operation. Currently, after 2 months of follow-up, the patient has remained asymptomatic. Herein, we report the rare case of an obstructive ileus caused by phlebosclerotic colitis with a colon stricture. PMID:27799889

  16. How I Manage Abdominal Injuries.

    ERIC Educational Resources Information Center

    Haycock, Christine E.

    1986-01-01

    In sports, abdominal injuries occur most frequently in cycling, horseback riding, and skiing. Most involve children, not adults. Any athlete sustaining a severe blow to the abdomen should be examined. Guidelines are provided for recognizing and treating injuries to the abdominal muscles, kidneys, spleen, and liver. (Author/MT)

  17. Rumen perforation caused by horn injury in two cows.

    PubMed

    Braun, Ueli; Gerspach, Christian; Stettler, Manuela; Grob, Daniela; Sydler, Titus

    2016-01-20

    Post-operative complications of trocarisation and rumenotomy are the most common causes of peritonitis associated with a rumen disorder. Since horn injury leading to rumen perforation has not previously been reported in the literature, two cows with this condition are reported. Small superficial skin lesions were observed in one of the cows and the other had a perforating skin lesion in the left abdomen. Both cows had signs of hypovolaemic shock. Ultrasonography revealed hypoechoic fluid, echoic lesions and occasional fibrinous septa caudoventral to the reticulum. Caudally the fluid extended to the left flank fold and occupied about one third of the peritoneal cavity. The area of the skin perforation in the left abdomen was swollen and the muscle layers could not be differentiated using ultrasonography. Diffuse fibrino-purulent peritonitis was diagnosed in both cows, and because of a poor prognosis, they were euthanased and necropsied. Perforation of the abdominal wall and rumen with diffuse fibrino-purulent peritonitis was present. Ultrasonography is a suitable tool to characterise the inflammatory lesions between the rumen and left abdominal wall and objectify the interpretation of clinical findings. Horn injury should be included in the rule outs for cattle with left abdominal skin wounds and diffuse peritonitis.

  18. Intestinal anisakiasis as a rare cause of small bowel obstruction.

    PubMed

    Kojima, Gotaro; Usuki, Shinichiro; Mizokami, Ken; Tanabe, Marianne; Machi, Junji

    2013-09-01

    Anisakiasis, a parasitic infection by larvae of the nematode Anisakis found in raw or undercooked saltwater fish, mostly involves stomach but rarely small intestine. We report a rare case of a 61-year-old man who presented with abdominal pain and developed small bowel obstruction caused by intestinal anisakiasis. Abdominal computed tomography revealed segmental edema of the intestinal wall with proximal dilatation. The patient underwent urgent laparotomy because strangulated small bowel obstruction was suspected. A localized portion of the intestine around jejunoileal junction was found to be erythematous, edematous, and hardened, which was resected. The resected specimen showed a linear whitish worm, Anisakis simplex, penetrating into the intestinal mucosa. It is often clinically challenging to consider intestinal anisakiasis in the differential diagnosis because of its nonspecific abdominal symptoms and findings. Although gastrointestinal anisakiasis is still rare in the United States, the incidence is expected to rise given the growing popularity of Japanese cuisine such as sushi or sashimi. Anisakiasis should be considered as one of the differential diagnoses in patients with nonspecific abdominal symptoms after consumption of raw or undercooked fish.

  19. CT of abdominal tuberculosis

    SciTech Connect

    Epstein, B.M.; Mann, J.H.

    1982-11-01

    Intraabdominal tuberculosis (TB) presents with a wide variety of clinical and radiologic features. Besides the reported computed tomographic (CT) finding of high-density ascites in tuberculous peritonitis, this report describes additional CT features highly suggestive of abdominal tuberculosis in eight cases: (1) irregular soft-tissue densities in the omental area; (2) low-density masses surrounded by thick solid rims; (3) a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a poorly defined mass; (4) low-density lymph nodes with a multilocular appearance after intravenous contrast administration; and (5) possibly high-density ascites. The differential diagnosis of these features include lymphoma, various forms of peritonitis, peritoneal carcinomatosis, and peritoneal mesothelioma. It is important that the CT features of intraabdominal tuberculosis be recognized in order that laparotomy be avoided and less invasive procedures (e.g., laparoscopy, biopsy, or a trial of antituberculous therapy) be instituted.

  20. Spectrum of abdominal organ injury in a primary blast type

    PubMed Central

    2009-01-01

    Introduction Abdominal organ injury in a primary blast type is always challenging for diagnosis. Air containing abdominal viscera is most vulnerable to effects of primary blast injury. In any patient exposed to a primary blast wave who presents with an acute abdomen, an abdominal organ injury is to be kept in a clinical suspicion. Aim Study various abdominal organ injuries occurring in a primary type of blast injury. Material and methods: All those who had exploratory laparotomy for abdominal organ injuries after a primary blast injury for a period of 10 years from January 1998 - January 2008 were included in this retrospective study. Results Total 154 patients had laparotomy for abdominal organ injuries with a primary blast type of injury. Small intestine was damaged in 48 patients (31.1%) followed by spleen in 22.7% cases. 54 patients (35.06%) had more than one organ injured. Liver laceration was present in 30 patients (19.48%). Multiple small gut perforations were present in 37 patients (77.08%). Negative laparotomy was found in 5 patients (3.24%) whereas 3 (1.94%) had re-exploration. Mortality was present in 6 patients (3.89%). Conclusions Primary blast injury causes varied abdominal organ injuries. Single or multiple organ damage can be there. Small intestine is commonest viscera injured. Laparotomy gives final diagnosis. PMID:20025766

  1. [Genetic aspects of the pathogenesis of aortic abdominal aneurysms].

    PubMed

    Waliszewski, Krzysztof; Słomski, Ryszard; Oszkinis, Grzegorz; Majewski, Wacław

    2005-01-01

    In industrialized countries the number of abdominal aortic aneurysms (AAA) is continuously rising. In recent years the mortality rate tripled and it is the number 13 cause of death in United States. Despite many identified risk factors and understanding of their pathomechanisms, the pathogenesis of AAA remains unclear. Thanks to the epidemiological researches and improvement of molecular techniques it was noted that AAA may have a genetic bases. The diversity between the possible genomic defects that could lead to the development of aneurytic changes was also suggested. This has a direct relationship with the complexity of the aortic wall structure and therefore with the number of potential injury locations. Current genetic research confirms the changes in expression and the many polymorphic variants of genes coding structural and enzymatic proteins. Thus, AAA seems to be a disease with multifactor pathogenesis and numerous possible genome anomaly variants. Hence, it seems that the complete understanding of the genetic bases of AAA continuous to be distant. However, efforts in this matter remain valuable, giving hope for an improved diagnosis, prophylaxis and treatment of this disease. This article is a review of the available knowledge regarding the genetic origin of AAA.

  2. Fungal cell wall polymer based nanoparticles in protection of tomato plants from wilt disease caused by Fusarium oxysporum f.sp. lycopersici.

    PubMed

    Sathiyabama, M; Charles, R Einstein

    2015-11-20

    Cell wall polymer (chitosan) was isolated from Fusarium oxysporum f.sp. lycopersici. They were cross linked with sodium tripolyphosphate (TPP) to synthesize nanoparticles (CWP-NP). The nanoparticles were characterized by FTIR, DLS, SEM, XRD and NMR analyses. The isolated CWP-NP exhibit antifungal activity under in vitro condition. The foliar application of the CWP-NP to tomato plants challenged with F. oxysporum f. sp. lycopersici showed delay in wilt disease symptom expression and reduce the wilt disease severity. Treated plants also showed enhanced yield. These results suggested the role of the CWP-NP in protecting tomato plants from F. oxysporum f.sp. lycopersici infection.

  3. Refractory Abdominal Pain in a Hemodialysis Patient

    PubMed Central

    Qian, Ying; Chen, Xiao-nong; Shi, Hao; Xie, Jingyuan; Chen, Nan

    2015-01-01

    Nonocclusive mesenteric ischemia (NOMI) is a rare disorder. Failure of an early diagnosis may cause progressive intestinal ischemia, leading to abdominal pain, sepsis, and death. Patients with end-stage renal disease are among the highest risk populations for developing this lethal complication. The key to a correct diagnosis at an early stage is a high index of suspicion in predisposed patients. In our case, we present a 62-year-old female undergoing maintenance hemodialysis for 8 years; she complained of abdominal pain after hemodialysis in the last 3 months; NOMI was suspected after a CT angiography. She partially recovered after multiple clinical interventions such as decreased ultrafiltration, an increased dose of low molecular-weight heparin and the use of vasoactive drugs. In conclusion, NOMI can be reversible if it is diagnosed as early as possible and after the necessary diagnostic measurements are initiated. PMID:26266246

  4. [Postoperative foreign objects in the abdominal cavity].

    PubMed

    Kazarian, V M

    2008-01-01

    The study was designed to elucidate the circumstances under which iatrogenic foreign objects can be mistakenly left inside the patient's body after surgical interventions and to outline measures to prevent such errors. The data obtained in forensic medical examination of two cases of urgent surgery on abdominal organs are analysed. They indicate that the main causes of leaving behind foreign bodies in a patient include improper organization of emergency medical aid, personal qualities of the surgeon, and psycho-emotional atmosphere during the operation. Comprehensive evaluation of the associated clinical symptoms and their dynamics is necessary for early identification and removal of foreign objects left in the abdominal cavity. It would help to avoid undesirable outcomes of surgery and reduce the number of legal proceedings against medical and preventive treatment facilities.

  5. Quantitative Assessment of Abdominal Aortic Aneurysm Geometry

    PubMed Central

    Shum, Judy; Martufi, Giampaolo; Di Martino, Elena; Washington, Christopher B.; Grisafi, Joseph; Muluk, Satish C.; Finol, Ender A.

    2011-01-01

    Recent studies have shown that the maximum transverse diameter of an abdominal aortic aneurysm (AAA) and expansion rate are not entirely reliable indicators of rupture potential. We hypothesize that aneurysm morphology and wall thickness are more predictive of rupture risk and can be the deciding factors in the clinical management of the disease. A non-invasive, image-based evaluation of AAA shape was implemented on a retrospective study of 10 ruptured and 66 unruptured aneurysms. Three-dimensional models were generated from segmented, contrast-enhanced computed tomography images. Geometric indices and regional variations in wall thickness were estimated based on novel segmentation algorithms. A model was created using a J48 decision tree algorithm and its performance was assessed using ten-fold cross validation. Feature selection was performed using the χ2-test. The model correctly classified 65 datasets and had an average prediction accuracy of 86.6% (κ = 0.37). The highest ranked features were sac length, sac height, volume, surface area, maximum diameter, bulge height, and intra-luminal thrombus volume. Given that individual AAAs have complex shapes with local changes in surface curvature and wall thickness, the assessment of AAA rupture risk should be based on the accurate quantification of aneurysmal sac shape and size. PMID:20890661

  6. Pulsatile blood flow in Abdominal Aortic Aneurysms

    NASA Astrophysics Data System (ADS)

    Salsac, Anne-Virginie; Lasheras, Juan C.; Singel, Soeren; Varga, Chris

    2001-11-01

    We discuss the results of combined in-vitro laboratory measurements and clinical observations aimed at determining the effect that the unsteady wall shear stresses and the pressure may have on the growth and eventual rupturing of an Abdominal Aortic Aneurysm (AAA), a permanent bulging-like dilatation occurring near the aortic bifurcation. In recent years, new non-invasive techniques, such as stenting, have been used to treat these AAAs. However, the development of these implants, aimed at stopping the growth of the aneurysm, has been hampered by the lack of understanding of the effect that the hemodynamic forces have on the growth mechanism. Since current in-vivo measuring techniques lack the precision and the necessary resolution, we have performed measurements of the pressure and shear stresses in laboratory models. The models of the AAA were obtained from high resolution three-dimensional CAT/SCANS performed in patients at early stages of the disease. Preliminary DPIV measurements show that the pulsatile blood flow discharging into the cavity of the aneurysm leads to large spikes of pressure and wall shear stresses near and around its distal end, indicating a possible correlation between the regions of high wall shear stresses and the observed location of the growth of the aneurysm.

  7. Total abdominal colectomy

    MedlinePlus

    ... small intestine and the rectum. This can cause an infection or abscess. Scarring of the connection between the small intestine and the rectum. This can cause a blockage of the intestine Wound breaking open Wound infections

  8. A 3-D Finite Element Model of Anterior Vaginal Wall Support to Evaluate Mechanisms Underlying Cystocele Formation

    PubMed Central

    Chen, Luyun; Ashton-Miller, James A.; DeLancey, John O.L.

    2009-01-01

    Objectives To develop a 3D computer model of the anterior vaginal wall and its supports, validate that model, and then use it to determine the combinations of muscle and connective tissue impairments that result in cystocele formation, as observed on dynamic magnetic resonance imaging (MRI). Methods A subject-specific 3D model of the anterior vaginal wall and its supports was developed based on MRI geometry from a healthy nulliparous woman. It included simplified representations of the anterior vaginal wall, levator muscle, cardinal and uterosacral ligaments, arcus tendineus fascia pelvis and levator ani, paravaginal attachments, and the posterior compartment. This model was then imported into ABAQUS™ and tissue properties were assigned from the literature. An iterative process was used to refine anatomical assumptions until convergence was obtained between model behavior under increases of abdominal pressure up to 168 cmH2O and deformations observed on dynamic MRI. Results Cystocele size was sensitive to abdominal pressure and impairment of connective tissue and muscle. Larger cystocele formed in the presence of impairments in muscular and apical connective tissue support compared to either support element alone. Apical impairment resulted in a larger cystocele than paravaginal impairment. Levator ani muscle impairment caused a larger urogenital hiatus size, longer length of the distal vagina exposed to a pressure differential, larger apical descent and resulted in a larger cystocele size. Conclusions Development of a cystocele requires a levator muscle impairment, an increase in abdominal pressure, and apical and paravaginal support defects. PMID:19481208

  9. Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

    PubMed Central

    Cho, Hyun Suk; Hong, Hye-Suk; Park, Mee Hyun; Ha, Hong Il; Yang, Ik; Lee, Yul; Jung, Ah Young; Hwang, Ji-Young

    2013-01-01

    Objective Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. Materials and Methods We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. Results The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Conclusion Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity. PMID:23901318

  10. Laparoscopic repair of abdominal wall hernia: one-year experience

    NASA Astrophysics Data System (ADS)

    Kavic, Michael S.

    1993-05-01

    In this study, 101 consecutive laparoscopic transabdominal preperitoneal hernia repairs (LTPR) were performed in 62 patients by a single surgeon. The series was begun in April 1991, and involved repair of 49 direct, 41 indirect, 4 femoral, 3 umbilical, 3 sliding, and 1 incisional hernias. Twelve cases were bilateral, eleven hernias were incarcerated, and fifteen hernias were recurrent. There were no intraoperative complications, and none of the procedures required conversion to open surgery. Patients experienced the following postoperative complications: transient testicular pain (1), transient anterior thigh paresthesias (2), urinary retention requiring TURP (1), and hernia recurrences (2). Follow up has ranged from 4 - 15 months and initial results have been encouraging.

  11. Hemodynamic flow modeling through an abdominal aorta aneurysm using data mining tools.

    PubMed

    Filipovic, Nenad; Ivanovic, Milos; Krstajic, Damjan; Kojic, Milos

    2011-03-01

    Geometrical changes of blood vessels, called aneurysm, occur often in humans with possible catastrophic outcome. Then, the blood flow is enormously affected, as well as the blood hemodynamic interaction forces acting on the arterial wall. These forces are the cause of the wall rupture. A mechanical quantity characteristic for the blood-wall interaction is the wall shear stress, which also has direct physiological effects on the endothelial cell behavior. Therefore, it is very important to have an insight into the blood flow and shear stress distribution when an aneurysm is developed in order to help correlating the mechanical conditions with the pathogenesis of pathological changes on the blood vessels. This insight can further help in improving the prevention of cardiovascular diseases evolution. Computational fluid dynamics (CFD) has been used in general as a tool to generate results for the mechanical conditions within blood vessels with and without aneurysms. However, aneurysms are very patient specific and reliable results from CFD analyses can be obtained by a cumbersome and time-consuming process of the computational model generation followed by huge computations. In order to make the CFD analyses efficient and suitable for future everyday clinical practice, we have here employed data mining (DM) techniques. The focus was to combine the CFD and DM methods for the estimation of the wall shear stresses in an abdominal aorta aneurysm (AAA) underprescribed geometrical changes. Additionally, computing on the grid infrastructure was performed to improve efficiency, since thousands of CFD runs were needed for creating machine learning data. We used several DM techniques and found that our DM models provide good prediction of the shear stress at the AAA in comparison with full CFD model results on real patient data.

  12. Understanding the pathogenesis of abdominal aortic aneurysms

    PubMed Central

    Kuivaniemi, Helena; Ryer, Evan J.; Elmore, James R.; Tromp, Gerard

    2016-01-01

    Summary An aortic aneurysm is a dilatation in which the aortic diameter is ≥ 3.0 cm. If left untreated, the aortic wall continues to weaken and becomes unable to withstand the forces of the luminal blood pressure resulting in progressive dilatation and rupture, a catastrophic event associated with a mortality of 50 – 80%. Smoking and positive family history are important risk factors for the development of abdominal aortic aneurysms (AAA). Several genetic risk factors have also been identified. On the histological level, visible hallmarks of AAA pathogenesis include inflammation, smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. We expect that large genetic, genomic, epigenetic, proteomic and metabolomic studies will be undertaken by international consortia to identify additional risk factors and biomarkers, and to enhance our understanding of the pathobiology of AAA. Collaboration between different research groups will be important in overcoming the challenges to develop pharmacological treatments for AAA. PMID:26308600

  13. Antimicrobial susceptibility and extended-spectrum beta-lactamase rates in aerobic gram-negative bacteria causing intra-abdominal infections in Vietnam: report from the Study for Monitoring Antimicrobial Resistance Trends (SMART 2009-2011).

    PubMed

    Biedenbach, Douglas J; Bouchillon, Samuel K; Hoban, Daryl J; Hackel, Meredith; Phuong, Doan Mai; Nga, Tran Thi Thanh; Phuong, Nguyen Tran My; Phuong, Tran Thi Lan; Badal, Robert E

    2014-08-01

    Treatment options for multidrug-resistant pathogens remain problematic in many regions and individual countries, warranting ongoing surveillance and analysis. Limited antimicrobial susceptibility information is available for pathogens from Vietnam. This study determined the bacterial susceptibility of aerobic gram-negative pathogens of intra-abdominal infections among patients in Vietnam during 2009-2011. A total of 905 isolates were collected from 4 medical centers in this investigation as part of the Study for Monitoring Antimicrobial Resistance Trends. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) rates among the appropriate species were determined by a central laboratory using Clinical and Laboratory Standards Institute methods. Among the species collected, Escherichia coli (48.1% ESBL-positive) and Klebsiella pneumoniae (39.5% ESBL-positive) represented the majority (46.4%) of the isolates submitted for this study. Ertapenem MIC90 values were lowest for these 2 species at 0.12 and 0.25μg/mL and remained unchanged for ESBL-positive isolates. Imipenem MIC90 values were also the same for all isolates and ESBL-positive strains at 0.25 and 0.5μg/mL, respectively. Ertapenem MIC90 values for additional species with sufficient numbers for analysis, including Enterobacter cloacae, Proteus mirabilis, Acinetobacter baumannii, and Pseudomonas aeruginosa, were 1, 0.06, >4, and >4μg/mL, respectively. Analysis of beta-lactamases in a subset of 132 phenotypically ESBL-positive Enterobacteriaceae demonstrated that CTX-M variants, particularly CTX-M-27 and CTX-M-15, were the predominant enzymes. High resistance rates in Vietnam hospitals dictate continuous monitoring as antimicrobial inactivating enzymes continue to spread throughout Asia and globally.

  14. [Penetrating abdominal injuries].

    PubMed

    Nesbakken, A; Pillgram-Larsen, J; Naess, F; Gerner, T; Solheim, K; Stadaas, J O; Gjøra, O

    1990-02-28

    We have reviewed the medical records of 111 patients treated for abdominal stab wounds during the period 1980-87. Our two hospitals serve a catchment area of about 450,000 people. Exploratory laparotomy was performed in 89 patients with suspected peritoneal penetration. In 16 patients the laparotomy was negative, and in 15 patients only minor injuries were noted. There were no serious complications in these 31 patients. Twenty-seven patients had thoracic wounds below the fourth intercostal space, 15 with intraabdominal injuries. The most common injuries were lacerations of the liver, the small bowel and the diaphragm. The mortality in the series was 2%. Stab wounds are infrequent in Norway, and most surgeons have limited experience of such injuries. We discuss whether to employ immediate exploratory laparotomy or selective management when the peritoneum has been penetrated. When there is no evidence of evisceration or omental protrusion, local exploration of the wound should be performed in order to confirm or exclude peritoneal penetration. Injury to the diaphragm and intraabdominal viscera should always be suspected in thoracic stab wounds below the fourth intercostal space.

  15. Abdominal aortic feminism.

    PubMed

    Mortimer, Alice Emily

    2014-11-14

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  16. Thermography Examination of Abdominal Area Skin Temperatures in Individuals With and Without Focal-Onset Epilepsy.

    PubMed

    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.

  17. Perfusion computed tomography imaging of abdominal aortic aneurysms may be of value for patient specific rupture risk estimation.

    PubMed

    Kontopodis, Nikolaos; Galanakis, Nikolaos; Tsetis, Dimitrios; Ioannou, Christos V

    2017-04-01

    Abdominal aortic aneurysm (AAA) continues to pose a significant cause of unexpected mortality in the developed countries with its incidence constantly rising. The indication of elective surgical repair is currently based on the maximum diameter and growth rate criteria which represent an oversimplification of the Law of Laplace stating that the stress exerted in a cylinder or sphere is proportional to its radius. These criteria fail to capture the complex pathophysiology of the aneurismal disease thus often leading to therapeutic inaccuracies (treating large AAAs with a very low actual rupture risk while observing smaller ones with a much greater risk). Aneurysmal disease is mainly a degenerative process leading to loss of structural integrity of the diseased aortic wall which cannot withhold the stresses due to systemic pressurization. Moreover aortic wall degeneration has been shown to be a localized phenomenon and rupture depends on the pointwise comparison of strength and stress rather than a global aortic wall weakening. Ex-vivo mechanical studies have related vessel wall hypoxia to loss of structural endurance and reduced wall strength. Therefore a module to capture in vivo variation of aortic wall blood supply and oxygenation would be of value for the evaluation of AAA rupture risk. Perfusion computed tomography (PCT) imaging represents a novel technique which has been already used to estimate tissue vascularity in several clinical conditions but not aneurismal disease. We hypothesize that PCT could be used as an adjunct tool during AAA diagnostics in order to evaluate aortic wall oxygenation in vivo, therefore providing a possible means to identify weak spots making the lesion amenable to rupture.

  18. Secondary cell wall polysaccharides of Bacillus anthracis are antigens that contain specific epitopes which cross-react with three pathogenic Bacillus cereus strains that caused severe disease, and other epitopes common to all the Bacillus cereus strains tested.

    PubMed

    Leoff, Christine; Saile, Elke; Rauvolfova, Jana; Quinn, Conrad P; Hoffmaster, Alex R; Zhong, Wei; Mehta, Alok S; Boons, Geert-Jan; Carlson, Russell W; Kannenberg, Elmar L

    2009-06-01

    The immunoreactivities of hydrogen fluoride (HF)-released cell wall polysaccharides (HF-PSs) from selected Bacillus anthracis and Bacillus cereus strains were compared using antisera against live and killed B. anthracis spores. These antisera bound to the HF-PSs from B. anthracis and from three clinical B. cereus isolates (G9241, 03BB87, and 03BB102) obtained from cases of severe or fatal human pneumonia but did not bind to the HF-PSs from the closely related B. cereus ATCC 10987 or from B. cereus type strain ATCC 14579. Antiserum against a keyhole limpet hemocyanin conjugate of the B. anthracis HF-PS (HF-PS-KLH) also bound to HF-PSs and cell walls from B. anthracis and the three clinical B. cereus isolates, and B. anthracis spores. These results indicate that the B. anthracis HF-PS is an antigen in both B. anthracis cell walls and spores, and that it shares cross-reactive, and possibly pathogenicity-related, epitopes with three clinical B. cereus isolates that caused severe disease. The anti-HF-PS-KLH antiserum cross-reacted with the bovine serum albumin (BSA)-conjugates of all B. anthracis and all B. cereus HF-PSs tested, including those from nonclinical B. cereus ATCC 10987 and ATCC 14579 strains. Finally, the serum of vaccinated (anthrax vaccine adsorbed (AVA)) Rhesus macaques that survived inhalation anthrax contained IgG antibodies that bound the B. anthracis HF-PS-KLH conjugate. These data indicate that HF-PSs from the cell walls of the bacilli tested here are (i) antigens that contain (ii) a potentially virulence-associated carbohydrate antigen motif, and (iii) another antigenic determinant that is common to B. cereus strains.

  19. Incidental discovery of radiopaque pills on abdominal CT in a patient with abdominal pain.

    PubMed

    Judge, Bryan S; Hoyle, John D

    2008-07-01

    We present a case in which a young female ingested several tablets of an over-the-counter cough and cold remedy over the course of a week. Pill fragments were identifiable and incidentally discovered when a CT scan of the abdomen was performed to evaluate the cause of her abdominal pain. Discovery of radiopaque pills on diagnostic imaging studies warrants further history and appropriate testing to rule out a life-threatening ingestion.

  20. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    ... signs or symptoms of an abdominal aortic aneurysm (AAA). The final recommendation statement summarizes what the Task ... the potential benefits and harms of screening for AAA: (1) Men ages 65 to 75 who smoke ...

  1. Children's (Pediatric) Abdominal Ultrasound Imaging

    MedlinePlus Videos and Cool Tools

    ... not use ionizing radiation, has no known harmful effects, and is particularly valuable for evaluating abdominal, pelvic ... of the reflected sound waves (called the Doppler effect). A computer collects and processes the sounds and ...

  2. Incentive spirometry after abdominal surgery.

    PubMed

    Davis, Suja P

    Patients face various possible complications after abdominal surgery. This article examines best practice in guiding and teaching them how to use an incentive spirometer to facilitate recovery and prevent respiratory complications.

  3. Robot-Assisted Abdominal Cerclage During Pregnancy

    PubMed Central

    Zeybek, Burak; Hill, Amanda; Menderes, Gulden; Borahay, Mostafa A.; Azodi, Masoud

    2016-01-01

    Background and Objectives: Cervical insufficiency is a difficult condition to diagnose and can lead to preterm birth, miscarriage, or perinatal infant morbidity and mortality. We conducted this retrospective case study and literature review to evaluate the safety and efficacy of robot-assisted abdominal cerclage during pregnancy. Methods: We conducted a case series and a systematic review that included patients who underwent robot-assisted abdominal cerclage during pregnancy from January 2010 through March 2016. Results: Six patients met the criteria for the case series. Median age was 34 years (range, 28–37) at the time of the procedure. In 5 cases, the indication for transabdominal cerclage was a failed vaginal cerclage in a previous pregnancy, whereas a scarred and shortened cervix caused by a previous dilatation and curettage–induced cervical laceration was the indication in the remaining case. Median operating time was 159.5 minutes (range, 124–204), and median estimated blood loss was 25 mL (range, 10–25). No surgeries were converted to laparotomies; all patients were discharged on postoperative day 1. The median gestational age at delivery was 37.5 weeks (range, 22–39). Five patients delivered between 36 and 39 weeks. No patients had chorioamnionitis or preterm premature rupture of membranes. One patient went into preterm labor at 22 weeks, and the cerclage was removed via minilaparotomy. Eight articles met the criteria for systematic review. Sixteen patients underwent robot-assisted abdominal cerclage during pregnancy. Median age was 31.5 years (range, 25–37). The major indication in most articles was previous failed transvaginal cerclage. The median gestational ages at time of procedure and delivery were 12 weeks (range, 10–15) and 37 weeks (range, 33–39), respectively. Conclusion: Robot-assisted abdominal cerclage is safe and effective during pregnancy. PMID:27904309

  4. [A rare variant of enterocele entrapment in the abdominal cavity of a woman].

    PubMed

    Vinnik, Yu S; Prusov, I A; Serova, E V; Shirokobokov, A O; Berdnikov, S I; Struzik, A S; Loginovsky, A S

    2015-01-01

    Abdominal enterocele is a result of entering abdominal organs into peritoneal pockets and folds through the holes in mesenterium or into the adjoining cavities through defects in their walls. Enteroceles are localized at the sites where one segment of the gastrointestinal tract passes into another, in a pocket behind the cecum and sigmoid, between mesenteric layers of small intestine and colon, in the holes of mesenterium of vermiform appendage, gastrocolic and falciform ligaments, pockets and holes of broad ligament of the uterine, omental foramen, rectouterine excavation, and diaphragmal defects. We observed a 26 year old woman with enterocele entrapment in the abdominal cavity complicated by necrosis of part of the small intestine.

  5. Commentary on Predictors of Failed Primary Abdominal Closure in the Trauma Patient with an Open Abdomen

    DTIC Science & Technology

    2013-05-01

    abdomen leads to the loss of abdominal wall domain and the need for skin autografting over viscera with planned ventral hernia.As the open abdomen...MAY 2013 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Commentary on "predictors of failed primary abdominal closure in the...Z39-18 Commentary on ‘‘Predictors of Failed Primary Abdominal Closure in the Trauma Patient with an Open Abdomen’’ Jonathan B. Lundy, MD Damage

  6. Xanthogranulomatous panniculitis after spillage of gallstones during laparoscopic cholecystectomy mimics intra-abdominal malignancy.

    PubMed

    Lin, Chien-Hua; Chu, Heng-Cheng; Hsieh, Huan-Fa; Jin, Jong-Shiaw; Yu, Jyh-Cherng; Cheng, Ming-Fang; Hsu, Sheng-Der; Chan, De-Chuan

    2006-08-01

    Spillage of gallstones into the peritoneal cavity during laparoscopic cholecystectomy (LC) occurs frequently and may be associated with complications. Most of these complications present late after the original procedure, and many have clinical pictures that are not related to biliary etiology, which can confound and delay adequate management. Our patient presented with an intra-abdominal firm heterogeneous mass lesion. Imaging studies showed obvious abdominal wall invasion, and CA-125 level was elevated. Thus, malignancy could not be excluded. Final operative pathology revealed xanthogranulomatous inflammation. Complications of LC should be considered for patients with intra-abdominal abscess or mass lesion if there is a history of LC, regardless of time interval.

  7. Does Lower Limb Exercise Worsen Renal Artery Hemodynamics in Patients with Abdominal Aortic Aneurysm?

    PubMed Central

    Zhang, Nan; Xu, Zaipin; Deng, Xiaoyan; Liu, Ming; Liu, Xiao

    2015-01-01

    Renal artery stenosis (RAS) and renal complications emerge in some patients after endovascular aneurysm repair (EVAR) to treat abdominal aorta aneurysm (AAA). The mechanisms for the causes of these problems are not clear. We hypothesized that for EVAR patients, lower limb exercise could negatively influence the physiology of the renal artery and the renal function, by decreasing the blood flow velocity and changing the hemodynamics in the renal arteries. To evaluate this hypothesis, pre- and post-operative models of the abdominal aorta were reconstructed based on CT images. The hemodynamic environment was numerically simulated under rest and lower limb exercise conditions. The results revealed that in the renal arteries, lower limb exercise decreased the wall shear stress (WSS), increased the oscillatory shear index (OSI) and increased the relative residence time (RRT). EVAR further enhanced these effects. Because these parameters are related to artery stenosis and atherosclerosis, this preliminary study concluded that lower limb exercise may increase the potential risk of inducing renal artery stenosis and renal complications for AAA patients. This finding could help elucidate the mechanism of renal artery stenosis and renal complications after EVAR and warn us to reconsider the management and nursing care of AAA patients. PMID:25946196

  8. Abdominal Complications after Severe Burns

    DTIC Science & Technology

    2009-05-01

    abdominal compartment syndrome, schemic bowel, biliary disease, peptic ulcer disease and astritis requiring laparotomy, small bowel obstruction, rimary fungal...complications in- luded trauma exploratory laparotomy, abdominal com- artment syndrome, ischemic bowel, biliary disease, peptic lcer disease and gastritis, large...70%); 13 for other compli- ations, such as biliary or perineal conditions (26%); and 4 or feeding access (8%). For the civilians, 2 had trauma

  9. Recurrent abdominal pain in children: a clinical approach

    PubMed Central

    Quak, Seng Hock

    2015-01-01

    The term ‘recurrent abdominal pain’, or RAP, refers mainly to the duration of painful period and frequency of pain. The commonly accepted duration is at least three months in the preceding period, and over this three-month period, there are at least three episodes of pain that are severe enough to affect the daily activities of the affected patients. Over the years, with advances in medical technology and better understanding of the pathophysiology of abdominal pain, more and more organic causes have been identified. However, the most common cause of RAP in children is still functional in origin. PMID:25820843

  10. Treatment Experience of Severe Abdominal Infection after Orthotopic Liver Transplantation.

    PubMed

    Wang, Y-G; Wu, J-S; Jiang, B; Wang, J-H; Liu, C-P; Peng, C; Tian, B-Z

    2015-06-01

    This study aims to investigate the causes and treatment experience of severe abdominal infection after orthotopic liver transplantation. Clinical data were retrospectively analysed in perioperative severe abdominal infection of 186 orthotopic liver transplantation cases from March 2004 to November 2011. Among the 186 patients, 16 cases had severe abdominal infection: five cases had bile duct anastomotic leakage-inducing massive hydrops and infection under liver interstice, 10 cases had extensive bleeding of surgical wound leading to massive haematocele and infection around the liver, and one case had postoperative lower oesophageal fistula leakage causing massive hydrops and infection under the left diaphragm. After definite diagnosis, 12 cases underwent surgery within three days, with no death. Among the four cases that underwent surgery three days after diagnosis, one case died of multiple-organ failure five days after abdominal cavity exploration, which was performed 21 days after liver transplantation. Severe abdominal infections after liver transplantation were the most common causes of death in perioperative liver transplantation. Comprehensive treatment with efficacious antibiotics, multiple-organ support, controlled surgical removal of the lesion, and adequate drainage establishment was the key to the entire treatment.

  11. Management of a subclavian artery thrombosis causing acute anterior wall infarction and concurrent left arm ischemia in a patient with prior coronary bypass.

    PubMed

    Akgüllü, Çağdaş; Eryılmaz, Ufuk; Zencir, Cemil; Güngör, Hasan

    2014-12-01

    We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.

  12. Disruption of the ESX-5 system of Mycobacterium tuberculosis causes loss of PPE protein secretion, reduction of cell wall integrity and strong attenuation.

    PubMed

    Bottai, Daria; Di Luca, Mariagrazia; Majlessi, Laleh; Frigui, Wafa; Simeone, Roxane; Sayes, Fadel; Bitter, Wilbert; Brennan, Michael J; Leclerc, Claude; Batoni, Giovanna; Campa, Mario; Brosch, Roland; Esin, Semih

    2012-03-01

    The chromosome of Mycobacterium tuberculosis encodes five type VII secretion systems (ESX-1-ESX-5). While the role of the ESX-1 and ESX-3 systems in M. tuberculosis has been elucidated, predictions for the function of the ESX-5 system came from data obtained in Mycobacterium marinum, where it transports PPE and PE_PGRS proteins and modulates innate immune responses. To define the role of the ESX-5 system in M. tuberculosis, in this study, we have constructed five M. tuberculosis H37Rv ESX-5 knockout/deletion mutants, inactivating eccA(5), eccD(5), rv1794 and esxM genes or the ppe25-pe19 region. Whereas the Mtbrv1794ko displayed no obvious phenotype, the other four mutants showed defects in secretion of the ESX-5-encoded EsxN and PPE41, a representative member of the large PPE protein family. Strikingly, the MtbeccD(5) ko mutant also showed enhanced sensitivity to detergents and hydrophilic antibiotics. When the virulence of the five mutants was evaluated, the MtbeccD(5) ko and MtbΔppe25-pe19 mutants were found attenuated both in macrophages and in the severe combined immune-deficient mouse infection model. Altogether these findings indicate an essential role of ESX-5 for transport of PPE proteins, cell wall integrity and full virulence of M. tuberculosis, thereby opening interesting new perspectives for the study of this human pathogen.

  13. Visceral scalloping on abdominal computed tomography due to abdominal tuberculosis

    PubMed Central

    Sharma, Vishal; Bhatia, Anmol; Malik, Sarthak; Singh, Navjeet; Rana, Surinder S.

    2017-01-01

    Objective: Scalloping of visceral organs is described in pseudomyxoma peritonei, malignant ascites, among other conditions, but not tuberculosis. Methods: We report findings from a retrospective study of patients with abdominal tuberculosis who had visceral scalloping on abdominal computed tomography (CT). Diagnosis of abdominal tuberculosis was made on the basis of combination of clinical, biochemical, radiological and microbiological criteria. The clinical data, hematological and biochemical parameters, and findings of chest X-ray, CT, Mantoux test, and HIV serology were recorded. Results: Of 72 patients with abdominal tuberculosis whose CT scans were included, seven patients had visceral scalloping. The mean age of these patients was 32.14 ± 8.43 years and four were men. While six patients had scalloping of liver, one had splenic scalloping. The patients presented with abdominal pain (all), abdominal distension (five patients), loss of weight or appetite (all), and fever (four patients). Mantoux test was positive in five, while none had HIV infection. The diagnosis was based on fluid (ascitic or collections) evaluation in four patients, ileo-cecal biopsy in one patient, fine needle aspiration from omental thickening in one patient, and sputum positivity for acid fast bacilli (AFB) in one patient. On CT examination, four patients had ascites, five had collections, one had lymphadenopathy, four had peritoneal involvement, three had pleural effusion, and two had ileo-cecal thickening. All except one patient received standard ATT for 6 months or 9 months (one patient). Pigtail drainage for collections was needed for two patients. Discussion: This report is the first description of visceral scalloping of liver and spleen in patients with abdominal tuberculosis. Previously, this finding has been reported primarily with pseudomyxoma peritonei and peritoneal carcinomatosis. Conclusion: Visceral scalloping may not conclusively distinguish peritoneal

  14. Endovascular treatment of spontaneous isolated abdominal aortic dissection

    PubMed Central

    Giribono, Anna Maria; Ferrara, Doriana; Spalla, Flavia; Narese, Donatella; Bracale, Umberto; Pecoraro, Felice; Bracale, Renata; del Guercio, Luca

    2016-01-01

    Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible. PMID:27994881

  15. Should intensivist do routine abdominal ultrasound?

    PubMed Central

    Samanta, Sukhen; Samanta, Sujay; Soni, Kapil Dev; Aggarwal, Richa

    2015-01-01

    Roundworm infestation is common in tropical climate population with a low socioeconomic status. We describe a case of a young male with polytrauma accident who presented with small bowel dysfunction with a high gastric residual volume during enteral feeding. While searching the etiology, the intensivist performed bedside abdominal ultrasound (USG) as a part of whole body USG screening along with clinical examination using different frequency probes to examine bowel movement and ultimately found ascariasis to be the cause. This case report will boost up the wide use of bedside USG by critical care physicians in their patient workup. PMID:26430346

  16. Abdominal Tuberculosis with an Acute Abdomen: Our Clinical Experience

    PubMed Central

    Dey, Ramprasad; Bhattacharya, Ujjwal

    2014-01-01

    Introduction: Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is a great mimicker and is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to involved sites and surgical pathology. The study also discusses the indications and extent of surgical intervention. Materials and Methods: Seventy new cases of Abdominal Tuberculosis (out of 718 cases of acute abdomen) were diagnosed and treated over a period of three years in the surgical ward of Calcutta National Medical College. Macroscopic appearance of abdominal tissues during surgery suggested the diagnosis of tuberculosis. The diagnosis was confirmed by histopathology and tissue culture. All patients were subsequently treated with a full course of antitubercular drugs (ATD). Results: The clinical presentations of acute abdomen included acute intestinal obstruction, perforative peritonitis and acute appendicitis etc. Terminal ileum and ileocaecal region were predominantly involved. The most common pathology was intestinal stricture with or without perforation. Most of the patients (approx 78.5%) required emergency surgery as a therapeutic intervention. A two-stage procedure was preferred in peritonitis and sepsis. Most of the remaining patients (12.8%) required surgery after initial conservative treatment for the first few days. Undiagnosed Abdominal Tuberculosis represents a notable percentage (10%) of patients who present with an acute abdomen as a surgical emergency. Conclusion: Abdominal Tuberculosis is very difficult to diagnose and diagnosis is often delayed till an acute abdomen is presented with. Almost all patients needed surgical intervention. Irrespective of surgery, all patients of abdominal tuberculosis require a

  17. Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis

    PubMed Central

    Chen, Xiyang; Zhao, Jichun; Huang, Bin; Yuan, Ding; Yang, Yi; Ma, Yukui

    2016-01-01

    Abstract Introduction: Abdominal compartment syndrome (ACS) after endovascular repair (EVAR) of rupture abdominal aortic aneurysm (rAAA) is a rare emergency situation, which has a high mortality. However, the progression of ACS is rapid and the diagnosis is usually been delayed, which increase the difficulties in treatment and affect the prognosis. We describe a case of a sever complication (acute intestinal necrosis) resulting from ACS after endovascular repair of rAAA. Clinical Finding: An elderly man, 81 years old, complained a sudden lower abdominal and back pain without any predisposing cause. He had a history of hypertension for 20 years without any regular anti-hypertensive therapy. Physical Examination revealed that the blood pressure was 89/54 mmHg, pulse was 120/min, oxygen saturation was 91%. The abdominal ultrasound and the CTA (computed tomography angiography) scan revealed a rAAA. Emergency EVAR under general anesthesia was performed for this patient. Diagnosis: Fourteen hours after endovascular repair, sudden decreased of blood pressure (70/50 mmHg) and oxygen saturation (70%) was observed. ACS or bleeding of retroperitoneal space was diagnosed. Interventions: Abdominal laparotomy was immediately performed. ACS was verified and a severe complication (acute intestinal necrosis) was observed, intestinal resection was performed for this patient. Outcomes: Unfortunately, this patient died after operation because of multi-organ failure in a very short period, which is very rare regarding to this condition. Surgical pathology, diagnosis and management were discussed. Conclusion: ACS was occurred with a severe complication (acute intestinal necrosis) in a very short period, which is very rare regarding to this condition after EVAR, it reminds us the severe result of ACS and more methods to prevent it happened after surgical management. PMID:27893667

  18. ACR Appropriateness Criteria® pulsatile abdominal mass, suspected abdominal aortic aneurysm.

    PubMed

    Desjardins, Benoit; Dill, Karin E; Flamm, Scott D; Francois, Christopher J; Gerhard-Herman, Marie D; Kalva, Sanjeeva P; Mansour, M Ashraf; Mohler, Emile R; Oliva, Isabel B; Schenker, Matthew P; Weiss, Clifford; Rybicki, Frank J

    2013-01-01

    Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Generally an arterial aneurysm is defined as a localized arterial dilatation ≥50% greater than the normal diameter. Imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches. Ultrasound (US) is the initial imaging modality of choice when a pulsatile abdominal mass is present. Noncontrast computed tomography (CT) may be substituted in patients for whom US is not suitable. When aneurysms have reached the size threshold for intervention or are clinically symptomatic, contrast-enhanced multidetector CT angiography (CTA) is the best diagnostic and preintervention planning study, accurately delineating the location, size, and extent of aneurysm and the involvement of branch vessels. Magnetic resonance angiography (MRA) may be substituted if CT cannot be performed. Catheter arteriography has some utility in patients with significant contraindications to both CTA and MRA. The American College of Radiology Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  19. Increased risk of the abdominal aortic aneurysm in carriers of the MTHFR 677T allele.

    PubMed

    Strauss, Ewa; Waliszewski, Krzysztof; Gabriel, Marcin; Zapalski, Stanisław; Pawlak, Andrzej L

    2003-01-01

    Abdominal aortic aneurysm (AAA) presents itself as a progressive dilation of the abdominal aorta, leading--if untreated--to rupture. It is a common disease of the elderly, with a complex etiology. Several genetic, biochemical and environmental factors are recognized as relevant for the pathogenesis of AAA. We determined the polymorphism of the MTHFR (methylenetetrahydrofolate reductase) gene within the fourth exon (C677T) in 63 patients with AAA and compared it to that in 75 subjects of the population sample. The frequencies of the C/C, C/T and T/T genotypes were 65%, 27%, and 8% in the population sample and 33%, 60%, and 6% in the patients. This corresponds to a 4.4-fold greater risk of AAA in subjects who have the 677C/T variant of MTHFR, as compared with those who are 677C/C (p < 0.0001; 95% CI=2.11-9.34). The frequency of allele MTHFR 677T in patients (0.37) was higher than in the population sample (0.21; p < 0.007). This association between the common allele of the MTHFR gene--MTHFR 677T--and the development of AAA suggests that elevated homocysteine (Hcy) may disturb the function of the aortic wall. The disturbance may involve enhancement of elastin degradation, the process enhanced by mild hyperhomocysteinemia in minipigs. The magnitude of this effect, which refers to the AAA patients unselected for familial occurrence, indicates that the disturbance of aortic wall physiology caused by the presence of the MTHFR 677T allele is greater than the effect of the earlier described allele disequilibrium at the polymorphic alleles of the PAI1 (plasminogen activator inhibitor 1) gene seen only in familial cases of AAA.

  20. CeO2 NPs, toxic or protective to phytoplankton? Charge of nanoparticles and cell wall as factors which cause changes in cell complexity.

    PubMed

    Sendra, M; Yeste, P M; Moreno-Garrido, I; Gatica, J M; Blasco, J

    2017-07-15

    and toxic responses are found. Results show that two factors, the charge of CeO2 NPs and cell wall structure, constitute the primary barrier to the possible accumulation of CeO2 NPs within phytoplankton cytosol.

  1. Juxtarenal Modular Aortic Stent Graft Infection Caused by Staphylococcus aureus

    PubMed Central

    Novotný, Róbert; Mitáš, Petr; Hlubocký, Jaroslav; Hrubý, Ján; Slautin, Andrey; Špunda, Rudolf; Lindner, Jaroslav

    2016-01-01

    Introduction. We are presenting a case report of an infected modular abdominal stent graft. Case Presentation. A 67-year-old male patient three years after Cook's modular abdominal aortic aneurysm (AAA) graft implantation for juxtarenal AAA with an implantation of a stent extension into the right common iliac artery for type Ib endoleak. The patient was admitted into our center in severe condition with suspected retroperitoneal bleeding. Computed tomography angiography (CTAG) confirmed retroperitoneal bleeding in the right common iliac artery. An urgent surgical revision was indicated; destructed arterial wall around the stent extension in the right common iliac artery was discovered. Due to the severe state of health of the patient, a resection of the infected stent and affected arterial wall was performed, followed by an iliac-femoral crossover bypass. The patient was transported to the intensive care unit with hepatic and renal failure, with maximal catecholamine support. Combined antibiotic treatment was started. The patient died five hours after the procedure. The cause of death was multiorgan failure caused by sepsis. Hemocultures and perioperative microbiological cultures showed the infection agent to be Staphylococcus aureus methicillin sensitive. Conclusion. Stent graft infection is a rare complication. Treatment is associated with high mortality and morbidity. PMID:26904354

  2. Wall Turbulence.

    ERIC Educational Resources Information Center

    Hanratty, Thomas J.

    1980-01-01

    This paper gives an account of research on the structure of turbulence close to a solid boundary. Included is a method to study the flow close to the wall of a pipe without interferring with it. (Author/JN)

  3. Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: A case report

    PubMed Central

    Nie, Jing; Zhang, Bo; Duan, Yan-Chao; Hu, Yue-Hua; Gao, Xin-Ying; Gong, Jian; Cheng, Ming; Li, Yan-Qing

    2014-01-01

    Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer. PMID:24605042

  4. Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: a case report.

    PubMed

    Nie, Jing; Zhang, Bo; Duan, Yan-Chao; Hu, Yue-Hua; Gao, Xin-Ying; Gong, Jian; Cheng, Ming; Li, Yan-Qing

    2014-03-07

    Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.

  5. [Radiographic diagnosis of abdominal diseases in foals and ponys. II. Pathologic findings in 60 cases].

    PubMed

    Gerhards, H; Klein, H J; Offeney, F

    1990-08-01

    A diagnostic approach based on clinical and radiographic examinations for evaluation of young foals and small ponies with acute abdominal discomfort is presented. Standing right to left lateral abdominal radiographs were taken of 54 foals and 6 ponies using a previously described technique. Interpretation of the radiographs was in conjunction with all clinical and laboratory findings and patient management. Using this approach, the site and cause of acute abdominal discomfort could be diagnosed accurately in 55 of 60 (91%) patients as confirmed by clinical, surgical or necropsy findings. Typical radiographs and photographs taken at surgery or at necropsy are presented. Typical radiographic findings, their interpretation and possible underlying gastrointestinal diseases are listed. The incorporation of standing lateral abdominal radiography in the clinical evaluation of foals and ponies with acute abdominal diseases gives findings of high diagnostic significance and should contribute to clinical decision-making. Abdominal radiography can replace data from rectal palpation in foals and ponies.

  6. Abdominal sling surgery--artificial sacro-uterine ligament.

    PubMed

    Draca, Petar; Miljković, Stamenko; Jakovljević, Branislava

    2002-01-01

    Abdominal sling surgery is defined as attachment of either the connective tissue graft (fascia lata) or some synthetic material (Mersilene) to the anterior wall of the exposed vaginal vault following total hysterectomy or to the posterior wall of the uterine cervix in total and subtotal uterine prolapse, whereas the other end is attached to the anterior longitudinal ligament extending along the anterior surface of the vertebrae. Our analysis comprised 45 operations: 20 cases of vaginal vault prolapse following vaginal hysterectomy; 7 cases of vaginal vault prolapse following HTA: 2 cases of prolapse following subtotal hysterectomy; 3 cases of nondefined TH; 2 cases following Burch operation; 1 following Kocher; 1 following Manchester, 1 following Neugebauer-Le Fort operation in which HTA was performed 2 times. Abdominal sling operation was associated with the following surgical procedures: sling in 13 cases, sling + douglasorrhaphy in 16 cases, sling + douglasorrhaphy + colpoperineoplastics in 6 cases, sling + colpoperineoplastics in 9 cases and sling + marshall marcetti in 1 case. Recurrence of enterocele was recorded in 5 patients in whom closure of the douglas pouch had not been performed. This procedure was therefore later included into our approach to the operation. The abdominal sling operation has been a logical and physiologic approach to surgical therapy of genital prolapse, particularly of the vaginal vault prolapse following total hysterectomy. This operation ensures subsequent normal sexual relations.

  7. Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation?

    PubMed

    Kirkpatrick, Andrew W; Pelosi, Paolo; De Waele, Jan J; Malbrain, Manu Lng; Ball, Chad G; Meade, Maureen O; Stelfox, Henry T; Laupland, Kevin B

    2010-01-01

    Prone ventilation (PV) is a ventilatory strategy that frequently improves oxygenation and lung mechanics in critical illness, yet does not consistently improve survival. While the exact physiologic mechanisms related to these benefits remain unproven, one major theoretical mechanism relates to reducing the abdominal encroachment upon the lungs. Concurrent to this experience is increasing recognition of the ubiquitous role of intra-abdominal hypertension (IAH) in critical illness, of the relationship between IAH and intra-abdominal volume or thus the compliance of the abdominal wall, and of the potential difference in the abdominal influences between the extrapulmonary and pulmonary forms of acute respiratory distress syndrome. The present paper reviews reported data concerning intra-abdominal pressure (IAP) in association with the use of PV to explore the potential influence of IAH. While early authors stressed the importance of gravitationally unloading the abdominal cavity to unencumber the lung bases, this admonition has not been consistently acknowledged when PV has been utilized. Basic data required to understand the role of IAP/IAH in the physiology of PV have generally not been collected and/or reported. No randomized controlled trials or meta-analyses considered IAH in design or outcome. While the act of proning itself has a variable reported effect on IAP, abundant clinical and laboratory data confirm that the thoracoabdominal cavities are intimately linked and that IAH is consistently transmitted across the diaphragm--although the transmission ratio is variable and is possibly related to the compliance of the abdominal wall. Any proning-related intervention that secondarily influences IAP/IAH is likely to greatly influence respiratory mechanics and outcomes. Further study of the role of IAP/IAH in the physiology and outcomes of PV in hypoxemic respiratory failure is thus required. Theories relating inter-relations between prone positioning and the

  8. [Abdominal cavity adhesions. Some issues of pathogenesis, prophylaxis and treatment].

    PubMed

    Tishchenko, V V

    2010-07-01

    The abdominal cavity adhesions (ACA) constitute frequent consequence of various abdominal cavity diseases and traumas and frequent cause of the abdominal adhesive disease and its complications. In spite of the known pathogenesis of ACA, the surgeons had failed throughout the decades of years to find out the measures and methods of its prophylaxis. There are several causes of such a situation and the main of them is that ACA in its origin constitutes a philogenetically developed defense biologic reaction of organism. Because of the fact, that an organism constitutes the self-regulated biological system, any external inputs (including the treatment), directed on qualitative or quantitative signs of these reactions, meet systemic counteraction and become annihilated. The forced overcome of such a counteraction may cause the development of severe systemic disorders in organism. The only prophylactic measures against ACA, which were already tested throughout the time, are the tactical and technical methods, promoting the reduction of severity of morphological changes in peritoneum and abdominal organs, thus causing reduction of natural reaction of organism. When the adhesions formation is inevitable it is necessary to apply surgical methods of governing such a process, and omentoparietopexy may constitutes one of such methods.

  9. Diffuse abdominal gallium-67 citrate uptake in salmonella infections

    SciTech Connect

    Garty, I.; Koren, A.

    1987-11-01

    Two pediatric patients with salmonella infections (one with typhoid fever and the second with salmonella C2 gastroenteritis), had a diffuse abdominal uptake of Ga-67 citrate. The possible explanation for this finding is discussed. Salmonella infection should be included as a cause in the differential diagnosis of diffuse accumulation of Ga-67 citrate.

  10. Abdominal Bloating: Pathophysiology and Treatment

    PubMed Central

    Seo, A Young; Oh, Dong Hyun

    2013-01-01

    Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional gastrointestinal disorders or organic diseases, but it may also appear alone. The pathophysiology of bloating remains ambiguous, although some evidences support the potential mechanisms, including gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes. Owing to the insufficient understanding of these mechanisms, the available therapeutic options are limited. However, medical treatment with some prokinetics, rifaximin, lubiprostone and linaclotide could be considered in the treatment of bloating. In addition, dietary intervention is important in relieving symptom in patients with bloating. PMID:24199004

  11. Abdominal obesity and metabolic syndrome.

    PubMed

    Després, Jean-Pierre; Lemieux, Isabelle

    2006-12-14

    Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance or full-blown diabetes, and increased risk of developing cardiovascular disease. Proposed criteria for identifying patients with metabolic syndrome have contributed greatly to preventive medicine, but the value of metabolic syndrome as a scientific concept remains controversial. The presence of metabolic syndrome alone cannot predict global cardiovascular disease risk. But abdominal obesity - the most prevalent manifestation of metabolic syndrome - is a marker of 'dysfunctional adipose tissue', and is of central importance in clinical diagnosis. Better risk assessment algorithms are needed to quantify diabetes and cardiovascular disease risk on a global scale.

  12. Abdominal surgery in neonatal foals.

    PubMed

    Bryant, James E; Gaughan, Earl M

    2005-08-01

    Abdominal surgery in foals under 30 days old has become more common with improved neonatal care. Early recognition of a foal at risk and better nursing care have increased the survival rates of foals that require neonatal care. The success of improved neonatal care also has increased the need for accurate diagnosis and treatment of gastrointestinal, umbilical, and bladder disorders in these foals. This chapter focuses on the early and accurate diagnosis of specific disorders that require abdominal exploratory surgery and the specific treatment considerations and prognosis for these disorders.

  13. An epidemiological analysis of patients with abdominal trauma in an eastern Indian metropolitan city.

    PubMed

    Ghosh, Parthasarathi; Halder, Sandip Kumar; Paira, Susil Kumar; Mukherjee, Ramanuj; Kumar, Soumen Kanti; Mukherjee, Saibal Kumar

    2011-01-01

    The profile and pattern of abdominal trauma is changing with progressing civilisation. We are lacking epidemiological data from most parts of the world. This study was conducted to prepare a database in our set up and look into the pattern of abdominal trauma, make an aetiological correlation of abdominal trauma with the types of injuries, identify the preventable factors causing delay in intervention and, compare the data with the other available national and international data. This prospective, observational study was done in a teaching hospital in a metropolitan city of eastern India. Records of patients with abdominal trauma were collected in predesigned forms, from admission to discharge. Data were analysed applying standard statistical techniques. Males (87.3%) predominated with the age range between 21 and 30 years, and the majority (73.5%) had blunt abdominal trauma. Compression injury (57.3%) commonly caused blunt trauma and stab injuries caused majority of penetrating trauma. The commonest organ injured both in blunt and penetrating trauma was small bowel (30.7% and 33.3% respectively). It was found that prehospital trauma care is virtually non-existent in this region. We are lacking a uniform protocol for the management of abdominal trauma across the hospitals. With the availability of better investigational modalities we are moving more towards a conservative approach to the abdominal trauma patients, especially the blunt abdominal trauma patients with solid organ injuries.

  14. [Peritoneal lavage and blunt abdominal injuries in childhood].

    PubMed

    Belgerden, S; Demirkol, K; Kayabali, M

    1987-01-01

    Traffic accidents are increasingly responsible for mortality in childhood in Turkey. Between 1982 and 1984, 197 children were admitted for contused abdominal injuries to the surgical casualty ward at the School of Medicine of Istanbul University. Most of these children had been involved in traffic accidents, and peritoneal lavage was applied to all of them. The diagnosis on admission was confirmed by laparotomy in 90 per cent of all cases. 20 children died (10.1 per cent). Uncontrollable abdominal bleeding was the cause of ten deaths and massive brain lesion of another six.

  15. Ultrasonographic characteristics of abdominal and thoracic abscesses in cattle and buffaloes.

    PubMed

    Mohamed, T; Oikawa, S

    2007-11-01

    Six cows and five buffaloes with abdominal and thoracic abscesses were examined clinically and ultrasonographically. There was a wide range of clinical signs and at least 50% of the animals exhibited dull demeanour, anorexia, abdominal pain, recurrent tympany and/or weight loss. Three cases of abdominal abscesses were imaged in the left ventral abdomen between the rumen and abdominal wall, two cases were imaged at the xiphoid cartilage near the reticular wall and one case was imaged on the right ventral abdomen between the jejunum and right abdominal wall. Four cases of thoracic abscesses were imaged in the third intercostal space on the left side; however, one case of abscess was imaged in the fourth intercostal space, also on the left side. The content of the abscess was echogenic in eight animals and anechoic in three. In three animals, the content of the abscess was partitioned by echogenic septae. In two cows, the echogenic content of the abscess was surrounded by a narrow rim of anechoic fluid. The diameters of the abscesses were 5-10 cm in three cows, 11-15 cm in seven cows and >15 cm in one cow. In every case, the diagnosis was confirmed by centesis and aspiration of the abscess, which yielded purulent material. There were biochemical data of hypoalbuminaemia and hyperglobulinaemia and 90% of tested animals had neutrophilia. Five cows were examined at slaughter, where the ultrasonographic diagnosis was confirmed.

  16. Gastric Intramural and Portal Venous Gas Following Blunt Abdominal Injury

    PubMed Central

    Sen, Indrani; Samarasam, Inian; Chandran, Sudhakar; Mathew, George

    2013-01-01

    Introduction Gastric emphysema or pneumatosis is a rare finding. Early endoscopy and urgent laparotomy is advised in post-trauma patients. Case Presentation A 29 year old man presented with blunt abdominal injury following a high-speed motorbike crash He complained of abdominal pain and abdomen was distended. CT abdomen revealed air in the gastric wall with disruption of gastric mucosa. He had normal white cell counts, bleeding parameters and blood gases. He was treated conservatively with nasogastric decompression, intravenous analgesics and antibiotics with which he recovered well. Conclusions Early surgical management is indicated in post-trauma patients in whom bowel infarction is suspected. In a stable patient, a negative laparotomy is a major additional stress post trauma - conservative management with close clinical observation is a suitable management alternative. PMID:24396802

  17. Large Gastric Teratoma: A Rare Intra-abdominal Mass of Infancy

    PubMed Central

    Hasan, Roumina; Monappa, Vidya; Kumar, Sandeep; Kumar, Vijay

    2016-01-01

    Amongst the varied, diverse causes of intraabdominal masses in infancy and early childhood, gastric teratomas (GTs) account for a very small proportion. A worldwide literature search reveals only around one hundred cases of GT and also supports the fact that its preoperative diagnosis remains elusive. Here we report the case of a two-month-old male who presented to the pediatric surgery outpatient department of Kasturba Medical College and Hospital, Karnataka, India, with progressive distension of abdomen since birth. Clinically, a large firm, non-mobile and non-tender mass involving all four quadrants of the abdomen was seen. Ultrasound revealed a large solid-cystic mass with internal septations extending from the epigastrium up to the pelvis. Computed tomography revealed a large intraperitoneal fat containing solid-cystic mass lesion showing curvilinear and chunky areas of calcification, with the mass focally indenting the posterior gastric wall and showing focal polypoidal intragastric extension. Exploratory laparotomy revealed a large cystic tumor with a solid component, arising from lesser curvature of the stomach, showing focal intraluminal extension across the posterior gastric wall, and occupying the whole lesser sac and abdominal cavity. The tumor was excised in toto along with the body of the stomach. Histopathological examination showed mature tissue derived from all three germ cell layers and confirmed the diagnosis of mature gastric teratoma. The patient was disease free at one-year follow-up. PMID:27162596

  18. A case of abdominal apoplexy because of the rupture of the short gastric vessel

    PubMed Central

    Osunkunle, Olaoluwakitan A.; Al-Shoek, Ihsan

    2015-01-01

    Abdominal apoplexy or idiopathic spontaneous intraperitoneal haemorrhage is defined as the presence of free blood within the peritoneal cavity. Non-traumatic and non-iatrogenic causes may cause abdominal apoplexy. It has a variable clinical presentation, with abdominal pain being an early and non-specific symptom. We report a rare case of a 23-year-old male with abdominal apoplexy because of rupture of the short gastric artery. He presented to our department with abdominal pain. Later, he developed signs of shock, and was found to have haemoperitoneum on laparotomy. We ligated the short gastric artery, which was the bleeding source, and he had an uneventful postoperative course. We also review the literature on existing cases of short gastric vessel rupture. PMID:25759171

  19. Spectrum of Abdominal Aortic Disease in a Tertiary Health Care Setup: MDCT Based Observational Study

    PubMed Central

    Kumar, DG Santosh; Gadabanahalli, Karthik; Kalyanpur, Arjun

    2016-01-01

    Introduction Abdominal aortic disease is an important cause of clinical disability that requires early detection by imaging methods for prompt and effective management. Understanding regional disease pattern and prevalence has a bearing on healthcare management and resource planning. Non-invasive, conclusive imaging strategy plays an important role in the detection of disease. Multi-Detector Computed Tomography (MDCT) with its technological developments provides affordable, accurate and comprehensive imaging solution. Aim To evaluate regional demography of abdominal aortic disease spectrum detected using MDCT imaging data in a tertiary hospital. Materials and Methods A descriptive study was conducted based on MDCT imaging data of patients who were investigated with clinical diagnosis of abdominal aortic disease, from March 2008-2010, over a period of 24 months. Patients were examined with the contrast-enhanced MDCT examination. Morphological diagnosis of the aortic disease was based on changes in relative aortic caliber, luminal irregularity, presence of wall calcification, dissection or thrombus and evidence of major branch occlusion. Patients were categorized into four groups based on imaging findings. MDCT information and associated clinical parameters were examined and correlated to management of patient. Descriptive statistical data, namely mean, standard deviation and frequency of disease were evaluated. Results A total of 90 out of 210 patients (43%) were detected with the abdominal aortic abnormality defined by imaging criteria. Group I, comprising of patients with atherosclerosis –including those with complications, constituted 65.5% of the patients. Group II represented patients with aneurysms (45.5%). Group III, consisting of 32.2% of the patients, contained those with dissections. The rest of the patients, including patients with aorto-arteritis, were classified as group IV. Eight patients with aneurysm and one patient with aorto-arteritis were

  20. 'Stucco' Walls

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This projected mosaic image, taken by the microscopic imager, an instrument located on the Mars Exploration Rover Opportunity 's instrument deployment device, or 'arm,' shows the partial clotting or cement-like properties of the sand-sized grains within the trench wall. The area in this image measures approximately 3 centimeters (1.2 inches) wide and 5 centimeters (2 inches) tall.(This image also appears as an inset on a separate image from the rover's navigation camera, showing the location of this particular spot within the trench wall.)