Management of complex abdominal wall defects associated with penetrating abdominal trauma.

PubMed

Arul, G Suren; Sonka, B J; Lundy, J B; Rickard, R F; Jeffery, S L A

2015-03-01

The paradigm of Damage Control Surgery (DCS) has radically improved the management of abdominal trauma, but less well described are the options for managing the abdominal wall itself in an austere environment. This article describes a series of patients with complex abdominal wall problems managed at the UK-led Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan. Contemporaneous review of a series of patients with complex abdominal wall injuries who presented to the Role 3 MTF between July and November 2012. Five patients with penetrating abdominal trauma associated with significant damage to the abdominal wall were included. All patients were managed using DCS principles, leaving the abdominal wall open at the end of the first procedure. Subsequent management of the abdominal wall was determined by a multidisciplinary team of general and plastic surgeons, intensivists and specialist nurses. The principles of management identified included minimising tissue loss on initial laparotomy by joining adjacent wounds and marginal debridement of dead tissue; contraction of the abdominal wall was minimised by using topical negative pressure dressing and dermal-holding sutures. Definitive closure was timed to allow oedema to settle and sepsis to be controlled. Closure techniques include delayed primary closure with traction sutures, components separation, and mesh closure with skin grafting. A daily multidisciplinary team discussion was invaluable for optimal decision making regarding the most appropriate means of abdominal closure. Dermal-holding sutures were particularly useful in preventing myostatic contraction of the abdominal wall. A simple flow chart was developed to aid decision making in these patients. This flow chart may prove especially useful in a resource-limited environment in which returning months or years later for closure of a large ventral hernia may not be possible. Published by the BMJ Publishing Group Limited. For permission to use

Differentiation between intra-abdominal neoplasms and abscesses in horses, using clinical and laboratory data: 40 cases (1973-1988).

PubMed

Zicker, S C; Wilson, W D; Medearis, I

1990-04-01

The medical records of 25 horses with intra-abdominal neoplasms and 15 horses with intra-abdominal abscesses were reviewed. Common clinical signs of disease observed by owners of horses in both groups included anorexia, weight loss, fever, signs of colic, and depression. Clinical laboratory abnormalities included leukocytosis, hyperfibrinogenemia, hypoalbuminemia, and hypocalcemia. There was considerable overlap of laboratory test results within and between the 2 groups of horses. Peritoneal fluid was classified as an exudate in 12 of 15 horses with intra-abdominal abscesses and in 14 of 25 horses with intra-abdominal neoplasms. Cytologic examination of peritoneal fluid yielded an accurate diagnosis in 11 of 25 horses with neoplasia and in 3 of 15 horses with abscesses. A mean number of 1.45 cytologic analyses/horse was needed to diagnose neoplasms in the 11 horses in which the analysis was successful in definitively diagnosing the condition.

Desmoid Fibromatosis of the Lower Abdominal Wall in Irrua Nigeria

PubMed Central

Awe, Oluwafemi Olasupo; Eluehike, Sylvester

2018-01-01

Desmoid fibromatosis (desmoid tumors) is rare tumors. It can occur as intra-abdominal, extraabdominal, or abdominal wall tumor depending on the site. The abdominal wall type is usually sporadic, but few have been associated with familial adenomatous polyposis. They are commonly seen in young females who are pregnant with a history of the previous cesarean section scar or within the 1st year of the last childbirth. There is an association between this tumor, presence of estrogen receptors, and abdominal trauma. We present a 29-year-old Nigerian woman with fungating lower abdominal wall tumor. This tumor is rare, a high index of suspicion will be very important in making the diagnosis. PMID:29643736

Desmoid tumors of the abdominal wall: A case report

PubMed Central

Overhaus, Marcus; Decker, Pan; Fischer, Hans Peter; Textor, Hans Jochen; Hirner, Andreas

2003-01-01

Background Desmoid tumors are slow growing deep fibromatoses with aggressive infiltration of adjacent tissue but without any metastatic potential. Case Presentation We report on two female patients with desmoid tumor of the abdominal wall who underwent primary resection. Both patients had a history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, magnetic resonance imaging and computed tomography. The histology in both cases revealed a desmoid tumor. Conclusion Complete surgical resection is the first line management of this tumor entity. PMID:12890284

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.

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

Improving the Efficiency of Abdominal Aortic Aneurysm Wall Stress Computations

PubMed Central

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. PMID:25007052

WSES guidelines for emergency repair of complicated abdominal wall hernias

PubMed Central

2013-01-01

Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. PMID:24289453

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. Copyright © 2013 Elsevier Inc. All rights reserved.

Chronic abdominal wall pain and ultrasound-guided abdominal cutaneous nerve infiltration: a case series.

PubMed

Kanakarajan, Saravanakumar; High, Kristina; Nagaraja, Ravi

2011-03-01

Chronic abdominal wall pain occurs in about 10-30% of patients presenting with chronic abdominal pain. Entrapment of abdominal cutaneous nerves at the lateral border of the rectus abdominis muscle has been attributed as a cause of abdominal wall pain. We report our experience of treating such patients using ultrasound-guided abdominal cutaneous nerve infiltration. We conducted a retrospective audit of abdominal cutaneous nerve infiltration performed in the period between September 2008 to August 2009 in our center. All patients had received local anesthetic and steroid injection under ultrasound guidance. The response to the infiltration was evaluated in the post-procedure telephone review as well as in the follow-up clinic. Brief pain inventory (BPI) and numerical rating scale pain scores were collated from two points: the initial outpatient clinic and the follow up clinic up to 5 months following the injection. Nine patients had abdominal cutaneous nerve injections under ultrasound guidance in the period under review. Six patients reported 50% pain relief or more (responders) while three patients did not. Pain and BPI scores showed a decreasing trend in responders. The median duration of follow-up was 12 weeks. Ultrasound can reliably be used for infiltration of the abdominal cutaneous nerves. This will improve the safety as well as diagnostic utility of the procedure. Wiley Periodicals, Inc.

[Abdominal traumatic evisceration: reconstruction abdominal wall with biologic mesh and negative pressure therapy].

PubMed

Jiménez Gómez, M; Betancor Rivera, N; Lima Sánchez, J; Hernández Hernández, J R

2016-04-10

Abdominal traumatic evisceration as a result of high energy trauma is uncommon. Once repaired the possible internal damage, an abdominal wall defect of high complexity may exist, whose reconstruction represents a surgical challenge. Politraumatized male with important abdominal muculocutaneous avulsion and evisceration. After initial repair, the patient developed a big eventration in which we use a porcine dermis-derived mesh (Permacol TM ), a safe and effective alternative in abdominal wall repair, thanks to its seamless integration with other tissues, even when exposed. Negative pressure therapy has been used for the management of wound complications after surgical implantation of PermacolTM mesh. We describe our experience with the use of PermacolTM mesh and negative pressure therapy to aid the wound closure after skin necrosis and exposed mesh.

Ultrasound-guided core needle biopsy in diagnosis of abdominal and pelvic neoplasm in pediatric patients.

PubMed

Wang, Hailing; Li, Fangxuan; Liu, Juntian; Zhang, Sheng

2014-01-01

Ultrasound-guided core needle biopsy of abdominal and pelvic masses in adults has gained tremendous popularity. However, the application of the same treatment in children is not as popular because of apprehensions regarding inadequate tissues for the biopsy and accidental puncture of vital organs. Data of the application of ultrasound-guided core needle biopsy in 105 pediatric patients with clinically or ultrasound-diagnosed abdominopelvic masses were reviewed. Diagnostic procedures were conducted in our institution from May 2011 to May 2013. The biopsies were conducted on 86 malignant lesions and 19 benign lesions. 86 malignant tumors comprised neuroblastomas (30 cases), hepatoblastomas (15 cases), nephroblastomas (11 cases), and primitive neuroectodermal tumors/malignant small round cells (6 cases). Among malignant tumor cases, only a pelvic primitive neuroectodermal tumor did not receive a pathological diagnosis. Therefore, the biopsy accuracy was 98.8 % in malignant tumor. However, the biopsies for one neuroblastomas and one malignant small round cell tumor were inadequate for cytogenetic analysis. Therefore, 96.5 % of the malignant tumor patients received complete diagnosis via biopsy. 19 benign tumors comprised mature teratoma (10 cases), hemangioendothelioma (3 cases), paraganglioma (2 cases), and infection (2 cases). The diagnostic accuracy for benign neoplasm was 100 %. Five patients experienced postoperative complications, including pain (2 patients), bleeding from the biopsy site (2 patients), and wound infection (1 patient). Ultrasound-guided core needle biopsy is an efficient, minimally invasive, accurate, and safe diagnostic method that can be applied in the management of abdominal or pelvic mass of pediatric patients.

Rare Abdominal Wall Malformation: Case Report of Umbilical Cord Hernia.

PubMed

Gliha, Andro; Car, Andrija; Višnjić, Stjepan; Zupancic, Bozidar; Kondza, Karmen; Petracic, Ivan

The umbilical cord hernia is the rarest form of abdominal wall malformations, anatomically completely different from gastroschisis and omphalocele. It occurs due to the permanent physiological evisceration of abdominal organs into umbilical celom and persistence of a patent umbilical ring. The umbilical cord hernia is often mistaken for omphalocele and called "small omphalocele". Here we present a case of a female newborn with umbilical cord hernia treated in our Hospital. After preoperative examinations surgery was done on the second day of life. The abdominal wall was closed without tension. The aim of this article is to present the importance of the proper diagnose of these three entities and to stimulate academic community for the answer, is this umbilical cord hernia or small omphalocele.

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. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Abdominal wall reconstruction with collagen membrane in an animal model of abdominal hernia. A preliminary report].

PubMed

Łukasiewicz, Aleksander; Drewa, Tomasz; Skopińska-Wiśniewska, Joanna; Molski, Stanisław

2008-01-01

Abdominal hernia repair is one of the most common surgical procedures. Current data indicate that the best treatment results are achieved with use of synthetic material to reinforce weakened abdominal wall. Prosthetic materials utilized for hernia repair induce adhesions with underlying viscera. They should be therefore separated from them by a layer of peritoneum otherwise adhesions may cause to serious complications such as bowel-skin fistulas. The aim of our work was to determine if implantation of our collagen membrane into abdominal wall defect induce adhesions in rat model of ventral hernia. The collagen film was obtained by acetic acid extraction of rat tail tendons and than casting the soluble fraction onto polyethylene shits. Abdominal wall defect was created in 10 Wistar male rats. Collagen membranes were implanted into the defect using interrupted polypropylene stitches. After 3 months of observation all animals were sacrificed. No adhesions between path structure and bowel developed. In one often rats (10%) adhesion between fixating stitch and omentum was observed. Complete mesothelium lining and vascular ingrowth were microscopically observed within implanted structure. Promising result requires further confirmation in a larger series of animals.

Bioprosthetic tissue matrices in complex abdominal wall reconstruction.

PubMed

Broyles, Justin M; Abt, Nicholas B; Sacks, Justin M; Butler, Charles E

2013-12-01

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. 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. 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. 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.

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

Temporary closure of the abdominal wall by use of silicone rubber sheets after operative repair of ruptured abdominal aortic aneurysms.

PubMed

Akers, D L; Fowl, R J; Kempczinski, R F; Davis, K; Hurst, J M; Uhl, S

1991-07-01

Management of patients after operative repair of abdominal aortic aneurysms can be further complicated if primary closure of the abdominal wall cannot be technically accomplished or is associated with profound increases in intraabdominal and peak inspiratory pressures. We recently treated five patients with ruptured abdominal aortic aneurysms and one patient with a ruptured thoracoabdominal aneurysm whose abdominal incisions had to be closed with a Dacron reinforced, silicone sheet. All patients were hemodynamically unstable either at admission to the hospital or became so during operation. Four patients required the insertion of a silicone rubber sheet at the primary operation because of massive retroperitoneal hematoma or edema of the bowel wall or both. Incisions in two patients were closed primarily, but the patients required reexploration and secondary closure with silicone rubber sheets because of the development of marked increases in peak inspiratory pressures, intraabdominal pressures, and decreased urinary output. Four of the six patients subsequently underwent successful removal of the silicone rubber sheets with delayed primary closure of the abdominal wall, and two others died before removal. The patient with the ruptured thoracoabdominal aneurysm died on postoperative day 20 because of pulmonary sepsis but had a healed abdominal incision. The three surviving patients have been discharged. A silicone rubber sheet may be necessary for closure of the abdominal wall after repair of ruptured abdominal aortic aneurysm in patients where primary abdominal wall closure is impossible or where it results in compromise in respiratory or renal function.

Resterilized mesh in repair of abdominal wall defects in rats.

PubMed

Sucullu, Ilker; Akin, Mehmet Levhi; Yitgin, Selahattin; Filiz, Ali Ilker; Kurt, Yavuz

2008-01-01

A variety of negative opinions about repeated usage of relatively expensive resterilized synthetic meshes have been considered. It had been stated that resterilized polypropylene meshes inhibits fibroblastic activity, decreases proliferative activity, and increases apoptosis in human fibroblast culture, in vitro. The purpose of this study is the in vivo evaluation of the resterilized mesh repairs of abdominal hernia defects in rat models of incisional hernia by comparing primer repair and original mesh repairs. The rats (n = 22) were separated into three groups. While the abdominal defect was repaired by primary suture in the control group (CG), the defects were repaired by original mesh (OG) or resterilized mesh (RG) in mesh-repaired groups. After 21 days, the rats were evaluated for tissue tensile strengths, tissue hydroxyproline levels, tissue inflammation, fibrosis, and apoptosis. Although the tensile strengths in OG and RG were significantly higher than those of CG (p < .05 and p < .05), there was no significant difference between two groups. The tissue hydroxyproline levels in OG and RG were also higher than those of CG. The difference was not significant between the two groups. The inflammation and fibrosis indexes in OG and RG were significantly higher than those of CG (p < .0001 for both), but there was no difference between groups. While the apoptosis index in OG and RG was also higher than that of CG (p < .0001 for both), there was no significant difference between OG and RG. The usage of resterilized mesh in abdominal wall repair did not reduce the tissue tensile strength, did not affect the tissue hydroxyproline levels, did not decrease the fibrosis, and did not increase the tissue inflammation and apoptosis. In conclusion, usage of resterilized meshes in abdominal wall defects was as safe as sterilized meshes.

[Case report: Rapidly growing abdominal wall giant desmoid tumour during pregnancy].

PubMed

Palacios-Zertuche, Jorge Tadeo; Cardona-Huerta, Servando; Juárez-García, María Luisa; Valdés-Flores, Everardo; Muñoz-Maldonado, Gerardo Enrique

Desmoid tumours are one of the rarest tumours worldwide, with an estimated yearly incidence of 2-4 new cases per million people. They are soft tissue monoclonal neoplasms that originate from mesenchymal stem cells. It seems that the hormonal and immunological changes occurring during pregnancy may play a role in the severity and course of the disease. The case is presented on 28-year-old female in her fifth week of gestation, in whom an abdominal wall tumour was found attached to left adnexa and uterus while performing a prenatal ultrasound. The patient was followed up under clinical and ultrasonographic surveillance. When she presented with abnormal uterine activity at 38.2 weeks of gestation, she was admitted and obstetrics decided to perform a caesarean section. Tumour biopsy was taken during the procedure. Histopathology reported a desmoid fibromatosis. A contrast enhanced abdominal computed tomography scan was performed, showing a tumour of 26×20.5×18cm, with well-defined borders in contact with the uterus, left adnexa, bladder and abdominal wall, with no evidence of infiltration to adjacent structures. A laparotomy, with tumour resection, hysterectomy and left salpingo-oophorectomy, components separation techniques, polypropylene mesh insertion, and drainage was performed. The final histopathology report was desmoid fibromatosis. There is no evidence of recurrence after 6 months follow-up. Desmoid tumours are locally aggressive and surgical resection with clear margins is the basis for the treatment of this disease, using radiotherapy, chemotherapy and hormone therapy as an adjunct in the treatment. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Aggregatibacter actinomycetemcomitans pneumonia with chest and abdominal wall involvement.

PubMed

Storms, Iris; van den Brand, Marre; Schneeberger, Peter; van 't Hullenaar, Nico

2017-04-21

A 54-year-old man presented with a productive cough, chest pain, fever and weight loss. Initial analysis revealed a palpable chest wall mass and consolidation in the left lower lobe and pleural abnormalities on imaging. At that point no infectious cause or malignancy was identified. Microbiological analysis of a needle biopsy from a newly developed abdominal wall mass revealed growth of Aggregatibacter actinomycetemcomitans The patient was successfully treated with antibiotic therapy for 1 year. Aggregatibacter actinomycetemcomitans is a Gram-negative coccobacillus and is part of the normal oral flora. It is capable of causing infections in humans including periodontitis, soft tissue abscesses and systemic invasive infections, most commonly endocarditis. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Necrotizing Fasciitis of the Abdominal Wall Caused by Serratia Marcescens

PubMed Central

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

2015-01-01

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. PMID:26294949

[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. Georg Thieme Verlag KG Stuttgart New York.

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. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

The risk of volvulus in abdominal wall defects.

PubMed

Abdelhafeez, Abdelhafeez H; Schultz, Jessica A; Ertl, Allison; Cassidy, Laura D; Wagner, Amy J

2015-04-01

Congenital abdominal wall defects are associated with abnormal intestinal rotation and fixation. A Ladd's procedure is not routinely performed in these patients; it is believed intestinal fixation is provided by adhesions that develop post-repair of the defects. However, patients with omphalocele may not have adequately protective postoperative adhesions because of difference in the inflammatory state of the bowel wall and in repair strategy. The aim of this study is to describe the occurrence of midgut volvulus in patients with gastroschisis or omphalocele. A retrospective chart review was performed for all patients managed in a single institution born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy. Of the 206 patients identified with abdominal wall defects, 142 patients (69%) had gastroschisis and 64 patients (31%) had omphalocele. Patients' follow up ranged from 4 years to 13 years. The median gestational age was 36 weeks (26-41 weeks) and the median birth weight was 2.42 kg (0.8-4.87 kg). None of the patients with gastroschisis developed midgut volvulus, however two patients (3%) with omphalocele developed midgut volvulus. No patients with gastroschisis developed midgut volvulus. Therefore, the current practice of not routinely performing a Ladd's procedure is a safe approach during surgical repair of gastroschisis. The two cases of volvulus in patients with omphalocele may be related to less bowel fixation. It is necessary to examine current practice in regards to the need for assessing the risk of volvulus during omphalocele closure and counseling of these patients. This assessment may be achieved via routine examination of the width of the small bowel mesenteric base, whenever feasible; however, the sample size is relatively small to draw any definitive conclusions. Published by Elsevier Inc.

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.

Atelectasis after free rectus transfer and abdominal wall reconstruction.

PubMed

Lo, Jamie O; Weber, Stephen M; Andersen, Peter E; Gross, Neil D; Gosselin, Marc; Wax, Mark K

2008-10-01

Atelectasis is commonly encountered in patients undergoing rectus abdominus tissue transfer. Primary closure of the anterior rectus sheath may contribute to this process. Augmentation of the closure with mesh may decrease the incidence of Atelectasis. In this retrospective review 32 patients with preoperative and postoperative augmentation were compared to 23 who had primary closure of the anterior rectus sheath. Augmentation consisted of acellular dermis (25) or mesh (7). Postoperative atelectasis was radiographically detected in: 91% (n=29) of augmented patients versus 83% (n=19) of primary closure patients. Major atelectasis in 41% (n=13) of augmented patients versus 61% (n=14) of primary closure patients p<.05. The incidence of atelectasis was independent of skin flap size and operative times. The use of acellular dermis or mesh to augment the abdominal wall appears to reduce the high incidence of postoperative atelectasis following rectus-free flap harvest. Copyright (c) 2008 Wiley Periodicals, Inc. Head Neck 2008.

Abdominal Wall Defects in Greenland 1989-2015.

PubMed

Bugge, Merete; Drachmann, Gitte; Kern, Peder; Budtz-Jørgensen, Esben; Eiberg, Hans; Olsen, Britta; Tommerup, Niels; Nielsen, Inge-Merete

2017-07-03

In the last decades, an increasing rate of gastroschisis but not of omphalocele has been reported worldwide. Greenland is the world's largest island, but 80% is covered by an ice cap, it has a small population of around 56,000 peoples (as of 2016). The occurrence of abdominal wall defects has never been investigated in Greenland. The present study is based on data retrieved from three nationwide and two local registries in the Greenlandic health care system over 27 years (1989-2015). We identified 33 infants with abdominal wall defects born in the study time period. All cases were reclassified to 28 cases of gastroschisis, four cases of omphalocele, and there was 1 infant in the indeterminate group. The point prevalence at birth for gastroschisis increased significantly from 8 to 35 (average 10.7) per 10,000 liveborn and -stillborn infants. Mothers below 20 years of age represented 23% of all cases and the prevalence for this group was 17 per 10,000 liveborn and stillborn. Perinatal mortality for infants with gastroschisis was high (18%), and 1 year survival was 71%. For omphalocele, the prevalence varied from 8 to 11 per 10,000 liveborn and stillborn infants. There was no increasing rate in the period, further highlighting an etiological difference between gastroschisis and omphalocele. This study confirms the increasing prevalence of gastroschisis in Greenland in the period from 1989 to 2015. The average was 10.7 per 10,000 liveborn and -stillborn infants and, to the best of our knowledge, this is the highest prevalence ever reported. Birth Defects Research 109:836-842, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Abdominal wall reinforcement: biologic vs. degradable synthetic devices.

PubMed

Gruber-Blum, S; Brand, J; Keibl, C; Fortelny, R H; Redl, H; Mayer, F; Petter-Puchner, A H

2017-04-01

New biodegradable synthetic and biologic hernia implants have been promoted for rapid integration and tissue reinforcement in challenging repairs, e.g. at the hiatus or in contaminated wound fields. Interestingly, experimental data to support or falsify this assumption is scarce. Synthetic (BioA ® ) and biologic implants (porcine and bovine collagen matrices Strattice ® and Veritas ® ) have been tested in experimental onlay hernia repair in rats in observation periods of 30 and 60 days. The key outcome parameters were mesh integration and reinforcement of the tissue at the implant site over sutured and sealed defects as well as comparison to native abdominal wall. Macroscopic assessment, biomechanical analysis and histology with haematoxylin/eosin staining, collagen staining and van Willebrand factor staining for detection of neovascularization were performed. BioA ® was well integrated. Although the matrices were already fragmented at 60 days follow-up, hernia sites treated with synthetic scaffolds showed a significantly enhanced tissue deflection and resistance to burst force when compared to the native abdominal wall. In porcine and bovine matrices, tissue integration and shrinkage were significantly inferior to BioA ® . Histology revealed a lack of fibroblast ingrowth through mesh interstices in biologic samples, whereas BioA ® was tightly connected to the underlying tissue by reticular collagen fibres. Strattice ® and Veritas ® yielded reduced tissue integration and significant shrinkage, prohibiting further biomechanical tests. The synthetic BioA ® provides little inherent strength but reticular collagen remodelling led to an augmentation of the scar due to significantly higher burst force resistance in comparison to native tissue.

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.

Chronic abdominal wall pain--a diagnostic challenge for the surgeon.

PubMed

Lindsetmo, Rolv-Ole; Stulberg, Jonah

2009-07-01

Chronic abdominal wall pain (CAWP) occurs in about 30% of all patients presenting with chronic abdominal pain. The authors review the literature identified in a PubMed search regarding the abdominal wall as the origin of chronic abdominal pain. CAWP is frequently misinterpreted as visceral or functional abdominal pain. Misdiagnosis often leads to a variety of investigational procedures and even abdominal operations with negative results. With a simple clinical test (Carnett's test), >90% of patients with CAWP can be recognized, without risk for missing intra-abdominal pathology. The condition can be confirmed when the injection of local anesthetics in the trigger point(s) relieves the pain. A fasciotomy in the anterior abdominal rectus muscle sheath through the nerve foramina of the affected branch of one of the anterior intercostal nerves heals the pain.

Grey Turner's and Cullen's signs induced by spontaneous hemorrhage of the abdominal wall after coughing.

PubMed

Fan, Zhe; Zhang, Yingyi

2017-08-01

Grey Turner's and Cullen's signs are rare clinical signs, which most appear in patients with severe acute pancreatitis. The present patient complained of abdominal pain after coughing. However, contrast-enhanced CT revealed a hemorrhage of the abdominal wall. Therefore, spontaneous hemorrhage of the abdominal wall was diagnosed. The patient recovered through immobilization and hemostasis therapy. This case report and literature review aims to remind clinicians of manifestations and treatment of spontaneous hemorrhage.

Technical advances for abdominal wall closure after intestinal and multivisceral transplantation.

PubMed

Gerlach, Undine A; Pascher, Andreas

2012-06-01

Abdominal wall closure after intestinal transplantation (ITX) or multivisceral transplantation (MVTX) is challenging because of the loss of abdominal domain and wall elasticity as a result of previous operations and donor-to-recipient weight and height mismatch. We report on abdominal wall closure management in 30 ITX and MVTX recipients. In 60% of patients (n = 18), a primary abdominal closure (PAC) was achieved, in 40% (n = 12) a staged closure (SAC) was necessary. Patients with PAC had undergone less pretransplant operations and required less posttransplant relaparotomies. They were mainly ITX recipients or more abdominal domain because of a longer intestinal remnant. A literature review revealed different strategies to overcome a failed primary closure. They focus on graft reduction or an enlargement of the abdominal domain. The latter includes temporary coverage with prosthetic materials for SAC. Definite abdominal closure is achieved by skin only closure, or by using acellular dermal matrix, rotational flaps, rectus muscle fascia or abdominal wall grafts. Abdominal wall reconstruction after ITX/MVTX is commonly demanded and can be conducted by different strategies. The technique should be easy to use in a timely manner and should prevent abdominal infections, intestinal fistulation, incisional hernias, and wound dehiscence.

The impact of personalized probabilistic wall thickness models on peak wall stress in abdominal aortic aneurysms.

PubMed

Biehler, J; Wall, W A

2018-02-01

If computational models are ever to be used in high-stakes decision making in clinical practice, the use of personalized models and predictive simulation techniques is a must. This entails rigorous quantification of uncertainties as well as harnessing available patient-specific data to the greatest extent possible. Although researchers are beginning to realize that taking uncertainty in model input parameters into account is a necessity, the predominantly used probabilistic description for these uncertain parameters is based on elementary random variable models. In this work, we set out for a comparison of different probabilistic models for uncertain input parameters using the example of an uncertain wall thickness in finite element models of abdominal aortic aneurysms. We provide the first comparison between a random variable and a random field model for the aortic wall and investigate the impact on the probability distribution of the computed peak wall stress. Moreover, we show that the uncertainty about the prevailing peak wall stress can be reduced if noninvasively available, patient-specific data are harnessed for the construction of the probabilistic wall thickness model. Copyright © 2017 John Wiley & Sons, Ltd.

Laparoscopic excision of an epidermoid cyst arising from the deep abdominal wall.

PubMed

Ishikawa, Hajime; Nakai, Takuya; Ueda, Kazuki; Haji, Seiji; Takeyama, Yoshifumi; Ohyanagi, Harumasa

2009-10-01

Epidermoid cysts are the most common type of cutaneous cyst. However, their occurrence in the deep abdominal wall has not yet been reported. Here, we present the case of a 60-year-old woman who developed an epidermoid cyst in the deep abdominal wall, which was resected laparoscopically. The patient presented with right upper quadrant abdominal pain on admission to our hospital. Computed tomography revealed cholecystolithiasis and an incidentally identified well-defined hypoattenuating mass (62 x 47 x 65 mm) in the deep abdominal wall on the left side of the navel. We performed laparoscopic complete resection of the abdominal wall tumor followed by cholecystectomy. The excised specimen was a cyst covered with a smooth thin membrane and contained sludge. Histopathologic examination revealed an epidermoid cyst. This is a very rare case with no previous reports on a similar type of epidermoid cyst.

Abdominal wall dysfunction in adult bladder exstrophy: a treatable but under-recognized problem.

PubMed

Manahan, M A; Campbell, K A; Tufaro, A P

2016-08-01

Bladder exstrophy is defined by urogenital and skeletal abnormalities with cosmetic and functional deformity of the lower anterior abdominal wall. The primary management objectives have historically been establishment of urinary continence with renal function preservation, reconstruction of functional and cosmetically acceptable external genitalia, and abdominal wall closure of some variety. The literature has focused on the challenges of neonatal approaches to abdominal wall closure; however, there has been a paucity of long-term followup to identify the presence and severity of abdominal wall defects in adulthood. Our goal was to characterize the adult disease and determine effective therapy. A retrospective review of a consecutive series of six patients was performed. We report and characterize the presence of severe abdominal wall dysfunction in these adult exstrophy patients treated as children. We tailored an abdominal wall and pelvic floor reconstruction with long-term success to highlight a need for awareness of the magnitude of the problem and its solvability. The natural history of abdominal wall laxity and the long-term consequences of cloacal exstrophy closure have gone unexplored and unreported. Evaluation of our series facilitates understanding in this complex area and may be valuable for patients who are living limited lives thinking that no solution is available.

Fetal anterior abdominal wall defects: prenatal imaging by magnetic resonance imaging.

PubMed

Victoria, Teresa; Andronikou, Savvas; Bowen, Diana; Laje, Pablo; Weiss, Dana A; Johnson, Ann M; Peranteau, William H; Canning, Douglas A; Adzick, N Scott

2018-04-01

Abdominal wall defects range from the mild umbilical cord hernia to the highly complex limb-body wall syndrome. The most common defects are gastroschisis and omphalocele, and the rarer ones include the exstrophy complex, pentalogy of Cantrell and limb-body wall syndrome. Although all have a common feature of viscera herniation through a defect in the anterior body wall, their imaging features and, more important, postnatal management, differ widely. Correct diagnosis of each entity is imperative in order to achieve appropriate and accurate prenatal counseling and postnatal management. In this paper, we discuss fetal abdominal wall defects and present diagnostic pearls to aid with diagnosis.

[Gas gangrene of the abdominal wall due to underlying GI pathology: seven cases].

PubMed

Monneuse, O; Gruner, L; Barth, X; Malick, P; Timsit, M; Gignoux, B; Tissot, E

2007-01-01

Gas gangrene of the abdominal wall is a rare clinical occurrence with high rates of morbidity and mortality. The primary source of the infection is often unknown. To analyze the primary underlying intestinal etiologies and diagnostic approaches of gas gangrene of the abdominal wall, and to highlight specific treatment problems, particularly that of constructing a colostomy exteriorized through a massively infected abdominal wall. Seven cases of abdominal wall gas gangrene due to a gastrointestinal etiology were identified. (Cases arising from proctologic sources or related to recent abdominal surgery were excluded.) During the same period, 39 other patients presenting with abdominal wall gangrene from non-intestinal sources were treated. The etiologies were: perforated sigmoid diverticulitis (n=2), perforated appendicitis (n=1), acute pancreatitis with associated cecal perforation (n=1), and perforated colorectal cancer (n=3). Four of the seven patients died despite treatment (mortality of 57%). The clinical presentations of these seven cases demonstrate that a GI source must be suspected whenever a patient presents with abdominal wall gas gangrene, even when there are no specific GI symptoms. Imaging, particularly with CT scan, is essential both to visualize the extent of tissue necrosis and to reveal underlying primary GI pathology. This optimizes the surgical approach both by allowing for complete debridement and drainage of infected tissue, and by focussing the intervention on correction of the underlying primary GI source of infection.

Morphology of the abdominal wall in the bat, Pteronotus parnellii (Microchiroptera: Mormoopidae): implications for biosonar vocalization.

PubMed

Lancaster, W C; Henson, O W

1995-01-01

We investigated the structure of the abdominal wall of Pteronotus parnellii and made comparisons with eight other species of Microchiroptera and one megachiropteran. Similar to other mammals, the abdominal wall of bats consists of the three flank muscles laterally and the m. rectus abdominis ventrally. In Microchiroptera, flank muscles are mostly confined to dorsal portions of the wall. The mm. transversus abdominis and obliquus internus abdominis form the bulk of the wall; the m. obliquus externus is poorly developed. Ventrolaterally, a large portion of the wall is a dense, bilaminar aponeurosis, composed of collagen, elastin, and fibroblasts. The thicker, superficial lamina derives from the mm. obliquus internus and transversus abdominis. The deep lamina is a continuation of the transversalis fascia. Collagen fibers of the two fused laminae are oriented orthogonally, resulting in a resilient, composite fabric. Fascicles of the flank muscles are oriented along the margins of the aponeurosis so that their forces appear to be concentrated onto the aponeurosis. We suggest that this system is adapted for the regulation and generation of intra-abdominal pressure. The abdominal wall of Pteropus, the one megachiropteran examined, lacks the derived aponeurosis and is similar to other mammals. We consider the abdominal wall of Microchiroptera to be analogous to the diaphragma, in that it functions in the regulation of pressure within body cavities and facilitates biosonar vocalization.

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

PubMed

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

2002-02-01

During laparoscopic cholecystectomy, perforation of the gallbladder can occurs in < or = 20% of cases, while gallstone spillage occurs in < or = 6% of cases. In most cases, there are no consequences. Gallstones can be lost in the abdominal wall as well as the abdomen during extraction of the gallbladder. The fate of such lost gallstones, which can lead to the formation of an abscess, an abdominal wall mass, or a persistent sinus, has not been studied adequately. Herein we report the case of a persistent sinus of the abdominal wall after an emergent laparoscopic cholecystectomy in an 82-year-old woman with gangrenous cholecystitis and perforation of the friable wall in association with an empyema of the gallbladder. The culture of the obtained pus was positive for Escherichia coli. After a small leak of dirty fluid from the wound of the epigastric port site of 4 months' duration, surgical exploration under local anesthesia revealed that the sinus was caused by spilled gallstones impacting into the abdominal wall between the posterior sheath and left rectus abdominalis muscle. The removal of the stones resulted in complete healing. Long-term complications after laparoscopic cholecystectomy involving the abdominal wall are rare but important possible consequences that could be avoided.

Mechanical behaviour of synthetic surgical meshes: finite element simulation of the herniated abdominal wall.

PubMed

Hernández-Gascón, B; Peña, E; Melero, H; Pascual, G; Doblaré, M; Ginebra, M P; Bellón, J M; Calvo, B

2011-11-01

The material properties of meshes used in hernia surgery contribute to the overall mechanical behaviour of the repaired abdominal wall. The mechanical response of a surgical mesh has to be defined since the haphazard orientation of an anisotropic mesh can lead to inconsistent surgical outcomes. This study was designed to characterize the mechanical behaviour of three surgical meshes (Surgipro®, Optilene® and Infinit®) and to describe a mechanical constitutive law that accurately reproduces the experimental results. Finally, through finite element simulation, the behaviour of the abdominal wall was modelled before and after surgical mesh implant. Uniaxial loading of mesh samples in two perpendicular directions revealed the isotropic response of Surgipro® and the anisotropic behaviour of Optilene® and Infinit®. A phenomenological constitutive law was used to reproduce the measured experimental curves. To analyze the mechanical effect of the meshes once implanted in the abdomen, finite element simulation of the healthy and partially herniated repaired rabbit abdominal wall served to reproduce wall behaviour before and after mesh implant. In all cases, maximal displacements were lower and maximal principal stresses higher in the implanted abdomen than the intact wall model. Despite the fact that no mesh showed a behaviour that perfectly matched that of abdominal muscle, the Infinit® mesh was able to best comply with the biomechanics of the abdominal wall. Copyright © 2011 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Endometrial stromal cell attachment and matrix homeostasis in abdominal wall endometriomas.

PubMed

Itoh, Hiroko; Mogami, Haruta; Bou Nemer, Laurice; Word, Larry; Rogers, David; Miller, Rodney; Word, R Ann

2018-02-01

How does progesterone alter matrix remodeling in abdominal wall endometriomas compared with normal endometrium? Progesterone may prevent attachment of endometrial cells to the abdominal wall, but does not ameliorate abnormal stromal cell responses of abdominal wall endometriomas. Menstruation is a tightly orchestrated physiologic event in which steroid hormones and inflammatory cells cooperatively initiate shedding of the endometrium. Abdominal wall endometriomas represent a unique form of endometriosis in which endometrial cells inoculate fascia or dermis at the time of obstetrical or gynecologic surgery. Invasion of endometrium into ectopic sites requires matrix metalloproteinases (MMPs) for tissue remodeling but endometrium is not shed externally. Observational study in 14 cases and 19 controls. Tissues and stromal cells isolated from 14 abdominal wall endometriomas were compared with 19 normal cycling endometrium using immunohistochemistry, quantitative PCR, gelatin zymography and cell attachment assays. P values < 0.05 were considered significant and experiments were repeated in at least three different cell preps to provide scientific rigor to the conclusions. The results indicate that MMP2 and MMP9 are not increased by TGFβ1 in endometrioma stromal cells. Although progesterone prevents attachment of endometrioma cells to matrix components of the abdominal wall, it does not ameliorate these abnormal stromal cell responses to TGFβ1. N/A. Endometriomas were collected from women identified pre-operatively. Not all endometriomas were collected. Stromal cells from normal endometrium were from different patients, not women undergoing endometrioma resection. This work provides insight into the mechanisms by which progesterone may prevent abdominal wall endometriomas but, once established, are refractory to progesterone treatment. Tissue acquisition was supported by NIH P01HD087150. Authors have no competing interests. © The Author(s) 2017. Published by Oxford

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

An evaluation of abdominal wall closure in general surgical and gynecological residents.

PubMed

Williams, Z; Williams, S; Easley, H A; Seita, H M; Hope, W W

2017-12-01

To evaluate abdominal wall closure knowledge base and technical skills in surgical and OB/GYN residents. Residents consented to participate in a skills laboratory and quiz. The skills portion involved closure of a 10-cm incision on a simulated abdominal wall. Participants were timed, filmed, and graded using a standardized grading system. Thirty surgical and OB/GYN residents participated. All residents reported closing the abdominal wall continuously, 97% preferred slowly absorbing sutures (28/29), 97% preferred taking 1-cm bites (29/30), and 93% spaced bites 1 cm apart (27/29). However, 77% (10/13) of surgery residents identified 4:1 as the ideal suture to wound length ratio; 47% (7/15) of OB/GYN residents believed it to be 2:1, and another 40% (6/15) indicated 3:1 (p < 0.0001). In the simulation, OB/GYN residents used significantly fewer stitches (p = 0.0028), significantly more distance between bites (p < 0.0001), and significantly larger bite size (p < 0.0001) than surgery residents. When graded, there was no significant difference between programs. Despite some knowledge regarding the principles of abdominal wall closure among surgical and OB/GYN residents, more instruction is needed. We identified some differences in knowledge base and techniques for abdominal wall closure among general surgery and OB/GYN residents, which are likely due to differences in educational curriculums.

Mesh abdominal wall hernia surgery is safe and effective-the harm New Zealand media has done.

PubMed

Kelly, Steven

2017-10-06

Patients in New Zealand have now developed a fear of mesh abdominal wall hernia repair due to inaccurate media reporting. This article outlines the extensive literature that confirms abdominal wall mesh hernia repair is safe and effective. The worsening confidence in the transvaginal mesh prolapse repair should not adversely affect the good results of mesh abdominal wall hernia repair. New Zealand general surgeons are well trained in providing modern hernia surgery.

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. Copyright © 2013 Elsevier Inc. All rights reserved.

Texture analysis improves level set segmentation of the anterior abdominal wall

SciTech Connect

Xu, Zhoubing; Allen, Wade M.; Baucom, Rebeccah B.

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,more » 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

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. © 2016 S. Karger AG, Basel.

Abdominal wall Hydatid cyst: A review a literature with a case report.

PubMed

Salih, Abdulwahid M; Kakamad, F H; Hammood, Zuhair D; Yasin, Bzhwen; Ahmed, Dilshad M

2017-01-01

Hydatid cyst (HC) disease is a serious health problem in endemic areas. It is a parasitic infection that commonly involves liver and lungs while muscular HC is rare. HC of abdominal wall was reported only six times. We reported a 39-year-old male presented with HC of the right loin who was managed surgically with brief literature review. HC should be put in the differential diagnosis of the abdominal wall masses. Its pre-operative diagnosis is important to prevent rupture with subsequent anaphylaxis and recurrence. Surgery is the main modality of treatment. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Contraction of Abdominal Wall Muscles Influences Incisional Hernia Occurrence and Size

PubMed Central

Lien, Samuel C.; Hu, Yaxi; Wollstein, Adi; Franz, Michael G.; Patel, Shaun P.; Kuzon, William M.; Urbanchek, Melanie G.

2015-01-01

Background Incisional hernias are a complication in 10% of all open abdominal operations and can result in significant morbidity. The purpose of this study is to determine if inhibiting abdominal muscle contraction influences incisional hernia formation during laparotomy healing. We hypothesize that reducing abdominal musculature deformation reduces incisional hernia occurrence and size. Study Design Using an established rat model for incisional hernia, a laparotomy through the linea alba was closed with one mid-incision, fast-absorbing suture. Three groups were compared: a SHAM group (SHAM; n = 6) received no laparotomies while the Saline Hernia (SH; n = 6) and Botox Hernia (BH; n = 6) groups were treated once with equal volume saline or Botulinum Toxin (Botox®, Allergan) before the incomplete laparotomy closure. On post-operative day 14, the abdominal wall was examined for herniation and adhesions and contractile forces were measured for abdominal wall muscles. Results No hernias developed in SHAM rats. Rostral hernias developed in all SH and BH rats. Caudal hernias developed in all SH rats, but in only 50% of the BH rats. Rostral hernias in the BH group were 35% shorter and 43% narrower compared to those in the SH group (p < 0.05). The BH group had weaker abdominal muscles compared to the SHAM and SH groups (p < 0.05). Conclusions In our rat model, partial paralysis of abdominal muscles reduces the number and size of incisional hernias. These results confirm abdominal wall muscle contractions play a significant role in the pathophysiology of incisional hernia formation. PMID:25817097

Role of tissue expansion in abdominal wall reconstruction: A systematic evidence-based review.

PubMed

Wooten, Kimberly E; Ozturk, Cemile Nurdan; Ozturk, Can; Laub, Peter; Aronoff, Nell; Gurunluoglu, Raffi

2017-06-01

Tissue expanders (TEs) can be used to assist primary closure of complicated hernias and large abdominal wall defects. However, there is no consensus regarding the optimal technique, use, or associated risk of TE in abdominal wall reconstruction. A systematic search of PubMed and Embase databases was conducted to identify articles reporting abdominal wall reconstruction with TE techniques. English articles published between 1980 and 2016 were included on the basis of the following inclusion criteria: two-stage TE surgical technique, >3 cases, reporting of postoperative complications, hernia recurrence, and patient-based clinical data. Fourteen studies containing 103 patients (85 adults and 18 children) were identified for analysis. Most patients presented with a skin-grafted ventral hernia (n = 86). The etiology of the hernia was from trauma or prior abdominal surgery. The remaining patients had TE placed before organ transplantation (n = 12) or for congenital abdominal wall defects (n = 5). The location for expander placement was subcutaneous (n = 74), between the internal and external obliques (n = 26), posterior to the rectus sheath (n = 2), and intra-peritoneal (n = 1). Postoperative infections and implant-related problems were the most commonly reported complications after Stage I. The most common complication after Stage II was recurrent hernia, which was observed in 12 patients (11.7%). Five patients with TE died. Complications and mortality were more prevalent in children, immunosuppressed patients, and those with chronic illnesses. Tissue expansion for abdominal wall reconstruction can be successfully used for a variety of carefully selected patients with an acceptable complication and risk profile. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Dura covered with fibrin glue reduces adhesions in abdominal wall defects.

PubMed

Schier, F; Srour, N; Waldschmidt, J

1991-12-01

Dura can greatly facilitate the closure of abdominal wall defects. However, a main disadvantage of its use are the adhesions which develop between omentum, bowel and dura and may lead to bowel obstructions. In this study various groups of rats had either the anterior wall replaced by untreated dura or by dura covered with fibrin glue prior to implantation. Adhesions were found in 75% of sham operated rats, 100% after untreated dura implantation and 50% after the implantation of fibrin glue treated dura.

[Abdominal catastrophe--abdominal wall defect associated with gastrointestinal fistula--strategy of therapy].

PubMed

Chobola, M; Sobotka, L; Ferko, A; Oberreiter, M; Kaska, M; Motycka, V; Páral, J; Mottl, R

2010-11-01

Wound dehiscence complicated by gastrointestinal (GI) fistula to belong ,,abdominal catastrophe". Therapy is prolonged and connected with high morbidity and mortality rate. In the period from October 2006 to July 2009 we performed 12 reconstructive surgical procedures on gastrointestinal tract in patients with abdominal catastrophe. Treatment of 12 consecutive patients (9 men, 3 women) was managed according to a standardize protocol. The protocol consists of treatment of septic complications, optimisation of nutritional state, special wound procedures, diagnosis of gastrointestinal fistulas and GI tract, timing of surgical procedures, reconstruction of GI tract and postoperative care. Reconstructive surgery of GI tract was successful on 11 patients. One patient developed recurrence of early GI fistula. In four patients we let open abdomen to heal per secundam. We observed no deaths after operation. With regard to complex character of therapy of abdominal catastrophe there is a need of multidisciplinary approach. Considering long-lasting and expensive therapy there is logical step to concentrate these patients into special centres which are experienced, equipped and their staff is trained in treatment of such a seriously impaired patients.

Reconstruction of infected abdominal wall defects using latissimus dorsi free flap.

PubMed

Kim, Sang Wha; Han, Sang Chul; Hwang, Kyu Tae; Ahn, Byung Kyu; Kim, Jeong Tae; Kim, Youn Hwan

2013-12-01

Infected abdominal defects are a challenge to surgeons. In this study, we describe 10 cases in which the latissimus dorsi myocutaneous flap was used for successful reconstruction of abdominal wall defects severely infected with methicillin-resistant Staphylococcus aureus (MRSA). Retrospective review of 10 patients with abdominal wall defects that were reconstructed using the latissimus dorsi myocutaneous flap between 2002 and 2010. All patients had abdominal defects with hernias, combined with MRSA infections. The sizes of the flaps ranged from 120 to 364 cm(2) . The deep inferior epigastric artery was the recipient vessel in nine patients and the internal mammary vessels were used for one patient. There were no complications relating to the flaps, although there were other minor complications including wound dehiscence, haematoma and fluid correction. After reconstruction, there were no signs of infection during follow-up periods, and the patients were satisfied with the final results. Reconstruction using the latissimus dorsi myocutaneous flap, including muscle fascia structures, is a potential treatment option for severely infected large abdominal wall defects. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Impact of isotropic constitutive descriptions on the predicted peak wall stress in abdominal aortic aneurysms.

PubMed

Man, V; Polzer, S; Gasser, T C; Novotny, T; Bursa, J

2018-03-01

Biomechanics-based assessment of Abdominal Aortic Aneurysm (AAA) rupture risk has gained considerable scientific and clinical momentum. However, computation of peak wall stress (PWS) using state-of-the-art finite element models is time demanding. This study investigates which features of the constitutive description of AAA wall are decisive for achieving acceptable stress predictions in it. Influence of five different isotropic constitutive descriptions of AAA wall is tested; models reflect realistic non-linear, artificially stiff non-linear, or artificially stiff pseudo-linear constitutive descriptions of AAA wall. Influence of the AAA wall model is tested on idealized (n=4) and patient-specific (n=16) AAA geometries. Wall stress computations consider a (hypothetical) load-free configuration and include residual stresses homogenizing the stresses across the wall. Wall stress differences amongst the different descriptions were statistically analyzed. When the qualitatively similar non-linear response of the AAA wall with low initial stiffness and subsequent strain stiffening was taken into consideration, wall stress (and PWS) predictions did not change significantly. Keeping this non-linear feature when using an artificially stiff wall can save up to 30% of the computational time, without significant change in PWS. In contrast, a stiff pseudo-linear elastic model may underestimate the PWS and is not reliable for AAA wall stress computations. Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.

Rectus sheath block: successful use in the chronic pain management of pediatric abdominal wall pain.

PubMed

Skinner, Adam V; Lauder, Gillian R

2007-12-01

Seven pediatric patients (aged 11-16 years) with chronic abdominal wall pain are presented who gained significant relief from a rectus sheath block (RSB). We describe the case histories and review the relevant literature for this technique. The etiology of the abdominal wall pain was considered to be abdominal cutaneous nerve entrapment, iatrogenic peripheral nerve injury, myofascial pain syndrome or was unknown. All patients showed significant initial improvement in pain and quality of life. Three patients required only the RSB to enable them to be pain-free and return to normal schooling and physical activities. Two children received complete relief for more than 1 year. In the majority of cases, the procedure was carried out under general anesthesia as a daycase procedure. Local anesthetic and steroids were used. This is the first report of the successful use of this technique in the chronic pain management setting in children.

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.

PubMed

Birindelli, Arianna; Sartelli, Massimo; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; van Ramshorst, Gabrielle H; Campanelli, Giampiero; Khokha, Vladimir; Moore, Ernest E; Peitzman, Andrew; Velmahos, George; Moore, Frederick Alan; Leppaniemi, Ari; Burlew, Clay Cothren; Biffl, Walter L; Koike, Kaoru; Kluger, Yoram; Fraga, Gustavo P; Ordonez, Carlos A; Novello, Matteo; Agresta, Ferdinando; Sakakushev, Boris; Gerych, Igor; Wani, Imtiaz; Kelly, Michael D; Gomes, Carlos Augusto; Faro, Mario Paulo; Tarasconi, Antonio; Demetrashvili, Zaza; Lee, Jae Gil; Vettoretto, Nereo; Guercioni, Gianluca; Persiani, Roberto; Tranà, Cristian; Cui, Yunfeng; Kok, Kenneth Y Y; Ghnnam, Wagih M; Abbas, Ashraf El-Sayed; Sato, Norio; Marwah, Sanjay; Rangarajan, Muthukumaran; Ben-Ishay, Offir; Adesunkanmi, Abdul Rashid K; Lohse, Helmut Alfredo Segovia; Kenig, Jakub; Mandalà, Stefano; Coimbra, Raul; Bhangu, Aneel; Suggett, Nigel; Biondi, Antonio; Portolani, Nazario; Baiocchi, Gianluca; Kirkpatrick, Andrew W; Scibé, Rodolfo; Sugrue, Michael; Chiara, Osvaldo; Catena, Fausto

2017-01-01

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.

Clinical evaluation of extraperitoneal colostomy without damaging the muscle layer of the abdominal wall.

PubMed

Dong, L-R; Zhu, Y-M; Xu, Q; Cao, C-X; Zhang, B-Z

2012-01-01

This study investigated whether extraperitoneal colostomy without damaging the muscle layer of the abdominal wall is an improved surgical procedure compared with conventional sigmoid colostomy in patients undergoing abdominoperineal resection. Patients with rectal cancer undergoing abdominoperineal resection were selected and randomly divided into two groups: the study group received extraperitoneal colostomy without damaging the muscle layer of the abdominal wall and the control group received conventional colostomy. Clinical data from both groups were analysed. A total of 128 patients were included: 66 received extraperitoneal colostomy without damaging the muscle layer of the abdominal wall and 62 received conventional colostomy. Significant differences between the two groups were found in relation to colostomy operating time, defaecation sensation, bowel control and overall stoma-related complications. Duration of postoperative hospital stay was also significantly different between the study groups. Extraperitoneal colostomy without damaging the muscle layer of the abdominal wall was found to be an improved procedure compared with conventional sigmoid colostomy in abdominoperineal resection, and may reduce colostomy-related complications, shorten operating time and postoperative hospital stay, and potentially improve patients' quality of life.

[Experience with Clotteau-Prémont's technique in abdominal wall hernias. Preliminary report].

PubMed

Soto-Dávalos, Baltazar Alberto; Del Pozzo-Magaña, José Antonio; Luna-Martínez, Javier

2006-01-01

Incisional hernias account for at least a third of abdominal wall hernias. There are different techniques of repair that include the use of prosthetic materials, which has lowered the hernia recurrence rate. Nonetheless, its use in case of rejection or infection requires other techniques with local tissue. The use of prosthetic material in a contaminated environment is contraindicated because the risk of infection and recurrence rate is unacceptably high. In order to compare two repair techniques for abdominal wall hernias in terms of complications and recurrence to be used as an alternative for hernia repair in patients with abdominal wall hernias, we conducted, between January 2000 and January 2004, an observational, longitudinal, retrospective, non-randomized matched control case study in patients with abdominal wall hernia. A total of 30 patients were studied and were divided into two groups of 15 patients each. Subjects were matched for sex, age and hernia type (group A, mesh treated and group B, Clotteau-Prémont treated) who had at least a 5-month postoperative follow-up. Complication and recurrence rate was assessed and compared. There were no differences between the two groups in complications or recurrence (p <0.05). The average follow-up time was 18.9 +/- 8 months for group A and 15 +/- 7.9 months for group B. Clotteau-Prémont's technique is a safe and feasible alternative procedure with indications in selected patients.

Characterization of the anisotropic mechanical behavior of human abdominal wall connective tissues.

PubMed

Astruc, Laure; De Meulaere, Maurice; Witz, Jean-François; Nováček, Vit; Turquier, Frédéric; Hoc, Thierry; Brieu, Mathias

2018-06-01

Abdominal wall sheathing tissues are commonly involved in hernia formation. However, there is very limited work studying mechanics of all tissues from the same donor which prevents a complete understanding of the abdominal wall behavior and the differences in these tissues. The aim of this study was to investigate the differences between the mechanical properties of the linea alba and the anterior and posterior rectus sheaths from a macroscopic point of view. Eight full-thickness human anterior abdominal walls of both genders were collected and longitudinal and transverse samples were harvested from the three sheathing connective tissues. The total of 398 uniaxial tensile tests was conducted and the mechanical characteristics of the behavior (tangent rigidities for small and large deformations) were determined. Statistical comparisons highlighted heterogeneity and non-linearity in behavior of the three tissues under both small and large deformations. High anisotropy was observed under small and large deformations with higher stress in the transverse direction. Variabilities in the mechanical properties of the linea alba according to the gender and location were also identified. Finally, data dispersion correlated with microstructure revealed that macroscopic characterization is not sufficient to fully describe behavior. Microstructure consideration is needed. These results provide a better understanding of the mechanical behavior of the abdominal wall sheathing tissues as well as the directions for microstructure-based constitutive model. Copyright © 2018 Elsevier Ltd. All rights reserved.

Giant spigelian hernia due to abdominal wall injury: a case report.

PubMed

Topal, Ersun; Kaya, Ekrem; Topal, Naile Bolca; Sahin, Ilker

2007-02-01

Spigelian hernia is a rare clinical entity. It is difficult to diagnose due to its location. In this article we report the case of a giant spigelian hernia consequent to abdominal wall injury. The neck of the hernia was 10 cm in diameter. We repaired this hernia with a polypropylene mesh.

[Prophylactics and treatment of postoperative hernias of the lateral abdominal walls using polypropylene endoprosthesis].

PubMed

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

2011-01-01

An analysis of complex examination and treatment of 151 patients after planned and performed surgical interventions on organs of the retroperitoneal space was made. The patients were divided into 4 groups. The first group (of comparison) included 46 patients who were treated by lumbotomy for different diseases of organs of the urinary system. In 35 patients of the second group (prophylactics) the indications were determined and in 20 patients preventive endoprosthesis of the lateral abdominal wall using polypropylene endoprosthesis was fulfilled. Herniotomy with plasty of the lateral abdominal wall using local tissues was fulfilled in 30 patients. Prosthesing hernioplasty of the lateral abdominal wall was fulfilled in 40 patients of the main group. It was found that preventive endoprosthesis of the lateral abdominal wall allowed prevention of progressing anatomo-functional i/isufficiency and the appearance of postoperative hernias. The application of polypropylene endoprosthesis for the treatment of postoperative hernias allows obtaining 36.4% more good results as compared with the control group, 21.7% decreased number of satisfactory results and no recurrent hernias.

Investigation into the optimal prosthetic material for wound healing of abdominal wall defects

PubMed Central

Akcakaya, Adem; Aydogdu, Ibrahim; Citgez, Bulent

2018-01-01

The purpose of this experimental study is to investigate and compare the effects of prosthetic materials used for wound healing of abdominal wall hernias. A total of 60 rats were divided into five equal groups: Group I, control subjected to laparotomy; group II, abdominal wall defect 3×2 cm+polypropylene (PP) mesh; group III, abdominal wall defect 3×2 cm+PP mesh+hyaluronate and carboxymethylcellulose (H-CMC; Seprafilm®); group IV, abdominal wall defect 3×2 cm+polytetrafluoroethylene (PTFE; Composix™); and group V, abdominal wall defect 3×2 cm+polyethylene terephthalate (PET; Dacron®). A total of 14 days after the surgery, rats were sacrificed and the meshes with the surrounding tissue were extracted in block. The breaking strength of the mesh from the fascia was recorded. The healing tissue was examined with the index of histopathology and the hydroxyproline value was analyzed using the Switzer method. Both the breaking strength and histopathological index of the wound healing were significantly improved in groups II and III compared with that in groups IV and V (P<0.001). Hydroxyproline values were the highest in group I (P<0.001). There was also a statistically significant difference between groups II and IV, and group V and the other groups (P<0.001). The present findings demonstrated that PP mesh and PP mesh+H-CMC had a superior breaking strength and improved histopathologic indices compared with PTFE and PET. Furthermore, hydroxyproline values were the lowest in the PET group. In conclusion, wound healing was improved in the PP mesh group and the PP mesh+H-CMC group compared with the PTFE and PET groups according to the present study parameters. PMID:29399133

A novel nonoperative approach to abdominal compartment syndrome after abdominal wall reconstruction.

PubMed

Hasan, Zeenat R; Sorensen, G Brent

2013-01-01

Intraabdominal hypertension and abdominal compartment syndrome have been increasingly recognized as significant causes of morbidity and mortality in both medical and surgical patients. The gold standard remains surgical intervention; however, nonoperative approaches have been investigated less. Here, we describe the successful treatment of a severe acute case by intubation, nasogastric decompression, and paralysis--a novel approach not previously described in the literature. After the patient underwent laparoscopic bilateral component separation and repair of a large recurrent ventral hernia with a 20 30-cm Strattice mesh (LifeCell Corp, Branchburg, NJ), acute renal failure developed within 12 hours postoperatively, and was associated with oliguria, hyperkalemia, and elevated peak airway and bladder pressures. The patient was treated nonoperatively with intubation, nasogastric tube decompression, and paralysis with a vecuronium drip. Rapid reversal was seen, avoiding further surgery. Within 2 hours after intubation and paralysis, our patient's urine output improved dramatically with an initial diuresis of approximately 1 L, his bladder pressures decreased, and within 12 hours his creatinine level had normalized. Although surgical intervention has traditionally been thought of as the most effective--and thus the gold standard--for abdominal compartment syndrome, this preliminary experience demonstrates nonoperative management as highly efficacious, with the added benefit of decreased morbidity. Therefore, nonoperative management could be considered first-line therapy, with laparotomy reserved for refractory cases only. This suggests a more complex pathology than the traditional teaching of congestion and edema alone.

The Relationship Between Surface Curvature and Abdominal Aortic Aneurysm Wall Stress.

PubMed

de Galarreta, Sergio Ruiz; Cazón, Aitor; Antón, Raúl; Finol, Ender A

2017-08-01

The maximum diameter (MD) criterion is the most important factor when predicting risk of rupture of abdominal aortic aneurysms (AAAs). An elevated wall stress has also been linked to a high risk of aneurysm rupture, yet is an uncommon clinical practice to compute AAA wall stress. The purpose of this study is to assess whether other characteristics of the AAA geometry are statistically correlated with wall stress. Using in-house segmentation and meshing algorithms, 30 patient-specific AAA models were generated for finite element analysis (FEA). These models were subsequently used to estimate wall stress and maximum diameter and to evaluate the spatial distributions of wall thickness, cross-sectional diameter, mean curvature, and Gaussian curvature. Data analysis consisted of statistical correlations of the aforementioned geometry metrics with wall stress for the 30 AAA inner and outer wall surfaces. In addition, a linear regression analysis was performed with all the AAA wall surfaces to quantify the relationship of the geometric indices with wall stress. These analyses indicated that while all the geometry metrics have statistically significant correlations with wall stress, the local mean curvature (LMC) exhibits the highest average Pearson's correlation coefficient for both inner and outer wall surfaces. The linear regression analysis revealed coefficients of determination for the outer and inner wall surfaces of 0.712 and 0.516, respectively, with LMC having the largest effect on the linear regression equation with wall stress. This work underscores the importance of evaluating AAA mean wall curvature as a potential surrogate for wall stress.

The use of ultrasound in the diagnosis of abdominal wall hernias.

PubMed

Young, J; Gilbert, A I; Graham, M F

2007-08-01

The diagnosis of abdominal wall hernias is not always straightforward and may require additional investigative modalities. Real-time ultrasound is accurate, non-invasive, relatively inexpensive, and readily available. The value of ultrasound as an adjunctive tool in the diagnosis of abdominal wall hernias in both pre-operative and post-operative patients was studied. Retrospective analysis of 200 patients treated at the Hernia Institute of Florida was carried out. In these cases, ultrasound had been used to assist with case management. Patients without previous hernia surgery and those with early and late post-herniorrhaphy complaints were studied. Patients with obvious hernias were excluded. Indications for ultrasound examination included patients with abdominal pain without a palpable hernia, a palpable mass of questionable etiology, and patients with inordinate pain or excessive swelling during the early post-operative period. Patients were treated with surgery or conservative therapy depending on the results of the physical examination and ultrasound studies. Cases in which the ultrasound findings influenced the decision-making process by confirming clinical findings or altering the diagnosis and changing the treatment plan are discussed. Of the 200 patients, 144 complained of pain alone and on physical exam no hernia or mass was palpable. Of these 144 patients with pain alone, 21 had a hernia identified on the US examination and were referred for surgery. The 108 that had a negative ultrasound were treated conservatively with rest, heat, and anti-inflammatory drugs, most often with excellent results. Of the 56 remaining patients who had a mass, with or without pain, 22 had hernias identified by means of ultrasound examination. In the other 34, the etiology of the mass was not a hernia. Abdominal wall ultrasound is a valuable tool in the scheme of management of patients in whom the diagnosis of abdominal wall hernia is unclear. Therapeutic decisions can be

Catheter enterostomy and patch repair of the abdominal wall for gastroschisis with intestinal atresia: report of a case.

PubMed

Ohno, Koichi; Nakamura, Tetsuro; Azuma, Takashi; Yoshida, Tatsuyuki; Yamada, Hiroto; Hayashi, Hiroaki; Masahata, Kazunori

2009-01-01

A male infant, weighing 2177 g, was born with the entire intestine protruding through a defect on the right side of the navel. Intestinal atresia, approximately 70 cm from the Treitz ligament, was also confirmed. Primary anastomosis and abdominal wall repair were impossible because of the intestinal dilation and thick peel, as well as the small abdominal cavity. Thus, we initially performed catheter enterostomy with a 14-F balloon catheter and patch repair of the abdominal wall, to enable the baby to be fed. Secondary anastomosis and abdominal wall repair was safely performed when the baby was 106 days old. The combination of catheter enterostomy and patch repair of the abdominal wall does not require dissection of the intestine and it can be safely performed in low-birth-weight babies. It also enables feeding and weight gain, and the overlying skin prevents contamination of the artificial sheet. We recommend this combination for neonates with both gastroschisis and intestinal atresia.

Outcomes of abdominal wall reconstruction with acellular dermal matrix are not affected by wound contamination.

PubMed

Garvey, Patrick B; Martinez, Roberto A; Baumann, Donald P; Liu, Jun; Butler, Charles E

2014-11-01

The optimal type of mesh for complex abdominal wall reconstruction has not been elucidated. We hypothesized that AWRs using acellular dermal matrix (ADM) experience low rates of surgical site occurrence (SSO) and surgical site infection, despite increasing degrees of wound contamination. We retrospectively reviewed prospectively collected data from consecutive abdominal wall reconstructions with ADM over a 9-year period. Outcomes of abdominal wall reconstructions were compared between patients with different CDC wound classifications. Univariate and multivariate logistic regression and Cox proportional hazard regression analyses identified potential associations and predictive/protective factors. The 359 patients had a mean follow-up of 28.3 ± 19.0 months. Reconstruction of clean wounds (n = 171) required fewer reoperations than that of combined contaminated (n = 188) wounds (2.3% vs 11.2%; p = 0.001) and trended toward experiencing fewer SSOs (19.9% vs 28.7%, p = 0.052). There were no significant differences between clean and combined contaminated cases in 30-day SSI (8.8% vs 8.0%), hernia recurrence (9.9% vs 10.1%), and mesh removal (1.2% vs 1.1%) rates. Independent predictors of SSO included body mass index ≥30 kg/m(2) (odds ratio [OR] 3.6; p < 0.001), 1 or more comorbidities (OR 2.5; p = 0.008), and defect width ≥15 cm (OR 1.8; p = 0.02). Complex abdominal wall reconstructions using ADM demonstrated similar rates of complications between the different CDC wound classifications. This is in contradistinction to published outcomes for abdominal wall reconstruction using synthetic mesh that show progressively higher complication rates with increasing degrees of contamination. These data support the use of ADM rather than synthetic mesh for complex abdominal wall reconstruction in the setting of wound contamination. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Abdominal wall phlebitis due to Prevotella bivia following renal transplantation in a patient with an occluded inferior vena cava.

PubMed

Janssen, S; van Donselaar-van der Pant, K A M I; van der Weerd, N C; Develter, W; Bemelman, F J; Grobusch, M P; Idu, M M; Ten Berge, I J M

2013-02-01

Pre-existing occlusion of the inferior vena cava may complicate renal transplantation. Suppurative abdominal wall phlebitis following renal transplantation was diagnosed in a patient with pre-existing thrombosis of the inferior vena cava of unknown cause. The phlebitis developed in the subcutaneous collateral veins of the abdominal wall contra-laterally to the renal transplant. Cultures from abdominal wall micro-abscesses yielded Prevotella bivia as the causative agent. This complication has not been described before in the context of renal transplantation. The pathogenesis and management of this serious complication are discussed in this paper.

[Endoprosthetic replacement with lifting of abdominal wall in treatment of umbilical and postoperative ventral hernias].

PubMed

Sukhovatykh, B S; Valuyskaya, N M; Gerasimchuk, E V

2015-01-01

The results of complex clinical and ultrasonic investigation of abdominal wall and following surgical treatment in 60 women with umbilical and postoperative large ventral hernias combined with abdomen ptosis were analyzed. Patients were divided into 2 groups with 30 people per group. Endoprosthetic replacement of abdominal wall defect using standard polypropylene prosthesis was applied in the 1st group, endoprosthetic replacement with musculoaponeurotic tissues lifting in hypogastric area using original super lightweight polypropylenepolyvinylidenefluoride prosthesis--in the 2nd group. Polypropylene endoprosthesisconsist of main flap 15×15 cm with roundish edges and additional flap 5×40 cm in the form of wide stripe placed at the lower edge of main flap transversely to its direction. It was revealed increased physical health component in 1.8 times, psychic--in 2.5 times in the 2nd group. Thus number of excellent results increased on 33.3% and amount of satisfactory outcomes reduced on 30%.

Illustrated review of new imaging techniques in the diagnosis of abdominal wall hernias.

PubMed

Toms, A P; Dixon, A K; Murphy, J M; Jamieson, N V

1999-10-01

The assessment of abdominal wall hernias has long been a clinical skill that only occasionally required the supplementary radiological assistance of herniography. However, with the advent of cross-sectional imaging, a new range of diagnostic tools is now available to help the clinician in difficult cases. This review explores the ability of computed tomography and magnetic resonance imaging to demonstrate many of the hernias encountered in the anterior abdominal wall. Also discussed is the role of imaging techniques in the management of a variety of hernias. Cross-sectional imaging techniques are being employed with increasing frequency for the assessment of hernias. Although the anatomical detail can usually be delineated clearly, the accuracy of the various methods and their place in the clinical management of hernias has yet to be fully determined.

Desmoid Fibromatosis of the Abdominal Wall: Surgical Resection and Reconstruction with Biological Matrix Egis®

PubMed Central

Tropea, Saveria; Mocellin, Simone; Stramare, Roberto; Bonavina, Maria Giuseppina; Rossi, Carlo Riccardo; Rastrelli, Marco

2017-01-01

Desmoid tumor is a rare monoclonal fibroblast proliferation that is regarded as benign. The clinical management of desmoid tumors is very complex and requires a multidisciplinary approach because of the unpredictable disease course. For those cases localized in the anterior abdominal wall, symptomatic and unresponsive to medical treatment, radical resection and reconstruction with a prosthetic device are indicated. We present here a case of desmoid fibromatosis of the left anterolateral abdominal wall with a marked increase of the mass that required a large excision followed by reconstruction with biological matrix. The fact that it can be incorporated in patient tissue without a fibrotic response and that it can resist future infections, together with a very competetive price, made the new collagen matrix Egis® our first choice. PMID:28413398

Abdominal wall reconstruction following removal of a chronically infected mid-urethral tape.

PubMed

Walker, Helen; Brooker, Thomas; Gelman, Wolf

2009-10-01

We report a rare postoperative complication of a mid-urethral tape. The patient presented with a chronic infection resistant to treatment with several weeks of antibiotics, with eventual surgical removal, and the resulting complications of an infected incisional hernia and vesico-cutaneous fistula required reconstruction of the abdominal wall with Permacol and excision of the vesico-cutaneous fistula. We also look briefly at the impact of health tourism on the National Health Service.

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.

Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia.

PubMed

Parker, Michael; Goldberg, Ross F; Dinkins, Maryane M; Asbun, Horacio J; Daniel Smith, C; Preissler, Susanne; Bowers, Steven P

2011-11-01

Outcomes after ventral incisional hernia (VIH) repair are measured by recurrence rate and subjective measures. No objective metrics evaluate functional outcomes after abdominal wall reconstruction. This study aimed to develop testing of abdominal wall strength (AWS) that could be validated as a useful metric. Data were prospectively collected during 9 months from 35 patients. A total of 10 patients were evaluated before and after VIH repair, for a total of 45 encounters. The patients were tested simultaneously or in succession by two of three examiners. Data were collected for three tests: double leg lowering (DLL), trunk raising (TR), and supine reaching (SR). Raw data were compared and tested for validity, and continuous data were transformed to categorical data. Agreement was measured using the intraclass correlation coefficient (ICC) for DLL and using kappa for the ordinal measures. Simultaneous testing yielded the following interobserver reliability: DLL (0.96 and 0.87), TR (1.00 and 0.95), and SR (0.76). Reproducibility was assessed by consecutive tests, with correlation as follows: DLL (0.81), TR (0.81), and RCH (0.21). Due to poor interobserver reliability for the SR test compared with the DLL and TR tests, the SR test was excluded from calculation of an overall score. Based on raw data distribution from the DLL and TR tests, the DLL data were categorized into 10º increments, allowing construction of a 10-point score. The median AWS score was 5 (interquartile range [IQR], 4-7), and there was agreement within 1 point for 42 of the 45 encounters (93%). The findings from this study demonstrate that the 10-point AWS score may measure AWS in an accurate and reproducible fashion, with potential for objective description of abdominal wall function of VIH patients. This score may help to identify patients suited for abdominal wall reconstruction while measuring progress after VIH repair. Further longitudinal outcomes studies are needed.

Bovine versus porcine acellular dermal matrix for complex abdominal wall reconstruction.

PubMed

Clemens, Mark W; Selber, Jesse C; Liu, Jun; Adelman, David M; Baumann, Donald P; Garvey, Patrick B; Butler, Charles E

2013-01-01

Abdominal wall reconstruction with bioprosthetic mesh is associated with lower rates of mesh infection, fistula formation, and mesh explantation than reconstruction with synthetic mesh. The authors directly compared commonly used bioprosthetic meshes in terms of clinical outcomes and complications. A database of consecutive patients who underwent abdominal wall reconstruction with porcine or bovine acellular dermal matrix and midline musculofascial closure at their institution between January of 2008 and March of 2011 was reviewed. Surgical outcomes were compared. One hundred twenty patients were identified who underwent a nonbridged, inlay abdominal wall reconstruction with porcine [69 patients (57.5 percent)] or bovine acellular dermal matrix (51 patients (42.5 percent)]. The mean follow-up time was 21.0 ± 9.9 months. The overall complication rate was 36.6 percent; the porcine matrix group had a significantly higher complication rate (44.9 percent) than the bovine matrix group (25.5 percent; p = 0.04) and statistically equivalent surgical complications (29.2 percent versus 21.6 percent; p = 0.34). There were no significant differences in rates of recurrent hernia (2.9 percent versus 3.9 percent; p = 0.99) or bulge (7.2 percent versus 0 percent; p = 0.07). However, the rate of intraoperative adverse events in the porcine matrix group [seven events (10.1 percent)] was significantly higher than that in the bovine matrix group (0 percent; p = 0.02). In patients who undergo complex abdominal wall reconstruction, both bovine and porcine acellular dermal matrix are associated with similar rates of postoperative surgical complications and appear to result in similar outcomes. Porcine acellular dermal matrix may be prone to intraoperative device failure. Therapeutic, III.

Prior Radiotherapy Does Not Affect Abdominal Wall Reconstruction Outcomes: Evidence from Propensity Score Analysis.

PubMed

Giordano, Salvatore; Garvey, Patrick B; Baumann, Donald P; Liu, Jun; Butler, Charles E

2017-03-01

Prior abdominal wall radiotherapy (XRT) adversely affects wound healing, but data are limited on how prior XRT may affect abdominal wall reconstruction (AWR) outcomes. The purpose of this study was to determine whether prior abdominal wall radiotherapy is associated with a higher incidence of complications following AWR for a hernia or oncologic resection defect. We performed a retrospective study of consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) at a single center. We compared outcomes between patients who underwent prior XRT that directly involved the abdominal wall and those who did not receive XRT. Propensity score match-paired and multivariate analyses were performed. A total of 511 patients (130 [25.4 %] with prior XRT; 381 [74.6 %] without prior XRT) underwent AWR with ADM for repair of a complex hernia or oncologic resection defect. Mean follow-up was 31.4 months, mean XRT dose was 48.9 Gy, and mean time between XRT and reconstruction was 19.2 months. XRT AWR patients underwent more flap reconstructions (14.6 vs. 5.0 %, P < 0.001) but fewer component separations (61.5 vs. 71.4 %; P = 0.036) than non-XRT AWR patients. The two groups had similar rates of hernia recurrence (8.5 vs. 9.4 %; P = 0.737) and surgical site occurrence (25.4 vs. 23.4 %; P = 0.640). In the propensity score-matched subgroups, there were no differences in hernia recurrence, surgical site occurrence, and wound healing complication rates. Prior XRT does not adversely affect outcomes in AWR. However, surgeons should be aware of the higher likelihood of needing a soft tissue flap reconstruction for soft tissue replacement when performing AWR after XRT.

Necrotizing Fasciitis of the Abdominal Wall in a Premature Infant: A Case Study.

PubMed

Narvey, Michael; Byrne, Paul; Fraser, Debbie

2017-01-01

We present a first report of necrotizing fasciitis of the abdominal wall in a 23-day-of-age, former 32-week-gestation premature infant. She was successfully treated with antibiotics without the need for initial debridement. After reviewing the etiology of necrotizing fasciitis, we discuss the unique aspects of this case, including the noninvasive approach to initial treatment, which we consider significantly contributed to her survival.

Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report.

PubMed

Beerle, Corinne; Gelpke, Hans; Breitenstein, Stefan; Staerkle, Ralph F

2016-12-01

We report a case of a rare complication of acute appendicitis with perforation through the abdominal wall. The case points out that an intraabdominal origin should be considered in patients presenting with rapidly spreading soft tissue infections of the trunk. A 58-year-old European woman presented to our hospital with a 1-week history of severe abdominal pain accompanied by rapidly spreading erythema and emphysema of the lower abdomen. On admission, the patient was in septic shock with leukocytosis and elevation of C-reactive protein. Among other diagnoses, necrotizing fasciitis was suspected. Computed tomography showed a large soft tissue infection with air-fluid levels spreading through the lower abdominal wall. During the operation, we found a perforated appendicitis breaking through the fascia and causing a rapidly progressive soft tissue infection of the abdominal wall. Appendicitis was the origin of the soft tissue infection. The abdominal wall was only secondarily involved. Even though perforated appendicitis as an etiology of a rapidly progressive soft tissue infection of the abdominal wall is very rare, it should be considered in the differential diagnosis of abdominal wall cellulitis. The distinction between rapidly spreading subcutaneous infection with abscess formation and early onset of necrotizing fasciitis is often difficult and can be confirmed only by surgical intervention.

Comparison of prosthetic materials for abdominal wall reconstruction in the presence of contamination and infection.

PubMed Central

Brown, G L; Richardson, J D; Malangoni, M A; Tobin, G R; Ackerman, D; Polk, H C

1985-01-01

Abdominal wall defects resulting from trauma, invasive infection, or hernia present a difficult problem for the surgeon. In order to study the problems associated with the prosthetic materials used for abdominal wall reconstruction, an animal model was used to simulate abdominal wall defects in the presence of peritonitis and invasive infection. One hundred guinea pigs were repaired with either polytetrafluorethylene (PTFE) or polypropylene mesh (PPM). Our experiments included intra-operative contamination with Staphylococcus aureus. We found significantly fewer organisms (p less than 0.05) adherent to the PTFE than to the PPM when antibiotics were administered after surgery, as well as when no antibiotics were given. In the presence of peritonitis, we found no real difference in numbers of intraperitoneal bacteria present whether PTFE or PPM was used. In all instances, the PTFE patches produced fewer adhesions and were more easily removed. From these experiments, it appears that PTFE may be associated with fewer problems than PPM in the presence of contamination and infection. Images FIG. 1. PMID:3159353

The management of abdominal wall hernias – in search of consensus

PubMed Central

Bury, Kamil; Śmietański, Maciej

2015-01-01

Introduction Laparoscopic repair is becoming an increasingly popular alternative in the treatment of abdominal wall hernias. In spite of numerous studies evaluating this technique, indications for laparoscopic surgery have not been established. Similarly, implant selection and fixation techniques have not been unified and are the subject of scientific discussion. Aim To assess whether there is a consensus on the management of the most common ventral abdominal wall hernias among recognised experts. Material and methods Fourteen specialists representing the boards of European surgical societies were surveyed to determine their choice of surgical technique for nine typical primary ventral and incisional hernias. The access method, type of operation, mesh prosthesis and fixation method were evaluated. In addition to the laparoscopic procedures, the number of tackers and their arrangement were assessed. Results In none of the cases presented was a consensus of experts obtained. Laparoscopic and open techniques were used equally often. Especially in the group of large hernias, decisions on repair methods were characterised by high variability. The technique of laparoscopic mesh fixation was a subject of great variability in terms of both method selection and the numbers of tackers and sutures used. Conclusions Recognised experts have not reached a consensus on the management of abdominal wall hernias. Our survey results indicate the need for further research and the inclusion of large cohorts of patients in the dedicated registries to evaluate the results of different surgical methods, which would help in the development of treatment algorithms for surgical education in the future. PMID:25960793

Evaluation of a new composite prosthesis for the repair of abdominal wall defects.

PubMed

Losi, Paola; Munaò, Antonella; Spiller, Dario; Briganti, Enrica; Martinelli, Ilaria; Scoccianti, Marco; Soldani, Giorgio

2007-10-01

The degree of integration of biomaterials used in the repair of abdominal wall defects seems to depend upon the structure of the prosthesis. The present investigation evaluates the behaviour in terms of adhesion formation and integration of a new composite prosthesis that could be employed in this clinical application. Full-thickness abdominal wall defects (7 x 5 cm) were created in 16 anaesthetized New Zealand white rabbits and the prosthesis were placed in direct contact with the visceral peritoneum during the experiment. The defects were repaired with a composite prosthesis or pure polypropylene mesh to establish two study groups (n = 8 each). The composite device was constituted by a polypropylene mesh physically attached to a poly(ether)urethane-polydimethylsiloxane laminar sheet. Animals were sacrificed 7, 14, 21 and 30 days after implant and prosthesis/surrounding tissue specimens subjected to light and electron microscopy. Firm adhesions were detected in the polypropylene implants, while they were not present in the composite implants. The excellent behaviour of the composite prosthesis shown in this study warrants further investigation on its use for the repair of abdominal wall defects when a prosthetic device needs to be placed in contact with the intestinal loops.

Abdominal wall abscess secondary to spontaneous rupture of pyogenic liver abscess.

PubMed

Zizzo, Maurizio; Zaghi, Claudia; Manenti, Antonio; Luppi, Davide; Ugoletti, Lara; Bonilauri, Stefano

2016-01-01

Pyogenic liver abscess is a rare cause of hospitalization, related to a mortality rate ranging between 15% and 19%. Treatment of choice is represented by image-guided percutaneous drainage in combination with antibiotic therapy but, in some selected cases, surgical treatment is necessary. In extremely rare cases, spontaneous rupture of liver abscess may occur, free in the peritoneal cavity or in neighboring organs, an event which is generally considered a surgical emergency. A 95-years-old woman was hospitalized with fever, upper abdominal pain, mild dyspepsia and massive swelling of the anterior abdominal wall. Computed tomography revealed an oval mass located in the abdominal wall of 12cm×14cm×7cm, in continuity with an abscess of the left hepatic lobe. Because Proteus mirabilis was detected in both the liver abscess and the abdominal wall abscess, the patient was diagnosed with a ruptured pyogenic liver abscess. After spontaneous drainage to the exterior of the hepato-parietal abscess, she was successfully treated with antibiotics alone. Pyogenic liver abscess is a serious and life-threatening illness. Abscess rupture might occur. Many authors consider this complication a surgical emergency, but the site of abscess rupture changes the clinical history of the disease: in case of free rupture into the peritoneum, emergency surgery is mandatory, while a rupture localized in neighboring tissues or organs can be successfully treated by a combination of systemic antibiotics and fine needle aspiration and/or percutaneous drainage of the abscess. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Mechanical behavior of surgical meshes for abdominal wall repair: In vivo versus biaxial characterization.

PubMed

Simón-Allué, R; Ortillés, A; Calvo, B

2018-06-01

Despite the widespread use of synthetic meshes in the surgical treatment of the hernia pathology, the election criteria of a suitable mesh for specific patient continues to be uncertain. Thus, in this work, we propose a methodology to determine in advance potential disadvantages on the use of certain meshes based on the patient-specific abdominal geometry and the mechanical features of the certain meshes. To that purpose, we have first characterized the mechanical behavior of four synthetic meshes through biaxial tests. Secondly, two of these meshes were implanted in several New Zealand rabbits with a total defect previously created on the center of the abdominal wall. After the surgical procedure, specimen were subjected to in vivo pneumoperitoneum tests to determine the immediate post-surgical response of those meshes after implanted in a healthy specimen. Experimental performance was recorded by a stereo rig with the aim of obtaining quantitative information about the pressure-displacement relation of the abdominal wall. Finally, following the procedure presented in prior works (Simón-Allué et al., 2015, 2017), a finite element model was reconstructed from the experimental measurements and tests were computationally reproduced for the healthy and herniated cases. Simulations were compared and validated with the in vivo behavior and results were given along the abdominal wall in terms of displacements, stresses and strain. Mechanical characterization of the meshes revealed Surgipro TM as the most rigid implant and Neomesh SuperSoft® as the softer, while other two meshes (Neomesh Soft®, Neopore®) remained in between. These two meshes were employed in the experimental study and resulted in similar effect in the abdominal wall cavity and both were close to the healthy case. Simulations confirmed this result while showed potential objections in the case of the other two meshes, due to high values in stresses or elongation that may led to discomfort in real

Risk Assessment of Abdominal Wall Thickness Measured on Pre-Operative Computerized Tomography for Incisional Surgical Site Infection after Abdominal Surgery.

PubMed

Tongyoo, Assanee; Chatthamrak, Putipan; Sriussadaporn, Ekkapak; Limpavitayaporn, Palin; Mingmalairak, Chatchai

2015-07-01

The surgical site infection (SSI) is a common complication of abdominal operation. It relates to increased hospital stay, increased healthcare cost, and decreased patient's quality of life. Obesity, usually defined by BMI, is known as one of the risks of SSI. However, the thickness of subcutaneous layers of abdominal wall might be an important local factor affecting the rate of SSI after the abdominal operations. The objective of this study is to assess the importance of the abdominal wall thickness on incisional SSI rate. The subjects of the present study were patients who had undergone major abdominal operations at Thammasat University Hospital between June 2013 and May 2014, and had been investigated with CT scans before their operations. The demographic data and clinical information of these patients were recorded. The thickness ofsubcutaneous fatty tissue from skin down to the most superficial layer of abdominal wall muscle at the surgical site was measured on CT images. The wound infectious complication was reviewed and categorized as superficial and deep incisional SSIfollowing the definition from Centersfor Disease Control and Prevention (CDC) guidelines. The significance ofeach potentialfactors on SSI rates was determined separately with student t-test for quantitative data and χ2-test for categorical data. Then all factors, which had p < 0.10, were included into the multivariate logistic regression analysis and were analyzed with significance at p < 0.05. One hundred and thirty-nine patients were included in this study. They all underwent major abdominal surgery and had had pre-operative CTscans. Post-operative SSI was 25.2% (35/139), superficial and deep types in 27 and 8 patients, respectively. The comparison of abdominal wall thickness between patients with and without infection was significantly different (20.0 ± 8.4 mm and 16.0 ± 7.2 mm, respectively). When the thickness at 20 mm was used as the cut-off value, 43 of 139 patients had abdominal wall

A simple, effective and clinically applicable method to compute abdominal aortic aneurysm wall stress.

PubMed

Joldes, Grand Roman; Miller, Karol; Wittek, Adam; Doyle, Barry

2016-05-01

Abdominal aortic aneurysm (AAA) is a permanent and irreversible dilation of the lower region of the aorta. It is a symptomless condition that if left untreated can expand to the point of rupture. Mechanically-speaking, rupture of an artery occurs when the local wall stress exceeds the local wall strength. It is therefore desirable to be able to non-invasively estimate the AAA wall stress for a given patient, quickly and reliably. In this paper we present an entirely new approach to computing the wall tension (i.e. the stress resultant equal to the integral of the stresses tangent to the wall over the wall thickness) within an AAA that relies on trivial linear elastic finite element computations, which can be performed instantaneously in the clinical environment on the simplest computing hardware. As an input to our calculations we only use information readily available in the clinic: the shape of the aneurysm in-vivo, as seen on a computed tomography (CT) scan, and blood pressure. We demonstrate that tension fields computed with the proposed approach agree well with those obtained using very sophisticated, state-of-the-art non-linear inverse procedures. Using magnetic resonance (MR) images of the same patient, we can approximately measure the local wall thickness and calculate the local wall stress. What is truly exciting about this simple approach is that one does not need any information on material parameters; this supports the development and use of patient-specific modelling (PSM), where uncertainty in material data is recognised as a key limitation. The methods demonstrated in this paper are applicable to other areas of biomechanics where the loads and loaded geometry of the system are known. Copyright © 2015 Elsevier Ltd. All rights reserved.

Use of human and porcine dermal-derived bioprostheses in complex abdominal wall reconstructions: a literature review and case report.

PubMed

Baillie, Daniel R; Stawicki, S Peter; Eustance, Nicole; Warsaw, David; Desai, Darius

2007-05-01

The goal of abdominal wall reconstruction is to restore and maintain abdominal domain. A PubMed(R) review of the literature (including "old" MEDLINE through February 2007) suggests that bioprosthetic materials are increasingly used to facilitate complex abdominal wall reconstruction. Reported results (eight case reports/series involving 137 patients) are encouraging. The most commonly reported complications are wound seroma (18 patients, 13%), skin dehiscence with graft exposure without herniation (six, 4.4%), superficial and deep wound infections (five, 3.6%), hernia recurrence (four, 2.9%), graft failure with dehiscence (two), hematoma (two), enterocutaneous fistula (one), and flap necrosis (one). Two recent cases are reported herein. In one, a 46-year-old woman required open abdominal management after gastric remnant perforation following a Roux-en-Y gastric bypass procedure. Porcine dermal collagen combined with cutaneous flaps was used for definitive abdominal wall reconstruction. The patient's condition improved postoperatively and she was well 5 months after discharge from the hospital. In the second, a 54-year-old woman underwent repair of an abdominal wall defect following resection of a large leiomyosarcoma. Human acellular dermis combined with myocutaneous flaps was used to reconstruct the abdominal wall defect. The patient's recovery was uncomplicated and 20 weeks following surgery she was doing well with no evidence of recurrence or hernia. The results reported to date and the outcomes presented here suggest that bioprosthetic materials are safe and effective for repair of large abdominal wall defects. Prospective, randomized, controlled studies are needed to compare the safety and efficacy of other reconstructive techniques as well as human and porcine dermal-derived bioprostheses.

Isometric abdominal wall muscle strength assessment in individuals with incisional hernia: a prospective reliability study.

PubMed

Jensen, K K; Kjaer, M; Jorgensen, L N

2016-12-01

To determine the reliability of measurements obtained by the Good Strength dynamometer, determining isometric abdominal wall and back muscle strength in patients with ventral incisional hernia (VIH) and healthy volunteers with an intact abdominal wall. Ten patients with VIH and ten healthy volunteers with an intact abdominal wall were each examined twice with a 1 week interval. Examination included the assessment of truncal flexion and extension as measured with the Good Strength dynamometer, the completion of the International Physical Activity Questionnaire (IPAQ) and the self-assessment of truncal strength on a visual analogue scale (SATS). The test-retest reliability of truncal flexion and extension was assessed by interclass correlation coefficient (ICC), and Bland and Altman graphs. Finally, correlations between truncal strength, and IPAQ and SATS were examined. Truncal flexion and extension showed excellent test-retest reliability for both patients with VIH (ICC 0.91 and 0.99) and healthy controls (ICC 0.97 and 0.96). Bland and Altman plots showed that no systematic bias was present for neither truncal flexion nor extension when assessing reliability. For patients with VIH, no significant correlations between objective measures of truncal strength and IPAQ or SATS were found. For healthy controls, both truncal flexion (τ 0.58, p = 0.025) and extension (τ 0.58, p = 0.025) correlated significantly with SATS, while no other significant correlation between truncal strength measures and IPAQ was found. The Good Strength dynamometer provided a reliable, low-cost measure of truncal flexion and extension in patients with VIH.

What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction?

PubMed

Köckerling, F; Alam, N N; Antoniou, S A; Daniels, I R; Famiglietti, F; Fortelny, R H; Heiss, M M; Kallinowski, F; Kyle-Leinhase, I; Mayer, F; Miserez, M; Montgomery, A; Morales-Conde, S; Muysoms, F; Narang, S K; Petter-Puchner, A; Reinpold, W; Scheuerlein, H; Smietanski, M; Stechemesser, B; Strey, C; Woeste, G; Smart, N J

2018-04-01

Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations. A European working group, "BioMesh Study Group", composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used. The cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes. The routine use of biologic and biosynthetic meshes cannot be recommended.

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

SciTech Connect

Bossi, Alberto; De Wever, Ivo; Van Limbergen, Erik

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 2more » 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.« less

The effect of abdominal wall morphology on ultrasonic pulse distortion. Part II. Simulations.

PubMed

Mast, T D; Hinkelman, L M; Orr, M J; Waag, R C

1998-12-01

Wavefront propagation through the abdominal wall was simulated using a finite-difference time-domain implementation of the linearized wave propagation equations for a lossless, inhomogeneous, two-dimensional fluid as well as a simplified straight-ray model for a two-dimensional absorbing medium. Scanned images of six human abdominal wall cross sections provided the data for the propagation media in the simulations. The images were mapped into regions of fat, muscle, and connective tissue, each of which was assigned uniform sound speed, density, and absorption values. Propagation was simulated through each whole specimen as well as through each fat layer and muscle layer individually. Wavefronts computed by the finite-difference method contained arrival time, energy level, and wave shape distortion similar to that in measurements. Straight-ray simulations produced arrival time fluctuations similar to measurements but produced much smaller energy level fluctuations. These simulations confirm that both fat and muscle produce significant wavefront distortion and that distortion produced by fat sections differs from that produced by muscle sections. Spatial correlation of distortion with tissue composition suggests that most major arrival time fluctuations are caused by propagation through large-scale inhomogeneities such as fatty regions within muscle layers, while most amplitude and waveform variations are the result of scattering from smaller inhomogeneities such as septa within the subcutaneous fat. Additional finite-difference simulations performed using uniform-layer models of the abdominal wall indicate that wavefront distortion is primarily caused by tissue structures and inhomogeneities rather than by refraction at layer interfaces or by variations in layer thicknesses.

Wall stress reduction in abdominal aortic aneurysms as a result of polymeric endoaortic paving.

PubMed

Ashton, John H; Ayyalasomayajula, Avinash; Simon, Bruce R; Vande Geest, Jonathan P

2011-06-01

Polymeric endoaortic paving (PEAP) may improve endovascular repair of abdominal aortic aneurysms (AAA) since it has the potential to treat patients with complex AAA geometries while reducing the incidence of migration and endoleak. Polycaprolactone (PCL)/polyurethane (PU) blends are proposed as PEAP materials due to their range of mechanical properties, thermoformability, and resistance to biodegradation. In this study, the reduction in AAA wall stress that can be achieved using PEAP was estimated and compared to that resulting from stent-grafts. This was accomplished by mechanically modeling the anisotropic response of PCL/PU blends and implementing these results into finite element model (FEM) simulations. We found that at the maximum diameter of the AAA, the 50/50 and 10/90 PCL/PU blends reduced wall stress by 99 and 98%, respectively, while a stent-graft reduced wall stress by 99%. Our results also show that wall stress reduction increases with increasing PEAP thickness and PCL content in the blend ratio. These results indicate that PEAP can reduce AAA wall stress as effectively as a stent-graft. As such, we propose that PEAP may provide an improved treatment alternative for AAA, since many of the limitations of stent-grafts have the potential to be solved using this approach.

Reconstruction with latissimus dorsi, external abdominal oblique and cranial sartorius muscle flaps for a large defect of abdominal wall in a dog after surgical removal of infiltrative lipoma

PubMed Central

FENG, Yu-Ching; CHEN, Kuan-Sheng; CHANG, Shih-Chieh

2016-01-01

This animal was presented with a large-sized infiltrative lipoma in the abdominal wall that had been noted for 4 years. This lipoma was confirmed by histological examination from a previous biopsy, and the infiltrative features were identified by a computerized tomography scan. The surgical removal created a large-sized abdominal defect that was closed by a combination of latissimus dorsi and external abdominal oblique muscle flaps in a pedicle pattern. A small dehiscence at the most distal end of the muscle flap resulted in a small-sized abdominal hernia and was repaired with cranial sartorius muscle flap 14 days after surgery. The dog was in good general health with no signs of tumor recurrence after 18 months of follow-up. PMID:27476526

Perforator-Guided Drug Injection in the Treatment of Abdominal Wall Pain.

PubMed

Weum, Sven; de Weerd, Louis

2016-07-01

Pain from the abdominal wall can be caused by nerve entrapment, a condition called abdominal cutaneous nerve entrapment syndrome (ACNES). As an alternative to surgery, ACNES may be treated with injection of local anesthetics, corticosteroids, or botulinum toxin at the point of maximal pain. The point of maximal pain was marked on the abdominal skin. Using color Doppler ultrasound, the corresponding exit point of perforating blood vessels through the anterior fascia of the rectus abdominis muscle was identified. Ultrasound-guided injection of botulinum toxin in close proximity to the perforator's exit point was performed below and above the muscle fascia. The technique was used from 2008 to 2014 on 15 patients in 46 sessions with a total of 128 injections without complications. The injection technique provided safe and accurate administration of the drug in proximity to the affected cutaneous nerves. The effect of botulinum toxin on ACNES is beyond the scope of this article. Perforator-guided injection enables precise drug administration at the location of nerve entrapment in ACNES in contrast to blind injections. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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.

Stress adapted embroidered meshes with a graded pattern design for abdominal wall hernia repair

NASA Astrophysics Data System (ADS)

Hahn, J.; Bittrich, L.; Breier, A.; Spickenheuer, A.

2017-10-01

Abdominal wall hernias are one of the most relevant injuries of the digestive system with 25 million patients in 2013. Surgery is recommended primarily using allogenic non-absorbable wrap-knitted meshes. These meshes have in common that their stress-strain behaviour is not adapted to the anisotropic behaviour of native abdominal wall tissue. The ideal mesh should possess an adequate mechanical behaviour and a suitable porosity at the same time. An alternative fabrication method to wrap-knitting is the embroidery technology with a high flexibility in pattern design and adaption of mechanical properties. In this study, a pattern generator was created for pattern designs consisting of a base and a reinforcement pattern. The embroidered mesh structures demonstrated different structural and mechanical characteristics. Additionally, the investigation of the mechanical properties exhibited an anisotropic mechanical behaviour for the embroidered meshes. As a result, the investigated pattern generator and the embroidery technology allow the production of stress adapted mesh structures that are a promising approach for hernia reconstruction.

The risk of midgut volvulus in patients with abdominal wall defects: A multi-institutional study.

PubMed

Fawley, Jason A; Abdelhafeez, Abdelhafeez H; Schultz, Jessica A; Ertl, Allison; Cassidy, Laura D; Peter, Shawn St; Wagner, Amy J

2017-01-01

The management of malrotation in patients with congenital abdominal wall defects has varied among surgeons. We were interested in investigating the risk of midgut volvulus in patients with gastroschisis and omphalocele to help determine if these patients may benefit from undergoing a Ladd procedure. A retrospective chart review was performed for all patients managed at three institutions born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy. Of the 414 patients identified with abdominal wall defects, 299 patients (72%) had gastroschisis, and 115 patients (28%) had omphalocele. The mean gestational age at birth was 36.1±2.3weeks, and the mean birth weight was 2.57±0.7kg. There were a total of 8 (1.9%) cases of midgut volvulus: 3 (1.0%) patients with gastroschisis compared to 5 patients (4.4%) with omphalocele (p=0.04). Patients with omphalocele have a greater risk of developing midgut volvulus, and a Ladd procedure should be considered during definitive repair to mitigate these risks. III; retrospective comparative study. Copyright © 2017 Elsevier Inc. All rights reserved.

Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair.

PubMed

2017-08-29

Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation on magnetic resonance imaging (MRI). In patients with abdominal aortic aneurysm, we assessed whether USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes. In a prospective multicenter open-label cohort study, 342 patients with abdominal aortic aneurysm (diameter ≥40 mm) were classified by the presence of USPIO enhancement and were monitored with serial ultrasound and clinical follow-up for ≥2 years. The primary end point was the composite of aneurysm rupture or repair. Participants (85% male, 73.1±7.2 years) had a baseline aneurysm diameter of 49.6±7.7 mm, and USPIO enhancement was identified in 146 (42.7%) participants, absent in 191 (55.8%), and indeterminant in 5 (1.5%). During follow-up (1005±280 days), 17 (5.0%) abdominal aortic aneurysm ruptures, 126 (36.8%) abdominal aortic aneurysm repairs, and 48 (14.0%) deaths occurred. Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1±2.5 versus 2.5±2.4 mm/year, P =0.0424), although this was not independent of current smoking habit ( P =0.1993). Patients with USPIO enhancement had higher rates of aneurysm rupture or repair (47.3% versus 35.6%; 95% confidence intervals, 1.1-22.2; P =0.0308). This finding was similar for each component of rupture (6.8% versus 3.7%, P =0.1857) or repair (41.8% versus 32.5%, P =0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair ( P =0.0275), all-cause mortality ( P =0.0635), and aneurysm-related mortality ( P =0.0590). Baseline abdominal aortic aneurysm diameter ( P <0.0001) and current smoking habit ( P =0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic, 0.7935-0.7936). USPIO-enhanced MRI is a novel approach to the identification of aortic wall

Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair

PubMed Central

2017-01-01

identification of aortic wall cellular inflammation in patients with abdominal aortic aneurysms and predicts the rate of aneurysm growth and clinical outcome. However, it does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors. Clinical Trial Registration: URL: http://www.isrctn.com. Unique identifier: ISRCTN76413758. PMID:28720724

Feasibility of wall stress analysis of abdominal aortic aneurysms using three-dimensional ultrasound.

PubMed

Kok, Annette M; Nguyen, V Lai; Speelman, Lambert; Brands, Peter J; Schurink, Geert-Willem H; van de Vosse, Frans N; Lopata, Richard G P

2015-05-01

Abdominal aortic aneurysms (AAAs) are local dilations that can lead to a fatal hemorrhage when ruptured. Wall stress analysis of AAAs is a novel tool that has proven high potential to improve risk stratification. Currently, wall stress analysis of AAAs is based on computed tomography (CT) and magnetic resonance imaging; however, three-dimensional (3D) ultrasound (US) has great advantages over CT and magnetic resonance imaging in terms of costs, speed, and lack of radiation. In this study, the feasibility of 3D US as input for wall stress analysis is investigated. Second, 3D US-based wall stress analysis was compared with CT-based results. The 3D US and CT data were acquired in 12 patients (diameter, 35-90 mm). US data were segmented manually and compared with automatically acquired CT geometries by calculating the similarity index and Hausdorff distance. Wall stresses were simulated at P = 140 mm Hg and compared between both modalities. The similarity index of US vs CT was 0.75 to 0.91 (n = 12), with a median Hausdorff distance ranging from 4.8 to 13.9 mm, with the higher values found at the proximal and distal sides of the AAA. Wall stresses were in accordance with literature, and a good agreement was found between US- and CT-based median stresses and interquartile stresses, which was confirmed by Bland-Altman and regression analysis (n = 8). Wall stresses based on US were typically higher (+23%), caused by geometric irregularities due to the registration of several 3D volumes and manual segmentation. In future work, an automated US registration and segmentation approach is the essential point of improvement before pursuing large-scale patient studies. This study is a first step toward US-based wall stress analysis, which would be the modality of choice to monitor wall stress development over time because no ionizing radiation and contrast material are involved. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Tension-free repair during extensive radical surgery for cecal cancer with abdominal wall invasion and inguinal lymph node metastasis

PubMed Central

Xu, Kaiwu; Chen, Zhihui; Song, Xinming

2014-01-01

We report a case of cecal cancer with invasion of the abdominal wall and right inguinal lymph node metastasis. This patient had undergone an appendectomy 2 years previously. He underwent extensive radical right hemicolectomy with anastomosis and tension-free repair of the damaged right lower abdominal wall. The surgery progressed successfully, and the vital signs of the patient were stable (approximately 200 mL blood loss). Postoperative diagnosis revealed moderately to poorly differentiated adenocarcinoma of the cecum with invasion of the abdominal wall and metastasis of the inguinal lymph nodes (pT4bN2bM1, IV4a). The patient has remained well post-surgery. PMID:24855366

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.

Histopathological analysis of cellular localization of cathepsins in abdominal aortic aneurysm wall.

PubMed

Lohoefer, Fabian; Reeps, Christian; Lipp, Christina; Rudelius, Martina; Zimmermann, Alexander; Ockert, Stefan; Eckstein, Hans-Henning; Pelisek, Jaroslav

2012-08-01

An important feature of abdominal aortic aneurysm (AAA) is the destruction of vessel wall, especially elastin and collagen. Besides matrix metalloproteinases, cathepsins are the most potent elastolytic enzymes. The expression of cathepsins with known elastolytic and collagenolytic activities in the individual cells within AAA has not yet been determined. The vessel wall of 32 AAA patients and 10 organ donors was analysed by immunohistochemistry for expression of cathepsins B, D, K, L and S, and cystatin C in all cells localized within AAA. Luminal endothelial cells (ECs) of AAA were positive for cathepsin D and partially for cathepsins B, K and S. Endothelial cells of the neovessels and smooth muscle cells in the media were positive for all cathepsins tested, especially for cathepsin B. In the inflammatory infiltrate all cathepsins were expressed in the following pattern: B > D = S > K = L. Macrophages showed the highest staining intensity for all cathepsins. Furthermore, weak overall expression of cystatin C was observed in all the cells localized in the AAA with the exception of the ECs. There is markedly increased expression of the various cathepsins within the AAA wall compared to healthy aorta. Our data are broadly consistent with a role for cathepsins in AAA; and demonstrate expression of cathepsins D, B and S in phagocytic cells in the inflammatory infiltrate; and also may reveal a role for cathepsin B in lymphocytes. © 2012 The Authors. International Journal of Experimental Pathology © 2012 International Journal of Experimental Pathology.

Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis.

PubMed

Sabanis, Nikos; Paschou, Eleni; Gavriilaki, Eleni; Mourounoglou, Maria; Vasileiou, Sotirios

2015-01-01

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location.

Management of enterocutaneous fistulas and problem stomas with silicone casting of the abdominal wall defect.

PubMed

Streza, G A; Laing, B J; Gilsdorf, R B

1977-12-01

Silicone casting of abdominal wall defects around enteric fistulas in six patients and problem stomas in three patients proved to be an effective means of controlling the output of the fistulas, reducing wound care time, and reducing or eliminating parenteral nutrition needs. Outpatient management was possible in seven of the nine patients. It is observed that the wounds healed rapidly with this method of fistula control. Epithelialization occurred more rapidly than expected. This method of management may tend to make the fistulas remain open longer than by other means of care, but the significant increase in patient comfort, the financial savings, and the relative safety warrant continued utilization and observation of this method of management.

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

Necrotizing Fasciitis of Thoracic and Abdominal Wall with Emphysematous Pyelonephritis and Retroperitoneal Abscess

PubMed Central

Khaladkar, Sanjay Mhalasakant; Jain, Kunaal Mahesh; Kuber, Rajesh; Gandage, Sidappa

2018-01-01

Emphysematous pyelonephritis is a life-threatening severe form of pyelonephritis usually occurring in patients with diabetes mellitus with or without obstructive uropathies in whom there is necrotizing infection leading to the gas production of an unclear mechanism involving the renal parenchyma and the collecting system. Necrotizing fasciitis is characterized by progressive necrosis of fat and fascia due to deep-seated infection of subcutaneous tissue. It has a fulminant course with considerable mortality. Diabetes Mellitus is a common predisposing factor. The combined occurrence of emphysematous pyelonephritis and necrotizing fasciitis is extremely unusual. Early recognition and management is mandatory to avoid mortality. We report a case of a 53-year-old female, a known case of Type II diabetes mellitus, who presented with necrotizing fasciitis of thoracic and abdominal wall with emphysematous pyelonephritis in the left kidney with a retroperitoneal abscess. PMID:29541493

An observational study: Effects of tenting of the abdominal wall on peak airway pressure in robotic radical prostatectomy surgery

PubMed Central

Kakde, Avinash Sahebarav; Wagh, Harshal D.

2017-01-01

Background: Robotic radical prostatectomy (RRP) is associated with various anesthetic challenges due to pneumoperitoneum and deep Trendelenburg position. Tenting of the abdominal wall done in RRP surgery causes decrease in peak airway pressure leading to better ventilation. Herein, we aimed to describe the effects of tenting of the abdominal wall on peak airway pressure in RRP surgery performed in deep Trendelenburg position. Methods: One hundred patients admitted for RRP in Kokilaben Dhirubhai Ambani Hospital of American Society of Anesthesiologists 1 and 2 physical status were included in the study. After undergoing preanesthesia work-up, patients received general anesthesia. Peak airway pressures were recorded after induction of general anesthesia, after insufflation of CO2, after giving Trendelenburg position, and after tenting of the abdominal wall with robotic arms. Results: Mean peak airway pressure recording after induction in supine position was 19.5 ± 2.3 cm of H2O, after insufflation of CO2 in supine position was 26.3 ± 2.6 cm of H2O, after giving steep head low was 34.1 ± 3.4 cm of H2O, and after tenting of the abdominal wall with robotic arms was 29.5 ± 2.5 cm of H2O. P value is highly statistically significant (P = 0.001). Conclusion: Tenting of the abdominal wall during RRP is beneficial as it decreases peak airway pressure and helps in better ventilation and thus reduces the ill effects of raised peak airway pressure and intra-abdominal pressures. PMID:28757826

[Vesico-cutaneous fistula revealing abdominal wall malakoplakia accompanied by Boeck's sarcoidosis].

PubMed

Knausz, József; Lipták, József; Andrásovszky, Zsolt; Baranyay, Ferenc

2010-02-07

Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is hardly known, but it thought to be secondary to an acquired bactericidal defect in macrophages occurring mostly in immunosuppressed patients. 63-year-old female patient had been treated with methylprednisolone for ten years, because of pulmonary sarcoidosis. For six month, recurrent abdominal abscess and vesico-cutaneous fistula developed. Histological examination proved malakoplakia, and Escherichia coli was detected in the abscess cavity. Hematoxyline eosin staining, periodic acid-Schiff, Berlin-blue and Kossa reactions were performed. Microscopically malakoplakia consists of mainly macrophages, known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. In our presented case, after urological-surgical intervention and antibiotic therapy, the patient became free from complaints and symptoms. Malakoplakia has been described in numerous anatomic locations, mainly in the urogenital tract. Malakoplakia may be complicated with fistulas in different locations: vesico-coccygeal, rectoprostatic, anorectal fistulas have been were reported in the literature, while 6 cases of malakoplakia with Boeck's sarcoidosis are published. In the presented case sarcoidosis and the 10-year immunosuppressive treatment with methylprednisolone might have been in the background of abdominal wall malakoplakia, complicated by vesico-cutaneous fistula. The patient was successfully treated with surgery and the followed antibiotic therapy.

Non-cross-linked porcine acellular dermal matrices for abdominal wall reconstruction.

PubMed

Burns, Nadja K; Jaffari, Mona V; Rios, Carmen N; Mathur, Anshu B; Butler, Charles E

2010-01-01

Non-cross-linked porcine acellular dermal matrices have been used clinically for abdominal wall repair; however, their biologic and mechanical properties and propensity to form visceral adhesions have not been studied. The authors hypothesized that their use would result in fewer, weaker visceral adhesions than polypropylene mesh when used to repair ventral hernias and form a strong interface with the surrounding musculofascia. Thirty-four guinea pigs underwent inlay repair of surgically created ventral hernias using polypropylene mesh, porcine acellular dermal matrix, or a composite of the two. The animals were killed at 4 weeks, and the adhesion tenacity grade and surface area of the repair site involved by adhesions were measured. Sections of the repair sites, including the implant-musculofascia interface, underwent histologic analysis and uniaxial mechanical testing. The incidence of bowel adhesions to the repair site was significantly lower with the dermal matrix (8 percent, p < 0.01) and the matrix/mesh combination (0 percent, p < 0.001) than with polypropylene mesh alone (70 percent). The repairs made with the matrix or the matrix/mesh combination, compared with the polypropylene mesh repairs, had significantly lower mean adhesion surface areas [12.8 percent (p < 0.001), 9.2 percent (p < 0.001), and 79.9 percent] and grades [0.6 (p < 0.001), 0.6 (p < 0.001), and 2.9]. The dermal matrix underwent robust cellular and vascular infiltration. The ultimate tensile strength at the implant-musculofascia interface was similar in all groups. Porcine acellular dermal matrix becomes incorporated into the host tissue and causes fewer adhesions to repair sites than does polypropylene mesh, with similar implant-musculofascia interface strength. It also inhibits adhesions to adjacent dermal matrix in the combination repairs. It has distinct advantages over polypropylene mesh for complex abdominal wall repairs, particularly when material placement directly over bowel is

A systematic review of synthetic and biologic materials for abdominal wall reinforcement in contaminated fields.

PubMed

Lee, Lawrence; Mata, Juan; Landry, Tara; Khwaja, Kosar A; Vassiliou, Melina C; Fried, Gerald M; Feldman, Liane S

2014-09-01

Guidelines recommend the use of bioprosthetics for abdominal wall reinforcement in contaminated fields, but the evidence supporting the use of biologic over synthetic non-absorbable prosthetics for this indication is poor. Therefore, the objective was to perform a systematic review of outcomes after synthetic non-absorbable and biologic prosthetics for ventral hernia repair or prophylaxis in contaminated fields. The systematic literature search identified all articles published up to 2013 that reported outcomes after abdominal wall reinforcement using synthetic non-absorbable or biologic prosthetics in contaminated fields. Studies were included if they included at least 10 cases (excluding inguinal and parastomal hernias). Quality assessment was performed using the MINORS instrument. The main outcomes measures were the incidence of wound infection and hernia at follow-up. Weighted pooled proportions were calculated using a random effects model. A total of 32 studies met the inclusion criteria and were included for synthesis. Mean sample size was 41.4 (range 10-190), and duration of follow-up was >1 year in 72 % of studies. Overall quality was low (mean 6.2, range 1-12). Pooled wound infection rates were 31.6 % (95 % CI 14.5-48.7) with biologic and 6.4 % (95 % CI 3.4-9.4) with synthetic non-absorbable prosthetics in clean-contaminated cases, with similar hernia rates. In contaminated and/or dirty fields, wound infection rates were similar, but pooled hernia rates were 27.2 % (95 % CI 9.5-44.9) with biologic and 3.2 % (95 % CI 0.0-11.0) with synthetic non-absorbable. Other outcomes were comparable. The available evidence is limited, but does not support the superiority of biologic over synthetic non-absorbable prosthetics in contaminated fields.

Stochastic modelling of wall stresses in abdominal aortic aneurysms treated by a gene therapy.

PubMed

Mohand-Kaci, Faïza; Ouni, Anissa Eddhahak; Dai, Jianping; Allaire, Eric; Zidi, Mustapha

2012-01-01

A stochastic mechanical model using the membrane theory was used to simulate the in vivo mechanical behaviour of abdominal aortic aneurysms (AAAs) in order to compute the wall stresses after stabilisation by gene therapy. For that, both length and diameter of AAAs rats were measured during their expansion. Four groups of animals, control and treated by an endovascular gene therapy during 3 or 28 days were included. The mechanical problem was solved analytically using the geometric parameters and assuming the shape of aneurysms by a 'parabolic-exponential curve'. When compared to controls, stress variations in the wall of AAAs for treated arteries during 28 days decreased, while they were nearly constant at day 3. The measured geometric parameters of AAAs were then investigated using probability density functions (pdf) attributed to every random variable. Different trials were useful to define a reliable confidence region in which the probability to have a realisation is equal to 99%. The results demonstrated that the error in the estimation of the stresses can be greater than 28% when parameters uncertainties are not considered in the modelling. The relevance of the proposed approach for the study of AAA growth may be studied further and extended to other treatments aimed at stabilisation AAAs, using biotherapies and pharmacological approaches.

Suprascarpal fat pad thickness may predict venous drainage patterns in abdominal wall flaps.

PubMed

Bast, John; Pitcher, Austin A; Small, Kevin; Otterburn, David M

2016-02-01

Abdominal wall flaps are routinely used in reconstructive procedures. In some patients inadequate venous drainage from the deep vein may cause fat necrosis or flap failure. Occasionally the superficial inferior epigastric vessels (SIEV) are of sufficient size to allow for microvascular revascularization. This study looked at the ratio of the sub- and suprascarpal fat layers, the number of deep system perforators, and SIEV diameter to determine any correlation of the fat topography and SIEV. 50 abdominal/pelvic CT angiograms (100 hemiabdomens) were examined in women aged 34-70 years for number of perforators, SIEV diameter, and fat pad thickness above and below Scarpa's fascia. Data was analyzed using multivariate model. The average suprascarpal and subscarpal layers were 18.6 ± 11.5 mm and 6.2 ± 7.2 mm thick, respectively. The average SIEV diameter was 2.06 ± 0.81 mm and the average number of perforators was 2.09 ± 1.03 per hemiabdomen. Hemiabdomens with suprascarpal thickness>23 mm had greater SIEV diameter [2.69 mm vs. 1.8 mm (P < 0.0001)] The fat layer thickness did not correlate with the number of perforators. Neither subscarpal fat thickness nor suprascarpal-to-subscarpal fat layer thickness correlated significantly with SIEV caliber or number of perforators in multivariate model. Suprascarpal fat pad thicker than 23 mm had larger SIEVs irrespective of the number of deep system perforators. This may indicate a cohort of patients at risk of venous congestion from poor venous drainage if only the deep system is revascularized. We recommend harvesting the SIEV in patients with suprascarpal fat pad >23 mm to aid in superficial drainage. © 2015 Wiley Periodicals, Inc.

Efficacy of transversus abdominis plane block with liposomal bupivacaine during open abdominal wall reconstruction.

PubMed

Fayezizadeh, Mojtaba; Majumder, Arnab; Neupane, Ruel; Elliott, Heidi L; Novitsky, Yuri W

2016-09-01

Transversus abdominis plane block (TAPb) is an analgesic adjunct used for abdominal surgical procedures. Liposomal bupivacaine (LB) demonstrates prolonged analgesic effects, up to 72 hours. We evaluated the analgesic efficacy of TAPb using LB for patients undergoing open abdominal wall reconstruction (AWR). Fifty patients undergoing AWR with TAPb using LB (TAP-group) were compared with a matched historical cohort undergoing AWR without TAPb (control group). Outcome measures included postoperative utilization of morphine equivalents, numerical rating scale pain scores, time to oral narcotics, and length of stay (LOS). Cohorts were matched demographically. No complications were associated with TAPb or LB. TAP-group evidenced significantly reduced narcotic requirements on operative day (9.5 mg vs 16.5 mg, P = .004), postoperative day (POD) 1 (26.7 mg vs 39.5 mg, P = .01) and POD2 (29.6 mg vs 40.7 mg, P = .047) and pain scores on operative day (5.1 vs 7.0, P <.001), POD1 (4.2 vs 5.5, P = .002), and POD2 (3.9 vs 4.8, P = .04). In addition, TAP-group demonstrated significantly shorter time to oral narcotics (2.7 days vs 4.0 days, P <.001) and median LOS (5.2 days vs 6.8 days, P = .004). TAPb with LB demonstrated significant reductions in narcotic consumption and improved pain control. TAPb allowed for earlier discontinuation of intravenous narcotics and shorter LOS. Intraoperative TAPb with LB appears to be an effective adjunct for perioperative analgesia in patients undergoing open AWR. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2016-01-01

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

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

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

Laparoscopic-assisted management of traumatic abdominal wall hernias in children: case series and a review of the literature.

PubMed

Talutis, Stephanie D; Muensterer, Oliver J; Pandya, Samir; McBride, Whitney; Stringel, Gustavo

2015-03-01

Traumatic abdominal wall hernia (TAWH) is defined as herniation through a disrupted portion of musculature/fascia without skin penetration or history of prior hernia. In children, TAWH is a rare injury. The objectives of this study were to report our experience with different management strategies of TAWH in children and to determine the utility of laparoscopy. A retrospective chart review of all children treated by pediatric surgery at our institution for TAWH in a 5year interval was performed. Data were collected on mechanism of injury, initial patient presentation, surgical management, and outcomes. We present 5 cases of traumatic abdominal wall hernia; 3 were managed using laparoscopic assistance. One patient was managed nonoperatively. All patients recovered without complications and were asymptomatic on follow up. Traumatic abdominal wall hernias require a high index of suspicion in the cases of blunt abdominal trauma. Laparoscopy is useful mainly as a diagnostic modality, both to evaluate the hernia and associated injuries to intraabdominal structures. Its use may facilitate repair through a smaller incision. Conservative management of TAWH may be appropriate in select cases where there is a low risk of bowel strangulation. Copyright © 2015 Elsevier Inc. All rights reserved.

Skeletal muscle derived stem cells microintegrated into a biodegradable elastomer for reconstruction of the abdominal wall.

PubMed

Takanari, Keisuke; Hashizume, Ryotaro; Hong, Yi; Amoroso, Nicholas J; Yoshizumi, Tomo; Gharaibeh, Burhan; Yoshida, Osamu; Nonaka, Kazuhiro; Sato, Hideyoshi; Huard, Johnny; Wagner, William R

2017-01-01

A variety of techniques have been applied to generate tissue engineered constructs, where cells are combined with degradable scaffolds followed by a period of in vitro culture or direct implantation. In the current study, a cellularized scaffold was generated by concurrent deposition of electrospun biodegradable elastomer (poly(ester urethane)urea, PEUU) and electrosprayed culture medium + skeletal muscle-derived stem cells (MDSCs) or electrosprayed culture medium alone as a control. MDSCs were obtained from green fluorescent protein (GFP) transgenic rats. The created scaffolds were implanted into allogenic strain-matched rats to replace a full thickness abdominal wall defect. Both control and MDSC-integrated scaffolds showed extensive cellular infiltration at 4 and 8 wk. The number of blood vessels was higher, the area of residual scaffold was lower, number of multinucleated giant cells was lower and area of connective tissue was lower in MDSC-integrated scaffolds (p < 0.05). GFP + cells co-stained positive for VEGF. Bi-axial mechanical properties of the MDSC-microintegrated constructs better approximated the anisotropic behavior of the native abdominal wall. GFP + cells were observed throughout the scaffold at ∼5% of the cell population at 4 and 8 wk. RNA expression at 4 wk showed higher expression of early myogenic marker Pax7, and b-FGF in the MDSC group. Also, higher expression of myogenin and VEGF were seen in the MDSC group at both 4 and 8 wk time points. The paracrine effect of donor cells on host cells likely contributed to the differences found in vivo between the groups. This approach for the rapid creation of highly-cellularized constructs with soft tissue like mechanics offers an attractive methodology to impart cell-derived bioactivity into scaffolds providing mechanical support during the healing process and might find application in a variety of settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Abdominal Wall Reconstruction with Concomitant Ostomy-Associated Hernia Repair: Outcomes and Propensity Score Analysis.

PubMed

Mericli, Alexander F; Garvey, Patrick B; Giordano, Salvatore; Liu, Jun; Baumann, Donald P; Butler, Charles E

2017-03-01

The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is unclear. We hypothesized that the rate of ventral hernia recurrence in patients undergoing a combined ventral hernia repair and stomal-site herniorraphy would not differ clinically from the ventral hernia recurrence rate in patients undergoing an isolated ventral hernia repair. We also hypothesized that bridged ventral hernia repairs result in worse outcomes compared with reinforced repairs, regardless of stomal hernia. We retrospectively reviewed prospectively collected data from consecutive abdominal wall reconstructions performed with acellular dermal matrix (ADM) at a single center between 2000 and 2015. We compared patients who underwent a ventral hernia repair alone (AWR) and those who underwent both a ventral hernia repair and ostomy-associated herniorraphy (AWR+O). We conducted a propensity score matched analysis to compare the outcomes between the 2 groups. Multivariable Cox proportional hazards and logistic regression models were used to study associations between potential predictive or protective reconstructive strategies and surgical outcomes. We included 499 patients (median follow-up 27.2 months; interquartile range [IQR] 12.4 to 46.6 months), 118 AWR+O and 381 AWR. After propensity score matching, 91 pairs were obtained. Ventral hernia recurrence was not statistically associated with ostomy-associated herniorraphy (adjusted hazard ratio [HR] 0.7; 95% CI 0.3 to 1.5; p = 0.34). However, the AWR+O group experienced a significantly higher percentage of surgical site occurrences (34.1%) than the AWR group (18.7%; adjusted odds ratio 2.3; 95% CI 1.4 to 3.7; p < 0.001). In the AWR group, there were significantly fewer ventral hernia recurrences when the repair was reinforced compared with bridged (5.3% vs 38.5%; p < 0.001). There was no statistically significant difference in ventral hernia recurrence between the AWR and AWR+O groups. Bridging was associated

Laparoscopic-guided abdominal wall nerve blocks in the pediatric population: a novel technique with comparison to ultrasound-guided blocks and local wound infiltration alone.

PubMed

Landmann, Alessandra; Visoiu, Mihaela; Malek, Marcus M

2018-03-01

Abdominal wall nerve blocks have been gaining popularity for the treatment of perioperative pain in children. Our aim was to compare a technique of surgeon-performed, laparoscopic abdominal wall nerve blocks to anesthesia-placed, ultrasound-guided abdominal wall nerve blocks and the current standard of local wound infiltration. After institutional review board approval was obtained, a retrospective chart review was performed of pediatric patients treated at a single institution during a 2-year period. Statistics were calculated using analysis of variance with post-hoc Bonferonni t tests for pair-wise comparisons. Included in this study were 380 patients who received ultrasound-guided abdominal wall nerve blocks (n = 125), laparoscopic-guided abdominal wall nerve blocks (n = 88), and local wound infiltration (n = 117). Groups were well matched for age, sex, and weight. There was no significant difference in pain scores within the first 8 hours or narcotic usage between groups. Local wound infiltration demonstrated the shortest overall time required to perform (P < .0001). Patients who received a surgeon-performed abdominal wall nerve block demonstrated a shorter duration of hospital stay when compared to the other groups (P = .02). Our study has demonstrated that laparoscopic-guided abdominal wall nerve blocks show similar efficacy to ultrasound-guided nerve blocks performed by pain management physicians without increasing time in the operating room. Copyright © 2017 Elsevier Inc. All rights reserved.

Selecting criteria for the right prosthesis in defect of the abdominal wall surgery.

PubMed

Mohamed, H; Ion, D; Serban, M B; Ciurea, M

2009-01-01

The article is debating a theme of great interest for the defect of the abdominal wall surgery--the use of biocompatible prosthesis. The surgeon is often confused by the avalanche of offers made by the mesh producers, making it mandatory for him to know very well the behavior of these alloplastic structures in the tissue environment. From this point of view, we have discussed both the physicochemical properties and the histological reaction brought by the most common type of meshes: polypropylene, polyethylene - tereftalat, polytetrafluorideethylene. This presentation brings out the minimal but mandatory criteria for any mesh to be accepted, but also the criteria that need to be taken into consideration when we try to improve the qualities of the mesh closer to the desideratum of the "ideal mesh". The main conclusion of this review is that we have to change the myth of the "ideal mesh" with "the right chosen mesh", that based on its chemical, physical, structural and biological qualities will adapt perfectly first to the patient's needs and second to the surgeon's needs.

Predicting adverse neonatal outcomes in fetuses with abdominal wall defects using prenatal risk factors.

PubMed

Nicholas, Sara S; Stamilio, David M; Dicke, Jeffery M; Gray, Diana L; Macones, George A; Odibo, Anthony O

2009-10-01

The aim of this study was to determine whether prenatal variables can predict adverse neonatal outcomes in fetuses with abdominal wall defects. A retrospective cohort study that used ultrasound and neonatal records for all cases of gastroschisis and omphalocele seen over a 16-year period. Cases with adverse neonatal outcomes were compared with noncases for multiple candidate predictive factors. Univariable and multivariable statistical methods were used to develop the prediction models, and effectiveness was evaluated using the area under the receiver operating characteristic curve. Of 80 fetuses with gastroschisis, 29 (36%) had the composite adverse outcome, compared with 15 of 33 (47%) live neonates with omphalocele. Intrauterine growth restriction was the only significant variable in gastroschisis, whereas exteriorized liver was the only predictor in omphalocele. The areas under the curve for the prediction models with gastroschisis and omphalocele are 0.67 and 0.74, respectively. Intrauterine growth restriction and exteriorization of the liver are significant predictors of adverse neonatal outcome with gastroschisis and omphalocele.

Simultaneous Prosthetic Mesh Abdominal Wall Reconstruction with Abdominoplasty for Ventral Hernia and Severe Rectus Diastasis Repairs

PubMed Central

Cheesborough, Jennifer E.

2015-01-01

Background: Standard abdominoplasty rectus plication techniques may not suffice for severe cases of rectus diastasis. In the authors’ experience, prosthetic mesh facilitates the repair of severe rectus diastasis with or without concomitant ventral hernias. Methods: A retrospective review of all abdominal wall surgery patients treated in the past 8 years by the senior author (G.A.D.) was performed. Patients with abdominoplasty and either rectus diastasis repair with mesh or a combined ventral hernia repair were analyzed. Results: Thirty-two patients, 29 women and three men, underwent mesh-reinforced midline repair with horizontal or vertical abdominoplasty. Patient characteristics included the following: mean age, 53 years; mean body mass index, 26 kg/m2; average width of diastasis or hernia, 6.7 cm; and average surgery time, 151 minutes. There were no surgical-site infections and two surgical-site occurrences—two seromas treated with drainage in the office. After an average of 471 days’ follow-up, none of the patients had recurrence of a bulge or a hernia. Conclusions: For patients with significant rectus diastasis, with or without concomitant hernias, the described mesh repair is both safe and durable. Although this operation requires additional dissection and placement of prosthetic mesh in the retrorectus plane, it may be safely combined with standard horizontal or vertical abdominoplasty skin excision techniques to provide an aesthetically pleasing overall result. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. PMID:25539311

Active behavior of abdominal wall muscles: Experimental results and numerical model formulation.

PubMed

Grasa, J; Sierra, M; Lauzeral, N; Muñoz, M J; Miana-Mena, F J; Calvo, B

2016-08-01

In the present study a computational finite element technique is proposed to simulate the mechanical response of muscles in the abdominal wall. This technique considers the active behavior of the tissue taking into account both collagen and muscle fiber directions. In an attempt to obtain the computational response as close as possible to real muscles, the parameters needed to adjust the mathematical formulation were determined from in vitro experimental tests. Experiments were conducted on male New Zealand White rabbits (2047±34g) and the active properties of three different muscles: Rectus Abdominis, External Oblique and multi-layered samples formed by three muscles (External Oblique, Internal Oblique, and Transversus Abdominis) were characterized. The parameters obtained for each muscle were incorporated into a finite strain formulation to simulate active behavior of muscles incorporating the anisotropy of the tissue. The results show the potential of the model to predict the anisotropic behavior of the tissue associated to fibers and how this influences on the strain, stress and generated force during an isometric contraction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Port site endometrioma: a rare cause of abdominal wall pain following laparoscopic surgery.

PubMed

Siddiqui, Zohaib A; Husain, Fahd; Siddiqui, Zain; Siddiqui, Midhat

2017-06-18

Endometriomas are a rare cause of abdominal wall pain. We report a case of a port site endometrioma presenting with an umbilical swelling. The patient underwent a laparoscopy for pelvic endometriosis 6 months previously and presented with a swelling around her umbilical port site scar associated with cyclical pain during menses. Ultrasound scan reported a well-defined lesion in the umbilicus and MRI scanning excluded other pathology. As she was symptomatic, she underwent an exploration of the scar and excision of the endometrioma with resolution of her symptoms. Precautions should be taken to reduce the risk of endometrial seeding during laparoscopic surgery. All tissues should be removed in an appropriate retrieval bag and the pneumoperitoneum should be deflated completely before removing ports to reduce the chimney effect of tissue being forced through the port site. The diagnosis should be considered in all women of reproductive age presenting with a painful port site scar. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair?

PubMed

Scheuerlein, Hubert; Thiessen, Andreas; Schug-Pass, Christine; Köckerling, Ferdinand

2018-01-01

The component separation technique (CST) was introduced to abdominal wall reconstruction to treat large, complex hernias. It is very difficult to compare the published findings because of the vast number of technical modifications to CST as well as the heterogeneity of the patient population operated on with this technique. The main focus of the literature search conducted up to August 2017 in Medline and PubMed was on publications reporting comparative findings as well as on systematic reviews in order to formulate statements regarding the various CSTs. CST without mesh should no longer be performed because of too high recurrence rates. Open anterior CST has too high a surgical site occurrence rate and henceforth should only be conducted as endoscopic and perforator sparing anterior CST. Open posterior CST and posterior CST with transversus abdominis release (TAR) produce better results than open anterior CST. To date, no significant differences have been found between endoscopic anterior, perforator sparing anterior CST and posterior CST with transversus abdominis release. Robot-assisted posterior CST with TAR is the latest, very promising alternative. The systematic use of biologic meshes cannot be recommended for CST. CST should always be performed with mesh as endoscopic or perforator sparing anterior or posterior CST. Robot-assisted posterior CST with TAR is the latest development.

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. Copyright © 2011 Elsevier Ltd. All rights reserved.

Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

PubMed Central

Bae, Sung Kyu; Kang, Seok Joo; Kim, Jin Woo; Kim, Young Hwan

2013-01-01

Background If a chronically infected abdominal wound develops, complications such as peritonitis and an abdominal wall defect could occur. This could prolong the patient's hospital stay and increase the possibility of re-operation or another infection as well. For this reason, a solution for infection control is necessary. In this study, surgery using a rectus abdominis muscle myofascial splitting flap was performed on an abdominal wall defect. Methods From 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture, cesarean section, or uterine myoma were chosen. In each case, during the first week after operation, the wound showed signs of infection. Surgery was chosen because the wounds did not resolve with dressing. Debridement was performed along the previous operation wound and dissection of the skin was performed to separate the skin and subcutaneous tissue from the attenuated rectus muscle and Scarpa's fascial layers. Once the anterior rectus sheath and muscle were adequately mobilized, the fascia and muscle flap were advanced medially so that the skin defect could be covered for reconstruction. Results Upon 3-week follow-up after a rectus abdominis myofascial splitting flap operation, no major complication occurred. In addition, all of the patients showed satisfaction in terms of function and esthetics at 3 to 6 months post-surgery. Conclusions Using a rectus abdominis myofascial splitting flap has many esthetic and functional benefits over previous methods of abdominal defect treatment, and notably, it enabled infection control by reconstruction using muscle. PMID:23362477

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

SciTech Connect

Ikeda, Osamu, E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka

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.

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.

Correspondence: Laparoscopic repair of abdominal wall hernia--"How I do it"--synopsis of a seemingly straightforward technique.

PubMed

Berney, Christophe R

2015-08-19

Abdominal wall hernia repairs are commonly performed worldwide in general surgery. There is still no agreed consensus on the optimal surgical approach. Since the turn of the twenty-first century, minimally invasive techniques have gained in popularity as they combine the advantages of limited abdominal wall dissection, reduced post-operative pain and risk of complications, and shorter hospital stay. Although the added cost incurred by using sophisticated laparoscopic instruments may be quite substantial, it is precisely counterbalanced by an improved morbidity rate, faster discharge home and time to return to work. Laparoscopic abdominal wall hernia repair is often challenging, as it requires good anatomical knowledge, eye-hand coordination and diversified laparoscopic skills. The objective of this article is not to present another set of personal data and to compare it with already published results on this matter, but simply to offer comprehensive guidelines on the practical aspects of this relatively new technique. Some of these steps have already been discussed but most of the time in a scattered way in the surgical literature, while others are the fruit of a personal expertise grasped over the years.

Adventitial adipogenic degeneration is an unidentified contributor to aortic wall weakening in the abdominal aortic aneurysm.

PubMed

Doderer, Stefan A; Gäbel, Gabor; Kokje, Vivianne B C; Northoff, Bernd H; Holdt, Lesca M; Hamming, Jaap F; Lindeman, Jan H N

2018-06-01

The processes driving human abdominal aortic aneurysm (AAA) progression are not fully understood. Although antiinflammatory and proteolytic strategies effectively quench aneurysm progression in preclinical models, so far all clinical interventions failed. These observations hint at an incomplete understanding of the processes involved in AAA progression and rupture. Interestingly, strong clinical and molecular associations exist between popliteal artery aneurysms (PAAs) and AAAs; however, PAAs have an extremely low propensity to rupture. We thus reasoned that differences between these aneurysms may provide clues toward (auxiliary) processes involved in AAA-related wall debilitation. A better understanding of the pathophysiologic processes driving AAA growth can contribute to pharmaceutical treatments in the future. Aneurysmal wall samples were collected during open elective and emergency repair. Control perirenal aorta was obtained during kidney transplantation, and reference popliteal tissue obtained from the anatomy department. This study incorporates various techniques including (immuno)histochemistry, Western Blot, quantitative polymerase chain reaction, microarray, and cell culture. Histologic evaluation of AAAs, PAAs, and control aorta shows extensive medial (PAA) and transmural fibrosis (AAA), and reveals abundant adventitial adipocytes aggregates as an exclusive phenomenon of AAAs (P < .001). Quantitative polymerase chain reaction, immunohistochemistry, Western blotting, and microarray analysis showed enrichment of adipogenic mediators (C/EBP family P = .027; KLF5 P < .000; and peroxisome proliferator activated receptor-γ, P = .032) in AAA tissue. In vitro differentiation tests indicated a sharply increased adipogenic potential of AAA adventitial mesenchymal cells (P < .0001). Observed enrichment of adipocyte-related genes and pathways in ruptured AAA (P < .0003) supports an association between the extent of fatty degeneration and rupture. This

Laparoscopic cholecystectomy using abdominal wall retraction. Hemodynamics and gas exchange, a comparison with conventional pneumoperitoneum.

PubMed

Meijer, D W; Rademaker, B P; Schlooz, S; Bemelman, W A; de Wit, L T; Bannenberg, J J; Stijnen, T; Gouma, D F

1997-06-01

Disadvantages related to CO2 pneumoperitoneum have led to development of the abdominal wall retractor (AWR), a device designed to facilitate laparoscopic surgery without conventional pneumoperitoneum (15 mmHg CO2). We investigated the effects of the AWR on hemodynamics and gas exchange in humans. We also investigated whether the use of an AWR imposed extra technical difficulties for the surgeon. A pilot study revealed that cholecystectomy without low-pressure pneumoperitoneum was technically impossible. A prospective randomized controlled trial: Twenty patients undergoing laparoscopic cholecystectomy were randomly allocated into group 1: AWR with low-pressure pneumoperitoneum (5 mmHg), or group 2: conventional pneumoperitoneum (15 mmHg). Surgery using the AWR lasted longer, 72 +/- 16 min (mean +/- SD) vs 50 +/- 18 min compared with standard laparoscopic cholecystectomy. There were no differences between the groups with respect to hemodynamic parameters, although a small reduction of the cardiac output was observed using conventional pneumoperitoneum (from 3.9 +/- 0.7 to 3. 2 +/- 1.1 l/min) and an increase during AWR (from 4.2 +/- 0.9 to 5.2 +/- 1.5 l/min). Peak inspiratory pressures were significantly higher during conventional pneumoperitoneum compared to AWR. A slight decrease in pH accompanied by an increase in CO2 developed during pneumoperitoneum and during the use of the AWR. In both groups arterial PO2 decreased. The results indicate that the view was impaired during use of the AWR and therefore its use was difficult and time-consuming. Possible advantages of this devices' effects on hemodynamics and ventilatory parameters could not be confirmed in this study.

Primary fascial closure with mesh reinforcement is superior to bridged mesh repair for abdominal wall reconstruction.

PubMed

Booth, Justin H; Garvey, Patrick B; Baumann, Donald P; Selber, Jesse C; Nguyen, Alexander T; Clemens, Mark W; Liu, Jun; Butler, Charles E

2013-12-01

Many surgeons believe that primary fascial closure with mesh reinforcement should be the goal of abdominal wall reconstruction (AWR), yet others have reported acceptable outcomes when mesh is used to bridge the fascial edges. It has not been clearly shown how the outcomes for these techniques differ. We hypothesized that bridged repairs result in higher hernia recurrence rates than mesh-reinforced repairs that achieve fascial coaptation. We retrospectively reviewed prospectively collected data from consecutive patients with 1 year or more of follow-up, who underwent midline AWR between 2000 and 2011 at a single center. We compared surgical outcomes between patients with bridged and mesh-reinforced fascial repairs. The primary outcomes measure was hernia recurrence. Multivariate logistic regression analysis was used to identify factors predictive of or protective for complications. We included 222 patients (195 mesh-reinforced and 27 bridged repairs) with a mean follow-up of 31.1 ± 14.2 months. The bridged repairs were associated with a significantly higher risk of hernia recurrence (56% vs 8%; hazard ratio [HR] 9.5; p < 0.001) and a higher overall complication rate (74% vs 32%; odds ratio [OR] 3.9; p < 0.001). The interval to recurrence was more than 9 times shorter in the bridged group (HR 9.5; p < 0.001). Multivariate Cox proportional hazard regression analysis identified bridged repair and defect width > 15 cm to be independent predictors of hernia recurrence (HR 7.3; p < 0.001 and HR 2.5; p = 0.028, respectively). Mesh-reinforced AWRs with primary fascial coaptation resulted in fewer hernia recurrences and fewer overall complications than bridged repairs. Surgeons should make every effort to achieve primary fascial coaptation to reduce complications. Published by Elsevier Inc.

Meta-analysis of peak wall stress in ruptured, symptomatic and intact abdominal aortic aneurysms.

PubMed

Khosla, S; Morris, D R; Moxon, J V; Walker, P J; Gasser, T C; Golledge, J

2014-10-01

Abdominal aortic aneurysm (AAA) is an important cause of sudden death; however, there are currently incomplete means to predict the risk of AAA rupture. AAA peak wall stress (PWS) can be estimated using finite element analysis (FEA) methods from computed tomography (CT) scans. The question is whether AAA PWS can predict AAA rupture. The aim of this systematic review was to compare PWS in patients with ruptured and intact AAA. The MEDLINE database was searched on 25 May 2013. Case-control studies assessing PWS in asymptomatic intact, and acutely symptomatic or ruptured AAA from CT scans using FEA were included. Data were extracted independently. A random-effects model was used to calculate standard mean differences (SMDs) for PWS measurements. Nine studies assessing 348 individuals were identified and used in the meta-analysis. Results from 204 asymptomatic intact and 144 symptomatic or ruptured AAAs showed that PWS was significantly greater in the symptomatic/ ruptured AAAs compared with the asymptomatic intact AAAs (SMD 0·95, 95 per cent confidence interval 0·71 to 1·18; P < 0·001). The findings remained significant after adjustment for mean systolic blood pressure, standardized at 120 mmHg (SMD 0·68, 0·39 to 0·96; P < 0·001). Minimal heterogeneity between studies was noted (I(2)  = 0 per cent). This study suggests that PWS is greater in symptomatic or ruptured AAA than in asymptomatic intact AAA. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Myelodysplastic/ Myeloproliferative Neoplasms Treatment

MedlinePlus

... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Myelodysplastic/ ...

Primary fascial closure with biologic mesh reinforcement results in lesser complication and recurrence rates than bridged biologic mesh repair for abdominal wall reconstruction: A propensity score analysis.

PubMed

Giordano, Salvatore; Garvey, Patrick B; Baumann, Donald P; Liu, Jun; Butler, Charles E

2017-02-01

Previous studies suggest that bridged mesh repair for abdominal wall reconstruction may result in worse outcomes than mesh-reinforced, primary fascial closure, particularly when acellular dermal matrix is used. We compared our outcomes of bridged versus reinforced repair using ADM in abdominal wall reconstruction procedures. This retrospective study included 535 consecutive patients at our cancer center who underwent abdominal wall reconstruction either for an incisional hernia or for abdominal wall defects left after excision of malignancies involving the abdominal wall with underlay mesh. A total of 484 (90%) patients underwent mesh-reinforced abdominal wall reconstruction and 51 (10%) underwent bridged repair abdominal wall reconstruction. Acellular dermal matrix was used, respectively, in 98% of bridged and 96% of reinforced repairs. We compared outcomes between these 2 groups using propensity score analysis for risk-adjustment in multivariate analysis and for 1-to-1 matching. Bridged repairs had a greater hernia recurrence rate (33.3% vs 6.2%, P < .001), a greater overall complication rate (59% vs 30%, P = .001), and worse freedom from hernia recurrence (log-rank P <.001) than reinforced repairs. Bridged repairs also had a greater rate of wound dehiscence (26% vs 14%, P = .034) and mesh exposure (10% vs 1%, P = .003) than mesh-reinforced abdominal wall reconstruction. When the treatment method was adjusted for propensity score in the propensity-score-matched pairs (n = 100), we found that the rates of hernia recurrence (32% vs 6%, P = .002), overall complications (32% vs 6%, P = .002), and freedom from hernia recurrence (68% vs 32%, P = .001) rates were worse after bridged repair. We did not observe differences in wound healing and mesh complications between the 2 groups. In our population of primarily cancer patients at MD Anderson Cancer Center bridged repair for abdominal wall reconstruction is associated with worse outcomes than mesh

Volume rather than flow incentive spirometry is effective in improving chest wall expansion and abdominal displacement using optoelectronic plethysmography.

PubMed

Paisani, Denise de Moraes; Lunardi, Adriana Claudia; da Silva, Cibele Cristine Berto Marques; Porras, Desiderio Cano; Tanaka, Clarice; Carvalho, Celso Ricardo Fernandes

2013-08-01

Incentive spirometers are widely used in clinical practice and classified as flow-oriented (FIS) and volume-oriented (VIS). Until recently the respiratory inductive plethysmography used to evaluate the effects of incentive spirometry on chest wall mechanics presented limitations, which may explain why the impact of VIS and FIS remains poorly known. To compare the effects of VIS and FIS on thoracoabdominal mechanics and respiratory muscle activity in healthy volunteers. This cross-sectional trial assessed 20 subjects (12 female, ages 20-40 years, body mass index 20-30 kg/m(2)). All subjects performed 8 quiet breaths and 8 deep breaths with FIS and VIS, in a randomized order. We measured thoracoabdominal chest wall, upper and lower rib-cage, and abdominal volumes with optoelectronic plethysmography, and the muscle activity of the sternocleidomastoid and superior and inferior intercostal muscles with electromyography. VIS increased chest wall volume more than did FIS (P = .007) and induced a larger increase in the upper and lower rib-cages and abdomen (156%, 91%, and 151%, respectively, P < .001). By contrast, FIS induced more activity in the accessory muscles of respiration than did VIS (P < .001). VIS promotes a greater increase in chest wall volume, with a larger abdominal contribution and lower respiratory muscle activity, than does FIS in healthy adults.

The Effects of Modified Wall Squat Exercises on Average Adults’ Deep Abdominal Muscle Thickness and Lumbar Stability

PubMed Central

Cho, Misuk

2013-01-01

[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. PMID:24259831

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.

Robotic Transversus Abdominis Release (TAR): is it possible to offer minimally invasive surgery for abdominal wall complex defects?

PubMed

Amaral, Maria Vitória França DO; Guimarães, José Ricardo; Volpe, Paula; Oliveira, Flávio Malcher Martins DE; Domene, Carlos Eduardo; Roll, Sérgio; Cavazzola, Leandro Totti

2017-01-01

We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR) technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects. RESUMO Descrevemos a experiência preliminar nacional na utilização da cirurgia robótica para realizar a separação posterior de componentes da parede abdominal pela técnica transversus abdominis release (TAR) na correção de defeitos complexos da parede abdominal e seus resultados precoces. As cirurgias foram realizadas entre 02/04/2015 e 15/06/2015 e o tempo de acompanhamento dos resultados foi de até seis meses, com tempo mínimo de dois meses. O tempo cirúrgico médio foi de cinco horas e 40 minutos. Dois pacientes necessitaram reintervenção por laparoscopia, pois um desenvolveu hérnia por migração peritoneal da tela e um teve escape da tela. A cirurgia provou ser factível do ponto de vista técnico, com um tempo cirúrgico ainda elevado. Tendo em vista as vantagens potenciais da cirurgia robótica e aquelas relacionadas ao TAR e os resultados obtidos ao se associar essas duas técnicas, conclui-se que elas parecem ser uma boa opção para a correção de defeitos complexos da parede abdominal.

Comparison of the sonographic features of the abdominal wall muscles and connective tissues in individuals with and without lumbopelvic pain.

PubMed

Whittaker, Jackie L; Warner, Martin B; Stokes, Maria

2013-01-01

Cross-sectional, case-control study. To measure and compare the resting thickness of the 4 abdominal wall muscles, their associated perimuscular connective tissue (PMCT), and interrecti distance (IRD) in persons with and without lumbopelvic pain (LPP), using ultrasound imaging. The muscles and PMCT of the abdominal wall assist in controlling the spine. Functional deficits of the abdominal wall muscles have been detected in populations with LPP. Investigations of the abdominal wall in those with LPP are primarily concerned with muscle, most commonly the transversus abdominis (TrA) and internal oblique (IO). Because the abdominal wall functions as a unit, all 4 abdominal muscles and their associated connective tissues should be considered concurrently. B-mode ultrasound imaging was used to measure the resting thickness of the rectus abdominis (RA), external oblique, IO, and TrA muscles; the PMCT planes; and IRD in 50 male and female subjects, 25 with and 25 without LPP (mean ± SD age, 36.3 ± 9.4 and 46.6 ± 8.0 years, respectively). Univariate correlation analysis was used to identify covariates. Analyses of covariance (ANCOVAs) and the Kruskal-Wallis test (IRD) were used to compare cohorts (α = .05). The LPP cohort had less total abdominal muscle thickness (LPP mean ± SD, 18.9 ± 3.0 mm; control, 20.3 ± 3.0 mm; ANCOVA adjusted for body mass index, P = .03), thicker PMCT (LPP, 5.5 ± 0.2 mm; control, 4.3 ± 0.2 mm; ANCOVA adjusted for body mass index, P = .007), and wider IRD (LPP, 11.5 ± 2.0 mm; control, 8.4 ± 1.8 mm; Kruskal-Wallis, P = .005). Analysis of individual muscle thickness revealed no difference in the external oblique, IO, and TrA, but a thinner RA in the LPP cohort (LPP mean ± SD, 7.8 ± 1.5 mm; control, 9.1 ± 1.2 mm; ANCOVA adjusted for body mass index, P<.001). To our knowledge, this is the first study to investigate the morphological characteristics of all 4 abdominal muscles and PMCT in individuals with LPP. The results suggest that there

Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature.

PubMed

Nuño-Guzmán, Carlos M; Arróniz-Jáuregui, José; Espejo, Ismael; Valle-González, Jesús; Butus, Hernán; Molina-Romo, Alejandro; Orranti-Ortega, Rodrigo I

2012-01-10

Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature. A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health. The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and the previous abdominal surgery are likely to have contributed to

Long-Term Outcomes after Abdominal Wall Reconstruction with Acellular Dermal Matrix.

PubMed

Garvey, Patrick B; Giordano, Salvatore A; Baumann, Donald P; Liu, Jun; Butler, Charles E

2017-03-01

Long-term outcomes data for hernia recurrence rates after abdominal wall reconstruction (AWR) with acellular dermal matrix (ADM) are lacking. The aim of this study was to assess the long-term durability of AWR using ADM. We studied patients who underwent AWR with ADM at a single center in 2005 to 2015 with a minimum follow-up of 36 months. Hernia recurrence was the primary end point and surgical site occurrence (SSO) was a secondary end point. The recurrence-free survival curves were estimated by Kaplan-Meier product limit method. Univariate and multivariable Cox proportional hazards regression models and logistic regression models were used to evaluate the associations of risk factors at surgery with subsequent risks for hernia recurrence and SSO, respectively. A total of 512 patients underwent AWR with ADM. After excluding those with follow-up less than 36 months, 191 patients were included, with a median follow-up of 52.9 months (range 36 to 104 months). Twenty-six of 191 patients had a hernia recurrence documented in the study. The cumulative recurrence rates were 11.5% at 3 years and 14.6% by 5 years. Factors significantly predictive of hernia recurrence developing included bridged repair, wound skin dehiscence, use of human cadaveric ADM, and coronary disease; component separation was protective. In a subset analysis excluding bridged repairs and human cadaveric ADM patients, cumulative hernia recurrence rates were 6.4% by 3 years and 8.3% by 5 years. The crude rate of SSO was 25.1% (48 of 191). Factors significantly predictive of the incidence of SSO included at least 1 comorbidity, BMI ≥30 kg/m 2 , and defect width >15 cm. Use of ADM for AWR was associated with 11.5% and 14.6% hernia recurrence rates at 3- and 5-years follow-up, respectively. Avoiding bridged repairs and human cadaveric ADM can improve long-term AWR outcomes using ADM. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

PubMed Central

Giordano, Salvatore A; Garvey, Patrick B; Baumann, Donald P; Liu, Jun; Butler, Charles E

2016-01-01

Background Obesity and higher body mass index (BMI) may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction (AWR). We hypothesized that higher BMI’s result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in AWR patients. Methods We included 511 consecutive patients who underwent AWR with underlay mesh. Patients were divided into three groups on the basis of preoperative BMI: <30 kg/m2 (non-obese), 30–34.9 kg/m2 (class I obesity) and ≥35 kg/m2 (class II/III obesity). We compared postoperative outcomes among these three groups. Results Class I and class II/III obesity patients had higher surgical site occurrence rates than non-obese patients (26.4% vs. 14.9%; p=0.006 and 36.8% vs. 14.9%; p<0.001, respectively) and higher overall complication rates (37.9% vs. 24.7%; p=0.007 and 43.4% vs. 24.7%; p<0.001, respectively). Similarly, obese patients had significantly higher skin dehiscence (19.3% vs 7.2%; p<0.001 and 26.5% vs 7.2%; p<0.001, respectively) and fat necrosis rates (10.0% vs 2.1%; p=0.001 and 11.8% vs 2.1%; p<0.001, respectively) than non-obese patients. Obesity class II/III patients had higher infection and seroma rates than non-obese patients (9.6% vs 4.3%; p=0.041 and 8.1% vs 2.1%; p=0.006, respectively). However, class I and class II/III obesity patients experienced hernia recurrence rates (11.4% vs. 7.7%; p=0.204 and 10.3% vs. 7.7%; p=0.381, respectively) and freedom from hernia recurrence (overall log-rank p=0.41) similar to non-obese patients. Conclusions Hernia recurrence rates do not appear to be affected by obesity on long-term follow-up in AWR. PMID:28445378

A Case of Pediatric Abdominal Wall Reconstruction: Components Separation within the Austere War Environment

PubMed Central

Sabino, Jennifer; Kumar, Anand

2014-01-01

Summary: Reconstructive surgeons supporting military operations are required to definitively treat severe pediatric abdominal injuries in austere environments. The safety and efficacy of using a components separation technique to treat large ventral hernias in pediatric patients in this setting remains understudied. Components separation technique was required to achieve definitive closure in a 12-month-old pediatric patient in Kandahar, Afghanistan. Her course was complicated by an anastomotic leak after small bowel resection. Her abdominal was successfully reopened, the leak repaired, and closed primarily without incident on postinjury day 9. Abdominal trauma with a large ventral hernia requiring components separation is extremely rare. A pediatric patient treated with components separation demonstrated minimal complications, avoidance of abdominal compartment syndrome, and no mortality. PMID:25426363

Tissue-engineering with muscle fiber fragments improves the strength of a weak abdominal wall in rats.

PubMed

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

2017-02-01

Alternative approaches to reinforce the native tissue in patients with pelvic organ prolapse (POP) are needed to improve surgical outcome. Our aims were to develop a weakened abdominal wall in a rat model to mimic the weakened vaginal wall in women with POP and then evaluate the regenerative potential of a quickly biodegradable synthetic scaffold, methoxypolyethylene glycol polylactic-co-glycolic acid (MPEG-PLGA), seeded with autologous muscle fiber fragments (MFFs) using this model. In an initial pilot study with 15 animals, significant weakening of the abdominal wall and a feasible technique was established by creating a partial defect with removal of one abdominal muscle layer. Subsequently, 18 rats were evenly divided into three groups: (1) unrepaired partial defect; (2) partial defect repaired with MPEG-PLGA; (3) partial defect repaired with MPEG-PLGA and MFFs labeled with PKH26-fluorescence dye. After 8 weeks, we performed histopathological and immunohistochemical testing, fluorescence analysis, and uniaxial biomechanical testing. Both macroscopically and microscopically, the MPEG-PLGA scaffold was fully degraded, with no signs of an inflammatory or foreign-body response. PKH26-positive cells were found in all animals from the group with added MFFs. Analysis of variance (ANOVA) showed a significant difference between groups with respect to load at failure (p = 0.028), and post hoc testing revealed that the group with MPEG-PLGA and MFFs showed a significantly higher strength than the group with MPEG-PLGA alone (p = 0.034). Tissue-engineering with MFFs seeded on a scaffold of biodegradable MPEG-PLGA might be an interesting adjunct to future POP repair.

Challenges in the repair of large abdominal wall hernias in Nigeria: review of available options in resource limited environments.

PubMed

Ezeome, E R; Nwajiobi, C E

2010-06-01

To evaluate the challenges and outcome of management of large abdominal wall hernias in a resource limited environment and highlight the options available to surgeons in similar conditions. A review of prospectively collected data on large abdominal wall hernias managed between 2003 and 2009. University of Nigeria Teaching Hospital, Enugu, Nigeria and surrounding hospitals. Patients with hernias more than 4 cm in their largest diameter, patients with closely sited multiple hernias or failed previous repairs and in whom the surgeon considers direct repair inappropriate. Demographics of patients with large hernias, methods of hernia repair, recurrences, early and late complications following the repair. There were 41 patients, comprising 28 females and 13 males with ages 14 - 73 years. Most (53.7%) were incisional hernias. Gynecological surgeries (66.7%) were the most common initiating surgeries. Fifteen of the patients (36.6%) have had failed previous repairs, 41.5% were obese, five patients presented with intestinal obstruction. Thirty nine of the hernias were repaired with prolene mesh, one with composite mesh and one by danning technique. Most of the patients had extra peritoneal mesh placement. Three patients needed ventilator support. After a mean follow up of 18.6 months, there was a single failed repair. Two post op deaths were related to respiratory distress. There were 12 wound infection and 8 superficial wound dehiscence, all of which except one resolved with dressing. One reoperation was done following mesh infection and extrusion. Large abdominal wall hernia repair in resource limited environments present several challenges with wound infection and respiratory distress being the most notable. Surgeons who embark on it in these environments must be prepared t o secure the proper tissue replacement materials and have adequate ventilation support.

Sporadic extra abdominal wall desmoid-type fibromatosis: surgical resection can be safely limited to a minority of patients.

PubMed

Colombo, C; Miceli, R; Le Péchoux, C; Palassini, E; Honoré, C; Stacchiotti, S; Mir, O; Casali, P G; Dômont, J; Fiore, M; Le Cesne, A; Gronchi, A; Bonvalot, S

2015-01-01

To analyse the natural history of extra-abdominal wall desmoid-type fibromatosis (DF) and compare outcome in patients who underwent initial surgery with those who did not. All consecutive patients affected by primary sporadic extra-abdominal wall DF observed between January 1992 and December 2012 were included. Patients were divided into surgical (SG) or non-surgical groups (NSG) according to initial treatment. Relapse free survival was calculated for SG, and crude cumulative incidence (CCI) of switching to surgery or other treatments for NSG. 216 patients were identified, 94 in SG (43%), 122 in NSG (57%). A shift towards a more systematic use of a conservative approach (78% of all comers) was observed in the latter years (2006-2012), although a small proportion of patients (28%) had been offered the conservative strategy even in the early period (1992-2005). Median follow-up (FU) was 49 mo. (interquartile (IQ), 20-89 mo.), 76 months for SG and 39 months for NSG. 5-year relapse-free survival (RFS) for SG was 80% (95% confidence interval (CI), 72-89%). For the NSG, 5-year CCI of switching to surgery was 5% (95% CI: 1.7%, 14%), and 51% to other treatments (95% CI: 41%, 65%). 27 (20%) NSG patients underwent spontaneous regression. A non-surgical approach to extra-abdominal wall DF allowed surgery to be avoided in the majority of patients. This approach can be safely proposed and surgery offered as an option in selected cases. Copyright © 2014 Elsevier Ltd. All rights reserved.

Use of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases.

PubMed

Karamanos, Efstathios; Dream, Sophie; Falvo, Anthony; Schmoekel, Nathan; Siddiqui, Aamir

2017-01-01

Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common. To assess the impact of epidural analgesia in patients undergoing abdominal wall reconstruction. All patients who underwent elective ventral hernia repair from 2005 to 2014 were retrospectively identified. Patients were divided into two groups by the postoperative use of epidural analgesics as an adjunct analgesic method. Preoperative comorbidities, American Society of Anesthesiologists status, operative findings, postoperative pain management, and venothromboembolic prophylaxis were extracted from the database. Logistic regressions were performed to assess the impact of epidural use. Severity of pain on postoperative days 1 and 2. During the study period, 4983 patients were identified. Of those, 237 patients (4.8%) had an epidural analgesic placed. After adjustment for differences between groups, use of epidural analgesia was associated with significantly lower rates of 30-day presentation to the Emergency Department (adjusted odds ratio [AOR] = 0.53, 95% confidence interval [CI] = 0.32-0.87, adjusted p = 0.01). Use of epidural analgesia resulted in higher odds of abscess development (AOR = 5.89, CI = 2.00-17.34, adjusted p < 0.01) and transfusion requirement (AOR = 2.92, CI = 1.34-6.40, adjusted p < 0.01). Use of epidural analgesia resulted in a significantly lower pain score on postoperative day 1 (3 vs 4, adjusted p < 0.01). Use of epidural analgesia in patients undergoing abdominal wall reconstruction may result in longer hospital stay and higher incidence of complications while having no measurable positive clinical impact on pain control.

Changes in the frequencies of abdominal wall hernias and the preferences for their repair: a multicenter national study from Turkey.

PubMed

Seker, 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, Ibrahim; 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%. 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. 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), the ideal anesthesia (general, local, or regional), and the ideal mesh (standard polypropylene or newer meshes).

Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain.

PubMed

Montenegro, Mary L L S; Braz, Carolina A; Rosa-e-Silva, Julio C; Candido-dos-Reis, Francisco J; Nogueira, Antonio A; Poli-Neto, Omero B

2015-12-01

Chronic pelvic pain is a common condition among women, and 10 to 30 % of causes originate from the abdominal wall, and are associated with trigger points. Although little is known about their pathophysiology, variable methods have been practiced clinically. The purpose of this study was to evaluate the efficacy of local anaesthetic injections versus ischemic compression via physical therapy for pain relief of abdominal wall trigger points in women with chronic pelvic pain. We conducted a parallel group randomized trial including 30 women with chronic pelvic pain with abdominal wall trigger points. Subjects were randomly assigned to one of two intervention groups. One group received an injection of 2 mL 0.5 % lidocaine without a vasoconstrictor into a trigger point. In the other group, ischemic compression via physical therapy was administered at the trigger points three times, with each session lasting for 60 s, and a rest period of 30 s between applications. Both treatments were administered during one weekly session for four weeks. Our primary outcomes were satisfactory clinical response rates and percentages of pain relief. Our secondary outcomes are pain threshold and tolerance at the trigger points. All subjects were evaluated at baseline and 1, 4, and 12 weeks after the interventions. The study was conducted at a tertiary hospital that was associated with a university providing assistance predominantly to working class women who were treated by the public health system. Clinical response rates and pain relief were significantly better at 1, 4, and 12 weeks for those receiving local anaesthetic injections than ischemic compression via physical therapy. The pain relief of women treated with local anaesthetic injections progressively improved at 1, 4, and 12 weeks after intervention. In contrast, women treated with ischemic compression did not show considerable changes in pain relief after intervention. In the local anaesthetic injection group, pain threshold

A rare case of severe third degree friction burns and large Morel-Lavallee lesion of the abdominal wall.

PubMed

Brown, Darnell J; Lu, Kuo Jung G; Chang, Kristina; Levin, Jennifer; Schulz, John T; Goverman, Jeremy

2018-01-01

Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma; therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.

Abdominal wall reconstruction using a combination of free tensor fasciae lata and anterolateral thigh myocutaneous flap: a prospective study in 16 patients.

PubMed

Lv, Yang; Cao, Dongsheng; Guo, Fangfang; Qian, Yunliang; Wang, Chen; Wang, Danru

2015-08-01

Reconstruction of the abdominal wall continues to be a challenging problem for plastic surgeons. Transposition of well-vascularized flap tissue is the most effective way to repair composite abdominal wall defects. We retrospectively reviewed the treatment of such patients and assessed the reconstructive technique using combination of an inlay of bioprosthetic materials and a united thigh flap. A retrospective review of patients' records in the department was carried out. In total, 16 patients who underwent immediate abdominal wall reconstruction between 2000 and 2013 were identified. Patients' health status, defect sizes, and surgical technique were obtained from medical charts. The immediate reconstruction surgery of the abdominal wall was successful in all patients. One patient with dermatofibrosarcoma protuberans experienced recurrences at the former site. One patient died because of liver metastases at 21 months after surgery. No incisional hernia or infection in this series of patients was observed. Full-thickness, giant defects of the complicated abdominal wall can be repaired successfully with relatively minor complications using this reconstructive technique. Copyright © 2015 Elsevier Inc. All rights reserved.

Passive mechanical properties of rat abdominal wall muscles suggest an important role of the extracellular connective tissue matrix.

PubMed

Brown, Stephen H M; Carr, John Austin; Ward, Samuel R; Lieber, Richard L

2012-08-01

Abdominal wall muscles have a unique morphology suggesting a complex role in generating and transferring force to the spinal column. Studying passive mechanical properties of these muscles may provide insights into their ability to transfer force among structures. Biopsies from rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) were harvested from male Sprague-Dawley rats, and single muscle fibers and fiber bundles (4-8 fibers ensheathed in their connective tissue matrix) were isolated and mechanically stretched in a passive state. Slack sarcomere lengths were measured and elastic moduli were calculated from stress-strain data. Titin molecular mass was also measured from single muscle fibers. No significant differences were found among the four abdominal wall muscles in terms of slack sarcomere length or elastic modulus. Interestingly, across all four muscles, slack sarcomere lengths were quite long in individual muscle fibers (>2.4 µm), and demonstrated a significantly longer slack length in comparison to fiber bundles (p < 0.0001). Also, the extracellular connective tissue matrix provided a stiffening effect and enhanced the resistance to lengthening at long muscle lengths. Titin molecular mass was significantly less in TrA compared to each of the other three muscles (p < 0.0009), but this difference did not correspond to hypothesized differences in stiffness. Copyright © 2012 Orthopaedic Research Society.

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

Actinomycotic abscess of the anterior abdominal wall: a case report and literature review.

PubMed

Pitot, D; De Moor, V; Demetter, P; Place, S; Gelin, M; El Nakadi, I

2008-01-01

Actinomycosis is a rare, chronic, suppurative, pseudotumoral illness caused by an anaerobic gram positive organism usually Actinomyces israelii which can mimick a tumoral pathology leading to a mutilating surgical resection. We report a case of abdominal actinomycosis and a literature review.

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; Shioyama, Yoshiyuki; Nomoto, Satoru

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-inspirationmore » 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.« less

Learning curves in abdominal wall reconstruction with components separation: one step closer toward improving outcomes and reducing complications.

PubMed

Hultman, Charles Scott; Clayton, John L; Kittinger, Benjamin J; Tong, Winnie M

2014-01-01

Learning curves are characterized by incremental improvement of a process, through repetition and reduction in variability, but can be disrupted with the emergence of new techniques and technologies. Abdominal wall reconstruction continues to evolve, with the introduction of components separation in the 1990s and biologic mesh in the 2000s. As such, attempts at innovation may impact the success of reconstructive outcomes and yield a changing set of complications. The purpose of this project was to describe the paradigm shift that has occurred in abdominal wall reconstruction during the past 10 years, focusing on the incorporation of new materials and methods. We reviewed 150 consecutive patients who underwent abdominal wall reconstruction of midline defects with components separation, from 2000 to 2010. Both univariate and multivariate logistic regression analyses were performed to identify risk factors for complications. Patients were stratified into the following periods: early (2000-2003), middle (2004-2006), and late (2007-2010). From 2000 to 2010, we performed 150 abdominal wall reconstructions with components separation [mean age, 50.2 years; body mass index (BMI), 30.4; size of defect, 357 cm; length of stay, 9.6 days; follow-up, 4.4 years]. Primary fascial closure was performed in 120 patients. Mesh was used in 114 patients in the following locations: overlay (n = 28), inlay (n = 30), underlay (n = 54), and unknown (n = 2). Complications occurred in a bimodal distribution, highest in 2001 (introduction of biologic mesh) and 2008 (conversion from underlay to overlay location). Age, sex, history of smoking, defect size, and length of stay were not associated with incidence of complications. Unadjusted risk factors for seroma (16.8%) were elevated BMI, of previous hernia repairs, use of overlay mesh, and late portion of the learning curve, with logistic regression supporting only late portion of the learning curve [odds ratio (OR), 4.3; 95% confidence interval

Minilaparotomy with a gasless laparoscopic-assisted procedure by abdominal wall lifting for ileorectal anastomosis in patients with slow transit constipation.

PubMed

Tomita, Ryouichi; Fujisak, Shigeru

2009-01-01

Total colectomy with ileorectal anastomosis (IRA) is the most widely adopted procedure. The aim of this study was to introduce a minimally invasive procedure, i.e., minilaparotomy with laparoscopic-assisted procedure, by abdominal wall lifting for IRA in patients with slow transit constipation (STC). Six STC patients (6 women, aged 40-69 years, mean age 56.3 years) underwent minilaparotomy with gasless laparoscopic-assisted approach by abdominal wall lifting for IRA. The present procedure involved a 7-cm lower abdominal median incision made at the beginning of the operation. 12 mm ports were also placed in the right and left upper abdominal quadrant positions. The upper abdominal wall was lifted by a subcutaneous Kirshner wire. The small wound was pulled upward and/or laterally by retractors (abdominal lifting) and conventional surgical instruments were used through the wound. Occasionally laparoscopic assistance was employed. The terminal ileum with total colon was brought out through the small wound and transected, approximately 5 cm from the ileocecal valve. The colon was also resected at the level of promontrium. Then, IRA was performed in the instruments. The total surgical time was 197.7 +/- 33.9 min and the mean estimated blood loss was 176.8 +/- 42.2 ml. There was no surgical mortality. Post-operative hospitalization was 8.1 +/- 2.1 days. Six months after surgery, they defecated 1.8 +/- 2.1 times daily, have no abdominal distension, pain, and incontinence. The patients also take no laxatives. All subjects were satisfied with this procedure. Minilaparotomy with gasless laparoscopic-assisted IRA by abdominal wall lifting could be a safe and efficient technique in the treatment of STC.

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.

Recommendations for reporting outcome results in abdominal wall repair: results of a Consensus meeting in Palermo, Italy, 28-30 June 2012.

PubMed

Muysoms, F E; Deerenberg, E B; Peeters, E; Agresta, F; Berrevoet, F; Campanelli, G; Ceelen, W; Champault, G G; Corcione, F; Cuccurullo, D; DeBeaux, A C; Dietz, U A; Fitzgibbons, R J; Gillion, J F; Hilgers, R-D; Jeekel, J; Kyle-Leinhase, I; Köckerling, F; Mandala, V; Montgomery, A; Morales-Conde, S; Simmermacher, R K J; Schumpelick, V; Smietański, M; Walgenbach, M; Miserez, M

2013-08-01

The literature dealing with abdominal wall surgery is often flawed due to lack of adherence to accepted reporting standards and statistical methodology. The EuraHS Working Group (European Registry of Abdominal Wall Hernias) organised a consensus meeting of surgical experts and researchers with an interest in abdominal wall surgery, including a statistician, the editors of the journal Hernia and scientists experienced in meta-analysis. Detailed discussions took place to identify the basic ground rules necessary to improve the quality of research reports related to abdominal wall reconstruction. A list of recommendations was formulated including more general issues on the scientific methodology and statistical approach. Standards and statements are available, each depending on the type of study that is being reported: the CONSORT statement for the Randomised Controlled Trials, the TREND statement for non randomised interventional studies, the STROBE statement for observational studies, the STARLITE statement for literature searches, the MOOSE statement for metaanalyses of observational studies and the PRISMA statement for systematic reviews and meta-analyses. A number of recommendations were made, including the use of previously published standard definitions and classifications relating to hernia variables and treatment; the use of the validated Clavien-Dindo classification to report complications in hernia surgery; the use of "time-to-event analysis" to report data on "freedom-of-recurrence" rather than the use of recurrence rates, because it is more sensitive and accounts for the patients that are lost to follow-up compared with other reporting methods. A set of recommendations for reporting outcome results of abdominal wall surgery was formulated as guidance for researchers. It is anticipated that the use of these recommendations will increase the quality and meaning of abdominal wall surgery research.

Evaluation of optical data gained by ARAMIS-measurement of abdominal wall movements for an anisotropic pattern design of stress-adapted hernia meshes produced by embroidery technology

NASA Astrophysics Data System (ADS)

Breier, A.; Bittrich, L.; Hahn, J.; Spickenheuer, A.

2017-10-01

For the sustainable repair of abdominal wall hernia the application of hernia meshes is required. One reason for the relapse of hernia after surgery is seen in an inadequate adaption of the mechanical properties of the mesh to the movements of the abdominal wall. Differences in the stiffness of the mesh and the abdominal tissue cause tension, friction and stress resulting in a deficient tissue response and subsequently in a recurrence of a hernia, preferentially in the marginal area of the mesh. Embroidery technology enables a targeted influence on the mechanical properties of the generated textile structure by a directed thread deposition. Textile parameters like stitch density, alignment and angle can be changed easily and locally in the embroidery pattern to generate a space-resolved mesh with mechanical properties adapted to the requirement of the surrounding tissue. To determine those requirements the movements of the abdominal wall and the resulting distortions need to be known. This study was conducted to gain optical data of the abdominal wall movements by non-invasive ARAMIS-measurement on 39 test persons to estimate direction and value of the major strains.

Tissue factor levels and the fibrinolytic system in thin and thick intraluminal thrombus and underlying walls of abdominal aortic aneurysms.

PubMed

Siennicka, Aldona; Zuchowski, Marta; Kaczmarczyk, Mariusz; Cnotliwy, Miłosław; Clark, Jeremy Simon; Jastrzębska, Maria

2018-03-20

The hemostatic system cooperates with proteolytic degradation in processes allowing abdominal aortic aneurysm (AAA) formation. In previous studies, it has been suggested that aneurysm rupture depends on intraluminal thrombus (ILT) thickness, which varies across each individual aneurysm. We hypothesized that hemostatic components differentially accumulate in AAA tissue in relation to ILT thickness. Thick (A1) and thin (B1) segments of ILTs and aneurysm wall sections A (adjacent to A1) and B (adjacent to B1) from one aneurysm sac were taken from 35 patients undergoing elective repair. Factor levels were measured using enzyme-linked immunosorbent assay of protein extract. Tissue factor (TF) activities were significantly higher in thinner segments of AAA (B1 vs A1, P = .003; B vs A, P < .001; B vs A1, P < .001; B vs B1, P = .001). Significantly higher tissue plasminogen activator was found in thick thrombus-covered wall segments (A) than in B, A1, and B1 (P = .015, P < .001, and P < .001, respectively). Plasminogen concentrations were highest in ILT. Concentrations of α 2 -antiplasmin in thin ILT adjacent walls (B) were higher compared with wall (A) adjacent to thick ILT (P = .021) and thick ILT (A1; P < .001). Significant correlations between levels of different factors were mostly found in thick ILT (A1). However, no correlations were found at B sites, except for a correlation between plasmin and TF activities (r = 0.55; P = .004). These results suggest that higher TF activities are present in thinner AAA regions. These parameters and local fibrinolysis may be part of the processes leading to destruction of the aneurysm wall. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

[Tongue, trachea, abdominal wall, uterus, and penis allografts. More details on some other clinical applications of vascularized composite tissue allotransplantation].

PubMed

Petit, F

2007-10-01

The first hand and face allografts opened a new era in medicine history: a time when allotransplantation and reconstructive surgery coupled their principles. Their success and their development made composite tissue allotransplantation (CTA) a clinical reality for our speciality. Although still recent and limited, experience from this new surgical practice will widen with feedback from the first clinical cases and with experience gained from more clinical cases, more anatomical areas, more type of allografts, more surgical techniques, more immunosuppressive regimens. Tongue, trachea, abdominal wall, uterus, penis allotransplantations have been performed, contemporarily. Whatever the future and the benefits for the selected patients might have been, reports from these - un- and misknown - cases contribute to a better knowledge of CTA, its therapeutic potential, its limits, its challenges.

A Relation Between Near-Wall Particle-Hemodynamics and Onset of Thrombus Formation in Abdominal Aortic Aneurysms

PubMed Central

Basciano, C.; Kleinstreuer, C.; Hyun, S.; Finol, E. A.

2014-01-01

A novel computational particle-hemodynamics analysis of key criteria for the onset of an intraluminal thrombus (ILT) in a patient-specific abdominal aortic aneurysm (AAA) is presented. The focus is on enhanced platelet and white blood cell residence times as well as their elevated surface-shear loads in near-wall regions of the AAA sac. The generalized results support the hypothesis that a patient's AAA geometry and associated particle-hemodynamics have the potential to entrap activated blood particles, which will play a role in the onset of ILT. Although the ILT history of only a single patient was considered, the modeling and simulation methodology provided allow for the development of an efficient computational tool to predict the onset of ILT formation in complex patient-specific cases. PMID:21373952

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

Satisfaction and perceived quality of life results in patients operated on for primary hernia of the abdominal wall.

PubMed

de Miguel-Ibáñez, Ricardo; Nahban-Al Saied, Saif Adeen; Alonso-Vallejo, Javier; Escribano Sotos, Francisco

2015-12-01

Outpatient surgery is currently the standard procedure in 60-70% of the most prevalent surgical procedures. Minimally invasive models in health care have improved basic aspects such as postoperative pain and hospital stay, but there are few publications related to perceived quality shown by patients, such as the need for informal care at home or delay before surgery. The aim of the study was to determine the global satisfaction perceived by patients undergoing abdominal wall hernia repair. An ad hoc split questionnaire has been completed on satisfaction after a week and postoperative quality a month after intervention by 203 patients operated on for abdominal hernia in a year. Variables included postoperative pain, need for informal care, surgical delay, information supplied, professional management and overall satisfaction. A total of 48.28% of patients needed informal care at home. They were largely attended by women, wives or daughters, for a few days. In 45.81% they were discharged on the same day, and 53.2% in less than 72 h. Overall satisfaction in the program of day surgery and short hospital stay was 94.6%. The overall process of satisfaction was not related to age, sex or educational level of patients, while there was an inverse relationship between satisfaction and days of hospitalization and days of pain that required analgesia at home. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

A novel transperitoneal abdominal wall nerve block for postoperative pain in laparoscopic colorectal surgery.

PubMed

Nagata, Jun; Watanabe, Jun; Sawatsubashi, Yusuke; Akiyama, Masaki; Arase, Koichi; Minagawa, Noritaka; Torigoe, Takayuki; Hamada, Kotaro; Nakayama, Yoshifumi; Hirata, Keiji

2017-04-04

Although the laparoscopic approach reduces pain associated with abdominal surgery, postoperative pain remains a problem. Ultrasound-guided rectus sheath block and transversus abdominis plane block have become increasingly popular means of providing analgesia for laparoscopic surgery. Ninety patients were enrolled in this study. A laparoscopic puncture needle was inserted via the port, and levobupivacaine was injected into the correct plane through the peritoneum. The patients' postoperative pain intensity was assessed using a numeric rating scale. The effects of laparoscopic nerve block versus percutaneous anesthesia were compared. This novel form of transperitoneal anesthesia did not jeopardize completion of the operative procedures. The percutaneous approach required more time for performance of the procedure than the transperitoneal technique. This new analgesia technique can become an optional postoperative treatment regimen for various laparoscopic abdominal surgeries. What we mainly want to suggest is that the transperitoneal approach has the advantage of a higher completion rate. A percutaneous technique is sometimes difficult with patients who have severe obesity and/or coagulation disorders. Additional studies are required to evaluate its benefits. Copyright © 2017. Published by Elsevier Taiwan.

Improvement of mesh recolonization in abdominal wall reconstruction with adipose vs. bone marrow mesenchymal stem cells in a rodent model.

PubMed

van Steenberghe, M; Schubert, T; Guiot, Y; Goebbels, R M; Gianello, P

2017-08-01

Reconstruction of muscle defects remains a challenge. Our work assessed the potential of an engineered construct made of a human acellular collagen matrix (HACM) seeded with porcine mesenchymal stem cells (MSCs) to reconstruct abdominal wall muscle defects in a rodent model. This study compared 2 sources of MSCs (bone-marrow, BMSCs, and adipose, ASCs) in vitro and in vivo for parietal defect reconstruction. Cellular viability and growth factor release (VEGF, FGF-Beta, HGF, IGF-1, TGF-Beta) were investigated under normoxic/hypoxic culture conditions. Processed and recellularized HACMs were mechanically assessed. The construct was tested in vivo in full thickness abdominal wall defect treated with HACM alone vs. HACM+ASCs or BMSCs (n=14). Tissue remodeling was studied at day 30 for neo-angiogenesis and muscular reconstruction. A significantly lower secretion of IGF was observed with ASCs vs. BMSCs under hypoxic conditions (-97.6%, p<0.005) whereas significantly higher VEGF/FGF secretions were found with ASCs (+92%, p<0.001 and +72%, p<0.05, respectively). Processing and recellularization did not impair the mechanical properties of the HACM. In vivo, angiogenesis and muscle healing were significantly improved by the HACM+ASCs in comparison to BMSCs (p<0.05) at day 30. A composite graft made of an HACM seeded with ASCs can improve muscle repair by specific growth factor release in hypoxic conditions and by in vivo remodeling (neo-angiogenesis/graft integration) while maintaining mechanical properties. Copyright © 2017 Elsevier Inc. All rights reserved.

Relationship between intra-abdominal pressure and vaginal wall movements during Valsalva in women with and without pelvic organ prolapse: technique development and early observations.

PubMed

Spahlinger, D M; Newcomb, L; Ashton-Miller, J A; DeLancey, J O L; Chen, Luyun

2014-07-01

To develop and test a method for measuring the relationship between the rise in intra-abdominal pressure and sagittal plane movements of the anterior and posterior vaginal walls during Valsalva in a pilot sample of women with and without prolapse. Mid-sagittal MRI images were obtained during Valsalva while changes in intra-abdominal pressure were measured via a bladder catheter in 5 women with cystocele, 5 women with rectocele, and 5 controls. The regional compliance of the anterior and posterior vagina wall support systems were estimated from the ratio of displacement (mm) of equidistant points along the anterior and posterior vaginal walls to intra-abdominal pressure rise (mmHg). The compliance of both anterior and posterior vaginal wall support systems varied along different regions of vaginal wall for all three groups, with the highest compliance found near the vaginal apex and the lowest near the introitus. Women with cystocele had more compliant anterior and posterior vaginal wall support systems than women with rectocele. The movement direction differs between cystocele and rectocele. In cystocele, the anterior vaginal wall moves mostly toward the vaginal orifice in the upper vagina, but in a ventral direction in the lower vagina. In rectocele, the direction of the posterior vaginal wall movement is generally toward the vaginal orifice. Movement of the vaginal wall and compliance of its support is quantifiable and was found to vary along the length of the vagina. Compliance was greatest in the upper vagina of all groups. Women with cystocele demonstrated the most compliant vaginal wall support.

Critical overview of all available animal models for abdominal wall hernia research.

PubMed

Vogels, R R M; Kaufmann, R; van den Hil, L C L; van Steensel, S; Schreinemacher, M H F; Lange, J F; Bouvy, N D

2017-10-01

Since the introduction of the first prosthetic mesh for abdominal hernia repair, there has been a search for the "ideal mesh." The use of preclinical or animal models for assessment of necessary characteristics of new and existing meshes is an indispensable part of hernia research. Unfortunately, in our experience there is a lack of consensus among different research groups on which model to use. Therefore, we hypothesized that there is a lack of comparability within published animal research on hernia surgery due to wide range in experimental setup among different research groups. A systematic search of the literature was performed to provide a complete overview of all animal models published between 2000 and 2014. Relevant parameters on model characteristics and outcome measurement were scored on a standardized scoring sheet. Due to the wide range in different animals used, ranging from large animal models like pigs to rodents, we decided to limit the study to 168 articles concerning rat models. Within these rat models, we found wide range of baseline animal characteristics, operation techniques, and outcome measurements. Making reliable comparison of results among these studies is impossible. There is a lack of comparability among experimental hernia research, limiting the impact of this experimental research. We therefore propose the establishment of guidelines for experimental hernia research by the EHS.

Tomodensitometric survey of the distance between thoracic and abdominal vital organs and the wall according to BMI, abdominal diameter and gender: proposition of an indicative chart for the forensic activities.

PubMed

Venara, A; Gaudin, A; Lebigot, J; Airagnes, G; Hamel, J F; Jousset, N; Ridereau-Zins, C; Mauillon, D; Rouge-Maillart, C

2013-06-10

Forensic doctors are frequently asked by magistrates when dealing principally with knife wounds, about the depth of the blade which may have penetrated the victim's body. Without the use of imaging, it is often difficult to respond to this question, even in an approximate way. Knowledge of the various distances between organs and the skin wall would allow an assessment to be made of the minimum blade length required to obtain the injuries observed. The objective of this study is thus to determine average distances between the vital organs of the thorax and abdomen, and the skin wall, taking into account the person's body mass index (BMI). This is a prospective single-center study, carried out over a 2-month period at University Hospital in Angers. A sample of 200 people was studied. The inclusion criteria were as follows: all patients coming to the radiology department and the emergency department for an abdominal, thoracic or thoraco-abdominal scan with injection. The exclusion criteria included patients presenting a large lymphoma, a large abdominal or retroperitoneal tumor, a tumor in one of the organs targeted by our study and patients presenting ascites. The organs focused on were: the pericardium, pleura, aorta, liver, spleen, kidneys, abdominal aorta and femoral arteries. The shortest distance between the organ and the skin wall was noted. Median distances were calculated according to gender, abdominal diameter and BMI. We associated these values to propose an indicative chart which may be used by doctors in connection with their forensic activities. The problem of the depth of a wound is frequently exposed to the expert. Without a reliable tool, it is difficult to value and a personal interpretation is often done. Even if, in current days, tomodensitometry is frequently done in vivo or after death, measurement can be difficult because of the local conditions. We classified values according to the different factors of fat repartition (BMI, abdominal diameter

Biomechanical and histologic evaluation of two application forms of surgical glue for mesh fixation to the abdominal wall.

PubMed

Ortillés, Á; Pascual, G; Peña, E; Rodríguez, M; Pérez-Köhler, B; Mesa-Ciller, C; Calvo, B; Bellón, J M

2017-11-01

The use of an adhesive for mesh fixation in hernia repair reduces chronic pain and minimizes tissue damage in the patient. This study was designed to assess the adhesive properties of a medium-chain (n-butyl) cyanoacrylate glue applied as drops or as a spray in a biomechanical and histologic study. Both forms of glue application were compared to the use of simple-loose or continuous-running polypropylene sutures for mesh fixation. Eighteen adult New Zealand White rabbits were used. For mechanical tests in an ex vivo and in vivo study, patches of polypropylene mesh were fixed to an excised fragment of healthy abdominal tissue or used to repair a partial abdominal wall defect in the rabbit respectively. Depending on the fixation method used, four groups of 12 implants each or 10 implants each respectively for the ex vivo and in vivo studies were established: Glue-Drops, Glue-Spray, Suture-Simple and Suture-Continuous. Biomechanical resistance in the ex vivo implants was tested five minutes after mesh fixation. In vivo implants for biomechanical and histologic assessment were collected at 14 days postimplant. In the ex vivo study, the continuous suture implants showed the highest failure sample tension, while the implants fixed with glue showed lower failure sample tension values. However, the simple and continuous suture implants returned the highest stretch values. In the in vivo implants, failure sample tension values were similar among groups while the implants fixed with a continuous running suture had the higher stretch values, and the glue-fixed implants the lower stretch values. All meshes showed good tissue integration within the host tissue regardless of the fixation method used. Our histologic study revealed the generation of a denser, more mature repair tissue when the cyanoacrylate glue was applied as a spray rather than as drops. Copyright © 2017 Elsevier Ltd. All rights reserved.

A rare sinonasal neoplasm: fibrosarcoma.

PubMed

Bercin, Sami; Muderris, Togay; Kırıs, Muzaffer; Kanmaz, Alper; Kandemir, Olcay

2011-05-01

Sinonasal fibrosarcoma is an infrequently occurring malignant neoplasm. It usually presents with nasal obstruction and epistaxis, as do other sarcomas in this region. The final diagnosis is based on the histopathologic and immunohistochemical examination. We report a case involving a 47-year-old woman with a 2-year history of left nasal obstruction and proptosis, as well as diplopia for the 2 months preceding her visit. Computed tomography and magnetic resonance imaging showed a neoplasm occupying the left nasal cavity, ethmoid sinuses, and bilateral frontal sinuses. The neoplasm also was eroding the medial wall of the maxillary sinus, the lamina papyracea, the cribriform plate, and the anterior wall of the frontal sinus. Complete removal of the tumor was achieved both endoscopically and through a Lynch incision. Sinonasal fibrosarcoma was found on histopathologic examination.

[Morphology of tissue reactions around implants after combined surgical repair of the abdominal wall].

PubMed

Vostrikov, O V; Zotov, V A; Nikitenko, E V

2004-01-01

Tissue reactions to titanium-nickelide and polypropylen and caprone implants used in surgical treatment of anterior aldomen wall hernias were studied in experiment. Digital density of leukocytes, fibroblasts, vessels, thickness of the capsule were studied. Pronounced inflammatory reaction was observed on day 3 which attenuated on day 14 in case of titanium nickelide and on day 30-60 in case of polypropylene and caprone. Fibroplastic processes start in the first group after 7 days while in the second group only after 30 days of the experiment. Thickness of the capsule around titanium-nickelide was 2-3 times less than around polypropylene and caprone. Thus, titanium-nickelide material is biologically more inert than caprone and polypropylen which are widely used in surgery of hernias.

Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable

MedlinePlus

... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Myelodysplastic/ ...

Open and Laparo-Endoscopic Repair of Incarcerated Abdominal Wall Hernias by the Use of Biological and Biosynthetic Meshes.

PubMed

Fortelny, René H; Hofmann, Anna; May, Christopher; Köckerling, Ferdinand

2016-01-01

Although recently published guidelines recommend against the use of synthetic non-absorbable materials in cases of potentially contaminated or contaminated surgical fields due to the increased risk of infection (1, 2), the use of bio-prosthetic meshes for abdominal wall or ventral hernia repair is still controversially discussed in such cases. Bio-prosthetic meshes have been recommended due to less susceptibility for infection and the decreased risk of subsequent mesh explantation. The purpose of this review is to elucidate if there are any indications for the use of biological and biosynthetic meshes in incarcerated abdominal wall hernias based on the recently published literature. A literature search of the Medline database using the PubMed search engine, using the keywords returned 486 articles up to June 2015. The full text of 486 articles was assessed and 13 relevant papers were identified including 5 retrospective case cohort studies, 2 case-controlled studies, and 6 case series. The results of Franklin et al. (3-5) included the highest number of biological mesh repairs (Surgisis(®)) by laparoscopic IPOM in infected fields, which demonstrated a very low incidence of infection and recurrence (0.7 and 5.2%). Han et al. (6) reported in his retrospective study, the highest number of treated patients due to incarcerated hernias by open approach using acellular dermal matrix (ADM(®)) with very low rate of infection as well as recurrences (1.6 and 15.9%). Both studies achieved acceptable outcome in a follow-up of at least 3.5 years compared to the use of synthetic mesh in this high-risk population (7). Currently, there is a very limited evidence for the use of biological and biosynthetic meshes in strangulated hernias in either open or laparo-endoscopic repair. Finally, there is an urgent need to start with randomized controlled comparative trials as well as to support registries with data to achieve more knowledge for tailored indication for the use of

Abdominal Aortic Aneurysm (AAA)

MedlinePlus

... plaque buildup causes the walls of the abdominal aorta to become weak and bulge outward like a ... treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, is a ...

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

NASA Astrophysics Data System (ADS)

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

2017-05-01

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.

Evaluation of the abdominal wall cicatrization of rabbits exposed to nicotine and undergone abdominoplasty using nylon thread or cyanoacrylate.

PubMed

Costa, Luciano Assis; Jardim, Paulo dos Reis; Macedo, Pedro Henrique Alvares Paiva; Amaral, Vânia da Fonseca; Silva, Alcino Lázaro da; Barbosa, Cirênio de Almeida

2012-12-01

To compare the wound healing of the abdominal wall of rabbits exposed to nicotine and submitted to abdominoplasty using 2-octyl cyanoacrylate or nylon thread for the surgery suture. Thirty two rabbits were used. They were divided in subgroups: A1, A2, B1 e B2. Group A received saline 0.9%; group B received nicotine, both groups for 14 days before surgery. We performed an abdominoplasty with a nylon suture into the A1 and B1 subgroups; as for A2 and B2 groups the suture was performed with cyanoacrylate. The euthanasia happened in the 14th post-operative day. After, we evaluated: swollen process, fibroblast proliferation, collagen, neovascularization, and macroscope and microscope epithelization of the scars. We observed the presence of eosinophils in all scars exposed to the cyanoacrylate, and a significant increase of neovascularization in the subgroup B2 comparing to the A2 one (p=0.037). The other variables haven't showed any statistical difference. Nicotine hasn't influenced the swollen process, the fibroblast proliferation, the presence of collagen, neither the epithelialization. The neovascularization showed cicatricial immaturity when comparing group A2 to group B2. The eosinophils in the scars repaired with glue showed that the substance has acted as an allergen.

Advanced age does not affect abdominal wall reconstruction outcomes using acellular dermal matrix: A comparative study using propensity score analysis.

PubMed

Giordano, Salvatore; Schaverien, Mark; Garvey, Patrick B; Baumann, Donald P; Liu, Jun; Butler, Charles E

2017-06-01

We hypothesized that elderly patients (≥65 years) experience worse outcomes following abdominal wall reconstruction (AWR) for hernia or oncologic resection. We included all consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) between 2005 and 2015. Propensity score analysis was performed for risk adjustment in multivariable analysis and for one-to-one matching. The primary outcome was hernia recurrence; the secondary outcomes included surgical site occurrence (SSO) and bulging. Mean follow-up for the 511 patients was 31.4 months; 184 (36%) patients were elderly. The elderly and non-elderly groups had similar rates of hernia recurrence (7.6% vs 10.1%, respectively; p = 0.43) and SSO (24.5% vs 23.5%, respectively; p = 0.82). Bulging occurred significantly more often in elderly patients (6.5% vs 2.8%, respectively; p = 0.04). After adjustment through the propensity score, which included 130 pairs, these results persisted. Contrary to our hypothesis, elderly patients did not have worse outcomes in AWR with ADM. Surgeons should not deny elderly patients AWR solely because of their age. Copyright © 2016 Elsevier Inc. All rights reserved.

Organ culture in 3-dimensional matrix: in vitro model for evaluating biological compliance of synthetic meshes for abdominal wall repair.

PubMed

Dasdia, T; Bazzaco, S; Bottero, L; Buffa, R; Ferrero, S; Campanelli, G; Dolfini, E

1998-01-01

A new in vitro method to evaluate the early critical interactions between synthetic prosthetic materials and growing tissues is reported. The correct spatial organization and proper cell to cell interaction required to mimic the in vivo environment was obtained in a 3-dimensional (3-D) embryo organ culture. The clot formed by plasma and chick-embryo extract provided a natural 3-D extracellular matrix that was able to support the growth and differentiation of intestinal tissue dissected from 12-day-old chick embryos. Different materials used for the repair of abdominal wall defects were taken as standards; all the prosthetic materials were devoid of any evident cytotoxic potential over a 10-day culture period, so they did not interfere with the organogenesis process. A polyglactin mesh (Vicryl) was fully incorporated into the growing tissue, but early signs of its degradation were detectable. The biologically inert materials polyethylene terephthalate (Mersilene) and polypropylene (Marlex, Prolene, and Herniamesh) retained their structural integrity when incubated with cultured tissue at 37 degrees C, and they did not hinder cellular proliferation or fibroblast migration. However, the outgrowth behavior was very different while the connective tissue invaded the interstices of the polyethylene terephthalate mesh; the explants and the migrating cells were repelled by hydrophobic polypropylene meshes. These findings are in agreement with other reported results in in vivo studies. Therefore, this method can be considered as reliable and predictable for the evaluation of biopolymers.

Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with 99mTc-MAA accumulation in the anterior abdominal wall?

PubMed

Ahmadzadehfar, Hojjat; Möhlenbruch, Markus; Sabet, Amir; Meyer, Carsten; Muckle, Marianne; Haslerud, Torjan; Wilhelm, Kai; Schild, Hans Heinz; Biersack, Hans Jürgen; Ezziddin, Samer

2011-08-01

While influx of chemoembolic agents into the hepatic falciform artery (HFA) from the hepatic artery can cause supraumbilical skin rash, epigastric pain and even skin necrosis, the significance of a patent HFA in patients undergoing radioembolization is not completely clear. Furthermore, the presence of tracer in the anterior abdominal wall seen in (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) images, which is generally performed prior to radioembolization, has been described as a sign of a patent HFA. The aim of this retrospective study was to evaluate the incidence and consequences of (99m)Tc-MAA accumulation in the anterior abdominal wall, indicating a patent HFA, in patients undergoing radioembolization of liver tumours. A total of 224 diagnostic hepatic angiograms combined with (99m)Tc-MAA SPECT/CT were acquired in 192 patients with different types of cancer, of whom 142 were treated with a total of 214 radioembolization procedures. All patients received a whole-body scan, and planar and SPECT/CT scans of the abdomen. Only patients with extrahepatic (99m)Tc-MAA accumulation in the anterior abdominal wall were included in this study. Posttreatment bremsstrahlung SPECT/CT and follow-up results for at least 3 months served as reference standards. Tracer accumulation in the anterior abdominal wall was present in pretreatment (99m)Tc-MAA SPECT/CT images of 18 patients (9.3%). The HFA was found and embolized by radiologists before treatment in one patient. In the remaining patients radioembolization was performed without any modification in the treatment plan despite the previously mentioned extrahepatic accumulation. Only one patient experienced abdominal muscle pain above the navel, which started 24 h after treatment and lasted for 48 h without any skin changes. The remaining patients did not experience any relevant side effects during the follow-up period. Side effects after radioembolization in patients with tracer accumulation in the anterior abdominal

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR).

PubMed

Gómez-Menchero, Julio; Guadalajara Jurado, Juan Francisco; Suárez Grau, Juan Manuel; Bellido Luque, Juan Antonio; García Moreno, Joaquin Luis; Alarcón Del Agua, Isaías; Morales-Conde, Salvador

2018-01-17

Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present the preliminary results of a new technique for medium midline hernias as an alternative to conventional CD. A prospective controlled study was conducted from January 2015 to January 2017 to evaluate an elective new procedure (LIRA) performed on patients with midline ventral hernias (4-10 cm width). The posterior rectus aponeurosis was opened lengthwise around the hernia defect using a laparoscopic approach to create two flaps and was then sutured. The size of the flaps was estimated using a mathematical formula. An on-lay mesh was placed intraperitoneal overlapping the fascia defect. The data analyzed included patient demographics, operative parameters, and complications. A computerized tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma. Twelve patients were included. Mean width of the defect was 5.5 cm. Average VAS (24 h) was 3.9, 1.1 (1 month), and 0 (1 year). Mean preoperative distance between rectus was 5.5 cm; postoperative was 2.2 cm (1 year). Radiological seroma at first month was detected in 50%. Mean follow-up was 15 months. The LIRA technique could be considered as an alternative to conventional CD or endoscopic component separation for medium defects under 10 cm in width. This technique obtained a "no tension" effect that could be related to a lower rate of postoperative pain with no recurrence or bulging, being a safe, feasible, and reproducible technique.

Component separation of abdominal wall with intraoperative botulinum A presents satisfactory outcomes in large incisional hernias: a case report.

PubMed

Oliveira, Lucas Torres; Essu, Felipe Futema; de Mesquita, Gustavo Heluani Antunes; Jardim, Yuri Justi; Iuamoto, Leandro Ryuchi; Suguita, Fábio Yuji; Martines, Diego Ramos; Nii, Fernanda; Waisberg, Daniel Reis; Meyer, Alberto; Andraus, Wellington; D'Albuquerque, Luiz Augusto Carneiro

2017-01-01

Transplantation patients have a series of associated risk factors that make appearance of incisional hernia (IH) more likely. A number of aspects of the closure of large defects remain controversial. In this manuscript, we present the repair of a large IH following liver transplantation through the technique of posterior components separation combined with the anterior, together with the intraoperative use of botulinum toxin A and the placement of mesh. As a secondary objective, we analyze the incidence of IH following liver transplantation in our service. Between the years 2013 and 2016, 247 patients underwent liver transplantation in the Liver Transplantation Service at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. We analyzed the incidence of IH in these patients. One of these cases operated in March 2017 presented a defect in the abdominal wall of 22×16.6×6.4cm in the median and paramedian regions. We present the details of this innovative surgical technique. The total operating time was 470min. During the postoperative phase the patient presented ileus paralysis, without systemic repercussions. Resumption of an oral diet on the fifth postoperative day, without incident. Hospital discharge occurred on the 12th postoperative day, with outpatient follow up. In our service, the incidence of incisional hernias following liver transplantation is 14.5%. We described a successful approach for selected patient group for whom there is no established standard treatment. Given the complexity of such cases, however, more studies are necessary. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Abdominal wall surgery

MedlinePlus

... Description Your surgery will be done in an operating room in a hospital. You will receive general anesthesia . This will keep you asleep and pain-free during the procedure. The surgery takes 2 to 6 hours. You ...

Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures.

PubMed

Emanuelsson, Peter; Gunnarsson, Ulf; Dahlstrand, Ursula; Strigård, Karin; Stark, Birgit

2016-11-01

The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only. Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4. One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up. There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain. Copyright © 2016 Elsevier Inc. All rights reserved.

On the effect of computed tomography resolution to distinguish between abdominal aortic aneurysm wall tissue and calcification: A proof of concept.

PubMed

Barrett, H E; Cunnane, E M; O Brien, J M; Moloney, M A; Kavanagh, E G; Walsh, M T

2017-10-01

The purpose of this study is to determine the optimal target CT spatial resolution for accurately imaging abdominal aortic aneurysm (AAA) wall characteristics, distinguishing between tissue and calcification components, for an accurate assessment of rupture risk. Ruptured and non-ruptured AAA-wall samples were acquired from eight patients undergoing open surgical aneurysm repair upon institutional review board approval and informed consent was obtained from all patients. Physical measurements of AAA-wall cross-section were made using scanning electron microscopy. Samples were scanned using high resolution micro-CT scanning. A resolution range of 15.5-155μm was used to quantify the influence of decreasing resolution on wall area measurements, in terms of tissue and calcification. A statistical comparison between the reference resolution (15.5μm) and multi-detector CT resolution (744μm) was also made. Electron microscopy examination of ruptured AAAs revealed extremely thin outer tissue structure <200μm in radial distribution which is supporting the aneurysm wall along with large areas of adjacent medial calcifications far greater in area than the tissue layer. The spatial resolution of 155μm is a significant predictor of the reference AAA-wall tissue and calcification area measurements (r=0.850; p<0.001; r=0.999; p<0.001 respectively). The tissue and calcification area at 155μm is correct within 8.8%±1.86 and 26.13%±9.40 respectively with sensitivity of 87.17% when compared to the reference. The inclusion of AAA-wall measurements, through the use of high resolution-CT will elucidate the variations in AAA-wall tissue and calcification distributions across the wall which may help to leverage an improved assessment of AAA rupture risk. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

Primary undifferentiated small round cell sarcoma of the deep abdominal wall with a novel variant of t(10;19) CIC-DUX4 gene fusion.

PubMed

Tsukamoto, Yoshitane; Futani, Hiroyuki; Yoshiya, Shinichi; Watanabe, Takahiro; Kihara, Takako; Matsuo, Shohei; Hirota, Seiichi

2017-10-01

We experienced a 38-year-old Japanese male with t(10;19) CIC-DUX4 -positive undifferentiated small round cell sarcoma in the deep abdominal wall. Three months before his first visit to our hospital, he noticed a mass in his right abdominal wall. Computed tomography on admission revealed a solid abdominal tumor 70×53mm in size and multiple small tumors in both lungs. The biopsy of the abdominal tumor revealed undifferentiated small round cell sarcoma, suggestive of Ewing sarcoma. Under the clinical diagnosis of Ewing-like sarcoma of the abdominal wall with multiple lung metastases, several cycles of ICE (ifosfamide, carboplatin and etoposide) therapy were performed. After the chemotherapy, the lung metastases disappeared, while the primary lesion rapidly grew. Additional VDC (vincristine, doxorubicin and cyclophosphamide) therapy was carried out without apparent effect. Although the surgical removal of the primary lesion was done, peritoneal dissemination and a huge metastatic liver tumor appeared thereafter. The patient died of disease progression two months after the surgery. The total clinical course was approximately one year, showing that the tumor was extremely aggressive. The tumor cells of the surgical specimen were positive for CD99, WT1, calretinin, INI1, ERG and Fli1 by immunohistochemistry. Fusion gene analyses using the frozen surgical material revealed negativity for EWSR1-Fli1, EWSR1-ERG and t(4;19) CIC-DUX4 fusions, but positivity for t(10;19) CIC-DUX4 fusion. Thus, we made a final pathological diagnosis of t(10;19) CIC-DUX4-positive undifferentiated small round cell sarcoma. To our knowledge, this is the 13th case of t(10;19) CIC-DUX4 undifferentiated small round cell sarcoma with precise clinicopathological information. Especially in our case, two types of t(10;19) CIC-DUX4 fusion transcripts were observed, both of which are in-frame and novel. Copyright © 2017 Elsevier GmbH. All rights reserved.

Verification of an optimized stimulation point on the abdominal wall for transcutaneous neuromuscular electrical stimulation for activation of deep lumbar stabilizing muscles.

PubMed

Baek, Seung Ok; Cho, Hee Kyung; Jung, Gil Su; Son, Su Min; Cho, Yun Woo; Ahn, Sang Ho

2014-09-01

Transcutaneous neuromuscular electrical stimulation (NMES) can stimulate contractions in deep lumbar stabilizing muscles. An optimal protocol has not been devised for the activation of these muscles by NMES, and information is lacking regarding an optimal stimulation point on the abdominal wall. The goal was to determine a single optimized stimulation point on the abdominal wall for transcutaneous NMES for the activation of deep lumbar stabilizing muscles. Ultrasound images of the spinal stabilizing muscles were captured during NMES at three sites on the lateral abdominal wall. After an optimal location for the placement of the electrodes was determined, changes in the thickness of the lumbar multifidus (LM) were measured during NMES. Three stimulation points were investigated using 20 healthy physically active male volunteers. A reference point R, 1 cm superior to the iliac crest along the midaxillary line, was used. Three study points were used: stimulation point S1 was located 2 cm superior and 2 cm medial to the anterior superior iliac spine, stimulation point S3 was 2 cm below the lowest rib along the same sagittal plane as S1, and stimulation point S2 was midway between S1 and S3. Sessions were conducted stimulating at S1, S2, or S3 using R for reference. Real-time ultrasound imaging (RUSI) of the abdominal muscles was captured during each stimulation session. In addition, RUSI images were captured of the LM during stimulation at S1. Thickness, as measured by RUSI, of the transverse abdominis (TrA), obliquus internus, and obliquus externus was greater during NMES than at rest for all three study points (p<.05). Transverse abdominis was significantly stimulated more by NMES at S1 than at the other points (p<.05). The LM thickness was also significantly greater during NMES at S1 than at rest (p<.05). Neuromuscular electrical stimulation at S1 optimally activated deep spinal stabilizing muscles, TrA and LM, as evidenced by RUSI. The authors recommend this

Polypropylene-based composite mesh versus standard polypropylene mesh in the reconstruction of complicated large abdominal wall hernias: a prospective randomized study.

PubMed

Kassem, M I; El-Haddad, H M

2016-10-01

To compare polypropylene mesh positioned onlay supported by omentum and/or peritoneum versus inlay implantation of polypropylene-based composite mesh in patients with complicated wide-defect ventral hernias. This was a prospective randomized study carried out on 60 patients presenting with complicated large ventral hernia in the period from January 2012 to January 2016 in the department of Gastrointestinal Surgery unit and Surgical Emergency of the Main Alexandria University Hospital, Egypt. Large hernia had an abdominal wall defect that could not be closed. Patients were divided into two groups of 30 patients according to the type of mesh used to deal with the large abdominal wall defect. The study included 38 women (63.3 %) and 22 men (37.7 %); their mean age was 46.5 years (range, 25-70). Complicated incisional hernia was the commonest presentation (56.7 %).The operative and mesh fixation times were longer in the polypropylene group. Seven wound infections and two recurrences were encountered in the propylene group. Mean follow-up was 28.7 months (2-48 months). Composite mesh provided, in one session, satisfactory results in patients with complicated large ventral hernia. The procedure is safe and effective in lowering operative time with a trend of low wound complication and recurrence rates.

A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap.

PubMed

Di Lorenzo, Sara; Zabbia, Giovanni; Corradino, Bartolo; Tripoli, Massimiliano; Pirrello, Roberto; Cordova, Adriana

2017-12-04

BACKGROUND Basal cell carcinoma (BCC) greater than 5 cm in diameter is called giant basal cell carcinoma (GBCC), or super giant basal cell carcinoma if it has a diameter larger than 20 cm. Giant BCC only accounts for 0.5% of BCCs and super giant BCC is exceedingly rare. On account of their rarity, there are no established guidelines for GBCC treatment. CASE REPORT We describe a peculiar case of an 82-year-old woman with a GBCC carcinoma of the lower abdominal wall. The tumor was surgically removed with ipsilateral inguinal lymph nodes and the abdominal wall was reconstructed immediately with a pedicled deep inferior epigastric artery perforator (DIEP) flap. CONCLUSIONS Treatment of giant basal cell carcinoma is often difficult, especially in elderly patients with poor general health and multiple pathologies. The pedicled DIEP flap is rotated to cover the loss of substance without tension, and it is easy to harvest and transfer. This flap allowed a good result without local or systemic complication. We present this report as a reminder of the occasional occurrence of extremely aggressive BCCs. We believe that, especially for rare tumors like these, it is very useful for the entire scientific community to publish these cases and the therapeutic strategies used to treat them.

A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap

PubMed Central

Di Lorenzo, Sara; Zabbia, Giovanni; Corradino, Bartolo; Tripoli, Massimiliano; Pirrello, Roberto; Cordova, Adriana

2017-01-01

Patient: Female, 82 Final Diagnosis: Giant basal cell carcinoma Symptoms: Anemia Medication: — Clinical Procedure: — Specialty: Plastic Surgery Objective: Rare disease Background: Basal cell carcinoma (BCC) greater than 5 cm in diameter is called giant basal cell carcinoma (GBCC), or super giant basal cell carcinoma if it has a diameter larger than 20 cm. Giant BCC only accounts for 0.5% of BCCs and super giant BCC is exceedingly rare. On account of their rarity, there are no established guidelines for GBCC treatment. Case Report: We describe a peculiar case of an 82-year-old woman with a GBCC carcinoma of the lower abdominal wall. The tumor was surgically removed with ipsilateral inguinal lymph nodes and the abdominal wall was reconstructed immediately with a pedicled deep inferior epigastric artery perforator (DIEP) flap. Conclusions: Treatment of giant basal cell carcinoma is often difficult, especially in elderly patients with poor general health and multiple pathologies. The pedicled DIEP flap is rotated to cover the loss of substance without tension, and it is easy to harvest and transfer. This flap allowed a good result without local or systemic complication. We present this report as a reminder of the occasional occurrence of extremely aggressive BCCs. We believe that, especially for rare tumors like these, it is very useful for the entire scientific community to publish these cases and the therapeutic strategies used to treat them. PMID:29199268

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.

In vitro fertilization surrogate pregnancy in a patient who underwent radical hysterectomy followed by ovarian transposition, lower abdominal wall radiotherapy, and chemotherapy.

PubMed

Steigrad, Stephen; Hacker, Neville F; Kolb, Bradford

2005-05-01

To describe an IVF surrogate pregnancy from a patient who had a radical hysterectomy followed by excision of a laparoscopic port site implantation with ovarian transposition followed by abdominal wall irradiation and chemotherapy, which resulted in premature ovarian failure from which there was partial recovery. Case report. Tertiary referral university women's hospital in Sydney, Australia and private reproductive medicine clinic in California. A 34-year-old woman who underwent laparoscopy for pelvic pain, shortly afterward followed by radical hysterectomy and pelvic lymph node dissection, who subsequently developed a laparoscopic port site recurrence, which was excised in association with ovarian transposition before abdominal wall irradiation and chemotherapy. Modified IVF treatment, transabdominal oocyte retrieval, embryo cryopreservation in Australia, and transfer to a surrogate mother in the United States. Pregnancy. Miscarriage in the second cycle and a twin pregnancy in the fourth cycle. This is the first case report of ovarian stimulation and oocyte retrieval performed on transposed ovaries after a patient developed premature ovarian failure after radiotherapy and chemotherapy with subsequent partial ovarian recovery.

The effect of TISSEEL fibrin sealant on seroma formation following complex abdominal wall hernia repair: a single institutional review and derived cost analysis.

PubMed

Azoury, S C; Rodriguez-Unda, N; Soares, K C; Hicks, C W; Baltodano, P A; Poruk, K E; Hu, Q L; Cooney, C M; Cornell, P; Burce, K; Eckhauser, F E

2015-12-01

The authors evaluated the ability of a fibrin sealant (TISSEEL™: Baxter Healthcare Corp, Deerfield, IL, USA) to reduce the incidence of post-operative seroma following abdominal wall hernia repair. We performed a 4-year retrospective review of patients undergoing abdominal wall hernia repair, with and without TISSEEL, by a single surgeon (FEE) at The Johns Hopkins Hospital. Demographics, surgical risk factors, operative data and 30-day outcomes, including wound complications and related interventions, were compared. The quantity and cost of Tisseel per case was reviewed. A total of 250 patients were evaluated: 127 in the TISSEEL group and 123 in the non-TISSEEL control group. The average age for both groups was 56.6 years (P = 0.97). The majority of patients were female (TISSEEL 52.8%, non-TISSEEL 56.1%, P = 0.59) and ASA Class III (TISSEEL 56.7%, non-TISSEEL 58.5%, P = 0.40). There was no difference in the average defect size for both groups (TISSEEL 217 ± 187.6 cm(2), non-TISSEEL 161.3 ± 141.5 cm(2), P = 0.36). Surgical site occurrences occurred in 18.1% of the TISSEEL and 13% of the non-TISSEEL group (P = 0.27). There was a trend towards an increased incidence of seroma in the TISSEEL group (TISSEEL 11%, non-TISSEEL 4.9%, P = 0.07). A total of $124,472.50 was spent on TISSEEL, at an average cost of $995.78 per case. In the largest study to date, TISSEEL™ application offered no advantage for the reduction of post-operative seroma formation following complex abdominal hernia repair. Moreover, the use of this sealant was associated with significant costs.

18F-FDG uptake assessed by PET/CT in abdominal aortic aneurysms is associated with cellular and molecular alterations prefacing wall deterioration and rupture.

PubMed

Courtois, Audrey; Nusgens, Betty V; Hustinx, Roland; Namur, Gauthier; Gomez, Pierre; Somja, Joan; Defraigne, Jean-Olivier; Delvenne, Philippe; Michel, Jean-Baptiste; Colige, Alain C; Sakalihasan, Natzi

2013-10-01

Rupture of abdominal aortic aneurysms (AAAs) leads to a significant morbidity and mortality in aging populations, and its prediction would be most beneficial to public health. Spots positive for uptake of (18)F-FDG detected by PET are found in 12% of AAA patients (PET+), who are most often symptomatic and at high rupture risk. Comparing the (18)F-FDG-positive site with a negative site from the same aneurysm and with samples collected from AAA patients with no (18)F-FDG uptake should allow the discrimination of biologic alterations that would help in identifying markers predictive of rupture. Biopsies of the AAA wall were obtained from patients with no (18)F-FDG uptake (PET0, n = 10) and from PET+ patients (n = 8), both at the site positive for uptake and at a distant negative site of the aneurysmal wall. Samples were analyzed by immunohistochemistry, quantitative real-time polymerase chain reaction, and zymography. The sites of the aneurysmal wall with a positive (18)F-FDG uptake were characterized by a strikingly increased number of adventitial inflammatory cells, highly proliferative, and by a drastic reduction of smooth muscle cells (SMCs) in the media as compared with their negative counterpart and with the PET0 wall. The expression of a series of genes involved in the maintenance and remodeling of the wall was significantly modified in the negative sites of PET+, compared with the PET0 wall, suggesting a systemic alteration of the aneurysmal wall. Furthermore, a striking increase of several matrix metalloproteinases (MMPs), notably the MMP1 and MMP13 collagenases, was observed in the positive sites, mainly in the adventitia. Moreover, PET+ patients were characterized by a higher circulating C-reactive protein. Positive (18)F-FDG uptake in the aneurysmal wall is associated with an active inflammatory process characterized by a dense infiltrate of proliferating leukocytes in the adventitia and an increased circulating C-reactive protein. Moreover, a loss of SMC

Abdominal Adhesions

MedlinePlus

... Clearinghouse What are abdominal adhesions? Abdominal adhesions are bands of fibrous tissue that can form between abdominal ... Esophagus Stomach Large intestine Adhesion Abdominal adhesions are bands of fibrous tissue that can form between abdominal ...

Abdominal Pain

MedlinePlus

... and Recurrent or Functional Abdominal Pain (RAP or FAP) What is abdominal pain? Abdominal pain , or stomachache, ... recurrent abdominal pain (RAP) or functional abdominal pain (FAP)? If your health care provider has ruled out ...

Malignant neoplasms of decidual origin (deciduosarcomas) induced by estrogen-progestin-releasing intravaginal devices in rabbits.

PubMed

Zook, B C; Spiro, I; Hertz, R

1987-08-01

A combination of estrogen and levonorgestrel was continuously delivered to 23 adult rabbits for up to 2 years via a Silastic ring device sutured into the vagina. Twenty-one control rabbits were given similar rings devoid of drugs. A marked decidual reaction of the endometrium occurred in 16 of 23 test rabbits. In 14 test rabbits (61%) malignant tumors developed of decidual type cells not heretofore described. The deciduosarcomas were composed of anaplastic cells that invaded the uterine walls, uterine lymphatics, and in 4 of 13 (31%) rabbits that survived 2 years of treatment, the tumors metastasized to the lungs. Several deciduosarcomas appeared to arise within the spleen or other abdominal organs. Other drug-related lesions included uterine or vaginal polyps, endometrial atrophy, and focal necrosis and mineralization of the uterine wall. Cells from several deciduosarcomas failed to produce tumors in nude mice or to colonize on soft agar. No decidualization or decidual neoplasms were seen in the controls.

Abdominal hernias: Radiological features

PubMed Central

Lassandro, Francesco; Iasiello, Francesca; Pizza, Nunzia Luisa; Valente, Tullio; Stefano, Maria Luisa Mangoni di Santo; Grassi, Roberto; Muto, Roberto

2011-01-01

Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations. PMID:21860678

Treatment Options for Myelodysplastic/Myeloproliferative Neoplasms

MedlinePlus

... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Myelodysplastic/ ...

Treatment Option Overview (Myelodysplastic/Myeloproliferative Neoplasms)

MedlinePlus

... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Myelodysplastic/ ...

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

PubMed

Shin, Jin Su; Choi, Hwan Jun

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.

Lymphedema of the Transplanted Kidney and Abdominal Wall with Ipsilateral Pleural Effusion Following Kidney Biopsy in a Patient Treated with Sirolimus: A Case Report and Review of the Literature

PubMed Central

Rashid-Farokhi, Farin; Afshar, Hale

2017-01-01

Patient: Female, 32 Final Diagnosis: Sirolimus induced congestion of kidney and overlying abdominal wall Symptoms: Abdominal pain • abdominal swelling • dyspnea Medication: — Clinical Procedure: Improvement of symptoms with drug withdrawal Specialty: Nephrology Objective: Adverse events of drug therapy Background: Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in organ transplant recipients. Although mTOR inhibitors are well tolerated, their adverse effects have been reported. Sirolimus treatment in transplant recipients has been reported to be associated with lymphedema of the skin and subcutaneous tissues, and with pleural effusion, but edema of internal organs and organomegaly have not been previously reported. A case is presented lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy in a patient treated with sirolimus. Case Report: A 32-year-old woman with a history of end-stage renal disease of unknown etiology had undergone right renal transplantation from an unrelated living donor, eight years previously. She was referred to our hospital with dyspnea, localized abdominal pain, and swelling of the transplanted kidney. The symptoms appeared following a kidney biopsy and the replacement of cyclosporin with sirolimus four months previously. On examination, she had localized swelling of the abdominal wall overlying the transplanted kidney, and a right pleural effusion. Hydronephrosis and nephrotic syndrome were excluded as causes of kidney enlargement. Following the withdrawal of sirolimus therapy her symptoms resolved within three months. Conclusions: A case is described of lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy attributed to her change in anti-rejection therapy to sirolimus. This case report should raise awareness of this unusual complication of

Percutaneous debridement and washout of walled-off abdominal abscess and necrosis using flexible endoscopy: a large single-center experience.

PubMed

Mathers, Bradley; Moyer, Matthew; Mathew, Abraham; Dye, Charles; Levenick, John; Gusani, Niraj; Dougherty-Hamod, Brandy; McGarrity, Thomas

2016-01-01

Direct percutaneous endoscopic necrosectomy has been described as a minimally invasive intervention for the debridement of walled-off pancreatic necrosis (WOPN). In this retrospective cohort study, we aimed to confirm these findings in a US referral center and evaluate the clinical value of this modality in the treatment of pancreatic necrosis as well as other types of intra-abdominal fluid collections and necrosis. Twelve consecutive patients with WOPN or other abdominal abscess requiring debridement and washout underwent computed tomography (CT)-guided drainage catheter placement. Each patient then underwent direct percutaneous endoscopic necrosectomy and washout with repeat debridement performed until complete. Drains were then removed once output fell below 30 mL/day and imaging confirmed resolution. The primary endpoints were time to clinical resolution and sustained resolution at 1-year follow up.  Ten patients were treated for WOPN, one for necrotic hepatic abscesses, and one for omental necrosis. The median time to intervention was 85 days with an average of 2.3 necrosectomies performed. Complete removal of drains was accomplished in 11 patients (92 %). The median time to resolution was 57 days. No serious adverse events occurred; however, one patient developed pancreaticocutaneous fistulas. Ten patients completed 1-year surveillance of which none required drain replacement. No patients required surgery or repeat endoscopy. This series supports the premise that direct percutaneous endoscopic necrosectomy is a safe and effective intervention for intra-abdominal fluid collections and necrosis in appropriately selected patients. Our study demonstrates a high clinical success rate with minimal adverse events. This modality offers several potential advantages over surgical and transgastric approaches including use of improved accessibility, an excellent safety profile, and requirement for only deep or moderate sedation.

Abdominal wall integrity after open abdomen: long-term results of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM).

PubMed

Willms, A; Schaaf, S; Schwab, R; Richardsen, I; Bieler, D; Wagner, B; Güsgen, C

2016-12-01

The open abdomen has become a standard technique in the management of critically ill patients undergoing surgery for severe intra-abdominal conditions. Negative pressure and mesh-mediated fascial traction are commonly used and achieve low fistula rates and high fascial closure rates. In this study, long-term results of a standardised treatment approach are presented. Fifty-five patients who underwent OA management for different indications at our institution from 2006 to 2013 were enrolled. All patients were treated under a standardised algorithm that uses a combination of vacuum-assisted wound closure and mesh-mediated fascial traction. Structured follow-up assessments were offered to patients and included a medical history, a clinical examination and abdominal ultrasonography. The data obtained were statistically analysed. The fascial closure rate was 74 % in an intention-to-treat analysis and 89 % in a per-protocol analysis. The fistula rate was 1.8 %. Thirty-four patients attended follow-up. The median follow-up was 46 months (range 12-88 months). Incisional hernias developed in 35 %. Patients with hernias needed more operative procedures (10.3 vs 3.4, p = 0.03) than patients without hernia formation. A Patient Observer Scar Assessment Scale (POSAS) of 31.1 was calculated. Patients with symptomatic hernias (NAS of 2-10) had a significantly lower mean POSAS score (p = 0.04). Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) seem to result in low complication rates and high fascial closure rates. Abdominal wall reconstruction, which is a challenging and complex procedure and causes considerable patient discomfort, can thus be avoided in the majority of cases. Available results are based on studies involving only a small number of cases. Multi-centre studies and registry-based data are therefore needed to validate these findings.

The Influence of a Pfannenstiel Scar on Venous Anatomy of the Lower Abdominal Wall and Implications for Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction.

PubMed

Kim, So Young; Lee, Kyeong-Tae; Mun, Goo-Hyun

2017-03-01

A Pfannenstiel incision involves the obstruction of superficial venous pathways and functional diversion of flow through alternative pathways and adjacent vessels. This study investigated the effect of a prior Pfannenstiel incision on venous anatomy of the lower abdominal wall; specifically, the superficial inferior epigastric vein (SIEV), using computed tomographic angiography. A case-control study was performed of 50 patients with Pfannenstiel scars and 50 age-matched, body mass index-matched control patients without Pfannenstiel scars. The authors compared the number of direct/indirect and total communications between the SIEV and deep inferior epigastric artery perforator (DIEP) venae comitantes, midline crossover, and other SIEV-related anatomical changes by using computed tomographic angiography. Flap-related clinical outcomes and donor-site-related complications were also assessed. The median number of direct and total communications between the SIEV and DIEP venae comitantes in the study group was greater than in the control group. The percentage of SIEVs having more than two branching patterns per hemiabdomen was significantly higher in the study group than in the control group. The study group also showed a significantly lower rate of fat necrosis compared with the control group (p = 0.03). The rate of donor-site seroma was significantly higher in the study group. This study suggests that the presence of a Pfannenstiel scar may promote the development of direct and total communications between the SIEV and DIEP venae comitantes and branching within the SIEV in the lower abdominal wall, which may facilitate venous drainage of adipose tissue in DIEP flap breast reconstruction. Risk, II.

Abdominal Pain Syndrome

MedlinePlus

... blood clots to the lungs) Abdominal or chest wall pain: Shingles (herpes zoster infection) Costochondritis (inflammation of ... or tumors), fat (evidence of impaired digestion and absorption of food), and the presence of germs. X- ...

Optimizing working space in laparoscopy: CT measurement of the effect of pre-stretching of the abdominal wall in a porcine model.

PubMed

Vlot, John; Wijnen, René; Stolker, Robert Jan; Bax, Klaas N

2014-03-01

Determinants of working space in minimal access surgery have not been well studied. Using computed tomography (CT) to measure volumes and linear dimensions, we are studying the effect of a number of determinants of CO2 working space in a porcine laparoscopy model. Here we report the effects of pre-stretching of the abdominal wall. Earlier we had noted an increase in CO2 pneumoperitoneum volume at repeat insufflation with an intra-abdominal pressure (IAP) of 5 mmHg after previous stepwise insufflation up to an IAP of 15 mmHg. We reviewed the data of this serendipity group; data of 16 pigs were available. In a new group of eight pigs, we also explored this effect at repeat IAPs of 10 and 15 mmHg. Volumes and linear dimensions of the CO2 pneumoperitoneum were measured on reconstructed CT images and compared between the initial and repeat insufflation runs. Previous stepwise insufflation of the abdomen with CO2 up to 15 mmHg significantly (p < 0.01) increased subsequent working-space volume at a repeat IAP of 5 mmHg by 21 %, 7 % at a repeat IAP of 10 mmHg and 3 % at a repeat IAP of 15 mmHg. The external anteroposterior diameter significantly (p < 0.01) increased by 0.5 cm (14 %) at repeat 5 mmHg. Other linear dimensions showed a much smaller change. There was no statistically significant correlation between the duration of the insufflation run and the volume increase after pre-stretching at all IAP levels. Pre-stretching of the abdominal wall allows for the same surgical-field exposure at lower IAPs, reducing the negative effects of prolonged high-pressure CO2 pneumoperitoneum on the cardiorespiratory system and microcirculation. Pre-stretching has important scientific consequences in studies addressing ways of increasing working space in that its effect may confound the possible effects of other interventions aimed at increasing working space.

Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial.

PubMed

Diener, Markus K; Knebel, Phillip; Kieser, Meinhard; Schüler, Philipp; Schiergens, Tobias S; Atanassov, Vladimir; Neudecker, Jens; Stein, Erwin; Thielemann, Henryk; Kunz, Reiner; von Frankenberg, Moritz; Schernikau, Utz; Bunse, Jörg; Jansen-Winkeln, Boris; Partecke, Lars I; Prechtl, Gerald; Pochhammer, Julius; Bouchard, Ralf; Hodina, René; Beckurts, K Tobias E; Leißner, Lothar; Lemmens, Hans-Peter; Kallinowski, Friedrich; Thomusch, Oliver; Seehofer, Daniel; Simon, Thomas; Hyhlik-Dürr, Alexander; Seiler, Christoph M; Hackert, Thilo; Reissfelder, Christoph; Hennig, René; Doerr-Harim, Colette; Klose, Christina; Ulrich, Alexis; Büchler, Markus W

2014-07-12

Postoperative surgical site infections are one of the most frequent complications after open abdominal surgery, and triclosan-coated sutures were developed to reduce their occurrence. The aim of the PROUD trial was to obtain reliable data for the effectiveness of triclosan-coated PDS Plus sutures for abdominal wall closure, compared with non-coated PDS II sutures, in the prevention of surgical site infections. This multicentre, randomised controlled group-sequential superiority trial was done in 24 German hospitals. Adult patients (aged ≥18 years) who underwent elective midline abdominal laparotomy for any reason were eligible for inclusion. Exclusion criteria were impaired mental state, language problems, and participation in another intervention trial that interfered with the intervention or outcome of this trial. A central web-based randomisation tool was used to randomly assign eligible participants by permuted block randomisation with a 1:1 allocation ratio and block size 4 before mass closure to either triclosan-coated sutures (PDS Plus) or uncoated sutures (PDS II) for abdominal fascia closure. The primary endpoint was the occurrence of superficial or deep surgical site infection according to the Centers for Disease Control and Prevention criteria within 30 days after the operation. Patients, surgeons, and the outcome assessors were masked to group assignment. Interim and final analyses were by modified intention to treat. This trial is registered with the German Clinical Trials Register, number DRKS00000390. Between April 7, 2010, and Oct 19, 2012, 1224 patients were randomly assigned to intervention groups (607 to PDS Plus, and 617 to PDS II), of whom 1185 (587 PDS Plus and 598 PDS II) were analysed by intention to treat. The study groups were well balanced in terms of patient and procedure characteristics. The occurrence of surgical site infections did not differ between the PDS Plus group (87 [14·8%] of 587) and the PDS II group (96 [16·1%] of 598

[The "martin-arm" system for abdominal wall fixation for many applications - experience from its use of gynaecology (author's transl)].

PubMed

Müller, H G

1979-01-01

The "martin-arm"-System meets the demand for optimal fixation of outer edges of the wound cavity and exact positioning of organs in a three dimensional manner at abdominal operations. The four joints of each arm individually connected to the Op-table make this possible. They are fixed in position by a central joint with a lever which can be tightened. An adequate assortment of exchangeable retractors, specula and spatulas offers the possibility of a clear view of the operation. All instruments are ready for use even without the "martin-Arm". This system is especially suitable for emergency surgery, for small gynaecology wards or during staff shortages e.g. at night. The operation setting, according to requirements, remains in position for the duration of the whole operation. In the case of long operations, fatigue symptoms of the assistant are no longer present with this instrumentation.

Abdominal tap

MedlinePlus

Peritoneal tap; Paracentesis; Ascites - abdominal tap; Cirrhosis - abdominal tap; Malignant ascites - abdominal tap ... abdominal cavity ( most often cancer of the ovaries ) Cirrhosis of the liver Damaged bowel Heart disease Infection ...

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: does it increase abdominal wall closure rates?

PubMed

Ball, Chad G; Dente, Christopher J; Shaz, Beth; Wyrzykowski, Amy D; Nicholas, Jeffrey M; Kirkpatrick, Andrew W; Feliciano, David V

2013-10-01

Massive transfusion protocols (MTPs) using high plasma and platelet ratios for exsanguinating trauma patients are increasingly popular. Major liver injuries often require massive resuscitations and immediate hemorrhage control. Current published literature describes outcomes among patients with mixed patterns of injury. We sought to identify the effects of an MTP on patients with major liver trauma. Patients with grade 3, 4 or 5 liver injuries who required a massive blood component transfusion were analyzed. We compared patients with high plasma:red blood cell:platelet ratio (1:1:1) transfusions (2007-2009) with patients injured before the creation of an institutional MTP (2005-2007). Among 60 patients with major hepatic injuries, 35 (58%) underwent resuscitation after the implementation of an MTP. Patient and injury characteristics were similar between cohorts. Implementation of the MTP significantly improved plasma: red blood cell:platelet ratios and decreased crystalloid fluid resuscitation (p = 0.026). Rapid improvement in early acidosis and coagulopathy was superior with an MTP (p = 0.009). More patients in the MTP group also underwent primary abdominal fascial closure during their hospital stay (p = 0.021). This was most evident with grade 4 injuries (89% vs. 14%). The mean time to fascial closure was 4.2 days. The overall survival rate for all major liver injuries was not affected by an MTP (p = 0.61). The implementation of a formal MTP using high plasma and platelet ratios resulted in a substantial increase in abdominal wall approximation. This occurred concurrently to a decrease in the delivered volume of crystalloid fluid.

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.

Myosonographic study of abdominal wall dynamics to assess donor site morbidity after microsurgical breast reconstruction with a DIEP or an ms-2 TRAM flap.

PubMed

Seidenstuecker, K; Legler, U; Munder, B; Andree, C; Mahajan, A; Witzel, C

2016-05-01

Currently, autologous breast reconstruction with a free tissue transfer from the lower abdomen is considered to be a safe method that provides a stable long-term solution. The DIEP-flap and the ms-2-TRAM-flap reconstructions have helped reduce donor site morbidity. In order to assess the potential differences between these techniques, we carried out myosonographic evaluations that assessed the muscle dynamics pre- and post-operatively. In addition to investigating the properties of the rectus abdominis muscle post-operatively, this prospective study also allowed us to analyse the muscle preoperatively and to investigate the prospects for harvesting a DIEP-flap as opposed to a TRAM-flap. Sixty patients underwent breast reconstruction with 71 (11 bilateral) free abdominal wall flaps (DIEP-: n = 48; ms-2-TRAM-flap: n = 23). Myosonographic examinations were performed preoperatively and at 3 and 6 months post-operatively. The thickness of the muscle at relaxation and maximum contraction and the difference between the muscle thickness measured at the two states were measured. A general-linear-model (GLM) was used for statistical analysis. The main variable was the surgical method, and the co-variables included BMI and patient age. The decision on whether to harvest a DIEP- or ms-2-TRAM-flap was made intra-operatively and based on the dominant perforator. It shows that the patients who underwent breast reconstruction with a DIEP-flap had significantly better muscle function (p < 0.05) in the follow-up. In addition, the analysis revealed that better muscle function before surgery made it more likely that a patient would undergo a DIEP-flap-reconstruction successfully. Patient age also had a highly significant effect on muscle recovery (p < 0.0005). This prospective study used a dynamic ultrasound evaluation of the abdominal wall and showed that the DIEP-flap significantly reduces donor site morbidity compared to the ms-2-TRAM-flap. The study also showed that good

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

Chronic Myeloproliferative Neoplasms Treatment

MedlinePlus

... are described below. Chronic myeloproliferative neoplasms sometimes become acute leukemia , in which too many abnormal white blood ... higher. Patients also have an increased risk of acute myeloid leukemia or primary myelofibrosis . Symptoms of polycythemia ...

Hospital readmission following open, single-stage, elective abdominal wall reconstructions using acellular dermal matrix affects long-term hernia recurrence rate.

PubMed

Giordano, Salvatore A; Garvey, Patrick B; Baumann, Donald P; Liu, Jun; Butler, Charles E

2018-02-05

We evaluated the incidence of and the risk factors for readmission in patients who underwent abdominal wall reconstruction (AWR) using acellular dermal matrix (ADM) and assess whether readmission affects AWR long-term outcomes. A retrospective, single-center study of patients underwent AWR with ADM was conducted. The primary outcome was the incidence of unplanned readmission within 30 days after the initial discharge post-AWR. Secondary outcomes were surgical site occurrence (SSO) and hernia recurrence at follow-up. Of 452 patients (mean age, 59 years; mean follow-up, 35 months), 29 (6.4%) were readmitted within 30 days. Most readmissions were due to SSO (44.8%) or wound infections (12.8%). The hernia recurrence rate was significantly higher in readmitted patients (17.2% vs 9.9%; P = 0.044). Wider defects, prolonged operative time, and coronary artery disease were independent predictors of readmission. Readmission is associated with hernia recurrence on long-term follow-up. SSO is the most common cause for readmission. Copyright © 2018 Elsevier Inc. All rights reserved.

Risk factors in congenital abdominal wall defects (omphalocele and gastroschisi): a study in a series of 265,858 consecutive births.

PubMed

Stoll, C; Alembik, Y; Dott, B; Roth, M P

2001-01-01

The aim of this study was to describe the prevalence at birth of two abdominal wall defects (AWD), omphalocela and gastroschisis and to identify possible etiologic factors. The AWD came from 265,858 consecutive births of known ouome registered in the registry of congenital malformations of Strasbourg for the period 1979 to 1998. Request information on the child, the pregnancy, the parents and the family was obtained for cases and for controls. Hundred five cases with AWD were analysed, 55.2 % were omphalocele and 44.8 % were gastroschisis. The mean prevalence rate for omphalocele was 2.18 per 10,000 and for gastroschisis 1.76 per 10,000. Associated malformations were found in 74.1 % of omphalocele compared with 53.2 % of gastroschisis; 29.3 % of fetuses with omphalocele had an abnormal karyotype, 44,8 % had a recognizable syndrome, association or an unspecified malformation pattern; 51.0 % of fetuses with gastroschisis had additional malformations that were not of chromosomal origin, but 1 case. Antenatal ultrasound examination was able to detect 39 (67.2 %) cases of omphaloceles and 27 (57.4 %) cases of gastroschisis. In 30 (51.7 %) cases of omphalocele and in 7 (14.9 %) cases of gastroschisis parents opted for termination of pregnancy. The overall survival rate was 14 (24.1 %) for omphalocele and 30 (63.8 %) for gastroschisis. Weight, length and head circumference at birth of infants with AWD were less than those of controls. The weight of placenta of infants with AWD was not different from the weight of placenta of controls. Gastroschisis was associated with significantly younger maternal age than omphalocele. Pregnancies with AWD were more often complicated by threatened abortion, oligohydramnios and polyhydramnios. Mothers of children with AWD took more often medication during pregnancy than mothers of controls.

Splanchnic and renal deterioration during and after laparoscopic cholecystectomy: a comparison of the carbon dioxide pneumoperitoneum and the abdominal wall lift method.

PubMed

Koivusalo, A M; Kellokumpu, I; Ristkari, S; Lindgren, L

1997-10-01

Carbon dioxide (CO2) pneumoperitoneum together with an increased intraabdominal pressure (IAP) induces a hemodynamic stress response, diminishes urine output, and may compromise splanchnic perfusion. A new retractor method may be less traumatic. Accordingly, 30 ASA physical status I or II patients undergoing laparoscopic cholecystectomy were randomly allocated to a CO2 pneumoperitoneum (IAP 12-13 mm Hg) (control) or to a gasless abdominal wall lift method (retractor) group. Anesthesia and intravascular fluids were standardized. Direct mean arterial pressure (MAP), urine output, urine-N-acetyl-beta-D-glucosaminidase (U-NAG), arterial blood gases, gastric mucosal PCO2, and intramucosal pH (pHi) were measured. Normoventilation was instituted in all patients. MAP increased (P < 0.001) only with CO2 pneumoperitoneum. Minute volume of ventilation had to be increased by 35% with CO2 insufflation. PaCO2 was significantly higher (P < 0.05) for 3 h postoperatively in the control group. Diuresis was less (P < 0.01) and U-NAG levels (P < 0.01) higher in the control group. The pHi decreased after induction of pneumoperitoneum up to three hours postoperatively and remained intact in the retractor group. We conclude that the retractor method for laparoscopic cholecystectomy ensures stable hemodynamics, prevents respiratory acidosis, and provides protection against biochemical effects, which reveal the renal and splanchic ischemia caused by CO2 insufflation. A mechanical retractor method (gasless) was compared with conventional CO2 pneumoperitoneum for laparoscopic cholestectomy. The gasless method ensured stable hemodynamics, prevented respiratory acidosis, and provided protection against the renal and splanchnic ischemia seen with CO2 pneumoperitoneum.

Correlating Abdominal Wall Thickness and Body Mass Index to Predict Usefulness of Right Lower Quadrant Ultrasound for Evaluation of Pediatric Appendicitis.

PubMed

Kwon, Jeannie K; Trexler, Nowice; Reisch, Joan; Pfeifer, Cory M; Ginos, Jason; Powell, Jerry Allen; Veltkamp, Jennifer; Anene, Alvin; Fernandes, Neil; Chen, Li Ern

2017-11-06

To inform selective and efficient use of appendix ultrasound (US) beyond adult parameters of body mass index (BMI) of less than 25 kg/m, we correlate abdominal wall thickness (AWT) with age and BMI to generate parameters for male and female children. Information presented in chart format can aid in the decision to utilize US for the evaluation of appendicitis. In this observational study, 1600 pediatric computed tomography scans of the abdomen and pelvis were analyzed to obtain measurements of AWT in the right lower quadrant. Measurements were correlated by patient age, BMI, and sex. Results and consensus-based recommendations were presented in chart format with color-coded groupings to allow for convenient referencing in the clinical setting. One thousand four hundred eighty-eight computed tomography scans and AWT measurements were included. All age groups with BMI of less than 25 kg/m and all male and female groups younger than 6 years regardless of BMI had median AWT of less than 4 cm resulting in strong recommendation for US. Males older than 6 years and all female age groups with BMI of greater than 30 kg/m and female older than 15 years and BMI of greater than 25 kg/m had AWT of more than 5 cm resulting in low recommendation for US. While the BMI cutoff standard of less than 25 kg/m for usefulness of appendix US holds in the adult population, our data expand the acceptable range in children younger than 9 years regardless of BMI and male children with BMI up to 30 kg/m. Female children younger than 15 years with a BMI up to 30 kg/m may also be amenable to right lower quadrant US based on AWT. These parameters inform selective and efficient use of US for appendix evaluation.

Intraperitoneal onlay mesh reinforcement of the abdominal wall: a new surgical option for treatment of anterior cutaneous nerve entrapment syndrome-a retrospective cohort analysis of 30 consecutive patients.

PubMed

Stirler, Vincent M A; Raymakers, Johan T F J; Rakic, Srdjan

2016-07-01

The aim of the study was to introduce a new surgical treatment for anterior cutaneous nerve entrapment syndrome, a frequently unrecognised disorder in the general population responsible for chronic abdominal wall pain with limited treatment options to date. We hypothesised that intraperitoneal onlay mesh reinforcement could dissipate excessive increases in intra-abdominal pressure and prevent entrapment of the neurovascular bundle. Retrospective cohort analysis was performed between September 2002 and March 2014. All consecutive patients diagnosed with anterior cutaneous nerve entrapment syndrome refractory to conservative treatment (n = 30) underwent laparoscopic intraperitoneal onlay mesh reinforcement of the painful area in the abdominal wall. Planned follow-up took place at 2, 6 and 12 weeks after surgery and at time of analysis (March 2015). Primary outcome was patients' satisfaction after treatment at short and long term (last follow-up) using a verbal rating score as measurement (1 = I am very satisfied; I never experience pain, 2 = I am satisfied; I occasionally experience some pain, 3 = I have improved but experience pain on a regular basis, 4 = I have had no result on this treatment, 5 = my pain is worse after treatment). Scores 1 and 2 were classified as success, and scores 4 and 5 as failure of the treatment. Thirty patients underwent laparoscopic intraperitoneal onlay mesh reinforcement. None were lost to follow-up (mean 54 ± 44 months, range 12-122, median 38). Short- and long-term success rates were 90 and 71 %, respectfully. Intraperitoneal onlay mesh reinforcement of the abdominal wall seems to be a promising option for the treatment of intractable anterior cutaneous nerve entrapment syndrome.

Lymphedema of the Transplanted Kidney and Abdominal Wall with Ipsilateral Pleural Effusion Following Kidney Biopsy in a Patient Treated with Sirolimus: A Case Report and Review of the Literature.

PubMed

Rashid-Farokhi, Farin; Afshar, Haleh

2017-12-22

BACKGROUND Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in organ transplant recipients. Although mTOR inhibitors are well tolerated, their adverse effects have been reported. Sirolimus treatment in transplant recipients has been reported to be associated with lymphedema of the skin and subcutaneous tissues, and with pleural effusion, but edema of internal organs and organomegaly have not been previously reported. A case is presented lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy in a patient treated with sirolimus. CASE REPORT A 32-year-old woman with a history of end-stage renal disease of unknown etiology had undergone right renal transplantation from an unrelated living donor, eight years previously. She was referred to our hospital with dyspnea, localized abdominal pain, and swelling of the transplanted kidney. The symptoms appeared following a kidney biopsy and the replacement of cyclosporin with sirolimus four months previously. On examination, she had localized swelling of the abdominal wall overlying the transplanted kidney, and a right pleural effusion. Hydronephrosis and nephrotic syndrome were excluded as causes of kidney enlargement. Following the withdrawal of sirolimus therapy her symptoms resolved within three months. CONCLUSIONS A case is described of lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy attributed to her change in anti-rejection therapy to sirolimus. This case report should raise awareness of this unusual complication of sirolimus anti-rejection therapy and its possible effects on the lymphatic system.

Solid pseudopapillary neoplasm of the pancreas: report of a rare case and review of the literature.

PubMed

Yener, Arzu Neşe; Manukyan, Manuk; Mıdı, Ahmet; Cubuk, Rahmi

2014-01-01

Solid pseudopapillary neoplasm, a rare primary neoplasm of the pancreas that typically affects young women, is a relatively indolent entity with favorable prognosis. We here report a 20-year-old young girl with solid pseudopapillary neoplasm who presented with mild dull abdominal discomfort without any significant laboratory findings. On MRI, a heterogenous mass was found at the distal pancreas. The patient underwent en-block distal pancreatectomy with splenectomy with the presumptive diagnosis of cystic neoplasm of the pancreas. The tumor was well-circumscribed, encapsulated, 5.5 cm in the greatest dimension and showed typical papillary and pseudopapillary structures. Capsular invasion was seen on focal areas. The patient was not given any adjuvant therapy and shows no sign of disease after six months follow-up. It is important to differentiate this tumor from other pancreatic neoplasms because this neoplasm is amenable to cure after complete surgical resection even in cases with capsular invasion, unlike malignant tumors of the pancreas.

A magnetic resonance imaging investigation of the transversus abdominis muscle during drawing-in of the abdominal wall in elite Australian Football League players with and without low back pain.

PubMed

Hides, Julie A; Boughen, Carly L; Stanton, Warren R; Strudwick, Mark W; Wilson, Stephen J

2010-01-01

Single-blinded quasi-experimental study. To investigate the ability of elite football players with and without low back pain (LBP) to voluntarily draw-in the abdominal wall. While there has been considerable debate regarding the contribution of the transversus abdominis (TrA) muscle to control the lumbar spine and pelvis, there is evidence that retraining motor control of the deep trunk muscles is commensurate with decreases in LBP. Magnetic resonance imaging (MRI) has been used to assess the TrA muscle during the draw-in maneuver, with the contraction of the TrA muscle reducing the circumference of the trunk. Impairments in performance of the draw-in maneuver have been shown in people with LBP. Forty-three elite players from a team in the Australian Football League were allocated to 3 groups: those with "no LBP," "a history of LBP but no current LBP," or "current LBP." MRI was used to image the cross-sectional area (CSA) of the trunk at the level of the L3-4 disc at the start and end of the draw-in maneuver. There was a significant decrease in the CSA of the trunk with the performance of the draw-in maneuver (P<.001). Subjects in the "no LBP" group were better able to "draw-in" the abdominal wall than subjects with current LBP (P = .015). This study provides evidence of an altered ability to draw-in the abdominal wall in footballers with current LBP. Retraining contraction of the TrA muscle may constitute one part of an exercise-therapy approach for athletes with current LBP.

Abdominal Assessment.

PubMed

Fritz, Deborah; Weilitz, Pamela Becker

2016-03-01

Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care.

[Differential diagnosis of abdominal pain].

PubMed

Frei, Pascal

2015-09-02

Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain.

Simultaneous liver mucinous cystic and intraductal papillary mucinous neoplasms of the bile duct: a case report.

PubMed

Budzynska, Agnieszka; Hartleb, Marek; Nowakowska-Dulawa, Ewa; Krol, Robert; Remiszewski, Piotr; Mazurkiewicz, Michal

2014-04-14

Cystic hepatic neoplasms are rare tumors, and are classified into two separate entities: mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms of the bile duct (IPMN-B). We report the case of a 56-year-old woman who presented with abdominal pain and jaundice due to the presence of a large hepatic multilocular cystic tumor associated with an intraductal tumor. Partial hepatectomy with resection of extrahepatic bile ducts demonstrated an intrahepatic MCN and an intraductal IPMN-B. This is the first report of the simultaneous occurrence of these two histologically distinct entities in the liver.

[Abdominal trauma].

PubMed

Sido, B; Grenacher, L; Friess, H; Büchler, M W

2005-09-01

Blunt abdominal trauma is much more frequent than penetrating abdominal trauma in Europe. As a consequence of improved quality of computed tomography, even complex liver injuries are increasingly being treated conservatively. However, missed hollow viscus injuries still remain a problem, as they considerably increase mortality in multiply injured patients. Laparoscopy decreases the rate of unnecessary laparotomies in perforating abdominal trauma and helps to diagnose injuries of solid organs and the diaphragm. However, the sensitivity in detecting hollow viscus injuries is low and the role of laparoscopy in blunt abdominal injury has not been defined. If intra-abdominal bleeding is difficult to control in hemodynamically unstable patients, damage control surgery with packing of the liver, total splenectomy, and provisional closure of hollow viscus injuries is of importance. Definitive surgical treatment follows hemodynamic stabilization and restoration of hemostasis. Injuries of the duodenum and pancreas after blunt abdominal trauma are often associated with other intra-abdominal injuries and the treatment depends on their location and severity.

Myeloproliferative Neoplasms in Children.

PubMed

Hofmann, Inga

2015-09-01

Myeloproliferative neoplasms (MPN) are a group of clonal hematopoietic stem cell disorders characterized by aberrant proliferation of one or more myeloid lineages often with increased immature cells in the peripheral blood. The three classical BCR-ABL-negative MPNs are: 1) polycythemia vera (PV), 2) essential thrombocythemia (ET), and 3) primary myelofibrosis (PMF), which are typically disorders of older adults and are exceedingly rare in children. The diagnostic criteria for MPNs remain largely defined by clinical, laboratory and histopathology assessments in adults, but they have been applied to the pediatric population. The discovery of the JAK2 V617F mutation, and more recently, MPL and CALR mutations, are major landmarks in the understanding of MPNs. Nevertheless, they rarely occur in children, posing a significant diagnostic challenge given the lack of an objective, clonal marker. Therefore, in pediatric patients, the diagnosis must rely heavily on clinical and laboratory factors, and exclusion of secondary disorders to make an accurate diagnosis of MPN. This review focuses on the clinical presentation, diagnostic work up, differential diagnosis, treatment and prognosis of the classical BCR-ABL-negative MPNs (PV, ET and PMF) in children and highlights key differences to the adult diseases. Particular attention will be given to pediatric PMF, as it is the only disorder of this group that is observed in infants and young children, and in many ways appears to be a unique entity compared to adult PMF.

Myeloproliferative Neoplasm Animal Models

PubMed Central

Mullally, Ann; Lane, Steven W.; Brumme, Kristina; Ebert, Benjamin L.

2012-01-01

Synopsis Myeloproliferative neoplasm (MPN) animal models accurately re-capitulate human disease in mice and have been an important tool for the study of MPN biology and therapy. Transplantation of BCR-ABL transduced bone marrow cells into irradiated syngeneic mice established the field of MPN animal modeling and the retroviral bone marrow transplantation (BMT) assay has been used extensively since. Genetically engineered MPN animal models have enabled detailed characterization of the effects of specific MPN associated genetic abnormalities on the hematopoietic stem and progenitor cell (HSPC) compartment and xenograft models have allowed the study of primary human MPN-propagating cells in vivo. All models have facilitated the pre-clinical development of MPN therapies. JAK2V617F, the most common molecular abnormality in BCR-ABL negative MPN, has been extensively studied using retroviral, transgenic, knock-in and xenograft models. MPN animal models have also been used to investigate additional genetic lesions found in human MPN and to evaluate the bone marrow microenvironment in these diseases. Finally, several genetic lesions, although not common, somatically mutated drivers of MPN in humans induce a MPN phenotype in mice. Future uses for MPN animal models will include modeling compound genetic lesions in MPN and studying myelofibrotic transformation. PMID:23009938

Haemangiopericytoma of greater omentum. A rare cause of acute abdominal pain.

PubMed

Bovino, A; Basso, L; Di Giacomo, G; Codacci Pisanelli, M; Basile, U; De Toma, G

2003-12-01

Haemangiopericytoma (HPT) is a rare neoplasm that can occur in any part of the human body. In this report, we describe the case of a patient with sudden severe upper abdominal pain caused by primary HPT in the greater omentum.

Myeloproliferative Neoplasms (MPNs) Patient Registry

ClinicalTrials.gov

2017-10-27

Primary Myelofibrosis; Polycythemia Vera; Essential Thrombocythemia; Mastocytosis; Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative; Leukemia, Myelomonocytic, Juvenile; Chronic Eosinophilic Leukemia-not Otherwise Specified; Myelodysplastic-Myeloproliferative Diseases; Neoplasms; Leukemia, Myelomonocytic, Chronic

Gastric outlet obstruction secondary to solid-pseudopapillary neoplasm of the pancreas in an eight year old child. Report of a case.

PubMed

Bidassek, Rick; Spelter, Herbert; Gödde, Daniel; Zirngibl, Hubert; Ambe, Peter C

2016-01-20

Solid pseudopapillary neoplasm is a rare cystic tumor of the exocrine pancreas. Abdominal pain or discomfort is the most common symptom, usually in young females. Herein we report the case of an 8 - year old child presenting with symptoms of gastric outlet obstruction. A solid pseudopapillary neoplasm of the pancreatic caput was diagnosed and surgically removed.

Anterior rectus sheath blocks in children with abdominal wall pain due to anterior cutaneous nerve entrapment syndrome: a prospective case series of 85 children.

PubMed

Siawash, Murid; Mol, Frederique; Tjon-A-Ten, Walther; Perquin, Christel; van Eerten, Percy; van Heurn, Ernst; Roumen, Rudi; Scheltinga, Marc

2017-05-01

Chronic abdominal pain in children may be caused by the anterior cutaneous nerve entrapment syndrome. Local nerve blocks are recommended as an initial treatment in adults. Evidence on effectiveness and safety of such a treatment in children is lacking. Our aim was to study outcome and adverse events of anterior rectus sheath blocks in childhood anterior cutaneous nerve entrapment syndrome. Patients <18 years of age receiving anterior rectus sheath blocks were prospectively followed. Injections were administered using a free-hand technique in the outpatient department. A total of 85 children were included (median age 15 years, range 8-17, 76% female). Eighty-three children reported immediate pain relief following a single lidocaine block and 13 achieved long-term success. Another 19 children was successfully treated with additional blocks combined with steroids. A total 38% success ratio was attained after a median 17-month follow-up (range, 4-39). Pain intensity and diagnostic delay were not associated with a beneficial outcome. However, young age predicted success. An infrequently occurring adverse event was temporarily increased pain some 6 h post injection. Anterior rectus sheath blocks using local anesthetics and steroids are safe and long-term successful in more than one-third of children suffering from abdominal pain due to anterior cutaneous nerve entrapment syndrome. © 2017 John Wiley & Sons Ltd.

Malignant melanocytic neoplasm of pancreas with liver metastasis: Is it malignant melanoma or clear cell sarcoma?

PubMed

Kodiatte, Thomas Alex; George, Sam Varghese; Chacko, Raju Titus; Ramakrishna, Banumathi

2017-01-01

Malignant melanocytic neoplasm, usually seen in soft tissues, is rare in a visceral location and presents as a diagnostic dilemma. We present a case of pancreatic malignant melanocytic neoplasm with liver metastasis. A 58-year-old man presented with left upper abdominal swelling and loss of appetite. Imaging revealed a large mass arising from the pancreatic tail, and this was diagnosed as malignant neoplasm with melanocytic differentiation on biopsy with the possible differentials of malignant melanoma, clear cell sarcoma (CCS), and perivascular epithelioid cell neoplasm. The patient underwent distal pancreatectomy and splenectomy for the same. Follow-up imaging 6 months later showed a metastatic liver lesion, for which he also underwent a liver resection. BRAF mutational analysis was found to be negative. Both CCS and malignant melanoma have similar morphological features and melanocytic differentiation, but each harbors a distinct genetic background. Differentiation of both has diagnostic and therapeutic implications.

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.

[Spontaneous neoplasms in guinea pigs].

PubMed

Khar'kovskaia, N A; Khrustalev, S A; Vasil'eva, N N

1977-01-01

The authors present an analysis of the data of foreign literature and the results of their personal studies of spontaneous neoplasms in 40 guinea pigs of national breeding observed during observed during a 5-year period. In 4 of them malignant tumors were diagnosed-lympholeucosis (2 cases), dermoid ovarian cysts and also cancer and adenoma of the adrenal cortex (in one animal). The neoplasms described developed in guinea pigs, aged over 4 years, and they are referred to as mostly common tumors in this species of animals.

Successful Treatment of Abdominal Cutaneous Entrapment Syndrome Using Ultrasound Guided Injection

PubMed Central

Hong, Myong Joo; Seo, Dong Hyuk

2013-01-01

There are various origins for chronic abdominal pain. About 10-30% of patients with chronic abdominal pain have abdominal wall pain. Unfortunately, abdominal wall pain is not thought to be the first origin of chronic abdominal pain; therefore, patients usually undergo extensive examinations, including diagnostic laparoscopic surgery. Entrapment of abdominal cutaneous nerves at the muscular foramen of the rectus abdominis is a rare cause of abdominal wall pain. If abdominal wall pain is considered in earlier stage of chronic abdominal pain, unnecessary invasive procedures are not required and patients will reach symptom free condition as soon as the diagnosis is made. Here, we report a case of successful treatment of a patient with abdominal cutaneous nerve entrapment syndrome by ultrasound guided injection therapy. PMID:23862004

Needle biopsy through the abdominal wall for the diagnosis of gastrointestinal stromal tumour - Does it increase the risk for tumour cell seeding and recurrence?

PubMed

Eriksson, Mikael; Reichardt, Peter; Sundby Hall, Kirsten; Schütte, Jochen; Cameron, Silke; Hohenberger, Peter; Bauer, Sebastian; Leinonen, Mika; Reichardt, Annette; Rejmyr Davis, Maria; Alvegård, Thor; Joensuu, Heikki

2016-05-01

Preoperative percutaneous transabdominal wall biopsy may be considered to diagnose gastrointestinal stromal tumour (GIST) and plan preoperative treatment with tyrosine kinase inhibitors when an endoscopic biopsy is not possible. Hypothetically, a transabdominal wall biopsy might lead to cell seeding and conversion of a local GIST to a disseminated one. We investigated the influence of preoperative needle biopsy on survival outcomes. We collected the clinical data from hospital case records of the 397 patients who participated in the Scandinavian Sarcoma Group (SSG) XVIII/Arbeitsgemeinschaft Internistische Onkologie (AIO) randomised trial and who had a transabdominal fine needle and/or core needle biopsy carried out prior to study entry. The SSG XVIII/AIO trial compared 1 and 3 years of adjuvant imatinib in a patient population with a high risk of GIST recurrence after macroscopically radical surgery. The primary end-point was recurrence-free survival (RFS), and the secondary end-points included overall survival (OS). A total of 47 (12.0%) out of the 393 patients with data available underwent a percutaneous biopsy. No significant difference in RFS or OS was found between the patients who underwent or did not undergo a percutaneous biopsy either in the entire series or in subpopulation analyses, except for a statistically significant RFS advantage for patients who had a percutaneous biopsy and a tumour ≥10 cm in diameter. A preoperative diagnostic percutaneous biopsy of a suspected GIST may not increase the risk for GIST recurrence in a patient population who receive adjuvant imatinib after the biopsy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Abdominal elephantiasis: a case report.

PubMed

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

2004-01-01

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

Abdominal rigidity

MedlinePlus

... other symptoms do you have at the same time? For example, do you have abdominal pain ? You may have the following tests: Barium studies of the stomach and intestines (such as an upper GI series ) Blood tests Colonoscopy Gastroscopy Peritoneal lavage Stool studies ...

Raman spectroscopy of skin neoplasms

NASA Astrophysics Data System (ADS)

Moryatov, A. A.; Kozlov, S. V.; Kaganov, O. I.; Orlov, A. E.; Zaharov, V. P.; Batrachenko, I. A.; Artemiev, D. N.; Blinov, N. V.

2017-09-01

Skin melanoma is spread inhomogeneously worldwide, particularly in Samara region there are high figures of skin neoplasms sick rate as well—18.6%. Research goal: to develop a new method of early non-invasive differential diagnostics of skin neoplasms. Registration of Raman spectrum was implemented in the distance of 3-4 mm, the spectrum registration from pathologically changed zone was subsequently conducted, then from healthy skin zone. The test time for 1 patient was no longer than 3-5 min. In a range of experiments ex vivo there were the following results: melanoma—24, basal cell cancer—25, squamosus cell sarcinoma—7, nevus pigmentosis—9, other malignant neoplasms—6; in vivo: melanoma—9, basal cell cancer—8, nevus pigmentosis—2, other benign neoplasms—2. The first results of the research dedicated to studying permissive opportunities of Raman spectroscopy, with successive two-phase analysis of received parameters display high efficiency of method of differential diagnostic for skin melanoma and other malignant neoplasms, pigment and benign skin neoplasms. Safety and rapidity of the research reveal a high potential of the technique.

Drugs Approved for Myeloproliferative Neoplasms

Cancer.gov

This page lists cancer drugs approved by the Food and Drug Administration (FDA) for myeloproliferative neoplasms. The list includes generic names, brand names, and common drug combinations, which are shown in capital letters. The drug names link to NCI's Cancer Drug Information summaries.

Saccular aortic aneurysm that resembled a mediastinal neoplasm

PubMed Central

Nose, Naohiro; Kataoka, Hiroumi; Hamada, Masakatsu; Kosako, Yukio; Matsuno, Yasuji; Ishii, Takahiro

2012-01-01

INTRODUCTION Saccular aortic arch aneurysms in unusual sites may be misdiagnosed as a neoplasm. We present the case of a rare saccular aortic arch aneurysm between trachea and esophagus that resembled a mediastinal neoplasm in the preoperative findings. PRESENTATION OF CASE A 63-year-old male with an abnormal mediastinal shadow on chest X-ray was referred to the hospital. An axial plain computed tomogram of the chest revealed mediastinal soft tissue next to the right side of the aortic arch resembling a neoplasm originating from the gap between the trachea and the esophagus. The coronal view constructed by enhanced 64-row multi detector computed tomography revealed the soft tissue was an aneurysm arising from the inner side of the aortic arch. An aortic arch replacement was performed via a median sternotomy. DISCUSSION A thoracic aortic aneurysm sometimes behaves like a mediastinal neoplasm. The multiple cross-sectional image from multidetector computed tomography was useful for the correct diagnosis of such an aneurysm. CONCLUSION The possibility of an aneurysm should be considered whenever a mass in contact with the aortic wall is identified. PMID:22995656

Enhancing Targeted Therapy for Myeloproliferative Neoplasms

DTIC Science & Technology

2013-10-01

Myeloproliferative Neoplasms PRINCIPAL INVESTIGATOR: Gary W. Reuther CONTRACTING...2. REPORT TYPE Annual 3. DATES COVERED 30 2012-2 2013 4. TITLE AND SUBTITLE Enhancing Targeted Therapy for Myeloproliferative Neoplasms ...AVAILABILITY STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Myeloproliferative neoplasms

The long-term behavior of lightweight and heavyweight meshes used to repair abdominal wall defects is determined by the host tissue repair process provoked by the mesh.

PubMed

Pascual, Gemma; Hernández-Gascón, Belén; Rodríguez, Marta; Sotomayor, Sandra; Peña, Estefania; Calvo, Begoña; Bellón, Juan M

2012-11-01

Although heavyweight (HW) or lightweight (LW) polypropylene (PP) meshes are widely used for hernia repair, other alternatives have recently appeared. They have the same large-pore structure yet are composed of polytetrafluoroethylene (PTFE). This study compares the long-term (3 and 6 months) behavior of meshes of different pore size (HW compared with LW) and composition (PP compared with PTFE). Partial defects were created in the lateral wall of the abdomen in New Zealand White rabbits and then repaired by the use of a HW or LW PP mesh or a new monofilament, large-pore PTFE mesh (Infinit). At 90 and 180 days after implantation, tissue incorporation, gene and protein expression of neocollagens (reverse transcription-polymerase chain reaction/immunofluorescence), macrophage response (immunohistochemistry), and biomechanical strength were determined. Shrinkage was measured at 90 days. All three meshes induced good host tissue ingrowth, yet the macrophage response was significantly greater in the PTFE implants (P < .05). Collagen 1/3 mRNA levels failed to vary at 90 days yet in the longer term, the LW meshes showed the reduced genetic expression of both collagens (P < .05) accompanied by increased neocollagen deposition, indicating more efficient mRNA translation. After 90-180 days of implant, tensile strengths and elastic modulus values were similar for all 3 implants (P > .05). Host collagen deposition is mesh pore size dependent whereas the macrophage response induced is composition dependent with a greater response shown by PTFE. In the long term, macroporous meshes show comparable biomechanical behavior regardless of their pore size or composition. Copyright © 2012 Mosby, Inc. All rights reserved.

[Immunohistochemical study of perivascular epithelioid cell neoplasms].

PubMed

Xia, Qiu-Yuan; Rao, Qiu; Shen, Qin; Liu, Biao; Li, Li; Shi, Qun-Li; Shi, Shan-Shan; Yu, Bo; Zhang, Ru-Song; Ma, Heng-Hui; Lu, Zhen-Feng; Wang, Xuan; Tu, Pin; Zhou, Xiao-Jun

2013-06-01

To study the clinicopathologic features, immunophenotype and genetic changes of perivascular epithelioid cell neoplasms (PEComa). A total of 25 cases of PEComa located in various anatomic sites were selected for immunohistochemical staining (SP or EnVision method). TFE3 fluorescence in-situ hybridization was also performed to determine the TFE3 gene status. The age of patient ranged from 21 to 61 years (mean = 43 years). The male-to-female ratio was 1: 1.3. Histologically, 22 cases represented conventional angiomyolipomas, composed of a mixture of adipose tissue, spindle element, epithelioid smooth muscle cells and abnormal thick-walled blood vessels in various proportions. Three cases involving lung, soft tissue and broad ligament had subtle but distinctive morphologic features. Nested or sheet-like architecture with epithelioid or spindle cells was observed. Immunohistochemical study showed that HMB 45, melan A, smooth muscle actin and cathepsin K were expressed in 80% (20/25), 88% (22/25), 88% (22/25) and 100% (25/25) of PEComa, respectively. Within positive cases, the average proportion of positive tumor cells was 36%, 41%, 35% and 90% respectively for HMB 45, melan A, smooth muscle actin and cathepsin K. TFE3 was negative in all of the 22 renal and hepatic PEComa studied, while it was positive in the 3 cases of extra-hepatorenal PEComa. None of the 25 cases exhibited evidence of TFE3 gene fusion or amplification. Extra-hepatorenal PEComa have distinctive morphologic features and are associated with TFE3 overexpression. Cathepsin K immunostaining demonstrates high sensitivity and specificity in PEComa, better than other commonly employed immunomarkers. This marker is thus useful in diagnosis of PEComa and distinction with other neoplasms.

[A commonly seen cause of abdominal pain: abdominal cutaneous nerve entrapment syndrome].

PubMed

Solmaz, Ilker; Talay, Mustafa; Tekindur, Şükrü; Kurt, Ercan

2012-01-01

Although abdominal cutaneous nerve entrapment syndrome (ACNES) is accepted as a rare condition, it is a syndrome that should be diagnosed more commonly when the clinical signs cannot explain the cause of abdominal pain. Abdominal pain is commonly considered by physicians to be based on intra-abdominal causes. Consequently, redundant tests and consultations are requested for these patients, and unnecessary surgical procedures may be applied. Patients with this type of pain are consulted to many clinics, and because their definitive diagnoses cannot be achieved, they are assessed as psychiatric patients. Actually, a common cause of abdominal wall pain is nerve entrapment on the lateral edge of the rectus abdominis muscle. In this paper, we would like to share information about the diagnosis and treatment of a patient who, prior to presenting to us, had applied to different clinics for chronic abdominal pain and had undergone many tests and consultations; abdominal surgery was eventually decided.

Evaluation of abdominal pain in the AIDS patient.

PubMed Central

Potter, D A; Danforth, D N; Macher, A M; Longo, D L; Stewart, L; Masur, H

1984-01-01

Acquired immune deficiency syndrome (AIDS) is a recently recognized entity characterized by a deficiency in cell mediated immune response. The syndrome is manifested by the development of otherwise rare malignant neoplasms and severe life-threatening opportunistic infections. Case histories of five AIDS patients evaluated for abdominal pain are presented to demonstrate the unusual spectrum of intra-abdominal pathology that may be encountered in the AIDS patient. As the number of patients with AIDS continues to escalate, surgical evaluation and intervention will be required more frequently. An understanding of this syndrome and its complications is mandatory for the surgeon to adequately evaluate AIDS patients with abdominal pain. PMID:6322708

Evaluation of the levels of metalloproteinsase-2 in patients with abdominal aneurysm and abdominal hernias.

PubMed

Antoszewska, Magdalena

2013-05-01

Abdominal aortic aneurysms and abdominal hernias become an important health problems of our times. Abdominal aortic aneurysm and its rupture is one of the most dangerous fact in vascular surgery. There are some theories pointing to a multifactoral genesis of these kinds of diseases, all of them assume the attenuation of abdominal fascia and abdominal aortic wall. The density and continuity of these structures depend on collagen and elastic fibers structure. Reducing the strength of the fibers may be due to changes in the extracellular matrix (ECM) by the proteolytic enzymes-matrix metalloproteinases (MMPs) that degrade extracellular matrix proteins. These enzymes play an important role in the development of many disease: malignant tumors (colon, breast, lung, pancreas), cardiovascular disease (myocardial infarction, ischemia-reperfusion injury), connective tissue diseases (Ehler-Danlos Syndrome, Marfan's Syndrome), complications of diabetes (retinopathy, nephropathy). One of the most important is matrix metalloproteinase-2 (MMP-2). The aim of the study was an estimation of the MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia, and in patients with only abdominal aortic aneurysm. The study involved 88 patients aged 42 to 89 years, including 75 men and 13 women. Patients were divided into two groups: patients with abdominal aortic aneurysm and primary abdominal hernia (45 persons, representing 51.1% of all group) and patients with only abdominal aortic aneurysm (43 persons, representing 48,9% of all group). It was a statistically significant increase in MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia compared to patients with only abdominal aortic aneurysm. It was a statistically significant increase in the prevalence of POCHP in patients with only abdominal aortic aneurysm compared to patients with abdominal aortic aneurysm and primary abdominal hernia. Statistically significant

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.

Spinal neoplasms in small animals.

PubMed

Bagley, Rodney S

2010-09-01

Tumors arising from or involving the spinal cord are important considerations in animals presented for pain and limb dysfunction. Clinical signs of spinal cord dysfunction, however, are not pathognomic for neoplastic disease in most instances. Advanced magnetic resonance imaging (MRI) often accurately identifies the location and extent of abnormalities. Although some spinal neoplasms have a characteristic appearance with MRI, in other instances the abnormalities may not be readily discernable as neoplastic. Histologic diagnosis, therefore, is imperative to provide information regarding potential treatment modalities and prognosis. Histologic diagnosis is most commonly performed following surgical biopsy and is often performed in combination with surgical removal. Copyright 2010 Elsevier Inc. All rights reserved.

Abdominal Aortic Aneurysm

MedlinePlus

... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life ... familydoctor.org editorial staff Categories: Family Health, Men, Seniors, WomenTags: abdominal aorta, abdominal aortic aneurysm, abdominal pain, ...

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

PubMed

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

2004-12-15

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

The Spindle Cell Neoplasms of the Oral Cavity.

PubMed

Shamim, Thorakkal

2015-01-01

Spindle cell neoplasms are defined as neoplasms that consist of spindle-shaped cells in the histopathology. Spindle cell neoplasms can affect the oral cavity. In the oral cavity, the origin of the spindle cell neoplasms may be traced to epithelial, mesenchymal and odontogenic components. This article aims to review the spindle cell neoplasms of the oral cavity with emphasis on histopathology.

The Spindle Cell Neoplasms of the Oral Cavity

PubMed Central

Shamim, Thorakkal

2015-01-01

Spindle cell neoplasms are defined as neoplasms that consist of spindle-shaped cells in the histopathology. Spindle cell neoplasms can affect the oral cavity. In the oral cavity, the origin of the spindle cell neoplasms may be traced to epithelial, mesenchymal and odontogenic components. This article aims to review the spindle cell neoplasms of the oral cavity with emphasis on histopathology. PMID:26351482

Low-grade appendiceal mucinous neoplasm mimicking an adnexal mass.

PubMed

Cristian, Daniel Alin; Grama, Florin Andrei; Becheanu, Gabriel; Pop, Anamaria; Popa, Ileana; Şurlin, Valeriu; Stănilescu, Sorin; Bratu, Ana Magdalena; Burcoş, Traean

2015-01-01

We present a rare case of malignant epithelial neoplasm of the appendix, an uncommon disorder encountered in clinical practice, which poses a variety of diagnostic and therapeutic challenges. We report a particular case in which the appendix was abnormally located in the pelvis, mimicking an adnexal mass. Therefore, it was difficult to make the preoperative diagnosis on clinical examination, imaging studies and laboratory tests and we discovered the lesion during the diagnostic laparoscopy. No lymphadenopathy or mucinous ascites were found. The case was completely handled via the laparoscopic approach keeping the appendix intact during the operation. The frozen section, the detailed histopathology overview as well as multiple immunostaining with a complex panel of markers report diagnosed a low-grade appendiceal mucinous neoplasm (LAMN) with no invasion of the wall. No adjuvant therapy was considered needed. At a one-year follow-up oncological assessment, the patient was free of disease. In women with cystic mass in the right iliac fossa an appendiceal mucocele should be considered in the differential diagnosis. Laparoscopic appendectomy can represent an adequate operation for the appendiceal mucinous neoplasm if the histological report is clear and surgical precautionary measures are taken.

Neurobehavioral presentations of brain neoplasms.

PubMed Central

Filley, C M; Kleinschmidt-DeMasters, B K

1995-01-01

We studied 8 patients with frontal or temporolimbic neoplasms who had psychiatric presentations to clarify diagnostic criteria for distinguishing psychiatric disease from structural brain lesions and to examine brain-behavior relationships associated with cerebral neoplasms using modern neuroimaging techniques. Medical records were retrospectively reviewed for evidence of neurobehavioral and neurologic manifestations, tumor histologic features, and the results of treatment. Clinical presentations were correlated with tumor location as determined by computed tomography and magnetic resonance imaging. Patients with frontal lobe tumors presented with abulia, personality change, or depression, whereas those with temporolimbic tumors had auditory and visual hallucinations, mania, panic attacks, or amnesia. After treatment, neurobehavioral syndromes abated or resolved in 7 of 8 patients. We recommend that any patient 40 years of age or older with a change in mental state, cognitive or emotional, should have neuroimaging of the brain. Any patient with a psychiatric presentation who has specific neurobehavioral or neurologic findings or an unexpectedly poor response to psychopharmacologic treatment should also have brain imaging. These case reports extend and update observations on the importance of frontal and temporolimbic systems in the pathogenesis of neurobehavioral disorders. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. PMID:7667978

Cathepsin K expression in a wide spectrum of perivascular epithelioid cell neoplasms (PEComas): a clinicopathological study emphasizing extrarenal PEComas.

PubMed

Rao, Qiu; Cheng, Liang; Xia, Qiu-yuan; Liu, Biao; Li, Li; Shi, Qun-li; Shi, Shan-shan; Yu, Bo; Zhang, Ru-song; Ma, Heng-hui; Lu, Zhen-feng; Tu, Pin; Zhou, Xiao-jun

2013-03-01

Recent studies have demonstrated that cathepsin K seems to be a powerful marker in identifying renal perivascular epithelioid cell neoplasms (PEComas). However, the expression in extrarenal PEComas has not been well characterized due to their rare incidence. Our aim was to investigate the expression of cathepsin K in a wide spectrum of extrarenal PEComas and evaluate its potential diagnostic usefulness in comparison with other commonly used markers. Twenty-three cases of PEComa (liver, n = 9; lung, n = 1; broad ligament of uterus, n = 1; vertex subcutaneous soft tissue, n = 1; abdominal wall, n = 1; and kidney, n = 10) were selected for study. All displayed a high percentage of cells with moderately to strongly positive reactions for cathepsin K (mean 91%; range 80-100%). HMB45, Melan-A and smooth muscle actin (SMA) were expressed in 78, 87 and 87% of cases, respectively, with various percentages of positive cells (mean, 34, 40 and 38%; range 0-80, 0-90 and 0-90%). Transcription factor E3 (TFE3) was expressed strongly in only three cases; none exhibited evidence of TFE3 gene fusion or amplification. Cathepsin K appears to be more powerful than other commonly used markers in diagnosing a wide spectrum of PEComas and distinguishing them from the majority of human cancers. © 2012 Blackwell Publishing Ltd.

Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension.

PubMed

Villoria, Albert; Azpiroz, Fernando; Burri, Emanuel; Cisternas, Daniel; Soldevilla, Alfredo; Malagelada, Juan-R

2011-05-01

The abdomen normally accommodates intra-abdominal volume increments. Patients complaining of abdominal distension exhibit abnormal accommodation of colonic gas loads (defective contraction and excessive protrusion of the anterior wall). However, abdominal imaging demonstrated diaphragmatic descent during spontaneous episodes of bloating in patients with functional gut disorders. We aimed to establish the role of the diaphragm in abdominal distension. In 20 patients complaining of abdominal bloating and 15 healthy subjects, we increased the volume of the abdominal cavity with a colonic gas load, while measuring abdominal girth and electromyographic activity of the anterior abdominal muscles and of the diaphragm. In healthy subjects, the colonic gas load increased girth, relaxed the diaphragm, and increased anterior wall tone. With the same gas load, patients developed significantly more abdominal distension; this was associated with paradoxical contraction of the diaphragm and relaxation of the internal oblique muscle. In this experimental provocation model, abnormal accommodation of the diaphragm is involved in abdominal distension.

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 CFR 311.11 - Neoplasms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Neoplasms. 311.11 Section 311.11 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY... CERTIFICATION DISPOSAL OF DISEASED OR OTHERWISE ADULTERATED CARCASSES AND PARTS § 311.11 Neoplasms. (a) An...

Treatment Options for Plasma Cell Neoplasms (Including Multiple Myeloma)

MedlinePlus

... Health Professional Plasma Cell Neoplasms Treatment Research Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Patient Version General Information About Plasma Cell Neoplasms Go to Health Professional Version Key Points ...

Stages of Plasma Cell Neoplasms (Including Multiple Myeloma)

MedlinePlus

... Health Professional Plasma Cell Neoplasms Treatment Research Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Patient Version General Information About Plasma Cell Neoplasms Go to Health Professional Version Key Points ...

Treatment Option Overview (Plasma Cell Neoplasms Including Multiple Myeloma)

MedlinePlus

... Health Professional Plasma Cell Neoplasms Treatment Research Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Patient Version General Information About Plasma Cell Neoplasms Go to Health Professional Version Key Points ...

Cystic neoplasms of the exocrine pancreas.

PubMed

Campbell, F; Azadeh, B

2008-04-01

The increasing use of radiological imaging has led to greater detection of small and asymptomatic cystic lesions of the pancreas. Most are resectable, but not all are neoplastic. This review provides an update on the histopathology, immunohistochemistry, molecular biology, pathogenesis and management of cystic neoplasms of the exocrine pancreas. These include the serous, the mucinous cystic, the intraductal papillary mucinous and the solid pseudopapillary neoplasms. Recently reported variants are described and very rare cystic variants of other pancreatic epithelial and mesenchymal neoplasms are briefly mentioned.

Outcomes analysis of laparoscopic resection of pancreatic neoplasms.

PubMed

Pierce, R A; Spitler, J A; Hawkins, W G; Strasberg, S M; Linehan, D C; Halpin, V J; Eagon, J C; Brunt, L M; Frisella, M M; Matthews, B D

2007-04-01

Experience with laparoscopic resection of pancreatic neoplasms remains limited. The purpose of this study is to critically analyze the indications for and outcomes after laparoscopic resection of pancreatic neoplasms. The medical records of all patients undergoing laparoscopic resection of pancreatic neoplasms from July 2000 to February 2006 were reviewed. Data are expressed as mean +/- standard deviation. Laparoscopic pancreatic resection was performed in 22 patients (M:F, 8:14) with a mean age of 56.3 +/- 15.1 years and mean body mass index (BMI) of 26.3 +/- 4.5 kg/m2. Nine patients had undergone previous intra-abdominal surgery. Indications for pancreatic resection were cyst (1), glucagonoma (1), gastrinoma (2), insulinoma (3), metastatic tumor (2), IPMT (4), nonfunctioning neuroendocrine tumor (3), and mucinous/serous cystadenoma (6). Mean tumor size was 2.4 +/- 1.6 cm. Laparoscopic distal pancreatectomy was attempted in 18 patients and completed in 17, and enucleation was performed in 4 patients. Laparoscopic ultrasound (n = 10) and a hand-assisted technique (n = 4) were utilized selectively. Mean operative time was 236 +/- 60 min and mean blood loss was 244 +/- 516 ml. There was one conversion to an open procedure because of bleeding from the splenic vein. The mean postoperative LOS was 4.5 +/- 2.0 days. Seven patients experienced a total of ten postoperative complications, including a urinary tract infection (UTI) (1), lower-extremity deep venous thrombosis (DVT) and pulmonary embolus (1), infected peripancreatic fluid collection (1), pancreatic pseudocyst (1), and pancreatic fistula (6). Five pancreatic fistulas were managed by percutaneous drainage. The reoperation rate was 4.5% and the overall pancreatic-related complication rate was 36.4%. One patient developed pancreatitis and a pseudocyst 5 months postoperatively, which was managed successfully with a pancreatic duct stent. There was no 30-day mortality. Laparoscopic pancreatic resection is safe and

In vitro comparison of intra-abdominal hypertension development after different temporary abdominal closure techniques.

PubMed

Benninger, Emanuel; Labler, Ludwig; Seifert, Burkhardt; Trentz, Otmar; Menger, Michael D; Meier, Christoph

2008-01-01

To compare volume reserve capacity (VRC) and development of intra-abdominal hypertension after different in vitro temporary abdominal closure (TAC) techniques. A model of the abdomen was designed. The abdominal wall was simulated with polychloroprene, a synthetic rubber compound. A lentil-shaped defect of 150 cm(2) was cut into the anterior aspect of the abdominal wall. TAC of this defect was performed by a zipper system (ZS), a bag silo closure (BSC), or a vacuum assisted closure (VAC) with subatmospheric pressures ranging from 0- to 200 mmHg. The model with intact abdominal wall served as reference. The model was filled with water to baseline level. The intra-abdominal pressure was increased in 2 mmHg steps from baseline level (6 mmHg) to 40 mmHg by adding volume to the system according to a standardized protocol. VRC with corresponding intra-abdominal pressure were analyzed and compared for the different TAC techniques. VRC was the highest after BSC at all pressure levels studied (P < 0.05). VAC and ZS resulted in significantly lower VRC compared with BSC and reference (P < 0.05). The magnitude of negative pressure on the VAC did not significantly influence the VRC. In the present in vitro model, BSC demonstrated the highest VRC of all evaluated TAC techniques. Different levels of subatmospheric pressures applied to the VAC did not affect VRC. The results for ZS and VAC indicate that these TAC techniques may increase the risk for recurrent intra-abdominal hypertension and should therefore not be used in high-risk patients during the initial phase after abdominal decompression.

Hemangiopericytoma of Greater Omentum Presenting as a Huge Abdominal Lump

PubMed Central

Chatterjee, Damodar; Sarkar, Pradip; Sengupta, Niladri; Singh, W. Gopimohan

2008-01-01

Hemangiopericytoma is a rare neoplasm that can occur in any part of the human body, but it rarely develops in the greater omentum. We report a case of a patient who presented with a huge abdominal lump. At laparotomy, a huge vascular tumor, which was observed originating from the greater omentum, was resected. Histopathology investigation revealed this tumor as a benign hemangiopericytoma with a malignant potential. PMID:19568508

[Vascular neoplasms of the mediastinum].

PubMed

Biriukov, Iu V; Charnetskiĭ, R I; Godzhello, E A

1991-04-01

During a period of 42 years the authors had 44 patients with various vascular neoplasms of the mediastinum--angiomas. Experience in the treatment of 6 of them is discussed in B. V. Petrovsky's monograph Surgery of the Mediastinum (1960). The other 38 cases were distributed as follows: hemangiomas 28 (14 mature and 14 immature) and lymphangiomas 10 (all mature). The patients' ages ranged from 11 to 63 years, the duration of the anamnesis from 4 weeks to 40 years. Mediastinal angiomas are mainly encountered in children and young people, with equal frequency among females and males. Their clinico-radiological picture is diverse and unspecific, the diagnosis is established with difficulty. Surgery is the principal method of treatment. Radical removal of the tumor must be attempted. Radiologically-guided endovascular occlusion of the vessel supplying the tumor is possible in some cases. The late results of surgical treatment are good in cases of mature angiomas and depend on the radicalism of the operation in immature forms.

Myeloproliferative Neoplasms in Danish Twins.

PubMed

Andersen, Michael Asger; Bjerrum, Ole Weis; Ranjan, Ajenthen; Skov, Vibe; Kruse, Torben A; Thomassen, Mads; Skytthe, Axel; Hasselbalch, Hans Carl; Christensen, Kaare

2018-01-01

Myeloproliferative neoplasms (MPNs) are a heterogeneous group of diseases characterized by clonal hyperproliferation of immature and mature cells of the myeloid lineage. Genetic differences have been proposed to play a role in the development of MPNs. Monozygotic twin pairs with MPNs have been reported in a few case reports, but the MPN concordance pattern in twins remains unknown. All twin pairs born in the period 1900-2010 were identified in the nationwide Danish Twin Registry. Only pairs with both twins alive on January 1, 1977, and those born thereafter were included to allow identification in the Danish National Patient Registry. A total of 158 twin pairs were registered with an MPN diagnosis: 36 monozygotic, 104 dizygotic, and 18 pairs with unknown zygosity. MPNs were diagnosed in both twins in 4 pairs. The probandwise concordance rates for monozygotic twin pairs were higher than for dizygotic twin pairs (15 vs. 0%; p = 0.016). An estimated concordance rate of 15% (95% CI 0.059-0.31) is modest, but given the rarity of MPNs this finding is clinically relevant and provides further support for the role of genetic predisposition in the development of MPNs. © 2018 S. Karger AG, Basel.

Deactylase inhibition in myeloproliferative neoplasms

PubMed Central

Mithraprabhu, Sridurga; Grigoriadis, George; Khong, Tiffany

2010-01-01

Summary Myeloproliferative neoplasms (MPN) are clonal haemopoietic progenitor cell disorders characterized by the proliferation of one or more of the haemopoietic lineages (myeloid, erythroid and/or megakaryocytic). The MPNs include eight haematological disorders: chronic myelogenous leukemia (CML), polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF), systemic mastocytosis (SM), chronic eosinophilic leukemia, not otherwise specified (CEL, NOS), chronic neutrophilic leukemia (CNL), and unclassifiable MPN (MPN, U). Therapeutic interventions for MPNs include the use of tyrosine kinase inhibitors (TKIs) for BCR-ABL1+ CML and JAK2 inhibitors for PV, ET and PMF. Histone deacetylase inhibitors (HDACi) are a novel class of drugs capable of altering the acetylation status of both histone and non-histone proteins, thereby affecting a repertoire of cellular functions in neoplastic cells including proliferation, differentiation, immune responses, angiogenesis and survival. Preliminary studies indicate that HDACi when used in combination with tyrosine kinase or JAK2 inhibitors may overcome resistance to the latter agents and enhance the pro-apoptotic effects on MPN cells. This review provides a review of pre-clinical and clinical studies that have explored the use of HDACi as potential therapeutics for MPNs. PMID:21127942

Molecular diagnostics of myeloproliferative neoplasms.

PubMed

Langabeer, Stephen E; Andrikovics, Hajnalka; Asp, Julia; Bellosillo, Beatriz; Carillo, Serge; Haslam, Karl; Kjaer, Lasse; Lippert, Eric; Mansier, Olivier; Oppliger Leibundgut, Elisabeth; Percy, Melanie J; Porret, Naomi; Palmqvist, Lars; Schwarz, Jiri; McMullin, Mary F; Schnittger, Susanne; Pallisgaard, Niels; Hermouet, Sylvie

2015-10-01

Since the discovery of the JAK2 V617F mutation in the majority of the myeloproliferative neoplasms (MPN) of polycythemia vera, essential thrombocythemia and primary myelofibrosis ten years ago, further MPN-specific mutational events, notably in JAK2 exon 12, MPL exon 10 and CALR exon 9 have been identified. These discoveries have been rapidly incorporated into evolving molecular diagnostic algorithms. Whilst many of these mutations appear to have prognostic implications, establishing MPN diagnosis is of immediate clinical importance with selection, implementation and the continual evaluation of the appropriate laboratory methodology to achieve this diagnosis similarly vital. The advantages and limitations of these approaches in identifying and quantitating the common MPN-associated mutations are considered herein with particular regard to their clinical utility. The evolution of molecular diagnostic applications and platforms has occurred in parallel with the discovery of MPN-associated mutations, and it therefore appears likely that emerging technologies such as next-generation sequencing and digital PCR will in the future play an increasing role in the molecular diagnosis of MPN. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Perivascular epithelioid cell neoplasms: pathology and pathogenesis.

PubMed

Folpe, Andrew L; Kwiatkowski, David J

2010-01-01

This review article summarizes our current understanding of the clinical, pathologic, immunohistochemical, and genetic aspects of perivascular epithelioid cell neoplasms, a rare group of related tumors defined by both morphologic and immunophenotypic criteria.

Treatment Options for Chronic Myeloproliferative Neoplasms

MedlinePlus

... are described below. Chronic myeloproliferative neoplasms sometimes become acute leukemia , in which too many abnormal white blood ... higher. Patients also have an increased risk of acute myeloid leukemia or primary myelofibrosis . Symptoms of polycythemia ...

Treatment Option Overview (Chronic Myeloproliferative Neoplasms)

MedlinePlus

... are described below. Chronic myeloproliferative neoplasms sometimes become acute leukemia , in which too many abnormal white blood ... higher. Patients also have an increased risk of acute myeloid leukemia or primary myelofibrosis . Symptoms of polycythemia ...

General Information about Chronic Myeloproliferative Neoplasms

MedlinePlus

... are described below. Chronic myeloproliferative neoplasms sometimes become acute leukemia , in which too many abnormal white blood ... higher. Patients also have an increased risk of acute myeloid leukemia or primary myelofibrosis . Symptoms of polycythemia ...

Pathological and Molecular Evaluation of Pancreatic Neoplasms

PubMed Central

Rishi, Arvind; Goggins, Michael; Wood, Laura D.; Hruban, Ralph H.

2015-01-01

Pancreatic neoplasms are morphologically and genetically heterogeneous and include wide variety of neoplasms ranging from benign to malignant with an extremely poor clinical outcome. Our understanding of these pancreatic neoplasms has improved significantly with recent advances in cancer sequencing. Awareness of molecular pathogenesis brings in new opportunities for early detection, improved prognostication, and personalized gene-specific therapies. Here we review the pathological classification of pancreatic neoplasms from their molecular and genetic perspective. All of the major tumor types that arise in the pancreas have been sequenced, and a new classification that incorporates molecular findings together with pathological findings is now possible (Table 1). This classification has significant implications for our understanding of why tumors aggregate in some families, for the development of early detection tests, and for the development of personalized therapies for patients with established cancers. Here we describe this new classification using the framework of the standard histological classification. PMID:25726050

Multiple abdominal cysts in a patient with Gorlin-Goltz syndrome: a case report.

PubMed

Haenen, F; Hubens, G; Creytens, D; Vaneerdeweg, W

2013-01-01

A rare case of symptomatic mesenteric cysts in a patient with Gorlin-Goltz syndrome, associated with various neoplasms, is presented. The patient, known with Gorlin-Goltz syndrome, consulted with increasingly severe abdominal pain and large abdominal cysts. At surgery, the cysts were excised and the postoperative course was uneventful. In conclusion, this case reminds clinicians to always maintain a wide differential diagnosis when dealing with patients known with Gorlin-Goltz syndrome.

Mucinous cystic neoplasms of the mesentery: a case report and review of the literature

PubMed Central

Metaxas, Georgios; Tangalos, Athanasios; Pappa, Polyxeni; Papageorgiou, Irene

2009-01-01

Background Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites. While their pathogenesis remains conjectural, their similarities suggest a common pathway of development. There have been rare reports involving the mesentery as a primary tumour site. Case presentation A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain. At laparotomy, the mass was fixed within the colonic mesentery. Histology demonstrated a benign mucinous cystadenoma. Methods and results We review the literature on mucinous cystic neoplasms of the mesentery and report on the pathogenesis, biologic behavior, diagnosis and treatment of similar extra-ovarian tumors. We propose an updated classification of mesenteric cysts and cystic tumors. Conclusion Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. An updated classification of mesenteric cysts and cystic tumors is proposed. PMID:19454018

An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report.

PubMed

Shimodaira, Masanori; Kitano, Tomohiro; Kibata, Minoru; Shirahata, Kumiko

2013-01-18

Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient's left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.

Autoimmunity and the risk of myeloproliferative neoplasms

PubMed Central

Kristinsson, Sigurdur Y.; Landgren, Ola; Samuelsson, Jan; Björkholm, Magnus; Goldin, Lynn R.

2010-01-01

The causes of myeloproliferative neoplasm (MPN) are unknown. We conducted a large population-based study including 11,039 myeloproliferative neoplasm patients and 43,550 matched controls with the aim of assessing the associations between a personal history of a broad span of autoimmune diseases and subsequent risk of myeloproliferative neoplasm. We found a prior history of any autoimmune disease to be associated with a significantly increased risk of myeloproliferative neoplasms (odds ratio (OR)=1.2; 95% confidence interval (CI) 1.0–1.3; P=0.021). Specifically, we found an increased risk of MPNs associated with a prior immune thrombocytopenic purpura (2.9; 1.7–7.2), Crohn’s disease (1.8; 1.1–3.0), polymyalgia rheumatica (1.7; 1.2–2.5), giant cell arteritis (5.9; 2.4–14.4), Reiter’s syndrome (15.9; 1.8–142) and aplastic anemia (7.8; 3.7–16.7). The risk of myeloproliferative neoplasms associated with prior autoimmune diseases is modest but statistically significant. Future studies are needed to unravel the effects of these autoimmune diseases themselves, their treatment, or common genetic susceptibility. PMID:20053870

[Pancreatic acinar neoplasms : Comparative molecular characterization].

PubMed

Bergmann, F

2016-11-01

Pancreatic acinar cell carcinomas are biologically aggressive neoplasms for which treatment options are very limited. The molecular mechanisms of tumor initiation and progression are largely not understood and precursor lesions have not yet been identified. In this study, pancreatic acinar cell carcinomas were cytogenetically characterized as well as by molecular and immunohistochemical analyses. Corresponding investigations were carried out on pancreatic ductal adenocarcinomas and pancreatic neuroendocrine neoplasms augmented by functional analyses. We show that pancreatic acinar cell carcinomas display a microsatellite stable, chromosomal unstable genotype, characterized by recurrent chromosomal imbalances that clearly discriminate them from pancreatic ductal adenocarcinomas and neuroendocrine neoplasms. Based on findings obtained from comparative genomic hybridization, candidate genes could be identified, such as deleted in colorectal cancer (DCC) and c-MYC. Furthermore, several therapeutic targets were identified in acinar cell carcinomas and other pancreatic neoplasms, including epidermal growth factor receptor (EGFR), L1 cell adhesion molecule (L1CAM) and heat shock protein 90 (HSP90). Moreover, L1CAM was shown to play a significant role in the tumorigenesis of pancreatic ductal adenocarcinoma. Functional analyses in cell lines derived from pancreatic neuroendocrine neoplasms revealed promising anti-tumorigenic effects using EGFR and HSP90 inhibitors affecting the cell cycle and in the case of HSP90, regulating several other oncogenes. Finally, based on mutational analyses of mitochondrial DNA, molecular evidence is provided that acinar cell cystadenomas (or better cystic acinar transformation) represent non-clonal lesions, suggesting an inflammatory reactive non-neoplastic nature.

Biliary papillary neoplasm of the liver.

PubMed

Nakanuma, Y; Sasaki, M; Ishikawa, A; Tsui, W; Chen, T C; Huang, S F

2002-01-01

Biliary papillary neoplasia of the liver characterized by intraductal papillary growth of neoplastic biliary epithelia with a fine fibrovascular stalk has been sporadically reported, and includes intraductal growing cholangiocarcinoma and biliary papillomatosis. In addition, biliary papillary dysplasia and in situ and microinvasive carcinoma with papillary configuration reported in hepatolithiasis and in other chronic biliary diseases, could be included in this category. Usually, they arise in the intrahepatic large bile ducts, and the neoplastic and non-neoplastic parts of the intrahepatic biliary tree show saccular and segmental dilatation with mucin hypersecretion. This neoplasia frequently shows intraductal spreading and peribiliary glandular involvement. Acute repeated episodes of cholangitis or obstructive jaundice are a frequent clinical manifestation. Gastroenteric metaplasia with aberrant expression of cytokeratin 20, MUC2, MUC5AC, and/or MUC6, is frequent in the neoplastic parts, and biliary epithelial dysplasia with such metaplasia may give rise to in situ and then invasive carcinoma in hepatolithiasis. Interestingly, this type tends to contain foci of mucinous carcinoma elements, and this element may be predominant (mucinous carcinoma). Some may progress to "mucinous biliary cystadenocarcinoma" without ovarian mesenchymal stroma and with intraluminal continuous growth into the neighboring bile duct lumens. Interestingly, the biliary papillary neoplasm resembles histologically, phenotypically and clinically intraductal papillary mucinous neoplasm of the pancreas which is now being established as an infrequent, slow-growing pancreatic neoplasm. Recognition of such biliary papillary neoplasm with respect to the pancreatic equivalent may lead to a better understanding and further studies of the intrahepatic biliary neoplasm.

Mechanisms of postprandial abdominal bloating and distension in functional dyspepsia.

PubMed

Burri, Emanuel; Barba, Elizabeth; Huaman, Jose Walter; Cisternas, Daniel; Accarino, Anna; Soldevilla, Alfredo; Malagelada, Juan-R; Azpiroz, Fernando

2014-03-01

Patients with irritable bowel syndrome and abdominal bloating exhibit abnormal responses of the abdominal wall to colonic gas loads. We hypothesised that in patients with postprandial bloating, ingestion of a meal triggers comparable abdominal wall dyssynergia. Our aim was to characterise abdominal accommodation to a meal in patients with postprandial bloating. A test meal (0.8 kcal/ml nutrients plus 27 g/litre polyethylenglycol 4000) was administered at 50 ml/min as long as tolerated in 10 patients with postprandial bloating (fulfilling Rome III criteria for postprandial distress syndrome) and 12 healthy subjects, while electromyographic (EMG) responses of the anterior wall (upper and lower rectus, external and internal oblique via bipolar surface electrodes) and the diaphragm (via six ring electrodes over an oesophageal tube in the hiatus) were measured. Means +/- SD were calculated. Healthy subjects tolerated a meal volume of 913±308 ml; normal abdominal wall accommodation to the meal consisted of diaphragmatic relaxation (EMG activity decreased by 15±6%) and a compensatory contraction (25±9% increase) of the upper abdominal wall muscles (upper rectus and external oblique), with no changes in the lower anterior muscles (lower rectus and internal oblique). Patients tolerated lower volume loads (604±310 ml; p=0.030 vs healthy subjects) and developed a paradoxical response, that is, diaphragmatic contraction (14±3% EMG increment; p<0.01 vs healthy subjects) and upper anterior wall relaxation (9±4% inhibition; p<0.01 vs healthy subjects). In functional dyspepsia, postprandial abdominal distension is produced by an abnormal viscerosomatic response to meal ingestion that alters normal abdominal accommodation.

Silent Presentation of a Solid Pseudopapillary Neoplasm of the Pancreas.

PubMed

Rivera, Melisa; Lara-Del Rio, Jose A; Di Pasquale-Guadalupe, Lorena; Zequeira, Jorge

2017-06-12

BACKGROUND Solid pseudopapillary neoplasm (SPN) is a rare tumor frequently found in the head or tail of the pancreas. It mainly presents in young women between the 2nd and 3rd decades of life. A predilection for African Americans and Asians has been observed and is rarely reported in children. Most patients are symptomatic, with abdominal pain as the most common presenting symptom. Clinical laboratory test results are usually normal and pancreatic markers are not typically elevated. Metastatic disease is very uncommon, but most often metastasizes to the liver and regional lymph nodes. Prognosis is usually excellent after surgical resection. CASE REPORT We present the case of a 14-year-old Hispanic female who presented to the emergency department after a high-speed motor vehicle accident. She suffered multiple body traumas. Specifically, the patient referred severe epigastric pain. No significant past medical or surgical history was obtained. Laboratory workup was non-contributory. Further evaluation with abdomen and pelvis contrast-enhanced computed tomography and magnetic resonance imaging revealed a pancreatic tail mass. Distal pancreatectomy followed. Pathologic diagnosis of SPN was established. CONCLUSIONS SPN is a rare exocrine tumor with excellent prognosis following resection. Imaging findings are suggestive, but a pathology evaluation is necessary to make the final diagnosis. Differential diagnosis includes entities such as mucinous cystic pancreatic tumor, pancreatic ductal carcinoma, and pancreatic serous cystadenoma. Radiologists play a vital role in the diagnosis, since many times, as in our case, it presents as an incidental finding. A small percentage of SPN neoplasms are associated with metastasis or local recurrence. Therefore, the aim of our case presentation is to review key imaging findings to guide early management and surgical planning.

Aggressive Management of Peritoneal Carcinomatosis from Mucinous Appendiceal Neoplasms

PubMed Central

Austin, Frances; Mavanur, Arun; Sathaiah, Magesh; Steel, Jennifer; Lenzner, Diana; Ramalingam, Lekshmi; Holtzman, Matthew; Ahrendt, Steven; Pingpank, James; Zeh, Herbert J.; Bartlett, David L.; Choudry, Haroon A.

2014-01-01

Background Peritoneal carcinomatosis (PC) in the setting of mucinous appendiceal neoplasms is characterized by the intraperitoneal accumulation of mucinous ascites and mucin-secreting epithelial cells that leads to progressive compression of intra-abdominal organs, morbidity, and eventual death. We assessed postoperative and oncologic outcomes after aggressive surgical management by experienced surgeons. Methods We analyzed clinicopathologic, perioperative, and oncologic outcome data in 282 patients with PC from appendiceal adenocarcinomas between 2001 and 2010 from a prospective database. Kaplan–Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting oncologic outcomes. Results Adequate cytoreduction was achieved in 82% of patients (completeness of cytoreduction score (CC)-0: 49%; CC-1: 33%). Median simplified peritoneal cancer index (SPCI), operative time, and estimated blood loss were 14 (range, 0–21), 483.5 min (range, 46–1,402), and 800 ml (range, 0–14,000), respectively. Pathology assessment demonstrated high-grade tumors in 36% of patients and lymph node involvement in 23% of patients. Major postoperative morbidity occurred in 70 (25%) patients. Median overall survival was 6.72 years (95% confidence interval (CI), 4.17 years not reached), with 5 year overall survival probability of 52.7% (95% CI, 42.4, 62%). In a multivariate Cox-regression model, tumor grade, age, preoperative SPCI and chemo-naïve status at surgery were joint significant predictors of overall survival. Tumor grade, postoperative CC-score, prior chemotherapy, and preoperative SPCI were joint significant predictors of time to progression. Conclusions Aggressive management of PC from mucinous appendiceal neoplasms, by experienced surgeons, to achieve complete cytoreduction provides long-term survival with low major morbidity. PMID:22302270

Skin neoplasms of dogs in Sydney.

PubMed

Rothwell, T L; Howlett, C R; Middleton, D J; Griffiths, D A; Duff, B C

1987-06-01

In a survey of dogs in Sydney, mastocytomas (16.1%) and histiocytomas (14.0%) were the most common in a total of 1,000 skin neoplasms. The basal cell and appendage group provided 25.5% of the neoplasms. The prevalence of the various neoplasms, the age of affected dogs, the proportion in the sexes, the common sites of occurrence and prevalence in the different breeds were broadly similar to findings in surveys in other countries, except that in the Syndeny dogs there was a greater prevalence of histiocytomas and haemangiopericytomas, a more common occurrence of histiocytomas in mature dogs, an occurrence of histiocytomas in similar numbers on the head, trunk and limbs, and a remarkably common development of squamous cell carcinomas in Dalmatians.

Pathology and Molecular Genetics of Pancreatic Neoplasms

PubMed Central

Wood, Laura D.; Hruban, Ralph H.

2014-01-01

Cancer is fundamentally a genetic disease caused by the ac cumulation of somatic mutations in oncogenes and tumor suppressor genes. In the last decade, rapid advances in sequencing and bioinformatic technology led to an explosion in sequencing studies of cancer genomes, greatly expanding our knowledge of the genetic changes underlying a variety of tumor types. Several of these studies of cancer genomes have focused on pancreatic neoplasms, and cancers from the pancreas are some of the best characterized tumors at the genetic level. Pancreatic neoplasms encompass a wide array of clinical diseases, from benign cysts to deadly cancers, and the genetic alterations underlying neoplasms of the pancreas are similarly diverse. This new knowledge of pancreatic cancer genomes has deepened our understanding of tumorigenesis in the pancreas and has opened several promising new avenues for novel diagnostics and therapeutics. PMID:23187835

Diagnostic Approach to Eosinophilic Renal Neoplasms

PubMed Central

Kryvenko, Oleksandr N.; Jorda, Merce; Argani, Pedram; Epstein, Jonathan I.

2015-01-01

Context Eosinophilic renal neoplasms include a spectrum of solid and papillary tumors ranging from indolent benign oncocytoma to highly aggressive malignancies. Recognition of the correct nature of the tumor, especially in biopsy specimens, is paramount for patient management. Objective To review the diagnostic approach to eosinophilic renal neoplasms with light microscopy and ancillary techniques. Data Sources Review of the published literature and personal experience. Conclusions The following tumors are in the differential diagnosis of oncocytic renal cell neoplasm: oncocytoma, chromophobe renal cell carcinoma (RCC), hybrid tumor, tubulocystic carcinoma, papillary RCC, clear cell RCC with predominant eosinophilic cell morphology, follicular thyroid-like RCC, hereditary leiomyomatosis–associated RCC, acquired cystic disease–associated RCC, rhabdoid RCC, microphthalmia transcription factor translocation RCC, epithelioid angiomyolipoma, and unclassified RCC. In low-grade nonpapillary eosinophilic neoplasms, distinction between oncocytoma and low-grade RCC mostly rests on histomorphology; however, cytokeratin 7 immunostain may be helpful. In high-grade nonpapillary lesions, there is more of a role for ancillary techniques, including immunohistochemistry for cytokeratin 7, CA9, CD10, racemase, HMB45, and Melan-A. In papillary eosinophilic neoplasms, it is important to distinguish sporadic type 2 papillary RCC from microphthalmia transcription factor translocation and hereditary leiomyomatosis–associated RCC. Histologic and cytologic features along with immunohistochemistry and fluorescence in situ hybridization tests for TFE3 (Xp11.2) and TFEB [t(6;11)] are reliable confirmatory tests. Eosinophilic epithelial neoplasms with architecture, cytology, and/or immunoprofile not qualifying for either of the established types of RCC should be classified as unclassified eosinophilic RCC and arbitrarily assigned a grade (low or high). PMID:25357116

Intraductal papillary mucinous neoplasm penetrating to the stomach, duodenum, and jejunum demonstrated on MR cholangiopancreatography with an oral negative contrast agent.

PubMed

Tajima, Naoshi; Utano, Kenichi; Kijima, Shigeyoshi; Kawai, Akira; Fujita, Akifumi; Sakuma, Kazuya; Sugimoto, Hideharu; Fujii, Hirofumi

2013-07-01

A 65-year-old man was referred to our hospital due to epigastric pain. Abdominal enhanced computed tomography (CT) demonstrated marked dilatation of the main pancreatic duct (MPD) and communication to the gastric and duodenal lumen was suspected. Esophagogastroduodenoscopy (EGD) showed a villous tumor with white mucous discharge in the posterior wall of the gastric corpus and duodenal bulb. Pathological specimens showed mucin-producing epithelium with nuclear atypia that had developed in a papillary form. Based on these findings, we diagnosed intraductal papillary mucinous neoplasm (IPMN) arising in the MPD with penetration into the gastric and duodenal lumen. Magnetic resonance cholangiopancreatography (MRCP) with an oral negative contrast agent (manganese chloride tetrahydrate) showed a fistulous tract not only to the stomach and duodenum, but also to the jejunum. MRCP demonstrated mucous streaming with remarkably high intensity. In this case, an oral negative contrast agent was useful to distinguish mucous discharge from gastric fluid, facilitating the diagnosis of penetration to the jejunum. This finding was unobtainable by CT or EGD. When IPMN penetrating to other organs is suspected, MRCP with an oral negative contrast agent may provide important information. Copyright © 2012 Wiley Periodicals, Inc.

Chronic myeloproliferative neoplasms in the elderly.

PubMed

Maffioli, Margherita; Orlandi, Ester; Passamonti, Francesco

2018-05-22

This review focuses on the management of elderly patients with chronic myeloid leukemia and chronic myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia and primary myelofibrosis. Median age in these neoplasms is within the 6th decades of age. All new therapies can be done at any age without absolute contraindication. However, the selection of the precise therapy for the single patient is mandatory. For these reasons, an accurate definition of diagnosis and prognostication is necessary. Precision in disease definition and prognostication is definitively helpful for personalizing therapeutic approach. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Radiology of pancreatic neoplasms: An update

PubMed Central

de la Santa, Luis Gijón; Retortillo, José Antonio Pérez; Miguel, Ainhoa Camarero; Klein, Lea Marie

2014-01-01

Diagnostic imaging is an important tool to evaluate pancreatic neoplasms. We describe the imaging features of pancreatic malignancies and their benign mimics. Accurate detection and staging are essential for ensuring appropriate selection of patients who will benefit from surgery and for preventing unnecessary surgeries in patients with unresectable disease. Ultrasound, multidetector computed tomography with multiplanar reconstruction and magnetic resonance imaging can help to do a correct diagnosis. Radiologists should be aware of the wide variety of anatomic variants and pathologic conditions that may mimic pancreatic neoplasms. The knowledge of the most important characteristic key findings may facilitate the right diagnosis. PMID:25232458

Radiology of pancreatic neoplasms: An update.

PubMed

de la Santa, Luis Gijón; Retortillo, José Antonio Pérez; Miguel, Ainhoa Camarero; Klein, Lea Marie

2014-09-15

Diagnostic imaging is an important tool to evaluate pancreatic neoplasms. We describe the imaging features of pancreatic malignancies and their benign mimics. Accurate detection and staging are essential for ensuring appropriate selection of patients who will benefit from surgery and for preventing unnecessary surgeries in patients with unresectable disease. Ultrasound, multidetector computed tomography with multiplanar reconstruction and magnetic resonance imaging can help to do a correct diagnosis. Radiologists should be aware of the wide variety of anatomic variants and pathologic conditions that may mimic pancreatic neoplasms. The knowledge of the most important characteristic key findings may facilitate the right diagnosis.

Child with Abdominal Pain.

PubMed

Iyer, Rajalakshmi; Nallasamy, Karthi

2018-01-01

Abdominal pain is one of the common symptoms reported by children in urgent care clinics. While most children tend to have self-limiting conditions, the treating pediatrician should watch out for underlying serious causes like intestinal obstruction and perforation peritonitis, which require immediate referral to an emergency department (ED). Abdominal pain may be secondary to surgical or non-surgical causes, and will differ as per the age of the child. The common etiologies for abdominal pain presenting to an urgent care clinic are acute gastro-enteritis, constipation and functional abdominal pain; however, a variety of extra-abdominal conditions may also present as abdominal pain. Meticulous history taking and physical examination are the best tools for diagnosis, while investigations have a limited role in treating benign etiologies.

Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback.

PubMed

Barba, Elizabeth; Burri, Emanuel; Accarino, Anna; Cisternas, Daniel; Quiroga, Sergi; Monclus, Eva; Navazo, Isabel; Malagelada, Juan-R; Azpiroz, Fernando

2015-04-01

In patients with functional gut disorders, abdominal distension has been associated with descent of the diaphragm and protrusion of the anterior abdominal wall. We investigated mechanisms of abdominal distension in these patients. We performed a prospective study of 45 patients (42 women, 24-71 years old) with functional intestinal disorders (27 with irritable bowel syndrome with constipation, 15 with functional bloating, and 3 with irritable bowel syndrome with alternating bowel habits) and discrete episodes of visible abdominal distension. Subjects were assessed by abdominothoracic computed tomography (n = 39) and electromyography (EMG) of the abdominothoracic wall (n = 32) during basal conditions (without abdominal distension) and during episodes of severe abdominal distension. Fifteen patients received a median of 2 sessions (range, 1-3 sessions) of EMG-guided, respiratory-targeted biofeedback treatment; 11 received 1 control session before treatment. Episodes of abdominal distension were associated with diaphragm contraction (19% ± 3% increase in EMG score and 12 ± 2 mm descent; P < .001 vs basal values) and intercostal contraction (14% ± 3% increase in EMG scores and 6 ± 1 mm increase in thoracic antero-posterior diameter; P < .001 vs basal values). They were also associated with increases in lung volume (501 ± 93 mL; P < .001 vs basal value) and anterior abdominal wall protrusion (32 ± 3 mm increase in girth; P < .001 vs basal). Biofeedback treatment, but not control sessions, reduced the activity of the intercostal muscles (by 19% ± 2%) and the diaphragm (by 18% ± 4%), activated the internal oblique muscles (by 52% ± 13%), and reduced girth (by 25 ± 3 mm) (P ≤ .009 vs pretreatment for all). In patients with functional gut disorders, abdominal distension is a behavioral response that involves activity of the abdominothoracic wall. This distension can be reduced with EMG-guided, respiratory-targeted biofeedback therapy. Copyright © 2015 AGA

Abdominal exploration - slideshow

MedlinePlus

... ency/presentations/100049.htm Abdominal exploration - series—Normal ... intestine (jejunum and ileum), the large intestine (colon), the liver, the spleen, the gallbladder, the pancreas, the uterus, ...

How useful is abdominal ultrasonography in dogs with diarrhoea?

PubMed

Mapletoft, E K; Allenspach, K; Lamb, C R

2018-01-01

To assess the utility of abdominal ultrasonography in the diagnostic work-up of dogs with diarrhoea. Retrospective cross-sectional study based on a referral population of dogs with diarrhoea. Associations between the clinical signs, use of abdominal ultrasonography, results of abdominal ultrasonography and subsequent work-up were examined. The utility of abdominal ultrasonography was scored as high, moderate, none or counterproductive based on review of medical records. Medical records of 269 dogs were reviewed, of which 149 (55%) had abdominal ultrasonography. The most frequent result was no ultrasonographic abnormalities affecting the intestine in 65 (44%) dogs. Ultrasonography results were associated with subsequent work-up as follows: (1) no detected abnormalities and dietary trial; (2) focal thickening of the intestinal wall, loss of intestinal wall layers or enlarged abdominal lymph nodes and ultrasound-guided fine-needle aspirates; (3) diffuse thickening of the intestinal wall or hyperechoic striations in the small intestinal mucosa and endoscopy; and (4) small intestinal foreign body and coeliotomy. Abdominal ultrasonography was considered to be diagnostic without further testing in only four (3%) dogs: two had a portosystemic shunt identified ultrasonographically, one had a linear foreign body and one had a perforated pyloric ulcer. Abdominal ultrasonography had moderate utility in 56 (38%) dogs and no utility in 79 (53%) dogs. Abdominal ultrasonography was considered counterproductive in 10 (7%) dogs because results were either falsely negative or falsely positive. These results should prompt clinicians to reconsider routine use of abdominal ultrasonography in dogs with diarrhoea. © 2017 British Small Animal Veterinary Association.

Philadelphia-negative chronic myeloproliferative neoplasms

PubMed Central

Bittencourt, Rosane Isabel; Vassallo, Jose; Chauffaille, Maria de Lourdes Lopes Ferrari; Xavier, Sandra Guerra; Pagnano, Katia Borgia; Nascimento, Ana Clara Kneese; De Souza, Carmino Antonio; Chiattone, Carlos Sergio

2012-01-01

Chronic myeloproliferative diseases without the Philadelphia chromosome marker (Ph-), although first described 60 years ago, only became the subject of interest after the turn of the millennium. In 2001, the World Health Organization (WHO) defined the classification of this group of diseases and in 2008 they were renamed myeloproliferative neoplasms based on morphological, cytogenetic and molecular features. In 2005, the identification of a recurrent molecular abnormality characterized by a gain of function with a mutation in the gene encoding Janus kinase 2 (JAK2) paved the way for greater knowledge of the pathophysiology of myeloproliferative neoplasms. The JAK2 mutation is found in 90-98% of polycythemia vera and in about 50% essential thrombocytosis and primary myelofibrosis. In addition to the JAK2 mutation, other mutations involving TET2 (ten-eleven translocation), LNK (a membrane-bound adaptor protein); IDH1/2 (isocitrate dehydrogenase 1/2 enzyme); ASXL1 (additional sex combs-like 1) genes were found in myeloproliferative neoplasms thus showing the importance of identifying molecular genetic alterations to confirm diagnosis, guide treatment and improve our understanding of the biology of these diseases. Currently, polycythemia vera, essential thrombocytosis, myelofibrosis, chronic neutrophilic leukemia, chronic eosinophilic leukemia and mastocytosis are included in this group of myeloproliferative neoplasms, but are considered different situations with individualized diagnostic methods and treatment. This review updates pathogenic aspects, molecular genetic alterations, the fundamental criteria for diagnosis and the best approach for each of these entities. PMID:23049404

[Therapy of orbital neoplasms in small animals].

PubMed

Spiess, B M; Rühli, M B; Bauer, G A

1995-10-01

The incidence, clinical signs and diagnostic work-up of orbital neoplasms is briefly discussed. The surgical management of such tumors is discussed in detail on the basis of three clinical cases. Long-term functional and cosmetic results are shown. Intraoperative and postoperative complications are discussed.

Calcified pancreatic and peripancreatic neoplasms: spectrum of pathologies.

PubMed

Verde, Franco; Fishman, Elliot K

2017-11-01

A variety of pancreatic and peripancreatic neoplasms may contain calcifications. We present a review of common to uncommon pancreatic neoplasms that may contain calcifications to include ductal adenocarcinoma, pancreatic neuroendocrine tumors, serous cystadenomas, solid pseudopapillary tumors, intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, and lymphoepithelial cysts. In addition, duodenal mucinous adenocarcinoma can present as a peripancreatic mass that may contain calcification. Knowledge of the spectrum of calcification patterns can help the interpreting radiologist provide a meaningful differential.

Abdominal Aortic Dissections

PubMed Central

Borioni, Raoul; Garofalo, Mariano; De Paulis, Ruggero; Nardi, Paolo; Scaffa, Raffaele; Chiariello, Luigi

2005-01-01

Isolated abdominal aortic dissections are rare events. Their anatomic and clinical features are different from those of atherosclerotic aneurysms. We report 4 cases of isolated abdominal aortic dissection that were successfully treated with surgical or endovascular intervention. The anatomic and clinical features and a review of the literature are also presented. PMID:15902826

Abdominal Trauma Revisited.

PubMed

Feliciano, David V

2017-11-01

Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.

Pancreatic mixed serous neuroendocrine neoplasm with clear cells leading to diagnosis of von Hippel Lindau disease.

PubMed

Kakkar, Aanchal; Sharma, Mehar C; Yadav, Rajni; Panwar, Rajesh; Mathur, Sandeep R; Iyer, Venkateswaran K; Sahni, Peush

2016-08-01

Mixed serous neuroendocrine neoplasms are extremely rare tumors that are usually seen in female patients and are often associated with von Hippel Lindau (VHL) disease. We describe the case of a 38-year-old male who presented with complaints of anorexia, weight loss, and abdominal pain. CT abdomen showed a mass in the head of the pancreas, multiple small nodules in the body of pancreas, and bilateral adrenal masses. Fine needle aspiration cytology (FNAC) from the mass showed features of a neuroendocrine tumor, with many of the cells demonstrating abundant clear cytoplasm. Histopathological examination of the pancreaticoduodenectomy specimen showed a mixed serous neuroendocrine neoplasm with two components viz. serous cystadenoma and neuroendocrine tumor (NET) World Health Organization (WHO) grade 2. In addition, he was diagnosed to have bilateral pheochromocytomas and a paraganglioma. The synchronicity of these tumors suggested the possibility of VHL disease. Thus, identification of a NET with clear cells or of a mixed serous neuroendocrine neoplasm should raise suspicion of VHL disease. In a mixed tumor, FNAC may identify only one of the two components. Thorough processing of all pancreatic serous tumors for pathological examination is recommended, as NET may occur as a small nodule within the serous cystadenoma. Copyright © 2016 Elsevier GmbH. All rights reserved.

Diffuse Peritoneal and Bowel Wall Infiltration by Light Chain-AL Amyloidosis with Omental Calcification Mimicking Abdominal Carcinomatosis - An Elderly Female with Incidental Finding of Light Chain Monoclonal Gammopathy of Undetermined Significance (LC-MGUS).

PubMed

Junejo, Shoaib; Ali, Yasir; Singh Lubana, Sandeep; Tuli, Sandeep S

2017-11-25

BACKGROUND Amyloidosis is the extracellular tissue deposition of plasma proteins, which after conformational changes, forms antiparallel beta pleated sheets of fibrils. Amyloid light-chain (AL) is a type of amyloidosis that is due to deposition of proteins derived from immunoglobulin (Ig) light chains. Gastrointestinal tract (GIT) involvement most often found in amyloid A (AA) amyloidosis type. There have been no reports of obstructive GIT AL amyloid patients having monoclonal gammopathy of undetermined significance (MGUS). Our case is the first case to show two coinciding conditions; one is the association of GIT AL amyloidosis with the incidental finding of a rare type of MGUS (LC-MGUS) and the other is the radiologic presentation of GIT amyloidosis with omental calcification mimicking the GIT malignancy. CASE REPORT A 68-year-old female presented with symptoms of partial bowel obstruction, including intermittent diffuse abdominal pain and constipation. After computed tomography (CT) abdomen and pelvis, an exploratory laparotomy was needed because of suspicion of abdominal carcinomatosis due to diffuse omental calcification. The tissue sent for biopsy surprisingly showed AL amyloidosis. The patient did not report any systemic symptoms. Further workup was advised to inquire about the plasma cell dyscrasia which eventually turned into a very rare version of MGUS knows as light chain MGUS (LC-MGUS). Following adequate resection of the involved structures, the patient was then placed on chemotherapy and successfully went into remission. CONCLUSIONS This case report illustrates that in an era of evidence based medicine, it is important to show through case reports the association of GIT AL amyloidosis with LC-MGUS, as the literature on this topic is lacking. It also points to the importance of timely intervention that can greatly enhance, not only the only the chances of remission but also prevention of further complications such as malignant transformation.

Anterior Cutaneous Nerve Entrapment Syndrome in a Pediatric Patient Previously Diagnosed With Functional Abdominal Pain: A Case Report.

PubMed

DiGiusto, Matthew; Suleman, M-Irfan

2018-03-23

Chronic abdominal pain is common in children and adolescents but challenging to diagnose, because practitioners may be concerned about missing serious occult disease. Abdominal wall pain is an often ignored etiology for chronic abdominal pain. Anterior cutaneous nerve entrapment syndrome causes abdominal wall pain but is frequently overlooked. Correctly diagnosing patients with anterior cutaneous nerve entrapment syndrome is important because nerve block interventions are highly successful in the remittance of pain. Here, we present the case of a pediatric patient who received a diagnosis of functional abdominal pain but experienced pain remittance after receiving a trigger-point injection and transverse abdominis plane block.

Perforated peptic ulcer associated with abdominal compartment syndrome.

PubMed

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

2008-11-01

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

Pseudotumors after primary abdominal lipectomy as a new sequela in patients with abdominal apron.

PubMed

Dragu, Adrian; Bach, Alexander D; Polykandriotis, Elias; Kneser, Ulrich; Horch, Raymund E

2009-11-01

Malnutrition and overweight is a common problem in modern societies. Primary abdominal lipectomy is a standard surgical tool in patients with these problems. However, unknown secondary problems result from recent advances in obesity surgery. Plication of the anterior musculoaponeurotic wall is a widely and commonly used operative technique during abdominoplasty. Many different plication techniques have been published. So far no common standard and long-term effectiveness is proven. In addition, there is no sufficient literature dealing with the postoperative risks of plication of the musculoaponeurotic wall. Four patients with development of pseudotumors were reviewed. All four patients received 12 months in advance a primary abdominal lipectomy including a vertical plication of the musculoaponeurotic wall. All four patients were females with mean age of 61 years and mean body mass index (BMI) of 37 kg/m(2). All four patients had developed a pseudotumor of the abdomen as a long-term complication more than 12 months after primary abdominal lipectomy including a vertical plication of the anterior rectus sheath. One should be aware of the potential long-term risk of secondary postoperative hematoma formation, with or without partial necrosis of the anterior rectus sheath after vertical plication of the anterior musculoaponeurotic wall. Viewed clinically and radiologically, such sequelas may appear as pseudotumor like masses and require immediate revision.

Computed Tomography (CT) Imaging of Injuries from Blunt Abdominal Trauma: A Pictorial Essay.

PubMed

Hassan, Radhiana; Abd Aziz, Azian

2010-04-01

Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.

Abdominal x-ray

MedlinePlus

... are, or may be, pregnant. Alternative Names Abdominal film; X-ray - abdomen; Flat plate; KUB x-ray ... Guidelines Viewers & Players MedlinePlus Connect for EHRs For Developers U.S. National Library of Medicine 8600 Rockville Pike, ...

Abdominal aortic aneurysm

MedlinePlus

... this problem include: Smoking High blood pressure Male gender Genetic factors An abdominal aortic aneurysm is most ... body from an aortic aneurysm, you will need surgery right away. If the aneurysm is small and ...

Abdominal CT scan

MedlinePlus

Computed tomography scan - abdomen; CT scan - abdomen; CT abdomen and pelvis ... An abdominal CT scan makes detailed pictures of the structures inside your belly very quickly. This test may be used to look ...

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 ...

Abdominal cocoon: sonographic features.

PubMed

Vijayaraghavan, S Boopathy; Palanivelu, Chinnusamy; Sendhilkumar, Karuppusamy; Parthasarathi, Ramakrishnan

2003-07-01

An abdominal cocoon is a rare condition in which the small bowel is encased in a membrane. The diagnosis is usually established at surgery. Here we describe the sonographic features of this condition.

Treatment by ultrasound-guided local infiltration in adhesion-related abdominal pain and intractable hiccups: A case report.

PubMed

Zhu, Dan; Gu, Zhi-Yong; Lin, Chia-Shiang; Nie, Fa-Chuan; Cui, Jian

2018-04-01

Abdominal pain and hiccups secondary to intra-abdominal adhesion are surgical complications that are often treated by painkillers and secondary surgeries with an unsatisfactory therapeutic effect. This study presents a new treatment method that uses ultrasound-guided local infiltration in peritoneal and abdominal wall adhesions in patients with hiccups and abdominal pain. A 62-year-old patient presented to our hospital with a history of intractable hiccups and abdominal pain for 30 years. Her abdominal examination revealed a scar with an approximate length of 10 cm on the abdominal umbilical plane; pressing the right scar area could simultaneously induce abdominal pain and hiccups. Intraperitoneal computed tomography examination clearly demonstrated that the bowel had no obvious expansion. Ultrasonographic examination found that peritoneal motility below the normal peritoneal adhesion regions was significantly slower than in the normal regions. The diagnosis of chronic postoperative pain syndrome was clear. The symptoms were significantly alleviated by a successful treatment with ultrasound-guided local infiltration in the peritoneal and abdominal wall scar adhesions. After 3 stages of hospitalization and 1 year of follow-up, the patient's abdominal wall pain was relieved by approximately 80% and hiccups were relieved by approximately 70%. The above treatment is a useful option for managing abdominal adhesion and accompanying pain or hiccups resulting from abdominal surgery. This method could ease the psychological and economic burden of patients and improve their quality of life.

Perspectives on testicular germ cell neoplasms.

PubMed

Cheng, Liang; Lyu, Bingjian; Roth, Lawrence M

2017-01-01

Our knowledge of testicular germ cell neoplasms has progressed in the last few decades due to the description of germ cell neoplasia in situ (GCNIS) and a variety of specific forms of intratubular germ cell neoplasia, the discovery of isochromosome 12p and its importance in the development of invasiveness in germ cell tumors (GCTs), the identification of specific transcription factors for GCTs, and the recognition that a teratomatous component in mixed GCT represents terminal differentiation. Isochromosome 12p and 12p overrepresentation, collectively referred to as 12p amplification, are fundamental abnormalities that account for many types of malignant GCTs of the testis. Embryonal carcinoma is common in the testis but rare in the ovary, whereas the converse is true for mature cystic teratoma. Spermatocytic tumor occurs only in the testis; it has not been described in the ovary or extragonadal sites. The origin of ovarian mature cystic teratoma is similar to that of prepubertal-type testicular teratoma and dermoid cyst at any age in that it arises from a nontransformed germ cell, whereas postpubertal-type testicular teratoma arises from a malignant germ cell, most commonly through the intermediary of GCNIS. Somatic neoplasms, often referred to as monodermal teratomas, arise not infrequently from mature cystic teratoma of the ovary, whereas such neoplasms are rare in testicular teratoma with the exception of carcinoid. Integration of classical morphologic observations and emerging novel molecular studies will result in better understanding of the pathogenesis of GCTs and will optimize patient therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Myeloproliferative neoplasms in five multiple sclerosis patients☆

PubMed Central

Thorsteinsdottir, Sigrun; Bjerrum, Ole Weis; Hasselbalch, Hans Carl

2013-01-01

The concurrence of myeloproliferative neoplasms (MPNs) and multiple sclerosis (MS) is unusual. We report five patients from a localized geographic area in Denmark with both MS and MPN; all the patients were diagnosed with MPNs in the years 2007–2012. We describe the patients' history and treatment. A potential link between MS and MPNs has not been previously recognized. This observation calls attention to potential environmental factors and/or previously unrecognized genetic factors predisposing these patients to both MS and MPNs. PMID:24371783

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. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Myxomatous neoplasms in the perineal region of baboons

PubMed Central

Wallace, Shannon M.; Szabo, Kathleen A.; Schlabritz-Loutsevitch, Natalia E.; Dick, Edward J.; Blanchard, Terrell W.; Hubbard, Gene B.

2012-01-01

Background In baboons, Papio sp. neoplasms tend to affect the hematopoietic system most commonly, with rare documentation of myxomatous neoplasms. In contrast, women can develop myxomatous masses within deep peripelvic tissues with some frequency during their reproductive years. Methods We have identified and examined, retrospectively, myxomatous perineal masses in twelve female baboons within one research facility and compared their histopathologic, immunohistochemical and electron microscopic features to their human variants. Results Our results indicate that these myxomatous neoplasms, in humans and non-human primates, share common features. Conclusion Further research, particularly molecular genetic analysis, may be needed to identify the baboon as a true animal model for myxomatous perineal neoplasms. PMID:19017193

Dysplastic intestinal-type metaplasia of appendiceal endometriosis: a mimic of low grade appendiceal mucinous neoplasm

PubMed Central

2014-01-01

We report an example of dysplastic intestinal-type metaplasia involving endometriosis of the appendix in a 45 year old woman. One other example of this phenomenon has been reported. As it occurs within the muscular wall of the appendix, confusion with low grade appendiceal mucinous neoplasm (LAMN) may occur. Evidence supporting the metaplastic nature of the intestinal epithelium is offered. As the initial pathological diagnosis was of invasive cancer with perforation of the appendix treatment consisted of peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC). Virtual slides The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1068246472111756. PMID:24559059

Abdominal pregnancy - Case presentation.

PubMed

Bohiltea, R; Radoi, V; Tufan, C; Horhoianu, I A; Bohiltea, C

2015-01-01

Abdominal pregnancy, a rare diagnosis, belongs to the ectopic pregnancy group, the leading cause of pregnancy related exitus. The positive diagnosis is very difficult to establish most often in an acute setting, leading to a staggering percent of feto-maternal morbidity and mortality. We present the case of 26-weeks-old abdominal pregnancy with partial feto-placental detachment in a patient, after hysteroscopy and in vitro fertilization, which until the acute symptoms that led to emergency laparotomy went unrecognized. The patient recovered completely and satisfactorily after surgery and, due to the high risk of uterine rupture with regard to a second pregnancy, opted for a surrogate mother. Abdominal pregnancy can be regarded as a difficult to establish diagnosis, with a greater chance in case of increased awareness. It is compulsory to be well informed in order not to be surprised by the diagnosis and to apply the correct treatment immediately as the morbidity and mortality rate is elevated.

Preincisional intraparietal Augmentin in abdominal operations.

PubMed Central

Pollock, A. V.; Evans, M.; Smith, G. M.

1989-01-01

A total of 624 consecutive eligible patients undergoing abdominal operations received a single preoperative dose of amoxycillin/clavulanic acid (1.2 g Augmentin) for the prophylaxis of surgical wound infection. They were randomised to have the antibiotic injected intravenously at induction of anaesthesia (n = 328) or infiltrated subcutaneously along the line of the proposed incision (n = 296). The incidence of wound infections was considerably lower in the group given the antibiotic into the abdominal wall (8.4% compared with 15.9%--chi 2 = 7.90, P = 0.005). No significant differences were found in the incidence of other major or minor infective or non-infective postoperative complications between the groups. It is concluded that preincisional intraparietal injection is more effective than intravenous injection of Augmentin for the prophylaxis of surgical wound infection. PMID:2523210

[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.

Abdominal collateral vein as an unconventional vascular access for hemodialysis in patient with central vein occlusion.

PubMed

Stróżecki, Paweł; Flisiński, Mariusz; Serafin, Zbigniew; Wiechecka-Korenkiewicz, Joanna; Manitius, Jacek

2014-01-01

A 65-year-old female patient with chronic kidney disease stage 5 and a history of spleen neoplasm with dissemination within peritoneum is presented. During 5 years of hemodialysis therapy, bilateral occlusion of brachiocephalic and iliac vein developed as a consequence of vein catheterization. An attempt to cannulate inferior vena cava was unsuccessful. A cannulation of dilated collateral abdominal veins with dialysis needles allowed to perform several hemodialysis sessions in the patient. © 2014 Wiley Periodicals, Inc.

Effect of exercise on hemodynamic conditions in the abdominal aorta.

PubMed

Taylor, C A; Hughes, T J; Zarins, C K

1999-06-01

The beneficial effect of exercise in the retardation of the progression of cardiovascular disease is hypothesized to be caused, at least in part, by the elimination of adverse hemodynamic conditions, including flow recirculation and low wall shear stress. In vitro and in vivo investigations have provided qualitative and limited quantitative information on flow patterns in the abdominal aorta and on the effect of exercise on the elimination of adverse hemodynamic conditions. We used computational fluid mechanics methods to examine the effects of simulated exercise on hemodynamic conditions in an idealized model of the human abdominal aorta. A three-dimensional computer model of a healthy human abdominal aorta was created to simulate pulsatile aortic blood flow under conditions of rest and graded exercise. Flow velocity patterns and wall shear stress were computed in the lesion-prone infrarenal aorta, and the effects of exercise were determined. A recirculation zone was observed to form along the posterior wall of the aorta immediately distal to the renal vessels under resting conditions. Low time-averaged wall shear stress was present in this location, along the posterior wall opposite the superior mesenteric artery and along the anterior wall between the superior and inferior mesenteric arteries. Shear stress temporal oscillations, as measured with an oscillatory shear index, were elevated in these regions. Under simulated light exercise conditions, a region of low wall shear stress and high oscillatory shear index remained along the posterior wall immediately distal to the renal arteries. Under simulated moderate exercise conditions, all the regions of low wall shear stress and high oscillatory shear index were eliminated. This numeric investigation provided detailed quantitative data on the effect of exercise on hemodynamic conditions in the abdominal aorta. Our results indicated that moderate levels of lower limb exercise are necessary to eliminate the flow

Advances in the Diagnosis of Neuroendocrine Neoplasms.

PubMed

Kulkarni, Harshad R; Singh, Aviral; Baum, Richard P

2016-09-01

Somatostatin receptor PET/CT using (68)Ga-labeled somatostatin analogs, is a mainstay for the evaluation of the somatostatin receptor status in neuroendocrine neoplasms. In addition, the assessment of glucose metabolism by (18)F-FDG PET/CT at diagnosis can overcome probable shortcomings of histopathologic grading. This offers a systematic theranostic approach for the management of neuroendocrine neoplasms, that is, patient selection for the appropriate treatment-surgery, somatostatin analogs, peptide receptor radionuclide therapy, targeted therapies like everolimus and sunitinib, or chemotherapy-and also for therapy response monitoring. Novel targets, for example, the chemokine receptor CXCR4 in higher-grade tumors and glucagon like peptide-1 receptor in insulinomas, appear promising for imaging. Scandium-44 and Copper-64, especially on account of their longer half-life (for pretherapeutic dosimetry) and cyclotron production (which favors mass production), might be the potential alternatives to (68)Ga for PET/CT imaging. The future of molecular imaging lies in Radiomics, that is, qualitative and quantitative characterization of tumor phenotypes in correlation with tumor genomics and proteomics, for a personalized cancer management. Copyright © 2016 Elsevier Inc. All rights reserved.

Splanchnic Vein Thrombosis in the Myeloproliferative Neoplasms.

PubMed

Akpan, Imo J; Stein, Brady Lee

2018-06-01

To review the epidemiology, diagnostic challenges, pathogenesis, and treatment strategies for patients with myeloproliferative neoplasm-associated splanchnic vein thrombosis. The epidemiology of myeloproliferative neoplasm-associated splanchnic vein thrombosis (MPN-SVT) has been well characterized. While typical MPN-associated thrombosis affects older patients and involves the arterial circulation, MPN-SVT mostly impacts younger women. An association with JAK2 V617F is well-known; recent studies have demonstrated only a weak association with CALR mutations. JAK inhibition may represent a novel treatment strategy, complementing anticoagulation, and management of portal hypertension. While the epidemiology has been well characterized, more work is needed to identify novel contributors to disease pathogenesis, beyond the JAK2 V617F mutation itself, and endothelial compromise. Testing for MPN mutations in the setting of non-cirrhotic SVT is commonplace; JAK2 V617F is the most likely to be identified. Testing for CALR or MPL mutations requires clinical judgement, though not unreasonable. The mainstay of therapy is indefinite anticoagulation; the role of direct oral anticoagulants is unclear. JAK inhibition may play a role in addressing associated splenomegaly and portal hypertension.

Chronic Myeloproliferative Neoplasms: a Collaborative Approach

PubMed Central

Pieri, Lisa; Guglielmelli, Paola; Vannucchi, Alessandro M.

2010-01-01

The classic chronic myeloproliferative neoplasms (MPN) include different entities that pose significant challenges for their optimal diagnosis, treatment and overall management. Polycythemia Vera and Essential Thrombocythemia are the most common among chronic myeloproliferative neoplasms (MPNs); major causes of morbidity and mortality are represented by arterial and venous thrombosis, as well as evolution to myelofibrosis or transformation to acute leukemia. However, survival is only minimally affected. Therapy aims at reducing the rate of thrombosis without increasing the risk of hematologic transformation which could be caused by exposure to cytotoxic drugs. On the other hand, survival is significantly reduced in primary myelofibrosis, and the clinical manifestations may be disabling. In the absence of therapies with the potential of curing the disease, a careful risk-oriented approach is employed for stratifying patients to the most appropriate, currently available, therapeutic options. In this brief review, we will discuss some of the key issues that can arise along the clinical course of MPNs and require an integrated, strictly patient-oriented, approach. PMID:21415968

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.

Abdominal paracentesis and thoracocentesis.

PubMed

Lee, Ser Yee; Pormento, James G; Koong, Heng Nung

2009-04-01

Abdominal paracentesis and thoracocentesis are common bedside procedures with diagnostic, therapeutic and palliative roles. We describe a useful and familiar a useful and familiar technique with the use of a multiple lumen catheter commonly used for central venous line insertion for drainage of ascites or moderate to large pleural effusions. The use of a multiple lumen catheter allows easier and more rapid aspiration of fluid with a smaller probability of the side holes being blocked as compared to the standard needle or single catheter methods. This is particularly useful in situations where the dedicated commercial kits for thoracocentesis and abdominal paracentesis are not readily available.

Staged abdominal re-operation for abdominal trauma.

PubMed

Taviloglu, Korhan

2003-07-01

To review the current developments in staged abdominal re-operation for abdominal trauma. To overview the steps of damage control laparotomy. The ever increasing importance of the resuscitation phase with current intensive care unit (ICU) support techniques should be emphasized. General surgeons should be familiar to staged abdominal re-operation for abdominal trauma and collaborate with ICU teams, interventional radiologists and several other specialties to overcome this entity.

Functional abdominal pain.

PubMed

Grover, Madhusudan; Drossman, Douglas A

2010-10-01

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

Plasma Cell Neoplasms (Including Multiple Myeloma)—Patient Version

Cancer.gov

Plasma cell neoplasms occur when abnormal plasma cells form cancerous tumors. When there is only one tumor, the disease is called a plasmacytoma. When there are multiple tumors, it is called multiple myeloma. Start here to find information on plasma cell neoplasms treatment, research, and statistics.

[Closed needle-biopsy in the diagnosis of neoplasms].

PubMed

Sforza, M; Perelli Ercolini, M; Beani, G

1979-04-01

The AA. demonstrate with this communication the validity of the needle biopsie for the diagnosis of neoplasms. They had used it for the breast, thyroid, flg and some other superficial tumefactions. In the mass-screening for the feminine neoplasms the clinical examination and the needle biopsy are very good method for a careful diagnosis.

Effect of Mutation Order on Myeloproliferative Neoplasms

PubMed Central

Nangalia, Jyoti; Silber, Yvonne; Wedge, David C.; Grinfeld, Jacob; Baxter, E. Joanna; Massie, Charles E.; Papaemmanuil, Elli; Menon, Suraj; Godfrey, Anna L.; Dimitropoulou, Danai; Guglielmelli, Paola; Bellosillo, Beatriz; Besses, Carles; Döhner, Konstanze; Harrison, Claire N.; Vassiliou, George S.; Vannucchi, Alessandro; Campbell, Peter J.; Green, Anthony R.

2015-01-01

BACKGROUND Cancers result from the accumulation of somatic mutations, and their properties are thought to reflect the sum of these mutations. However, little is known about the effect of the order in which mutations are acquired. METHODS We determined mutation order in patients with myeloproliferative neoplasms by genotyping hematopoietic colonies or by means of next-generation sequencing. Stem cells and progenitor cells were isolated to study the effect of mutation order on mature and immature hematopoietic cells. RESULTS The age at which a patient presented with a myeloproliferative neoplasm, acquisition of JAK2 V617F homozygosity, and the balance of immature progenitors were all influenced by mutation order. As compared with patients in whom the TET2 mutation was acquired first (hereafter referred to as “TET2-first patients”), patients in whom the Janus kinase 2 (JAK2) mutation was acquired first (“JAK2-first patients”) had a greater likelihood of presenting with polycythemia vera than with essential thrombocythemia, an increased risk of thrombosis, and an increased sensitivity of JAK2-mutant progenitors to ruxolitinib in vitro. Mutation order influenced the proliferative response to JAK2 V617F and the capacity of double-mutant hematopoietic cells and progenitor cells to generate colony-forming cells. Moreover, the hematopoietic stem-and-progenitor-cell compartment was dominated by TET2 single-mutant cells in TET2-first patients but by JAK2–TET2 double-mutant cells in JAK2-first patients. Prior mutation of TET2 altered the transcriptional consequences of JAK2 V617F in a cell-intrinsic manner and prevented JAK2 V617F from up-regulating genes associated with proliferation. CONCLUSIONS The order in which JAK2 and TET2 mutations were acquired influenced clinical features, the response to targeted therapy, the biology of stem and progenitor cells, and clonal evolution in patients with myeloproliferative neoplasms. (Funded by Leukemia and Lymphoma Research

Surgical and molecular pathology of pancreatic neoplasms.

PubMed

Hackeng, Wenzel M; Hruban, Ralph H; Offerhaus, G Johan A; Brosens, Lodewijk A A

2016-06-07

Histologic characteristics have proven to be very useful for classifying different types of tumors of the pancreas. As a result, the major tumor types in the pancreas have long been classified based on their microscopic appearance. Recent advances in whole exome sequencing, gene expression profiling, and knowledge of tumorigenic pathways have deepened our understanding of the underlying biology of pancreatic neoplasia. These advances have not only confirmed the traditional histologic classification system, but also opened new doors to early diagnosis and targeted treatment. This review discusses the histopathology, genetic and epigenetic alterations and potential treatment targets of the five major malignant pancreatic tumors - pancreatic ductal adenocarcinoma, pancreatic neuroendocrine tumor, solid-pseudopapillary neoplasm, acinar cell carcinoma and pancreatoblastoma.

[Angioscanning in the diagnosis of breast neoplasms].

PubMed

Trishkin, V A; Fadeev, N P; Tetel'baum, B I; Dymarskiĭ, L Iu

1976-01-01

Angioscanning with macroalbumin J131 was performed in 30 patients with different mammary gland diseases (breast cancer--in 22, breast sarcoma--in 1, cystic fibroadenomatosis--in 6 and one patients without any breast pathology). Twenty eight of thirty patients were subjected to surgery, and the diagnosis was supported histologically. Injection of macroalbumin J131 in the subclavian artery enabled the authors to visualize malignant neoplasms, located mainly in the external quadrants of the mammary gland. The least size of the tumor, revealed by angioscanning, was 1.5 cm in diameter. The method of isotope injection directly in the subclavian artery, employed by the authors, may be recommended for patients, whose primary tumor is localized in the external half of the gland and in the axillary process.

Secondary Neoplasms in Children Treated for Cancer.

PubMed

Kebudi, Rejin; Ozdemir, Gul Nihal

2017-01-01

The survival of children with cancer has improved dramatically in the last decades. Survivors of childhood cancer are at increased risk of long-term complications of therapeutic exposure. Second malignant neoplasms are one of the most severe side effects of cancer treatment. The frequency and type of secondary cancers may vary depending on the initial diagnosis, treatment administered and genetic predisposition. This review highlights the risk factors in the development of SMNs in survivors of pediatric cancers and their differences according to primary cancer type, genetic predisposition and treatment admistered. Finally, the review emphasizes the need for life-time follow-up of survivors of childhood cancer for the development of second malignancies. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Management of intraductal papillary mucinous neoplasms.

PubMed

Crippa, Stefano; Fernández-del Castillo, Carlos

2008-04-01

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are being diagnosed with increasing frequency, probably due to the widespread use of cross-sectional imaging. The natural history of these tumors is still largely unknown. Several studies have shown topographical as well as biological differences between main duct and branch duct IPMNs. In the past few years, diagnostic work-up and, in particular, management of these tumors have evolved significantly. Data support the need for resection of main duct IPMNs and the possibility of nonoperative management in selected cases of branch duct tumors. In this systematic review, we analyze the most recent publications related to IPMNs, with particular emphasis on problems related to managing this challenging disease.

Risk factors for development of internal neoplasms in koi carp Cyprinus carpio koi.

PubMed

Ott Knüsel, F; Doherr, M G; Knüsel, R; Wahli, T; Schmidt-Posthaus, H

2015-06-03

Fish, like mammals, can be affected by neoplastic proliferations. As yet, there are only a very small number of studies reporting on the occurrence of tumours in koi carp Cyprinus carpio koi and only sporadic reports on the nature of the tumours or on risk factors associated with their development. Between 2008 and 2012, koi with abdominal swelling were examined pathologically: neoplastic lesions were diagnosed and classified histologically. We evaluated possible risk factors for the development of these internal neoplasms in koi carp in Switzerland, using an online 2-part questionnaire sent to fish keepers with koi affected by internal tumours and to fish keepers who had not previously reported any affected koi. Part 1 addressed all participants and focused on general information about koi husbandry and pond technical data; Part 2 addressed participants that had one or several case(s) of koi with internal tumour(s) between 2008 and 2012, and consisted of specific questions about affected koi. A total of 112 internal tumours were reported by the 353 koi keepers participating in the survey. Analysis of the obtained data revealed that tumour occurrence was significantly associated with the location (indoors vs. outdoors) and volume of the pond, frequency of water changes, origin of the koi, number of koi kept in a pond and the use of certain pond disinfectant/medication products. Our results contribute to the identification of possible risk factors, which in turn could help to establish prophylactic measures in order to reduce the occurrence of internal neoplasms in koi.

[Polycystic hydatidosis: casual finding of calcified hydatid cyst simulating mesenteric neoplasm].

PubMed

Moraes, Mário A P; Sobreira, Maria de Nazareth M; Medeiros Filho, Plínio; Tavares, Alexandre Cavalca; Gomes, Maria Iolanda

2003-01-01

A case of abdominal hydatidosis, without hepatic involvement, in a patient from the State of Acre is reported. The hydatid, already in degeneration and partially calcified, was discovered incidentally by a radiologic examination of the vertebral column, carried out for evaluating the state of an intervertebral disk prolapse. Although the images suggested a mesenteric tumor, attached to the intestinal wall, the finding of rostellar hooklets in the dense contents of the cyst, after surgical removal, revealed the parasitic nature of the lesion.

Multiple neoplasms, single primaries, and patient survival

PubMed Central

Amer, Magid H

2014-01-01

Background Multiple primary neoplasms in surviving cancer patients are relatively common, with an increasing incidence. Their impact on survival has not been clearly defined. Methods This was a retrospective review of clinical data for all consecutive patients with histologically confirmed cancer, with emphasis on single versus multiple primary neoplasms. Second primaries discovered at the workup of the index (first) primary were termed simultaneous, if discovered within 6 months of the index primary were called synchronous, and if discovered after 6 months were termed metachronous. Results Between 2005 and 2012, of 1,873 cancer patients, 322 developed second malignancies; these included two primaries (n=284), and three or more primaries (n=38). Forty-seven patients had synchronous primaries and 275 had metachronous primaries. Patients with multiple primaries were predominantly of Caucasian ancestry (91.0%), with a tendency to develop thrombosis (20.2%), had a strong family history of similar cancer (22.3%), and usually presented with earlier stage 0 through stage II disease (78.9%). When compared with 1,551 patients with a single primary, these figures were 8.9%, 15.6%, 18.3%, and 50.9%, respectively (P≤0.001). Five-year survival rates were higher for metachronous cancers (95%) than for synchronous primaries (59%) and single primaries (59%). The worst survival rate was for simultaneous concomitant multiple primaries, being a median of 1.9 years. The best survival was for patients with three or more primaries (median 10.9 years) and was similar to the expected survival for the age-matched and sex-matched general population (P=0.06991). Conclusion Patients with multiple primaries are usually of Caucasian ancestry, have less aggressive malignancies, present at earlier stages, frequently have a strong family history of similar cancer, and their cancers tend to have indolent clinical behavior with longer survival rates, possibly related to genetic predisposition

Wonderful Walls

ERIC Educational Resources Information Center

Greenman, Jim

2006-01-01

In this article, the author emphasizes the importance of "working" walls in children's programs. Children's programs need "working" walls (and ceilings and floors) which can be put to use for communication, display, storage, and activity space. The furnishings also work, or don't work, for the program in another sense: in aggregate, they serve as…

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. Copyright © 2015. Published by Elsevier Masson SAS.

Normal pelvic ultrasound or MRI does not rule out neoplasm in patients with gonadal dysgenesis and Y chromosome material.

PubMed

Ebert, Kristin M; Hewitt, Geri D; Indyk, Justin A; McCracken, Katherine A; Nahata, Leena; Jayanthi, Venkata R

2018-04-01

Patients with gonadal dysgenesis (GD) with a Y chromosome have an increased risk of gonadal neoplasm. Few data exist on the ability of imaging to detect malignancy in intra-abdominal gonads in these patients. We aimed to determine the correlation between preoperative imaging findings and gonadal pathology in GD patients with Y chromosome material. A retrospective review was performed of patients with XY or XO/XY GD who underwent gonadectomy at our institution from 2003 to 2017. Patients were assessed preoperatively with ultrasonography; some additionally underwent MRI. The series consisted of 10 patients, all with female gender and non-palpable gonads. Median age was 13.1 years (range 2.4-18.3 years). Overall, four of the ten patients (40%) had a tumor (gonadoblastoma or dysgerminoma) on final pathology. Four patients had a gonad or gonads that were definitively seen on ultrasonography. All visualized gonads were described as "normal" or "small" with the exception of one patient, who had a normal MRI. Three of the four patients in this group had a tumor on final pathology. The remaining six patients had a gonad or gonads that were not definitively visualized on ultrasound; one patient in this group had a tumor on final pathology. Overall, five of seven gonads (71%) definitively visualized on ultrasound had tumor on final pathology, and two of thirteen gonads (15%) not visualized on ultrasound had tumor on final pathology; this difference was statistically significant (p = 0.012). Three patients were imaged with MRI. Of the gonads that could be visualized on MRI, no definitive abnormalities were seen. All patients imaged with MRI had tumors on final pathology. Both ultrasound and MRI are relatively poor at identifying and characterizing intra-abdominal gonads in GD patients. The majority of patients who had a neoplasm had normal imaging findings. Gonads that were definitively visualized on ultrasound were more likely to contain neoplasms that could not be

Ultrasound in the diagnosis of palpable abdominal masses in children.

PubMed

Annuar, Z; Sakijan, A S; Annuar, N; Kooi, G H

1990-12-01

Ultrasound examinations were done to evaluate clinically palpable abdominal masses in 125 children. The examinations were normal in 21 patients. In 15 patients, the clinically palpable masses were actually anterior abdominal wall abscesses or hematomas. Final diagnosis was available in 87 of 89 patients with intraabdominal masses detected on ultrasound. The majority (71%) were retroperitoneal masses where two-thirds were of renal origin. Ultrasound diagnosis was correct in 68 patients (78%). All cases of hydronephrosis were correctly diagnosed based on characteristic ultrasound appearances. Correct diagnoses of all cases of adrenal hematoma, psoas abscess, liver hematoma, liver abscess and one case of liver metastases were achieved with correlation of relevant clinical information.

Are the Sendai and Fukuoka consensus guidelines for cystic mucinous neoplasms of the pancreas useful in the initial triage of all suspected pancreatic cystic neoplasms? A single-institution experience with 317 surgically-treated patients.

PubMed

Goh, Brian K P; Tan, Damien M Y; Thng, Choon-Hua; Lee, Ser-Yee; Low, Albert S C; Chan, Chung-Yip; Wong, Jen-San; Lee, Victor T W; Cheow, Peng-Chung; Chow, Pierce K H; Chung, Alexander Y F; Wong, Wai-Keong; Ooi, London L P J

2014-06-01

The Sendai Consensus Guidelines (SCG) were formulated in 2006 and updated in Fukuoka in 2012 (FCG) to guide management of cystic mucinous neoplasms of the pancreas. This study aims to evaluate the clinical utility of the SCG and FCG in the initial triage of all suspected pancreatic cystic neoplasms. Overall, 317 surgically-treated patients with a suspected pancreatic cystic neoplasm were classified according to the SCG as high risk (HR(SCG)) and low risk (LR(SCG)), and according to the FCG as high risk (HR(FCG)), worrisome (W(FCG)), and low risk (LR(FCG)). Cystic lesions of the pancreas (CLP) were classified as potentially malignant/malignant or benign according to the final pathology. The presence of symptoms, proximal lesions with obstructive jaundice, elevated serum carcinoembryonic antigen/carbohydrate antigen 19-9 (CEA/CA 19-9), size ≥3 cm, presence of solid component, main pancreatic duct dilatation, thickened enhancing walls, and change in ductal caliber with distal atrophy were predictive of a potentially malignant/malignant CLP on univariate analyses. The positive predictive value (PPV) and negative predictive value (NPV) of HR(SCG) and HR(ICG2012) for a potentially malignant/malignant lesion was 67 and 88 %, and 88 and 92.5 %, respectively. There were no malignant lesions in both LR groups but some potentially malignant lesions such as cystic pancreatic neuroendocrine neoplasms with uncertain behavior were classified as LR. The updated FCG was superior to the SCG for the initial triage of all suspected pancreatic cystic neoplasms. CLP in the LR(FCG) group can be safely managed conservatively, and those in the HR(FCG) group should undergo resection.

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)

Coexisting Primary Ovarian and Omental Hydatid Disease Mimicking an Ovarian Neoplasm: A Case Report.

PubMed

Tas, Emre E; Yegin Akcay, Gulin F; Yildirim, Fatma; Yavuz, Filiz

2018-05-01

Hydatid disease is a parasitic infection that most commonly affects the liver and lungs, although the disease can arise in any part of the body. Cysts may mimic many benign and malignant conditions. The diagnosis cannot be confirmed preoperatively in all cases. A 44-yr-old menopausal woman was admitted to the department of gynecology with complaints of abdominal distention. A fixed abdominopelvic mass was identified. Radiology revealed a 20-cm mass with branched septations and solid components. CA-125 level was 55 kU/L, and Risk of Malignancy Index-2 score was 880. These findings suggested the presence of an ovarian neoplasm, and laparotomy was performed. Cystic masses measuring 22 cm and 4 cm, originating from the omentum majus and left ovary, respectively, were found during surgery. Frozen-section analysis revealed hydatid disease. Infracolic omentectomy and total abdominal hysterectomy with bilateral salpingo-oopherectomy were performed. Results of a serum Echinococcus hemagglutination test performed immediately after surgery were negative. The patient was prescribed albendazole for 6 mo and discharged on the third postoperative day with no complaints. The incidence of hydatid disease in the female reproductive system is very rare; however, clinicians must be aware of this disease and take necessary precautions while operating because any spillage may lead to anaphylactic shock and increased risk of recurrence.

Mechanisms of mutations in myeloproliferative neoplasms.

PubMed

Levine, Ross L

2009-12-01

In recent years, a series of studies have provided genetic insight into the pathogenesis of myeloproliferative neoplasms (MPNs). It is now known that JAK2V617F mutations are present in 90% of patients with polycythaemia vera (PV), 60% of patients with essential thrombocytosis (ET) and 50% of patients with myelofibrosis (MF). Despite the high prevalence of JAK2V617F mutations in these three myeloid malignancies, several questions remain. For example, how does one mutation contribute to the pathogenesis of three clinically distinct diseases, and how do some patients develop these diseases in the absence of a JAK2V617F mutation? Single nucleotide polymorphisms at various loci and somatic mutations, such as those in MPLW515L/K, TET2 and in exon 12 of JAK2, may also contribute to the pathogenesis of these MPNs. There are likely additional germline and somatic genetic factors important to the MPN phenotype. Additional studies of large MPN and control cohorts with new techniques will help identify these factors.

Myeloproliferative Neoplasms: Molecular Drivers and Therapeutics.

PubMed

Reuther, G W

2016-01-01

Activating mutations in genes that drive neoplastic cell growth are numerous and widespread in cancer, and specific genetic alterations are associated with certain types of cancer. For example, classic myeloproliferative neoplasms (MPNs) are hematopoietic stem cell disorders that affect cells of the myeloid lineage, including erythrocytes, platelets, and granulocytes. An activating mutation in the JAK2 tyrosine kinase is prevalent in these diseases. In MPN patients that lack such a mutation, other genetic changes that lead to activation of the JAK2 signaling pathway are present, indicating deregulation of JAK2 signaling plays an etiological driving role in MPNs, a concept supported by significant evidence from in vivo experimental MPN systems. Thus, small molecules that inhibit JAK2 activity are ideal drugs to impede the progression of disease in MPN patients. However, even though JAK inhibitors provide significant symptomatic relief, they have failed as a remission-inducing therapy. Nonetheless, the progress made understanding the molecular etiology of MPNs since 2005 is significant and has provided insight for the development and testing of novel molecular targeted therapeutic approaches. The current understanding of driver mutations in MPNs and an overview of current and potential therapeutic strategies for MPN patients will be discussed. © 2016 Elsevier Inc. All rights reserved.

Eponyms in cardiothoracic radiology: Part I. Neoplasms.

PubMed

Mohammed, Tan-Lucien H; Saettele, Megan R; Saettele, Timothy; Patel, Vikas; Kanne, Jeffrey P

2014-01-01

Eponyms serve the purpose of honoring individuals who have made important observations and discoveries. As with other fields of medicine, eponyms are frequently encountered in radiology, particularly in chest radiology. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medical literature. Furthermore, in some circumstances, more than one individual may have contributed to the description or discovery of a particular anatomical structure or disease, whereas in others, an eponym may have been incorrectly applied initially and propagated for years in medical literature. Nevertheless, radiologic eponyms are a means of honoring those who have made lasting contributions to the field of radiology, and familiarity with these eponyms is critical for proper reporting and accurate communication. In addition, the acquisition of some historical knowledge about those whose names are associated with various structures or pathologic conditions conveys a sense of humanity in the field of medicine. In this article, the first of a multipart series, the authors discuss a number of chest radiology eponyms as they relate to neoplasms, including relevant clinical and imaging features, as well biographic information of the respective eponym׳s namesake. Copyright © 2014 Elsevier Inc. All rights reserved.

General Information about Plasma Cell Neoplasms (Including Multiple Myeloma)

MedlinePlus

... Including Multiple Myeloma) Treatment (PDQ®)–Patient Version General Information About Plasma Cell Neoplasms Go to Health Professional ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

Chronic Myeloproliferative Neoplasms Treatment (PDQ®)—Health Professional Version

Cancer.gov

Chronic Myeloproliferative Neoplasms (MPN) treatment varies widely depending on the specific diagnosis. Treatment options may include observation, phlebotomy, steroids, chemotherapy, immunotherapy, and stem cell transplant. Get detailed information about MPNs in this summary for clinicians.

Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®)—Patient Version

Cancer.gov

Myelodysplastic/myeloproliferative neoplasms treatment options include supportive care, chemotherapy, radiation therapy, surgery, biologic/targeted therapy, and stem cell transplant. Learn more about these diseases in this expert-reviewed summary.

Ultrastructural characterization of pulmonary neoplasms. II. The role of electron microscopy in characterization of uncommon epithelial pulmonary neoplasms, metastatic neoplasms to and from lung, and other tumors, including mesenchymal neoplasms.

PubMed

Herrera, G A; Alexander, C B; Jones, J M

1985-01-01

Ultrastructural analysis through better resolution adds significant information to the evaluation and classification of primary pulmonary neoplasms. Light microscopy is limited in the evaluation of lung neoplasms. In some cases the light microscopic appearance may be entirely misleading, whereas in others it is inconclusive. Immunocytochemistry provides information on cytoplasmic differentiation of various tumors and hence more data on their corresponding phenotypes. The data from immunocytochemistry without corresponding objective electron microscopic evaluation may be very difficult to interpret. Correlation of historical, gross, light, electron microscopic, and immunocytochemical data is essential for a final accurate diagnosis (fig. 20). Fine needle aspiration of pulmonary neoplasms is becoming very fashionable and a diagnosis, including type of neoplasm, is expected on the basis of examination of a limited number of cells which further emphasizes the importance of ultrastructural characterization in helping to establish an accurate diagnosis [63-69]. The current classification of pulmonary neoplasms may need to be modified in the near future to incorporate the newly created data [70-72]. At the present time, there appears to be, at least, a need for a 'double standard', as Sobin [73] has suggested, which would permit the evaluation of the biologic significance of the ultrastructural and immunocytochemical findings (as applied to classification of neoplasms) in an effort to derive meaningful clinicopathologic correlations. Figure 20 emphasizes the additive role which should be played by the various diagnostic modalities to enable a morphologic assessment which would be an accurate predictor of biologic behavior. With an accurate assessment of biologic behavior, a more appropriate and rational approach for therapy is possible. There is also an important role for ultrastructural analysis in metastatic pleural and pulmonary neoplasms, primarily adenocarcinomas, as

[The etiological aspects of acute abdominal pain in children].

PubMed

Dinu, C A; Moraru, D

2011-01-01

The study of the etiological aspects of acute abdominal pain in children, in order to perceive the clinical-etiological correlations and the disorders distribution related to age, gender and the origin of the patients. The criteria for including patients were age (between 0 and 18 years) and the presence of acute abdominal pain before or during the consultation with the physician. The research on acute abdominal pain in children was performed on the level of the Surgery and Pediatrics II clinical departments of the "Sf. Ioan" Children's Emergency Clinical Hospital in Galati, between 01.01.2009 - 01.01.2011. The clinical study performed on the patients registered in the studied groups focused on the identification, the evaluation of the symptoms of acute abdominal pain in children, diagnosing and treating it. The criteria for excluding patients were an age older than 18 years or the absence of acute abdominal pain as a symptom before or during the examination. The statistical analysis used the descriptive and analytical methods. The data was centralized and statistically processed in M.S.EXCEL and S.P.S.S. databases. The patients with acute abdominal pain represent a percentage of 92.9% (2358 cases) of the total number of patients who suffer from abdominal pain (N=2537). The highest frequency of cases is represented by acute appendicitis (1056 cases - 44.8%). In the 5-18 years age group, acute appendicitis, mesenteric lymphadenitis, ovarian follicular cysts, acute pyelenophritis and salpingitis are predominant. In the 0-4 years age group gastroenteritis, acute pharyngitis, reactive hepatitis and lower digestive bleeding are predominant. In females, acute appendicitis, gastroenteritis, gastroduodenitis and cystitis are predominant, whereas in males, peritonitis, sepsis through E. coli, the contusion of the abdominal wall and acute pharyngitis are predominant.

Epidemiology of carcinoid neoplasms in Vaud, Switzerland, 1974–97

PubMed Central

Levi, F; Te, V-C; Randimbison, L; Rindi, G; La Vecchia, C

2000-01-01

In Vaud, Switzerland, the incidence of carcinoids based on 218 malignant and 215 benign cases rose from 19.6/106in 1974–85 to 28.2/106in 1986–97, more so among males and malignant neoplasms. Lung was the commonest site for malignant and large intestine for benign carcinoids. Sixty-eight (16%) carcinoids had another neoplasm. © 2000 Cancer Research Campaign PMID:10970700

[Approach to diagnosis and management of myeloproliferative neoplasm variants].

PubMed

Mitsumori, Toru; Kirito, Keita

2015-08-01

Myeloproliferative neoplasm (MPN) variants are defined as relatively uncommon myeloid neoplasms which do not meet the criteria for either classical MPN or myelodysplastic syndrome. Due to the lack of specific markers, it has been challenging to accurately diagnose these malignant diseases. Recent studies have revealed new genetic abnormalities in MPN variants. These research advances are anticipated to open new approaches to not only achieving accurate diagnosis but also novel therapeutic options for these diseases.

Abdominal Aortic Emergencies.

PubMed

Lech, Christie; Swaminathan, Anand

2017-11-01

This article discusses abdominal aortic emergencies. There is a common thread of risk factors and causes of these diseases, including age, male gender, hypertension, dyslipidemia, and connective tissue disorders. The most common presenting symptom of these disorders is pain, usually in the chest, flank, abdomen, or back. Computed tomography scan is the gold standard for diagnosis of pathologic conditions of the aorta in the hemodynamically stable patient. Treatment consists of a combination of blood pressure and heart rate control and, in many cases, emergent surgical intervention. Copyright © 2017 Elsevier Inc. All rights reserved.

Choloperitoneum causes extensive coloring of the abdominal wall skin.

PubMed

Mathioulakis, Stavros; Liverakou, Evangelia; Gourgiotis, Stavros; Salemis, Nikolaos S

2014-10-01

Laparoscopic cholecystectomy, because it is the less invasive surgical procedure, has been established as the procedure of choice for the treatment of patients with symptomatic gallbladder stones. However, bile leakage after laparoscopic cholecystectomy should not be overlooked. It is generally due to a minor biliary complication, although it can sometimes herald a major duct injury. Bile leakage rates of 1.2% to 4.0% in laparoscopic cholecystectomies have been reported, which are higher than the incidence with open cholecystectomies.

Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias.

PubMed

Mayagoitia, J C; Suárez, D; Arenas, J C; Díaz de León, V

2006-06-01

Induction of preoperative progressive pneumoperitoneum is an elective procedure in patients with hernias with loss of domain. A prospective study was carried out from June 2003 to May 2005 at the Hospital de Especialidades, Instituto Mexicano del Seguro Social, Leon, Mexico. Preoperative progressive pneumoperitoneum was induced using a double-lumen intraabdominal catheter inserted through a Veress needle and daily insufflation of ambient air. Variables analyzed were age, sex, body mass index, type, location and size of defective hernia, number of previous repairs, number of days pneumoperitoneum was maintained, type of hernioplasty, and incidence of complications. Of 12 patients, 2 were excluded because it was technically impossible to induce pneumoperitoneum. Of the remaining 10 patients, 60% were female and 40% were male. The patients' average age was 51.5 years, average body mass index was 34.7, and evolution time of their hernias ranged from 8 months to 23 years. Nine patients had ventral hernias and one had an inguinal hernia. Pneumoperitoneum was maintained for an average of 9.3 days and there were no serious complications relating to the puncture or the maintenance of the pneumoperitoneum. One patient who previously had undergone a mastectomy experienced minor complications. We were able to perform hernioplasty on all patients, eight with the Rives technique, one with supra-aponeurotic mesh, and one using the Lichtenstein method for inguinal hernia repair. One patient's wound became infected postoperatively. Preoperative progressive pneumoperitoneum is a safe procedure that is easy to perform and that facilitates surgical hernia repair in patients with hernia with loss of domain. Complications are infrequent, patient tolerability is adequate, and the proposed modification to the puncture technique makes the procedure even safer.

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...abdominal complications was 25%, with Curl- ng’s ulcer the most common malady (54% of the total), ollowed by esophageal lesions (17%), hemorrhagic...complications in- luded trauma exploratory laparotomy, abdominal com- artment syndrome, ischemic bowel, biliary disease, peptic lcer disease and gastritis, large

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

Molecular diagnostics in the neoplasms of the pancreas, liver, gall bladder, and extrahepatic biliary tract.

PubMed

Weindel, Michael; Zulfiqar, Muhammad; Bhalla, Amarpreet; Shidham, Vinod B

2013-12-01

Pancreatic neoplasms, including ductal adenocarcinoma, intraductal papillary mucinous neoplasm, solid pseudopapillary neoplasm, pancreatic endocrine neoplasms, acinar cell carcinoma, and ampullary carcinoma, are associated with different genetic abnormalities. Liver neoplasms, including hepatic adenomas, hepatocellular carcinomas, and cholangiocarcinomas, are associated with identifiable risk factors and genetic changes. Gall bladder adenomas and adenocarcinomas arise from distinct molecular pathways. The molecular abnormalities seen in these tumors are not used routinely in the molecular diagnostic laboratory. Copyright © 2013 Elsevier Inc. All rights reserved.

Clonal evolution in therapy-related neoplasms.

PubMed

Fabiani, Emiliano; Falconi, Giulia; Fianchi, Luana; Criscuolo, Marianna; Ottone, Tiziana; Cicconi, Laura; Hohaus, Stefan; Sica, Simona; Postorino, Massimiliano; Neri, Antonino; Lionetti, Marta; Leone, Giuseppe; Lo-Coco, Francesco; Voso, Maria Teresa

2017-02-14

Therapy-related myeloid neoplasms (t-MN) may occur as a late effect of cytotoxic therapy for a primary malignancy or autoimmune diseases in susceptible individuals. We studied the development of somatic mutations in t-MN, using a collection of follow-up samples from 14 patients with a primary hematologic malignancy, who developed a secondary leukemia (13 t-MN and 1 t-acute lymphoblastic leukemia), at a median latency of 73 months (range 18-108) from primary cancer diagnosis.Using Sanger and next generation sequencing (NGS) approaches we identified 8 mutations (IDH1 R132H, ASXL1 Y591*, ASXL1 S689*, ASXL1 R693*, SRSF2 P95H, SF3B1 K700E, SETBP1 G870R and TP53 Y220C) in seven of thirteen t-MN patients (54%), whereas the t-ALL patient had a t(4,11) translocation, resulting in the KMT2A/AFF1 fusion gene. These mutations were then tracked backwards in marrow samples preceding secondary leukemia occurrence, using pyrosequencing and a NGS protocol that allows the detection of low variant allele frequencies (≥0.1%).Somatic mutations were detectable in the BM harvested at the primary diagnosis, prior to any cytotoxic treatment in three patients, while they were not detectable and apparently acquired by the t-MN clone in five patients.These data show that clonal evolution in t-MN is heterogeneous, with some somatic mutations preceding cytotoxic treatment and possibly favoring leukemic development.

Secondary malignant neoplasms in testicular cancer survivors.

PubMed

Curreri, Stephanie A; Fung, Chunkit; Beard, Clair J

2015-09-01

Testicular cancer is the most common cancer among men aged 15 to 40 years, and the incidence of testicular cancer is steadily increasing. Despite successful treatment outcomes and the rate of survival at 5 to 10 years being 95%, survivors can experience late effects of both their cancer and the treatment they received, including secondary malignant neoplasms (SMNs). We discuss the development of non-germ cell SMNs that develop after diagnosis and treatment of testicular cancer and their effect on mortality. Patients diagnosed with testicular cancer frequently choose postoperative surveillance if they are diagnosed with clinical stage I disease. These patients may experience an increased risk for developing SMNs following radiation exposure from diagnostic imaging. Similarly, radiotherapy for testicular cancer is associated with increased risks of developing both solid tumors and leukemia. Studies have reported that patients exposed to higher doses of radiation have an increased risk of developing SMNs when compared with patients who received lower doses of radiation. Patients treated with chemotherapy also experience an increased risk of developing SMNs following testicular cancer, though the risk following chemotherapy and radiation therapy combined is not well described. A large population-based study concluded that the rate ratios for both cancer-specific and all-cause mortality for SMNs among testicular cancer survivors were not significantly different from those of matched first cancers. Although it is known that patients who receive adjuvant chemotherapy or radiotherapy or who undergo routine diagnostic or follow-up imaging for a primary testicular cancer are at an increased risk for developing SMNs, the extent of this risk is largely unknown. It is critically important that research be conducted to determine this risk and its contributing factors as accurately as possible. Copyright © 2015 Elsevier Inc. All rights reserved.

Minimally-aggressive gestational trophoblastic neoplasms.

PubMed

Cole, Laurence A

2012-04-01

We have previously defined a new syndrome "Minimally-aggressive gestational trophoblastic neoplasms" in which choriocarcinoma or persistent hydatidiform mole has a minimal growth rate and becomes chemorefractory. Previously we described a new treatment protocol, waiting for hCG rise to >3000 mIU/ml and disease becomes more advanced, then using combination chemotherapy. Initially we found this treatment successful in 8 of 8 cases, here we find this protocol appropriate in a further 16 cases. Initially we used hyperglycosylated hCG, a limited availability test, to identify this syndrome. Here we propose also using hCG doubling rate to detect this syndrome. Minimally aggressive gestational trophoblastic disease can be detected by chemotherapy resistance or low hyperglycosylated hCG, <40% of total hCG. It can also be identified by hCG doubling rate, with doubling time greater than 2 weeks. Nineteen new cases were identified as having minimally aggressive gestational trophoblastic disease by hyperglycosylated hCG and by hCG doubling test. All were recommended to hold off further chemotherapy until hCG >3000mIU/ml. One case died prior to the start of the study, one case withdrew because of a lung nodule and one withdrew refusing the suggested combination chemotherapy. The remaining 16 women were all successfully treated. A total of 8 plus 16 or 24 of 24 women were successfully treated using the proposed protocol, holding back on chemotherapy until hCG >3000mIU/ml. Copyright © 2011 Elsevier Inc. All rights reserved.

Targeting glutamine metabolism in myeloproliferative neoplasms

PubMed Central

Zhan, Huichun; Ciano, Kristen; Dong, Katherine; Zucker, Stanley

2016-01-01

JAK2V617F mutation can be detected in the majority of myeloproliferative neoplasm (MPN) patients. The JAK2 inhibitor Ruxolitinib is the first FDA-approved treatment for MPNs. However, its use is limited by various dose related toxicities. Here, we studied the metabolic state and glutamine metabolism of BaF3-hEPOR-JAK2V617F and BaF3-hEPOR-JAK2WT cells. We found that the JAK2V617F-mutant cells were associated with increased oxygen consumption rate and extracellular acidification rate than the JAK2WT cells and there was an increased glutamine metabolism in JAK2V617F-mutant cells compared to wild-type cells. Glutaminase (GLS), the key enzyme in gluta-mine metabolism, was upregulated in the JAK2V617F-mutant BaF3 cells compared to the JAK2WT BaF3 cells. In MPN patient peripheral blood CD34+ cells, GLS expression was increased in JAK2V617F-mutant progenitor cells compared to JAK2 wild-type progenitor cells from the same patients and GLS levels were increased at the time of disease progression compared to at earlier time points. Moreover, GLS inhibitor increased the growth inhibitory effect of Ruxolitinib in both JAK2V617F-mutant cell lines and peripheral blood CD34+ cells from MPN patients. Therefore, GLS inhibitor should be further explored to enhance the therapeutic effectiveness of JAK2 inhibitor and allow the administration of lower doses of the drug to avoid its toxicity. PMID:26227854

Myeloproliferative neoplasms: Current molecular biology and genetics.

PubMed

Saeidi, Kolsoum

2016-02-01

Myeloproliferative neoplasms (MPNs) are clonal disorders characterized by increased production of mature blood cells. Philadelphia chromosome-negative MPNs (Ph-MPNs) consist of polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). A number of stem cell derived mutations have been identified in the past 10 years. These findings showed that JAK2V617F, as a diagnostic marker involving JAK2 exon 14 with a high frequency, is the best molecular characterization of Ph-MPNs. Somatic mutations in an endoplasmic reticulum chaperone, named calreticulin (CALR), is the second most common mutation in patients with ET and PMF after JAK2 V617F mutation. Discovery of CALR mutations led to the increased molecular diagnostic of ET and PMF up to 90%. It has been shown that JAK2V617F is not the unique event in disease pathogenesis. Some other genes' location such as TET oncogene family member 2 (TET2), additional sex combs-like 1 (ASXL1), casitas B-lineage lymphoma proto-oncogene (CBL), isocitrate dehydrogenase 1/2 (IDH1/IDH2), IKAROS family zinc finger 1 (IKZF1), DNA methyltransferase 3A (DNMT3A), suppressor of cytokine signaling (SOCS), enhancer of zeste homolog 2 (EZH2), tumor protein p53 (TP53), runt-related transcription factor 1 (RUNX1) and high mobility group AT-hook 2 (HMGA2) have also identified to be involved in MPNs phenotypes. Here, current molecular biology and genetic mechanisms involved in MNPs with a focus on the aforementioned factors is presented. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

'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.)

Management of Complex Abdominal Wall Defects Associated with Penetrating Abdominal Trauma

DTIC Science & Technology

2014-05-09

recruitment): a new method of wound closure. Ann Plast Surg 2005;55:660–4. 8 Ramirez OM, Ruas E, Dellon AL. ‘Components separation’ method for closure of...patients with open abdomens closed by either permanent mesh, vicryl mesh or a modification of Ramirez ’ original method of components separation. These

Somatic CALR Mutations in Myeloproliferative Neoplasms with Nonmutated JAK2

PubMed Central

Baxter, E.J.; Nice, F.L.; Gundem, G.; Wedge, D.C.; Avezov, E.; Li, J.; Kollmann, K.; Kent, D.G.; Aziz, A.; Godfrey, A.L.; Hinton, J.; Martincorena, I.; Van Loo, P.; Jones, A.V.; Guglielmelli, P.; Tarpey, P.; Harding, H.P.; Fitzpatrick, J.D.; Goudie, C.T.; Ortmann, C.A.; Loughran, S.J.; Raine, K.; Jones, D.R.; Butler, A.P.; Teague, J.W.; O’Meara, S.; McLaren, S.; Bianchi, M.; Silber, Y.; Dimitropoulou, D.; Bloxham, D.; Mudie, L.; Maddison, M.; Robinson, B.; Keohane, C.; Maclean, C.; Hill, K.; Orchard, K.; Tauro, S.; Du, M.-Q.; Greaves, M.; Bowen, D.; Huntly, B.J.P.; Harrison, C.N.; Cross, N.C.P.; Ron, D.; Vannucchi, A.M.; Papaemmanuil, E.; Campbell, P.J.; Green, A.R.

2014-01-01

BACKGROUND Somatic mutations in the Janus kinase 2 gene (JAK2) occur in many myeloproliferative neoplasms, but the molecular pathogenesis of myeloproliferative neoplasms with nonmutated JAK2 is obscure, and the diagnosis of these neoplasms remains a challenge. METHODS We performed exome sequencing of samples obtained from 151 patients with myeloproliferative neoplasms. The mutation status of the gene encoding calreticulin (CALR) was assessed in an additional 1345 hematologic cancers, 1517 other cancers, and 550 controls. We established phylogenetic trees using hematopoietic colonies. We assessed calreticulin subcellular localization using immunofluorescence and flow cytometry. RESULTS Exome sequencing identified 1498 mutations in 151 patients, with medians of 6.5, 6.5, and 13.0 mutations per patient in samples of polycythemia vera, essential thrombocythemia, and myelofibrosis, respectively. Somatic CALR mutations were found in 70 to 84% of samples of myeloproliferative neoplasms with nonmutated JAK2, in 8% of myelodysplasia samples, in occasional samples of other myeloid cancers, and in none of the other cancers. A total of 148 CALR mutations were identified with 19 distinct variants. Mutations were located in exon 9 and generated a +1 base-pair frameshift, which would result in a mutant protein with a novel C-terminal. Mutant calreticulin was observed in the endoplasmic reticulum without increased cell-surface or Golgi accumulation. Patients with myeloproliferative neoplasms carrying CALR mutations presented with higher platelet counts and lower hemoglobin levels than patients with mutated JAK2. Mutation of CALR was detected in hematopoietic stem and progenitor cells. Clonal analyses showed CALR mutations in the earliest phylogenetic node, a finding consistent with its role as an initiating mutation in some patients. CONCLUSIONS Somatic mutations in the endoplasmic reticulum chaperone CALR were found in a majority of patients with myeloproliferative neoplasms with

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)

Mucinous cystic neoplasms of the pancreas: update on the surgical pathology and molecular genetics.

PubMed

Fukushima, Noriyoshi; Zamboni, Giuseppe

2014-11-01

Mucinous cystic neoplasms (MCNs) of the pancreas are primary pancreatic cyst-forming neoplasms that can be a precursor to invasive adenocarcinoma of the pancreas. MCNs occur almost exclusively in the distal pancreas of middle-aged women. MCNs typically show a "cyst-in-cyst" pattern of growth and are well encapsulated by a thick fibrous wall. MCNs are composed of mucin-producing neoplastic epithelial cells and "ovarian-type" subepithelial stroma. The epithelium is dysplastic and the grade can range from low to high grade; some MCNs have an associated invasive carcinoma. It is this associated invasive carcinoma that determines prognosis. MCNs harbor several characteristic genetic and epigenetic alterations, some of which are shared with conventional invasive pancreatic ductal adenocarcinoma. Furthermore, several studies reveal characteristic patterns of gene expression in the ovarian-type stroma that suggest steroidogenesis in the ovarian-type stroma. Better knowledge of the molecular alterations could help in the management of patients with this type of precursor of invasive carcinoma. Copyright © 2014 Elsevier Inc. All rights reserved.

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 ofmore » 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.« less

Functional abdominal pain syndrome.

PubMed

Clouse, Ray E; Mayer, Emeran A; Aziz, Qasim; Drossman, Douglas A; Dumitrascu, Dan L; Mönnikes, Hubert; Naliboff, Bruce D

2006-04-01

Functional abdominal pain syndrome (FAPS) differs from the other functional bowel disorders; it is less common, symptoms largely are unrelated to food intake and defecation, and it has higher comorbidity with psychiatric disorders. The etiology and pathophysiology are incompletely understood. Because FAPS likely represents a heterogeneous group of disorders, peripheral neuropathic pain mechanisms, alterations in endogenous pain modulation systems, or both may be involved in any one patient. The diagnosis of FAPS is made on the basis of positive symptom criteria and a longstanding history of symptoms; in the absence of alarm symptoms, an extensive diagnostic evaluation is not required. Management is based on a therapeutic physician-patient relationship and empirical treatment algorithms using various classes of centrally acting drugs, including antidepressants and anticonvulsants. The choice, dose, and combination of drugs are influenced by psychiatric comorbidities. Psychological treatment options include psychotherapy, relaxation techniques, and hypnosis. Refractory FAPS patients may benefit from a multidisciplinary pain clinic approach.

Associations between gender, disease features and symptom burden in patients with myeloproliferative neoplasms: an analysis by the MPN QOL International Working Group

PubMed Central

Geyer, Holly L.; Kosiorek, Heidi; Dueck, Amylou C.; Scherber, Robyn; Slot, Stefanie; Zweegman, Sonja; te Boekhorst, Peter AW; Senyak, Zhenya; Schouten, Harry C.; Sackmann, Federico; Fuentes, Ana Kerguelen; Hernández-Maraver, Dolores; Pahl, Heike L.; Griesshammer, Martin; Stegelmann, Frank; Döhner, Konstanze; Lehmann, Thomas; Bonatz, Karin; Reiter, Andreas; Boyer, Francoise; Etienne, Gabriel; Ianotto, Jean-Christophe; Ranta, Dana; Roy, Lydia; Cahn, Jean-Yves; Harrison, Claire N.; Radia, Deepti; Muxi, Pablo; Maldonado, Norman; Besses, Carlos; Cervantes, Francisco; Johansson, Peter L.; Barbui, Tiziano; Barosi, Giovanni; Vannucchi, Alessandro M.; Paoli, Chiara; Passamonti, Francesco; Andreasson, Bjorn; Ferrari, Maria L; Rambaldi, Alessandro; Samuelsson, Jan; Cannon, Keith; Birgegard, Gunnar; Xiao, Zhijian; Xu, Zefeng; Zhang, Yue; Sun, Xiujuan; Xu, Junqing; Kiladjian, Jean-Jacques; Zhang, Peihong; Gale, Robert Peter; Mesa, Ruben A.

2017-01-01

The myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia and myelofibrosis, are distinguished by their debilitating symptom profiles, life-threatening complications and profound impact on quality of life. The role gender plays in the symptomatology of myeloproliferative neoplasms remains under-investigated. In this study we evaluated how gender relates to patients’ characteristics, disease complications and overall symptom expression. A total of 2,006 patients (polycythemia vera=711, essential thrombocythemia=830, myelofibrosis=460, unknown=5) were prospectively evaluated, with patients completing the Myeloproliferative Neoplasm-Symptom Assessment Form and Brief Fatigue Inventory Patient Reported Outcome tools. Information on the individual patients’ characteristics, disease complications and laboratory data was collected. Consistent with known literature, most female patients were more likely to have essential thrombocythemia (48.6% versus 33.0%; P<0.001) and most male patients were more likely to have polycythemia vera (41.8% versus 30.3%; P<0.001). The rate of thrombocytopenia was higher among males than females (13.9% versus 8.2%; P<0.001) and males also had greater red-blood cell transfusion requirements (7.3% versus 4.9%; P=0.02) with shorter mean disease duration (6.4 versus 7.2 years, P=0.03). Despite there being no statistical differences in risk scores, receipt of most therapies or prior complications (hemorrhage, thrombosis), females had more severe and more frequent symptoms for most individual symptoms, along with overall total symptom score (22.8 versus 20.3; P<0.001). Females had particularly high scores for abdominal-related symptoms (abdominal pain/discomfort) and microvascular symptoms (headache, fatigue, insomnia, concentration difficulties, dizziness; all P<0.01). Despite complaining of more severe symptom burden, females had similar quality of life scores to those of males. The results of this study suggest

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

PubMed

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

2013-02-01

Two novel bioelectrical impedance analysis (BIA) methods have been developed recently for evaluation of intra-abdominal fat accumulation. Both methods use electrodes that are placed on abdominal wall and allow evaluation of intra-abdominal fat area (IAFA) easily without radiation exposure. Of these, "abdominal BIA" method measures impedance distribution along abdominal anterior-posterior axis, and IAFA by BIA method(BIA-IAFA) is calculated from waist circumference and the voltage occurring at the flank. Dual BIA method measures impedance of trunk and body surface at the abdominal level and calculates BIA-IAFA from transverse and antero-posterior diameters of the abdomen and the impedance of trunk and abdominal surface. BIA-IAFA by these two BIA methods correlated well with IAFA measured by abdominal CT (CT-IAFA) with correlatipn coefficient of 0.88 (n = 91, p < 0.0001) for the former, and 0.861 (n = 469, p < 0.01) for the latter. These new BIA methods are useful for evaluating abdominal adiposity in clinical study and routine clinical practice of metabolic syndrome and obesity.

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

Abdominal aortic aneurysms: an autoimmune disease?

PubMed

Jagadesham, Vamshi P; Scott, D Julian A; Carding, Simon R

2008-12-01

Abdominal aortic aneurysms (AAAs) are a multifactorial degenerative vascular disorder. One of the defining features of the pathophysiology of aneurysmal disease is inflammation. Recent developments in vascular and molecular cell biology have increased our knowledge on the role of the adaptive and innate immune systems in the initiation and propagation of the inflammatory response in aortic tissue. AAAs share many features of autoimmune disease, including genetic predisposition, organ specificity and chronic inflammation. Here, this evidence is used to propose that the chronic inflammation observed in AAAs is a consequence of a dysregulated autoimmune response against autologous components of the aortic wall that persists inappropriately. Identification of the molecular and cellular targets involved in AAA formation will allow the development of therapeutic agents for the treatment of AAA.

The role of intraluminal thrombus on oxygen transport in abdominal aortic aneurysms

NASA Astrophysics Data System (ADS)

Madhavan, Sudharsan; Cherry Kemmerling, Erica

2017-11-01

Abdominal aortic aneurysm is ranked as the 13th leading cause of death in the United States. The presence of intraluminal thrombus is thought to cause hypoxia in the vessel wall eventually aggravating the condition. Our work investigates oxygen transport and consumption in a patient-specific model of an abdominal aortic aneurysm. The model includes intraluminal thrombus and consists of the abdominal aorta, renal arteries, and iliac arteries. Oxygen transport to and within the aortic wall layer was modeled, accounting for oxygen consumption and diffusion. Flow and transport in the lumen layer were modeled using coupled Navier-Stokes and scalar transport equations. The thrombus layer was assumed to be biomechanically inactive but permeable to oxygen transport in accordance with previously-measured diffusion coefficients. Plots of oxygen concentration through the layers illustrating reduced oxygen supply to the vessel walls in parts of the model that include thrombus will be presented.

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis.

PubMed

Utiyama, Edivaldo Massazo; Pflug, Adriano Ribeiro Meyer; Damous, Sérgio Henrique Bastos; Rodrigues, Adilson Costa; Montero, Edna Frasson de Souza; Birolini, Claudio Augusto Vianna

2015-01-01

to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

Cystic pancreatic neoplasms evaluation by CT and magnetic resonance cholangiopancreatography.

PubMed

Sahani, Dushyant; Prasad, Srinivasa; Saini, Sanjay; Mueller, Peter

2002-10-01

CT provides limited assistance in the differentiation between serous and mucinous neoplasms. Because of the variability in the radiographic appearance of serous cystadenomas and overlap in CT characteristics with mucinous neoplasms, most serous neoplasms still require ancillary testing such as biopsy to reach a definitive diagnosis. MRCP is useful in differentiating benign and malignant mucinous tumors including IPMT of the pancreas. The presence of mural nodules is suggestive of malignancy; however, the absence of mural nodules does not indicate that the tumor is benign. A maximum main pancreatic duct diameter of greater than 15 mm and diffuse dilatation of the main pancreatic duct are suggestive of malignancy in main duct-type tumors. Among branch duct-type tumors, malignant tumors tend to be larger than benign tumors; however, this finding is variable. The presence of main pancreatic duct dilatation may be helpful in determining malignancy of branch duct-type tumors.

The role of JAK2 abnormalities in hematologic neoplasms

PubMed Central

Alabdulaali, Mohammed K.

2009-01-01

In 2005, an activating mutation in the Janus kinase 2 (JAK2) was identified in a significant proportion of patients with myeloproliferative neoplasms, mainly polycythemia vera, essential thrombocythemia and primary myelofibrosis. Many types of mutations in the JAK-STAT pathway have been identified, the majority are related to JAK2. Currently JAK2 mutations are important in the area of diagnosis of myeloid neoplasms, but its role beyond the confirmation of clonality is growing and widening our knowledge about these disorders. In addition to that, clinical trials to target JAK2-STAT pathway will widen our knowledge and hopefully will offer more therapeutic options. In this review, we will discuss the role of JAK2 abnormalities in the pathogenesis, diagnosis, classification, severity and management of hematologic neoplasms.

Penetrating abdominal trauma.

PubMed

Henneman, P L

1989-08-01

The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

A Newborn With Abdominal Pain.

PubMed

Alwan, Riham; Drake, Meredith; Gurria Juarez, Juan; Emery, Kathleen H; Shaaban, Aimen F; Szabo, Sara; Sobolewski, Brad

2017-11-01

A previously healthy 3-week-old boy presented with 5 hours of marked fussiness, abdominal distention, and poor feeding. He was afebrile and well perfused. His examination was remarkable for localized abdominal tenderness and distention. He was referred to the emergency department in which an abdominal radiograph revealed gaseous distention of the bowel with a paucity of gas in the pelvis. Complete blood cell count and urinalysis were unremarkable. His ongoing fussiness and abnormal physical examination prompted consultation with surgery and radiology. Our combined efforts ultimately established an unexpected diagnosis. Copyright © 2017 by the American Academy of Pediatrics.

Solute carrier transporters: potential targets for digestive system neoplasms

PubMed Central

Xie, Jing; Zhu, Xiao Yan; Liu, Lu Ming; Meng, Zhi Qiang

2018-01-01

Digestive system neoplasms are the leading causes of cancer-related death all over the world. Solute carrier (SLC) superfamily is composed of a series of transporters that are ubiquitously expressed in organs and tissues of digestive systems and mediate specific uptake of small molecule substrates in facilitative manner. Given the important role of SLC proteins in maintaining normal functions of digestive system, dysregulation of these protein in digestive system neoplasms may deliver biological and clinical significance that deserves systemic studies. In this review, we critically summarized the recent advances in understanding the role of SLC proteins in digestive system neoplasms. We highlighted that several SLC subfamilies, including metal ion transporters, transporters of glucose and other sugars, transporters of urea, neurotransmitters and biogenic amines, ammonium and choline, inorganic cation/anion transporters, transporters of nucleotide, amino acid and oligopeptide organic anion transporters, transporters of vitamins and cofactors and mitochondrial carrier, may play important roles in mediating the initiation, progression, metastasis, and chemoresistance of digestive system neoplasms. Proteins in these SLC subfamilies may also have diagnostic and prognostic values to particular cancer types. Differential expression of SLC proteins in tumors of digestive system was analyzed by extracting data from human cancer database, which revealed that the roles of SLC proteins may either be dependent on the substrates they transport or be tissue specific. In addition, small molecule modulators that pharmacologically regulate the functions of SLC proteins were discussed for their possible application in the treatment of digestive system neoplasms. This review highlighted the potential of SLC family proteins as drug target for the treatment of digestive system neoplasms. PMID:29416375

Solute carrier transporters: potential targets for digestive system neoplasms.

PubMed

Xie, Jing; Zhu, Xiao Yan; Liu, Lu Ming; Meng, Zhi Qiang

2018-01-01

Digestive system neoplasms are the leading causes of cancer-related death all over the world. Solute carrier (SLC) superfamily is composed of a series of transporters that are ubiquitously expressed in organs and tissues of digestive systems and mediate specific uptake of small molecule substrates in facilitative manner. Given the important role of SLC proteins in maintaining normal functions of digestive system, dysregulation of these protein in digestive system neoplasms may deliver biological and clinical significance that deserves systemic studies. In this review, we critically summarized the recent advances in understanding the role of SLC proteins in digestive system neoplasms. We highlighted that several SLC subfamilies, including metal ion transporters, transporters of glucose and other sugars, transporters of urea, neurotransmitters and biogenic amines, ammonium and choline, inorganic cation/anion transporters, transporters of nucleotide, amino acid and oligopeptide organic anion transporters, transporters of vitamins and cofactors and mitochondrial carrier, may play important roles in mediating the initiation, progression, metastasis, and chemoresistance of digestive system neoplasms. Proteins in these SLC subfamilies may also have diagnostic and prognostic values to particular cancer types. Differential expression of SLC proteins in tumors of digestive system was analyzed by extracting data from human cancer database, which revealed that the roles of SLC proteins may either be dependent on the substrates they transport or be tissue specific. In addition, small molecule modulators that pharmacologically regulate the functions of SLC proteins were discussed for their possible application in the treatment of digestive system neoplasms. This review highlighted the potential of SLC family proteins as drug target for the treatment of digestive system neoplasms.

The association between cecal insertion time and colorectal neoplasm detection

PubMed Central

2013-01-01

Background Information on the impact of cecal insertion time on colorectal neoplasm detection is limited. Our objective was to determine the association between cecal insertion time and colorectal neoplasm detection rate in colonoscopy screening. Methods We performed a cross-sectional study of 12,679 consecutive subjects aged 40–79 years undergoing screening colonoscopy in routine health check-ups at the Center for Health Promotion of the Samsung Medical Center from December 2007 to June 2009. Fixed effects logistic regression conditioning on colonoscopist was used to eliminate confounding due to differences in technical ability and other characteristics across colonoscopists. Results The mean cecal insertion time was 5.9 (SD, 4.4 minutes). We identified 4,249 (33.5%) participants with colorectal neoplasms, of whom 1,956 had small single adenomas (<5 mm), 595 had medium single adenomas (5–9 mm), and 1,699 had multiple adenomas or advanced colorectal neoplasms. The overall rates of colorectal neoplasm detection by quartiles of cecal insertion time were 36.8%, 33.4%, 32.7%, and 31.0%, respectively (p trend <0.001).The odds for small single colorectal adenoma detection was 16% lower (adjusted OR 0.84; 95% CI 0.71 to 0.99) in the fourth compared to the first quartile of insertion time (p trend 0.005). Insertion time was not associated with the detection rate of single adenomas ≥5 mm, multiple adenomas or advanced colorectal neoplasms. Conclusion Shorter insertion times were associated with increased rates of detection of small colorectal adenomas <5 mm. Cecal insertion time may be clinically relevant as missed small colorectal adenomas may progress to more advanced lesions. PMID:23915303

Transcription factor mutations in myelodysplastic/myeloproliferative neoplasms

PubMed Central

Ernst, Thomas; Chase, Andrew; Zoi, Katerina; Waghorn, Katherine; Hidalgo-Curtis, Claire; Score, Joannah; Jones, Amy; Grand, Francis; Reiter, Andreas; Hochhaus, Andreas; Cross, Nicholas C.P.

2010-01-01

Background Aberrant activation of tyrosine kinases, caused by either mutation or gene fusion, is of major importance for the development of many hematologic malignancies, particularly myeloproliferative neoplasms. We hypothesized that hitherto unrecognized, cytogenetically cryptic tyrosine kinase fusions may be common in non-classical or atypical myeloproliferative neoplasms and related myelodysplastic/myeloproliferative neoplasms. Design and Methods To detect genomic copy number changes associated with such fusions, we performed a systematic search in 68 patients using custom designed, targeted, high-resolution array comparative genomic hybridization. Arrays contained 44,000 oligonucleotide probes that targeted 500 genes including all 90 tyrosine kinases plus downstream tyrosine kinase signaling components, other translocation targets, transcription factors, and other factors known to be important for myelopoiesis. Results No abnormalities involving tyrosine kinases were detected; however, nine cytogenetically cryptic copy number imbalances were detected in seven patients, including hemizygous deletions of RUNX1 or CEBPA in two cases with atypical chronic myeloid leukemia. Mutation analysis of the remaining alleles revealed non-mutated RUNX1 and a frameshift insertion within CEBPA. A further mutation screen of 187 patients with myelodysplastic/myeloproliferative neoplasms identified RUNX1 mutations in 27 (14%) and CEBPA mutations in seven (4%) patients. Analysis of other transcription factors known to be frequently mutated in acute myeloid leukemia revealed NPM1 mutations in six (3%) and WT1 mutations in two (1%) patients with myelodysplastic/myeloproliferative neoplasms. Univariate analysis indicated that patients with mutations had a shorter overall survival (28 versus 44 months, P=0.019) compared with patients without mutations, with the prognosis for cases with CEBPA, NPM1 or WT1 mutations being particularly poor. Conclusions We conclude that mutations of

Blastic plasmacytoid dendritic cell neoplasm in an elderly woman.

PubMed

Foong, H B B; Chong, M; Taylor, E M; Carlson, J A; Petrella, T

2013-04-01

Blastic plasmacytoid dendritic cell neoplasm (a.k.a. NK cell lymphoma, CD4+CD56+ haematodermic neoplasm) is a rare aggressive tumour that arises from plasmacytoid dendritic cell precursors. We report the first case from Malaysia of a 79-year-old Chinese woman who presented with purpuric plaques and nodules produced by pleomorphic CD4+, CD56+, CD68+, CD123+ and CD303+, but CD2APmononuclear cell infiltrates. Leukemic dissemination occurred and she succumbed to disease without treatment 4 weeks after diagnosis and 9 months after onset of cutaneous disease.

Micromanaging Abdominal Aortic Aneurysms

PubMed Central

Maegdefessel, Lars; Spin, Joshua M.; Adam, Matti; Raaz, Uwe; Toh, Ryuji; Nakagami, Futoshi; Tsao, Philip S.

2013-01-01

The contribution of abdominal aortic aneurysm (AAA) disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs) by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility. PMID:23852016

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. 2014 BMJ Publishing Group Ltd.

Abdominal aortic feminism

PubMed Central

Mortimer, Alice Emily

2014-01-01

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. PMID:25398912

A nomogram based on mammary ductoscopic indicators for evaluating the risk of breast cancer in intraductal neoplasms with nipple discharge.

PubMed

Lian, Zhen-Qiang; Wang, Qi; Zhang, An-Qin; Zhang, Jiang-Yu; Han, Xiao-Rong; Yu, Hai-Yun; Xie, Si-Mei

2015-04-01

Mammary ductoscopy (MD) is commonly used to detect intraductal lesions associated with nipple discharge. This study investigated the relationships between ductoscopic image-based indicators and breast cancer risk, and developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge. A total of 879 consecutive inpatients (916 breasts) with nipple discharge who underwent selective duct excision for intraductal neoplasms detected by MD from June 2008 to April 2014 were analyzed retrospectively. A nomogram was developed using a multivariate logistic regression model based on data from a training set (687 cases) and validated in an independent validation set (229 cases). A Youden-derived cut-off value was assigned to the nomogram for the diagnosis of breast cancer. Color of discharge, location, appearance, and surface of neoplasm, and morphology of ductal wall were independent predictors for breast cancer in multivariate logistic regression analysis. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.36. Area under the curve values of 0.812 (95 % confidence interval (CI) 0.763-0.860) and 0.738 (95 % CI 0.635-0.841) was obtained in the training and validation sets, respectively. The accuracies of the nomogram for breast cancer diagnosis were 71.2 % in the training set and 75.5 % in the validation set. We developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge based on MD image findings. This model may aid individual risk assessment and guide treatment in clinical practice.

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.

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 ...

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...Fever Hospital, Cairo, In the past, abdominal tuberculous ýileocaecal: was Egypt, are prospectively evaluated by the US Naval one of the commonest forms...8217. females of child-bearing age) indicated that 9 of 20 40%, were diagnosed as extrapulmonary tuberculosis. isolates from 91 tuberculous peritonitis

Blunt abdominal trauma in children.

PubMed

Schonfeld, Deborah; Lee, Lois K

2012-06-01

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

Plasma Cell Neoplasms (Including Multiple Myeloma)—Health Professional Version

Cancer.gov

There are several types of plasma cell neoplasms, including monoclonal gammopathy of undetermined significance (MGUS), isolated plasmacytoma of the bone, extramedullary plasmacytoma, and multiple myeloma. Find evidence-based information on plasma cell neoplasms treatment, research, and statistics.

Perivascular epithelioid cell neoplasm of the urinary bladder in an adolescent: a case report and review of the literature

PubMed Central

2012-01-01

Abstract Perivascular epithelioid cell neoplasms (PEComas) of the urinary bladder are extremely rare and the published cases were comprised predominantly of middle-aged patients. Herein, the authors present the first urinary bladder PEComa occurring in an adolescent. This 16-year-old Chinese girl present with a 3-year history of abdominal discomfort and a solid mass was documented in the urinary bladder by ultrasonography. Two years later, at the age of 18, the patient underwent transurethral resection of the bladder tumor. Microscopically, the tumor was composed of spindled cells mixed with epithelioid cells. Immunohistochemically, the tumor were strongly positive for HMB45, smooth muscle actin, muscle-specific actin, and H-caldesmon. Fluorescence in situ hybridization analysis revealed no evidence of EWSR1 gene rearrangement. The patient had been in a good status without evidence of recurrence 13 months after surgery. Urinary bladder PEComa is an extremely rare neoplasm and seems occur predominantly in middle-aged patients. However, this peculiar lesion can develop in pediatric population and therefore it should be rigorously distinguished from their mimickers. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1870004378817301 PMID:23276164

Perivascular epithelioid cell neoplasm of the urinary bladder in an adolescent: a case report and review of the literature.

PubMed

Yin, Lijuan; Bu, Hong; Chen, Min; Yu, Jianqun; Zhuang, Hua; Chen, Jie; Zhang, Hongying

2012-12-31

Perivascular epithelioid cell neoplasms (PEComas) of the urinary bladder are extremely rare and the published cases were comprised predominantly of middle-aged patients. Herein, the authors present the first urinary bladder PEComa occurring in an adolescent. This 16-year-old Chinese girl present with a 3-year history of abdominal discomfort and a solid mass was documented in the urinary bladder by ultrasonography. Two years later, at the age of 18, the patient underwent transurethral resection of the bladder tumor. Microscopically, the tumor was composed of spindled cells mixed with epithelioid cells. Immunohistochemically, the tumor were strongly positive for HMB45, smooth muscle actin, muscle-specific actin, and H-caldesmon. Fluorescence in situ hybridization analysis revealed no evidence of EWSR1 gene rearrangement. The patient had been in a good status without evidence of recurrence 13 months after surgery. Urinary bladder PEComa is an extremely rare neoplasm and seems occur predominantly in middle-aged patients. However, this peculiar lesion can develop in pediatric population and therefore it should be rigorously distinguished from their mimickers. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1870004378817301.

Neuroendocrine neoplasms of the lung: Concepts and terminology.

PubMed

Wick, Mark R; Marchevsky, Alberto M

2015-11-01

Neuroendocrine neoplasms of the lung continue to undergo scrutiny, with respect to the diagnostic terminology recommended for them and details of their clinicopathologic profiles. This overview considers the nosological evolution of such lesions and presents current views on classification schemes that pertain to them. Copyright © 2015 Elsevier Inc. All rights reserved.

European evidence-based guidelines on pancreatic cystic neoplasms

PubMed Central

Del Chiaro, Marco

2018-01-01

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN. PMID:29574408

Molecular pathology of skin neoplasms of the head and neck.

PubMed

Kraft, Stefan; Granter, Scott R

2014-06-01

Skin neoplasms include the most common malignancies affecting humans. Many show an ultraviolet (UV)-induced pathogenesis and often affect the head and neck region. To review literature on cutaneous neoplasms that show a predilection for the head and neck region and that are associated with molecular alterations. Literature review. Common nonmelanoma skin cancers, such as basal and squamous cell carcinomas, show a UV-induced pathogenesis. Basal cell carcinomas are characterized by molecular alterations of the Hedgehog pathway, affecting patched and smoothened genes. While squamous cell carcinomas show UV-induced mutations in several genes, driver mutations are only beginning to be identified. In addition, certain adnexal neoplasms also predominantly affect the head and neck region and show interesting, recently discovered molecular abnormalities, or are associated with hereditary conditions whose molecular genetic pathogenesis is well understood. Furthermore, recent advances have led to an increased understanding of the molecular pathogenesis of melanoma. Certain melanoma subtypes, such as lentigo maligna melanoma and desmoplastic melanoma, which are more often seen on the chronically sun-damaged skin of the head and neck, show differences in their molecular signature when compared to the other more common subtypes, such as superficial spreading melanoma, which are more prone to occur at sites with acute intermittent sun damage. In summary, molecular alterations in cutaneous neoplasms of the head and neck are often related to UV exposure. Their molecular footprint often reflects the histologic tumor type, and familiarity with these changes will be increasingly necessary for diagnostic and therapeutic considerations.

[Diagnostic molecular pathology of lymphatic and myeloid neoplasms].

PubMed

Klapper, W; Kreipe, H

2015-03-01

Molecular pathology has been an integral part of the diagnostics of tumors of the hematopoietic system substantially longer than for solid neoplasms. In contrast to solid tumors, the primary objective of molecular pathology in hematopoietic neoplasms is not the prediction of drug efficacy but the diagnosis itself by excluding reactive proliferation and by using molecular features for tumor classification. In the case of malignant lymphomas, the most commonly applied molecular tests are those for gene rearrangements for immunoglobulin heavy chains and T-cell receptors. However, this article puts the focus on new and diagnostically relevant assays in hematopathology. Among these are mutations of MYD88 codon 265 in lymphoplasmacytic lymphomas, B-raf V600E in hairy cell leukemia and Stat3 exon 21 in indolent T-cell lymphomas. In myeloproliferative neoplasms, MPL W515, calreticulin exon 9 and the BCR-ABL and JAK2 V617F junctions are the most frequently analyzed differentiation series. In myelodysplastic and myeloproliferative neoplasms, SRSF2, SETBP1 and CSF3R mutations provide important differential diagnostic information. Genes mutated in myelodysplastic syndromes (MDS) are particularly diverse but their analysis significantly improves the differential diagnostics between reactive conditions and MDS. The most frequent changes in MDS include mutations of TET2 and various genes encoding splicing factors.

Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®)—Health Professional Version

Cancer.gov

Myelodysplastic/myeloproliferative neoplasms (MDS/MPN) are treated with chemotherapy or other drugs, stem cell transplant, supportive care, and targeted therapy. They include chronic myelomonocytic leukemia (CMML), juvenile myelomonocytic leukemia (JMML), and atypical chronic myeloid leukemia (aCML). Learn about the clinical features and treatment options for these leukemias.

Lifestyle Behaviors as Predictors of Malignant Neoplasm Development.

ERIC Educational Resources Information Center

Baum, L. S.; And Others

The relationship between lifestyle behaviors and the onset of neoplasm development has been researched extensively. This study took a multivariate approach in attempting to identify lifestyle variables which could predict group membership among subjects diagnosed as having cancer and those subjects who have not been diagnosed as having cancer.…

Wide abdominal rectus plication abdominoplasty for the treatment of chronic intractable low back pain.

PubMed

Oneal, Robert M; Mulka, Joseph P; Shapiro, Paul; Hing, David; Cavaliere, Christi

2011-01-01

A previous report demonstrated that the wide abdominal rectus plication abdominoplasty is an effective treatment modality in select patients with low back pain who failed to achieve relief with conservative therapy. The authors studied eight female patients who presented with chronic low back pain and marked lower abdominal wall muscular laxity. All had failed to respond to conservative management for their chronic back pain. They all underwent wide abdominal rectus plication abdominoplasty. Patient selection and details of the procedure are discussed. There were no significant complications in this series, and all the patients had prompt and prolonged alleviation of their back pain. Length of follow-up ranged from 2 to 11 years. Changes in the biomechanics of the lower abdominal musculature as a result of the wide abdominal rectus plication abdominoplasty are discussed in the context of increasing spinal stability, leading to an alleviation of chronic low back pain. An argument is made that this abdominoplasty procedure produces a spine-stabilizing effect by (1) tightening the muscles of the lateral abdominal complex and thus increasing intraabdominal pressure and (2) increasing the efficiency of these muscles so that their effectiveness as spine stabilizers is increased. Even though this is a small series, the fact that all the patients sustained long-term alleviation of their preoperative chronic back pain suggests that the wide abdominal rectus plication abdominoplasty should be considered as an option for patients with weak lower abdominal muscles and intractable low back pain who have failed conservative management.

Primary Tumors of the Osseous Chest Wall and Their Management.

PubMed

Thomas, Mathew; Shen, K Robert

2017-05-01

Primary osseous tumors of the chest wall are uncommon neoplasms. They occur in a wide variety of pathologic forms, most of which can be distinguished by unique radiologic appearance. Management of these tumors depends on the diagnosis and stage. Adequate surgical resection is critical in achieving the best outcomes for most of these tumors. Chemotherapy and radiation may have an adjuvant role. Surgeons considering resection of any chest wall tumor should have a sound knowledge of the principles of resection and reconstruction. Copyright © 2017 Elsevier Inc. All rights reserved.

Age-specific incidence of all neoplasms after colorectal cancer.

PubMed

Levi, Fabio; Randimbison, Lalao; Blanc-Moya, Rafael; La Vecchia, Carlo

2014-10-01

Patients diagnosed with a specific neoplasm tend to have a subsequent excess risk of the same neoplasm. The age incidence of a second neoplasm at the same site is approximately constant with age, and consequently the relative risk is greater at younger age. It is unclear whether such a line of reasoning can be extended from a specific neoplasm to the incidence of all neoplasms in subjects diagnosed with a defined neoplasm. We considered the age-specific incidence of all non-hormone-related epithelial neoplasms after a first primary colorectal cancer (n = 9542) in the Vaud Cancer Registry data set. In subjects with a previous colorectal cancer, the incidence rate of all other epithelial non-hormone-related cancers was stable around 800 per 100,000 between age 30 and 60 years, and rose only about twofold to reach 1685 at age 70 to 79 years and 1826 per 100,000 at age 80 years or older. After excluding synchronous cancers, the rise was only about 1.5-fold, that is, from about 700 to 1000. In the general population, the incidence rate of all epithelial non-hormone-related cancers was 29 per 100,000 at age 30 to 39 years, and rose 30-fold to 883 per 100,000 at age 70 to 79 years. Excluding colorectal cancers, the rise of all non-hormone-related cancers was from 360 per 100,000 at age 40 to 49 years to 940 at age 70 to 79 years after colorectal cancer, and from 90 to 636 per 100,000 in the general population (i.e., 2.6- vs. 7.1-fold). The rise of incidence with age of all epithelial non-hormone-related second cancers after colorectal cancer is much smaller than in the general population. This can possibly be related to the occurrence of a single mutational event in a population of susceptible individuals, although alternative models are plausible within the complexity of the process of carcinogenesis. Copyright © 2014 Elsevier Inc. All rights reserved.

MR imaging of the pelvis: a guide to incidental musculoskeletal findings for abdominal radiologists.

PubMed

Gaetke-Udager, Kara; Girish, Gandikota; Kaza, Ravi K; Jacobson, Jon; Fessell, David; Morag, Yoav; Jamadar, David

2014-08-01

Occasionally patients who undergo magnetic resonance imaging for presumed pelvic disease demonstrate unexpected musculoskeletal imaging findings in the imaged field. Such incidental findings can be challenging to the abdominal radiologist, who may not be familiar with their appearance or know the appropriate diagnostic considerations. Findings can include both normal and abnormal bone marrow, osseous abnormalities such as Paget's disease, avascular necrosis, osteomyelitis, stress and insufficiency fractures, and athletic pubalgia, benign neoplasms such as enchondroma and bone island, malignant processes such as metastasis and chondrosarcoma, soft tissue processes such as abscess, nerve-related tumors, and chordoma, joint- and bursal-related processes such as sacroiliitis, iliopsoas bursitis, greater trochanteric pain syndrome, and labral tears, and iatrogenic processes such as bone graft or bone biopsy. Though not all-encompassing, this essay will help abdominal radiologists to identify and describe this variety of pelvic musculoskeletal conditions, understand key radiologic findings, and synthesize a differential diagnosis when appropriate.

Dendritic cell and histiocytic neoplasms: biology, diagnosis, and treatment.

PubMed

Dalia, Samir; Shao, Haipeng; Sagatys, Elizabeth; Cualing, Hernani; Sokol, Lubomir

2014-10-01

Dendritic and histiocytic cell neoplasms are rare malignancies that make up less than 1% of all neoplasms arising in lymph nodes or soft tissues. These disorders have distinctive disease biology, clinical presentations, pathology, and unique treatment options. Morphology and immunohistochemistry evaluation by a hematopathologist remains key for differentiating between these neoplasms. In this review, we describe tumor biology, clinical features, pathology, and treatment of follicular dendritic cell sarcoma, interdigitating dendritic cell sarcoma, indeterminate dendritic cell sarcoma, histiocytic sarcoma, fibroblastic reticular cell tumors, and disseminated juvenile xanthogranuloma. A literature search for articles published between 1990 and 2013 was undertaken. Articles are reviewed and salient findings are systematically described. Patients with dendritic cell and histiocytic neoplasms have distinct but variable clinical presentations; however, because many tumors have recently been recognized, their true incidence is uncertain. Although the clinical features can present in many organs, most occur in the lymph nodes or skin. Most cases are unifocal and solitary presentations have good prognoses with surgical resection. The role of adjuvant therapy in these disorders remains unclear. In cases with disseminated disease, prognosis is poor and data on treatment options are limited, although chemotherapy and referral to a tertiary care center should be considered. Excisional biopsy is the preferred method of specimen collection for tissue diagnosis, and immunohistochemistry is the most important diagnostic method for differentiating these disorders from other entities. Dendritic cell and histiocytic cell neoplasms are rare hematological disorders with variable clinical presentations and prognoses. Immunohistochemistry remains important for diagnosis. Larger pooled analyses or clinical trials are needed to better understand optimal treatment options in these rare

Second neoplasms after invasive and borderline ovarian cancer.

PubMed

Levi, Fabio; Randimbison, Lalao; Blanc-Moya, Rafael; La Vecchia, Carlo

2009-06-01

Excess risk of subsequent cancers has been documented in women diagnosed with ovarian cancer. We updated to 2006 data on second cancers in women diagnosed with invasive and borderline ovarian cancer in the Swiss canton of Vaud. Between 1974 and 2006, 304 borderline and 1530 invasive first ovarian tumours were abstracted from the Vaud Cancer Registry database and followed up till the end of 2006. Calculation of expected numbers of tumours in the cohorts was based on site-specific, age-specific and calendar-year-specific incidence rates. We computed the standardized incidence ratios (SIRs) of second cancers, and the corresponding 95% confidence intervals (CI). There was no change in the incidence of malignant cancers, but that of borderline tumours increased over more recent years. Overall, 110 second neoplasms were observed versus 49.7 expected after invasive ovarian cancer (SIR 2.21; 95% CI: 1.82-2.67). Significant excess risks were observed for cancers of the breast, corpus uteri and leukaemias. When synchronous cancers were excluded, the overall SIR for all sites declined to 1.05. Thirty-one second neoplasms were observed after borderline tumours compared with 21.1 expected (SIR=1.47; 95% CI: 1.00-2.09). SIRs were above unity for ovary, colorectum and uterus. After exclusion of synchronous neoplasms, SIR for all neoplasms declined to 1.09, and remained significant only for second ovarian cancers (SIR=4.93). The present record linkage cohort study shows an excess risk for selected synchronous neoplasms in women diagnosed with both borderline and invasive ovarian cancer, likely because of shared genetic and perhaps environmental factors.

Acute myeloid leukemia mimicking primary testicular neoplasm. Presentation of a case with review of literature.

PubMed

McIlwain, Laura; Sokol, Lubomir; Moscinski, Lynn C; Saba, Hussain I

2003-04-01

We describe a new unique case of acute myeloid leukemia (AML) in a 21-yr-old male presenting with abdominal pain, bilateral testicular masses and gynecomastia. Further work-up with computed tomography of the chest, abdomen and pelvis revealed massive retroperitoneal, peripancreatic and mediastinal lymphadenopathy, suggesting primary testicular neoplasm. The patient was subjected to right orchiectomy that showed infiltration of testicular tissue with malignant cells, originally misinterpreted as undifferentiated carcinoma. Immunohistochemistry studies, however, showed these cells to be strongly positive for myeloperoxidase and CD45, indicating a myeloid cell origin. Bone marrow (BM) aspirate and biopsy demonstrated replacement of marrow with immature myeloid cells. Both the morphology and immunophenotype of the blast cells were consistent with AML type M4 (acute myelo-monocytic leukemia), using French-American-British (FAB) classification. The patient received standard induction chemotherapy with cytosine arabinoside (ARA-C) and daunorubicin followed with two cycles of consolidation therapy with high dose ARA-C, which resulted in remission of BM disease and resolution of lymphadenopathy and left testicular masses. After the second cycle of consolidation therapy, the patient developed sepsis that was complicated by refractory disseminated intravascular coagulopathy. He expired with a clinical picture of multiple organ failure. The unique features of this case are presented and the related literature is reviewed.

Haemangiosarcoma of the os penis in a dog: The most common neoplasm of the canine penis.

PubMed

Burchell, Richard K; Kirberger, Robert M; Janse van Rensberg, Drienie D Didi

2014-08-21

A castrated 9-year-old intact male boerboel cross-breed dog was presented with a month-long history of stranguria. On physical examination, a mass was noted at the caudal extremity of the os penis. Haematology, serum chemistry and urinalysis were all unremarkable. Abdominal and urethral ultrasound demonstrated an enlarged bladder and a dilated urethra, which was followed to the caudal extremity of the os penis. A hyperechoic, roughly spherical,vascularised mass was noted at the caudal os penis, which resulted in obstruction of the penile urethra. Radiographs demonstrated a soft tissue mass with osteolysis of the os penis. Cytology suggested an osteosarcoma. Treatment included amputation of the penis and adjuvant doxorubicin with carboplatin. Histopathology of the penis confirmed a haemangiosarcoma. The patient survived for 20 months. This is only the second published case report describing a penile haemangiosarcoma, and the first published report demonstrating the treatment and outcome of a case of haemangiosarcoma of the os penis. Based on published and unpublished reports, haemangiosarcoma appears to be the most common neoplasm of the canine penis.

Scrub typhus associated hepatic dysfunction and abdominal CT findings

PubMed Central

Park, Man Je; Lee, Hyoun Soo; Shim, Sang Goon; Kim, So Hee

2015-01-01

Objective: This retrospective study investigated abnormal hepatic dysfunction and abdominal computed tomography (CT) findings in scrub typhus. Methods: Three hundred forty nine adult patients were diagnosed with scrub typhus. Ninety four underwent abdominal CT. The CT images were reviewed by the attending radiologist. Patient data of history, symptoms, signs, and results of laboratory tests were collected from the electronic medical records. Results: In 349 patients with scrub typhus, elevation of aspartate aminotransferase (78.5%) and alanine aminotransferase (63.0%) were dominant compared to alkaline phosphatase (27.2%) and total bilirubin (16.1%). Abdominal CT findings of 94 patients were, in descending order of frequency, enlarged lymph node (53.2%), inhomogeneous enhancement of liver (47.9%), splenomegaly (46.8%), ascites (28.7%), low attenuation of periportal areas (27.7%), gallbladder wall thickening (17.0%), and splenic infarct (6.4%). Also, the level of aspartate aminotransferase tended to be elevated according to the number of CT findings (P= 0.028) Conclusions: We found that abdominal CT manifestations of scrub typhus with elevated aminotransferases were varied and not specific. However, knowledge of these findings may evoke the recognition of scrub typhus by clinicians in endemic areas. PMID:26101478

Detection of comorbidities and synchronous primary tumours via thoracic radiography and abdominal ultrasonography and their influence on treatment outcome in dogs with soft tissue sarcomas, primary brain tumours and intranasal tumours.

PubMed

Bigio Marcello, A; Gieger, T L; Jiménez, D A; Granger, L Abbigail

2015-12-01

Canine soft tissue sarcomas (STS), primary brain tumours and intranasal tumours are commonly treated with radiotherapy (RT). Given the low metastatic potential of these tumours, recommendations regarding imaging tests as staging are variable among institutions. The purpose of our study was to describe thoracic radiographic and abdominal ultrasonographic findings in dogs with these neoplasms and to investigate association of abnormal findings with alterations in recommended treatment. Medical records from 101 dogs, each having thoracic radiographs and abdominal ultrasound performed as part of their staging, were reviewed. In 98 of 101 (97%), imaging abnormalities were detected, 27% of which were further investigated with fine needle aspiration cytology or biopsy. Nine percent of the detected abnormalities were considered serious comorbidities that altered treatment recommendations, including 3 (3%) which were confirmed as synchronous primary neoplasms. These findings may influence recommendations regarding the decision to perform thoracic radiographs and abdominal ultrasound prior to initiation of RT. © 2013 John Wiley & Sons Ltd.

Abdominal stab wound protocol: prospective study documents applicability for widespread use.

PubMed

Rosemurgy, A S; Albrink, M H; Olson, S M; Sherman, H; Albertini, J; Kramer, R; Camps, M; Reiss, A

1995-02-01

Traditionally, stab wounds violating the abdominal wall fascia led to exploratory celiotomy that was often nontherapeutic. In an attempt to limit the number of nontherapeutic celiotomies (NTC), we devised a protocol to prospectively study stab wounds violating the anterior abdominal wall fascia. Through protocol, abdominal stab wounds were explored in stable adults. If the anterior fascia was violated, paracentesis and, if necessary, peritoneal lavage was undertaken in the absence of previous abdominal surgery. If evisceration was noted, it was reduced and the patient lavaged. Fascial penetration was noted in 72 patients. 46 patients underwent celiotomy: because of shock/peritonitis in 8 (2 NTC), fascial penetration with a history of previous celiotomy in 7 (5 NTC), positive paracentesis in 20 (5 NTC), or positive lavage in 10 (4 NTC). One patient underwent late celiotomy without ill-effect after a negative lavage because she subsequently developed fever and localized peritonitis (ice pick injury to cecum). Eleven patients had evisceration; nine underwent celiotomy. Patients with abdominal stab wounds can be selectively managed safely. More than one-third with fascial penetration, some with evisceration, avoided exploration. Only one patient underwent delayed celiotomy and did so without detriment. Nontherapeutic celiotomy rates were highest in patients with previous abdominal surgery who, thereby, could not undergo paracentesis/lavage; excluding these patients, the nontherapeutic celiotomy rate was 17% (11/65) for those with fascial penetration.

On the prediction of monocyte deposition in abdominal aortic aneurysms using computational fluid dynamics.

PubMed

Hardman, David; Doyle, Barry J; Semple, Scott I K; Richards, Jennifer M J; Newby, David E; Easson, William J; Hoskins, Peter R

2013-10-01

In abdominal aortic aneurysm disease, the aortic wall is exposed to intense biological activity involving inflammation and matrix metalloproteinase-mediated degradation of the extracellular matrix. These processes are orchestrated by monocytes and rather than affecting the aorta uniformly, damage and weaken focal areas of the wall leaving it vulnerable to rupture. This study attempts to model numerically the deposition of monocytes using large eddy simulation, discrete phase modelling and near-wall particle residence time. The model was first applied to idealised aneurysms and then to three patient-specific lumen geometries using three-component inlet velocities derived from phase-contrast magnetic resonance imaging. The use of a novel, variable wall shear stress-limiter based on previous experimental data significantly improved the results. Simulations identified a critical diameter (1.8 times the inlet diameter) beyond which significant monocyte deposition is expected to occur. Monocyte adhesion occurred proximally in smaller abdominal aortic aneurysms and distally as the sac expands. The near-wall particle residence time observed in each of the patient-specific models was markedly different. Discrete hotspots of monocyte residence time were detected, suggesting that the monocyte infiltration responsible for the breakdown of the abdominal aortic aneurysm wall occurs heterogeneously. Peak monocyte residence time was found to increase with aneurysm sac size. Further work addressing certain limitations is needed in a larger cohort to determine clinical significance.

Effects of abdominal pressure on venous return: abdominal vascular zone conditions.

PubMed

Takata, M; Wise, R A; Robotham, J L

1990-12-01

The effects of changes in abdominal pressure (Pab) on inferior vena cava (IVC) venous return were analyzed using a model of the IVC circulation based on a concept of abdominal vascular zone conditions analogous to pulmonary vascular zone conditions. We hypothesized that an increase in Pab would increase IVC venous return when the IVC pressure at the level of the diaphragm (Pivc) exceeds the sum of Pab and the critical closing transmural pressure (Pc), i.e., zone 3 conditions, but reduce IVC venous return when Pivc is below the sum of Pab and Pc, i.e., zone 2 conditions. The validity of the model was tested in 12 canine experiments with an open-chest IVC bypass. An increase in Pab produced by phrenic stimulation increased the IVC venous return when Pivc-Pab was positive but decreased the IVC venous return when Pivc - Pab was negative. The value of Pivc - Pab that separated net increases from decreases in venous return was 1.00 +/- 0.72 (SE) mmHg (n = 6). An increase in Pivc did not influence the femoral venous pressure when Pivc was lower than the sum of Pab and a constant, 0.96 +/- 0.70 mmHg (n = 6), consistent with presence of a waterfall. These results agreed closely with the predictions of the model and its computer simulation. The abdominal venous compartment appears to function with changes in Pab either as a capacitor in zone 3 conditions or as a collapsible Starling resistor with little wall tone in zone 2 conditions.

Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix

PubMed Central

Mylona, E.; Tsakalidis, C.; Spyridakis, I.; Mitsiakos, G.; Karagianni, P.

2016-01-01

Introduction. Incisional hernias are a common complication appearing after abdominal wall defects reconstruction, with omphalocele and gastroschisis being the most common etiologies in children. Abdominal closure of these defects represents a real challenge for pediatric surgeons with many surgical techniques and various prosthetic materials being used for this purpose. Case Report. We present a case of repair of a postoperative ventral hernia occurring after congenital omphalocele reconstruction in a three-and-a-half-year-old child using an acellular, sterile, porcine dermal mesh. Conclusion. Non-cross-linked acellular porcine dermal matrix is an appropriate mesh used for the reconstruction of abdominal wall defects and their postoperative complications like large ventral hernias with success and preventing their recurrence. PMID:27110247

Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix.

PubMed

Lambropoulos, V; Mylona, E; Mouravas, V; Tsakalidis, C; Spyridakis, I; Mitsiakos, G; Karagianni, P

2016-01-01

Introduction. Incisional hernias are a common complication appearing after abdominal wall defects reconstruction, with omphalocele and gastroschisis being the most common etiologies in children. Abdominal closure of these defects represents a real challenge for pediatric surgeons with many surgical techniques and various prosthetic materials being used for this purpose. Case Report. We present a case of repair of a postoperative ventral hernia occurring after congenital omphalocele reconstruction in a three-and-a-half-year-old child using an acellular, sterile, porcine dermal mesh. Conclusion. Non-cross-linked acellular porcine dermal matrix is an appropriate mesh used for the reconstruction of abdominal wall defects and their postoperative complications like large ventral hernias with success and preventing their recurrence.

Secondary abdominal appendicular ectopic pregnancy.

PubMed

Nama, Vivek; Gyampoh, Bright; Karoshi, Mahantesh; McRae, Reynold; Opemuyi, Isaac

2007-01-01

Although the case fatality rate for ectopic pregnancies has decreased to 0.08% in industrialized countries, it still represents 3.8% of maternal mortality in the United States alone. In developing countries, the case fatality rate varies from 3% to 27%. Laparoscopic management of tubal pregnancies is now the standard form of treatment where this technology is available. Abdominal pregnancies are rare, and secondary implantation of tubal ectopic pregnancies is the most common cause of abdominal gestations. We present an interesting case of secondary implantation of a tubal ectopic pregnancy to highlight the appendix as a possible secondary implantation site after a tubal ectopic pregnancy.

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.

Penetrating abdominal injuries: management controversies

PubMed Central

Butt, Muhammad U; Zacharias, Nikolaos; Velmahos, George C

2009-01-01

Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries. PMID:19374761

The influence of computational assumptions on analysing abdominal aortic aneurysm haemodynamics.

PubMed

Ene, Florentina; Delassus, Patrick; Morris, Liam

2014-08-01

The variation in computational assumptions for analysing abdominal aortic aneurysm haemodynamics can influence the desired output results and computational cost. Such assumptions for abdominal aortic aneurysm modelling include static/transient pressures, steady/transient flows and rigid/compliant walls. Six computational methods and these various assumptions were simulated and compared within a realistic abdominal aortic aneurysm model with and without intraluminal thrombus. A full transient fluid-structure interaction was required to analyse the flow patterns within the compliant abdominal aortic aneurysms models. Rigid wall computational fluid dynamics overestimates the velocity magnitude by as much as 40%-65% and the wall shear stress by 30%-50%. These differences were attributed to the deforming walls which reduced the outlet volumetric flow rate for the transient fluid-structure interaction during the majority of the systolic phase. Static finite element analysis accurately approximates the deformations and von Mises stresses when compared with transient fluid-structure interaction. Simplifying the modelling complexity reduces the computational cost significantly. In conclusion, the deformation and von Mises stress can be approximately found by static finite element analysis, while for compliant models a full transient fluid-structure interaction analysis is required for acquiring the fluid flow phenomenon. © IMechE 2014.

Implanting intra-abdominal radiotransmitters with external whip antennas in ducks