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Sample records for beim akuten abdomen

  1. Point tenderness - abdomen

    MedlinePlus

    ... medlineplus.gov/ency/article/003273.htm Point tenderness - abdomen To use the sharing features on this page, ... over a certain part of the belly area (abdomen). Considerations The abdomen is an area of the ...

  2. Abscess - abdomen or pelvis

    MedlinePlus

    ... infected fluid and pus located inside the belly (abdominal cavity). This type of abscess can be located near ... abdominal abscesses: Abdominal x-ray Ultrasound of the abdomen and pelvis CT scan of the abdomen and ...

  3. Ultrasound: Abdomen (For Parents)

    MedlinePlus

    ... for TV, Video Games, and the Internet Ultrasound: Abdomen KidsHealth > For Parents > Ultrasound: Abdomen Print A A A What's in this article? ... Child If You Have Questions en español Ultrasonido: abdomen What It Is An abdominal ultrasound is a ...

  4. CT angiography - abdomen and pelvis

    MedlinePlus

    Computed tomography angiography - abdomen and pelvis; CTA - abdomen and pelvis; Renal artery - CTA; Aortic - CTA; Mesenteric CTA ... belly or pelvis Masses and tumors in the abdomen or pelvis, including cancer, when needed to help ...

  5. Acute abdomen. Outcomes.

    PubMed

    Madonna, M B; Boswell, W C; Arensman, R M

    1997-05-01

    The outcome for children with common surgical conditions that cause an acute abdomen is discussed. These conditions include appendicitis, intussusception, malrotation, inflammatory bowel disease, intestinal obstructions, and nonorganic pain. Emphasis is placed on surgical intervention and disease processes that significantly affect outcome. The outcome of many of the diseases discussed is strongly influenced by the timing of diagnosis and treatment. These children should have prompt care and intervention to prevent morbidity and mortality. In addition, many children who present with common pediatric surgical emergencies have other medical conditions and are best treated in an environment that has a multidisciplinary team to handle their care and decrease the long-term complications.

  6. Drosophila pupal abdomen immunohistochemistry.

    PubMed

    Wang, Wei; Yoder, John H

    2011-10-02

    The Drosophila pupal abdomen is an established model system for the study of epithelial morphogenesis and the development of sexually dimorphic morphologies. During pupation, which spans approximately 96 hours (at 25 °C), proliferating populations of imaginal cells replace the larval epidermis to generate the adult abdominal segments. These imaginal cells, born during embryogenesis, exist as lateral pairs of histoblast nests in each abdominal segment of the larvae. Four pairs of histoblast nests give rise to the adult dorsal cuticle (anterior and posterior dorsal nests), the ventral cuticle (ventral nests) and the spiracles associated with each segment (spiracle nests). Upon puparation, these diploid cells (distinguishable by size from the larger polyploid larval epidermal cells- LECs) begin a stereotypical process of proliferation, migration and replacement of the LECs. Various molecular and genetic tools can be employed to investigate the contributions of genetic pathways involved in morphogenesis of the adult abdomen. Ultimate adult phenotypes are typically analyzed following dissection of adult abdominal cuticles. However, investigation of the underlying molecular processes requires immunohistochemical analyses of the pupal epithelium, which present unique challenges. Temporally dynamic morphogenesis and the interactions of two distinct epithelial populations (larval and imaginal) generate a fragile tissue prone to excessive cell loss during dissection and subsequent processing. We have developed methods of dissection, fixation, mounting and imaging of the Drosophila pupal abdominem epithelium for immunohistochemical studies that generate consistent high quality samples suitable for confocal or standard fluorescent microscopy.

  7. Closure of the open abdomen.

    PubMed

    Björck, Martin; D'Amours, Scott K; Hamilton, A E Ricardo

    2011-07-01

    The open abdomen is a valuable tool in the management of patients with intra-abdominal hypertension and abdominal compartment syndrome. The longer an abdomen is left open, the greater the potential morbidity, however. From the very start, specific measures should be considered to increase the likelihood of definitive closure and prevent the development of visceral adhesions, lateralization, and/or loss of skin and fascia, ileus, fistulae, and malnutrition. Early definitive closure of all abdominal wall layers is the short-term goal of management once the need for the open abdomen has resolved. Several devices and strategies improve the chances for definitive closure. If a frozen abdomen develops, split-thickness skin grafting of a granulating open abdominal wound base is an alternative. Early coverage of the exposed viscera and acceptance of a large abdominal hernia permit earlier reversal of the catabolic state and lower the risk of fistula formation. When a stoma is required, sealing and separation can become problematic. If a fistula develops, a more complex situation prevails, requiring specific techniques to isolate its output and a longer-term strategy to restore intestinal continuity. Planning the closure of an open abdomen is a process that starts on the first day that the abdomen is opened. Multiple factors need to be addressed, optimized, and controlled to achieve the best outcome.

  8. 49 CFR 572.186 - Abdomen assembly.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Abdomen assembly. 572.186 Section 572.186... Dummy, 50th Percentile Adult Male § 572.186 Abdomen assembly. (a) The abdomen assembly (175-5000) is...). When subjected to tests procedures specified in paragraph (b) of this section, the abdomen assembly...

  9. 49 CFR 572.186 - Abdomen assembly.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Abdomen assembly. 572.186 Section 572.186... Test Dummy, 50th Percentile Adult Male § 572.186 Abdomen assembly. (a) The abdomen assembly (175-5000...(e). When subjected to tests procedures specified in paragraph (b) of this section, the abdomen...

  10. 49 CFR 572.186 - Abdomen assembly.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Abdomen assembly. 572.186 Section 572.186... Test Dummy, 50th Percentile Adult Male § 572.186 Abdomen assembly. (a) The abdomen assembly (175-5000...(e). When subjected to tests procedures specified in paragraph (b) of this section, the abdomen...

  11. 49 CFR 572.186 - Abdomen assembly.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Abdomen assembly. 572.186 Section 572.186... Dummy, 50th Percentile Adult Male § 572.186 Abdomen assembly. (a) The abdomen assembly (175-5000) is...). When subjected to tests procedures specified in paragraph (b) of this section, the abdomen assembly...

  12. Nutrition and the open abdomen.

    PubMed

    Powell, Nathan J; Collier, Bryan

    2012-08-01

    Adequate nutrition support is critical in the management of patients with an open abdomen. Despite the literature supporting its use in trauma patients, provider concerns and clinical controversies remain regarding the early administration and long-term sequelae of enteral nutrition (EN) therapy in these patients. The purpose of this article is to review the clinical concepts behind the use of the open abdomen, as well as examine the altered nutrition requirements associated with the maintenance of a temporary laparostomy. The rationale for early EN is described, as well as the pros and cons surrounding the use of supplemental parenteral nutrition in those patients unable to meet nutrition goals enterally in a reasonable time frame. Finally, an open abdomen nutrition support algorithm is provided as part of the critical care plan in these patients who represent the sickest of surgical patients.

  13. Abdomen X-Ray (Radiography)

    MedlinePlus

    ... News Physician Resources Professions Site Index A-Z X-ray (Radiography) - Abdomen Abdominal x-ray uses a very ... of an abdominal x-ray? What is abdominal x-ray? An x-ray (radiograph) is a noninvasive medical ...

  14. Magnetic Resonance Elastography of Abdomen

    PubMed Central

    Venkatesh, Sudhakar K.; Ehman, Richard L.

    2015-01-01

    Many diseases cause substantial changes in the mechanical properties of tissue and this provides motivation for developing methods to non-invasively assess the stiffness of tissue using imaging technology. Magnetic resonance elastography (MRE) has emerged as a versatile MRI-based technique, based on direct visualization of propagating shear waves in the tissues. The most established clinical application of MRE in the abdomen is in chronic liver disease. MRE is currently regarded as the most accurate non-invasive technique for detection and staging of liver fibrosis. Increasing experience and ongoing research is leading to exploration of applications in other abdominal organs. In this review article, the current use of MRE in liver disease and the potential future applications of this technology in other parts of the abdomen are surveyed. PMID:25488346

  15. Verbesserung der Prozessbedingungen beim Einlippentiefbohren durch unterschiedliche Formen der Vorschubmodulation

    NASA Astrophysics Data System (ADS)

    Eisseler, Rocco

    Das Tiefbohren mit Einlippenwerkzeugen ist bei vielen Anwendungen das Verfahren der ersten Wahl, vor allem wenn kleine und kleinste Bohrungsdurchmesser, ein sehr großes Verhältnis zwischen Bohrtiefe und Durchmesser (l/D) und eine hohe Bearbeitungsqualität gefordert werden. Der erreichbare Durchmesserbereich des Verfahrens liegt zwischen D = 0,5 mm und 40 mm, wobei die möglichen Bohrtiefen von l = 3 x D bis 250 x D reichen. Diese Werte beziehen sich auf das Vollbohren, beim Aufbohren können noch größere Durchmesser erreicht werden [1]. Die erreichbare Oberflächenqualität ist so hoch, dass in den meisten Fällen auf eine nachfolgende Feinbearbeitung verzichtet werden kann.

  16. [Intravascular lymphoma causing acute abdomen].

    PubMed

    Kröber, S M

    2007-02-01

    A 65-year old man presented with acute abdominal pain and fever. The initial diagnosis was small bowel gangrene. Pathology revealed small to large abdominal vessels obliterated by cells of intravascular B-cell-lymphoma (IVL). Visceral IVL involvement is common at autopsy but rarely reported in patients with acute abdomen. The subtype of diffuse large B-cell lymphoma is a rare and aggressive malignancy, which in typical cases is characterized by cephalic or cutaneous manifestation. Few cases showed involvement of large vessels which in combination to fibrin thrombi may lead to infarction of the organ involved. Thus IVL should be considered in cases of ischemic diseases with fever of unknown origin.

  17. Dynamic radiology of the abdomen

    SciTech Connect

    Meyers, M.A.

    1988-01-01

    The third edition of this book remains the only text covering radiology of the abdomen as it relates to the progression of disease within organ and from one organ to another. New to this edition are discussions of: recent advances in the understanding of the normal and variant relationship of the lobar anatomy of the liver; the structural relationship of the porta hepatis and its contents; further refinements in the precise evaluation of the extraperitoneal fascia and spaces; new developments in the understanding of the intraperitoneal spread of infection and malignancy.

  18. Management of the open abdomen.

    PubMed

    Demetriades, Demetrios; Salim, Ali

    2014-02-01

    The open abdomen has become the standard of care in damage-control procedures, the management of intra-abdominal hypertension, and in severe intra-abdominal sepsis. This approach has saved many lives but has also created new problems, such as severe fluid and protein loss, nutritional problems, enteroatmospheric fistulas, fascial retraction with loss of abdominal domain, and development of massive incisional hernias. Early definitive closure is the basis of preventing or reducing the risk of these complications. The introduction of new techniques and materials for temporary and subsequent definitive abdominal closure has improved outcomes in this group of patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Magnetic Material Arrangement In Apis Mellifera Abdomens

    DTIC Science & Technology

    2002-04-01

    UNCLASSIFIED Defense Technical Information Center Compilation Part Notice ADP014406 TITLE: Magnetic Material Arrangement In Apis Mellifera Abdomens...Magnetic Material Arrangement In Apis Mellifera Abdomens Darci M. S. Esquivel, Eliane Wajnberg, Geraldo R. Cernicchiaro, Daniel Acosta-Avalos’ and B.E...transition (52 K- 91 K). Hysteresis curves of Apis mellifera abdomens organized parallel and perpendicular to the applied magnetic field were obtained

  20. 49 CFR 572.186 - Abdomen assembly.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... part of the dummy assembly shown in drawing 175-0000 including load sensors specified in § 572.189(e... measuring sensor in the abdomen as shown in Figure U5; (5) The impactor impacts the dummy's abdomen at 4.0 m... of the forces of the three abdominal load sensors, specified in 572.189(e), shall be not less...

  1. How to deal with an open abdomen?

    PubMed

    De Waele, Jan J; Kaplan, Mark; Sugrue, Michael; Sibaja, Pablo; Björck, Martin

    2015-01-01

    Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure.

  2. [Rational diagnostics of acute abdomen].

    PubMed

    Schildberg, C W; Skibbe, J; Croner, R; Schellerer, V; Hohenberger, W; Horbach, T

    2010-11-01

    In view of the threat that comes with an acute abdomen, it is of major importance that diagnostics are executed quickly and efficiently. In the course of this two tendencies can be differentiated: 1) general use of complex examination (e.g. CT, MRT) of all potential patients and 2) step-by-step-diagnostics with advanced diagnostics as and when required. A total of 444 patients with an acute abdomen as admission diagnosis were investigated. All data were evaluated prospectively and analyzed retrospectively. All patients had the same basic diagnostics consisting of aclinical history, clinical examination, laboratory examination, abdominal sonography and x-ray overview images. These examinations were supplemented when required by advanced measures, such as CT, colon enema with contrast fluid, endoscopic examination and diagnostic laparotomy. Three different disease groups of unequal diagnostic need could be identified. The first group, presented in the form of an appendicitis showed that in 80% of all patients a basic diagnosis was sufficient. Advanced examination such as CT affected 14%. The negative appendectomy rate amounted to 8%. Other diseases belonging to the first group were ileus, acute biliary diseases, perforation etc. In the second group presented in the form of a diverticulitis, an advanced radiological examination was required in 84% of all cases. Similar results are also expected in cases of pancreatitis. In the third group presented in the form of coprostasis, inflammatory etiology was found in 39% of all secondary diseases. However the symptoms became clinically apparent after treatment of the coprostasis. In this group a basic diagnosis was satisfactory in 84% of cases, however, a diagnostic laparotomy was inevitable for 3% of these patients. Generally step-by-step diagnostic approach has proven itself to be efficient. For 80% of all patients it makes advanced diagnostic measures unnecessary. The exceptions are diseases in which it is necessary to

  3. Ultrasound, normal fetus - abdomen measurements (image)

    MedlinePlus

    ... Many health care providers like to have fetal measurements to verify the size of the fetus and ... any abnormalities. This ultrasound is of an abdominal measurement. It shows a cross-section of the abdomen, ...

  4. [SURGICAL TREATMENT MANAGEMENT OF ABDOMEN GUNSHOT INJURIES].

    PubMed

    Linyov, K A

    2015-07-01

    The medical records of 100 patients with gunshot abdomen injuries were analysed. The damaging nature of the projectile, the nature of the damage and the combination with damage to other body parts were studied. The anesthesiologist--resuscitator and surgeon actions after hospitalisation of injured persons were postulated. The emergency victim examination was reduced to ultrasound and SCT. The indications for laparotomy in abdominal gunshot injuries were defined. Three most common variants of gunshot abdomen injuries were found. In surgical treatment we applied "damage control" strategy included the initial (abbreviated) operation, resuscitative therapy and final operation. The postoperative complications, couse of deaths was investigated.

  5. Nutrition Support in the Open Abdomen.

    PubMed

    Moore, Scott M; Burlew, Clay Cothren

    2016-02-01

    Early provision of enteral nutrition (EN) in critically ill and injured patients has become standard practice in surgical intensive care units (ICUs) due to its proven role in reducing septic complications. Increasingly, intensivists are confronted with patients with an open abdomen due to the use of damage control surgery and the recognition of the abdominal compartment syndrome; the role and timing of EN in these challenging patients continue to be debated. Patients with an open abdomen are often among the sickest in the ICU and hence could benefit from early nutrition support. However, the exposed abdominal viscera can understandably create anxiety regarding the initiation of EN; there is theoretic concern over exacerbation of bowel distention with resultant inability to close the abdomen and an increased aspiration risk due to paralytic ileus. Recent studies have investigated the utility of EN in the patient with an open abdomen, addressing these clinical concerns. The goal of this clinical review is to provide guidance to physicians caring for these complex patients.

  6. [Abnormal gas collections in the abdomen in infants].

    PubMed

    Cohen, M D; Robinson, A E; Neuffer, F; Smith, W L

    1985-01-01

    Many unusual and uncommon abnormal gas collections within the abdomen may be encountered. This paper reviews the reported causes for unusual gas collections in the abdomen and describes several new causes of abnormal bowel gas collections.

  7. Options for Closure of the Infected Abdomen

    PubMed Central

    Campbell, Chris A.; Rosenberger, Laura H.; Politano, Amani D.; Davies, Stephen W.; Riccio, Lin M.; Sawyer, Robert G.

    2012-01-01

    Abstract Background The infected abdomen poses substantial challenges to surgeons, and often, both temporary and definitive closure techniques are required. We reviewed the options available to close the abdominal wall defect encountered frequently during and after the management of complicated intra-abdominal infections. Methods A comprehensive review was performed of the techniques and literature on abdominal closure in the setting of intra-abdominal infection. Results Temporary abdominal closure options include the Wittmann Patch, Bogota bag, vacuum-assisted closure (VAC), the AbThera™ device, and synthetic or biologic mesh. Definitive reconstruction has been described with mesh, components separation, and autologous tissue transfer. Conclusion Reconstructing the infected abdomen, both temporarily and definitively, can be accomplished with various techniques, each of which is associated with unique advantages and disadvantages. Appropriate judgment is required to optimize surgical outcomes in these complex cases. PMID:23216525

  8. Acute vascular abdomen. General outlook and algorithms.

    PubMed

    Miani, S; Boneschi, M; La Penna, A; Erba, M; De Monti, M; Giordanengo, F

    1999-09-01

    Acute vascular abdomen is a severe and life-threatening pathology due to arterial degeneration, leading to hemorrhage or arterial occlusion leading to ischemia. Differential diagnosis of patients with severe abdominal pain and/or shock include several vascular and traumatic diseases, the most common being rupture of abdominal aortic aneurysm (AAA), or less frequently rupture of visceral artery aneurysm. Also acute aortic dissection, iatrogenic injury and acute mesenteric ischemia may lead to acute vascular abdomen. Clinical evaluation of the haemodynamic status of the patient may be very difficult, and may require airway maintenance and ventilation with a rapid treatment of hemorrhagic shock. In the stable patient with an uncertain diagnosis, CT scan, NMR and selective angiography may be helpful in diagnosis before vascular repair. On the contrary, the unstable patient, after hemodynamic resuscitation, must be operated on expeditiously. We present our vascular algorithms, to assess timing of diagnosis and treatment of this severe acute disease.

  9. [Diagnosis and therapy of an acute abdomen].

    PubMed

    Hecker, A; Hecker, B; Kipfmüller, K; Holler, J; Schneck, E; Reichert, M; Weigand, M A; Padberg, W; Hecker, M

    2014-09-01

    Patients with signs of an acute abdomen continue to be a challenge for both the emergency physician and the intensivist. Clinical symptoms usually result from secondary peritonitis possibly progressing to intraabdominal sepsis. Critically ill patients need rapid diagnostic work-up and an interdisciplinary therapeutic approach. Among patients with secondary peritonitis, those with postoperative peritonitis (e.g., after anastomotic leakage) show a particularly high mortality because of unspecific symptoms. Beyond routine diagnostic procedures, patients with an acute abdomen often require a CT scan which helps to detect the septic focus, thereby often allowing an interventional source control. Therapy consists of three main elements: source control, broad-spectrum antimicrobial therapy, and supportive intensive care medicine.

  10. Anesthesia for the acute abdomen patient.

    PubMed

    Hofmeister, Erik H

    2003-02-01

    Patients with acute abdomen often have marked physiologic and pathologic changes, making anesthesia both challenging and potentially hazardous for the patient. A thorough understanding of the pathophysiologic mechanisms of cardiovascular function under anesthesia and selection of appropriate anesthetic protocols are critical to a successful anesthetic outcome. The goal is to produce anesthesia while minimizing depression of the cardiovascular system. Monitoring and management of acid-base and cardiovascular function serve to ensure appropriate oxygen delivery to the tissues during anesthesia. Postoperative management can significantly influence patient outcome following anesthesic recovery, and must therefore be considered in the anesthetic plan. Finally, pain management in all patients is an important aspect of case management, and should not be overlooked. This article serves to educate the clinician in the above-described areas in regard to the acute abdomen patient.

  11. Scrub typhus presenting as an acute abdomen.

    PubMed

    Kundavaram, Abhilash Pp; Das, Sohini; George, Varghese M

    2014-01-01

    Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, which presents as an acute febrile illness with headache, myalgia, breathlessness, and an eschar, a pathognomonic sign, in a varying proportion of patients. However, this illness can present unusually with fever and severe abdominal pain mimicking acute abdomen. A careful search for an eschar in all patients with an acute febrile illness would provide a valuable diagnostic clue and avoid unnecessary investigations and surgical exploration.

  12. Acute Abdomen Caused by Brucellar Hepatic Abscess.

    PubMed

    Koca, Yavuz Savas; Barut, Ibrahim; Koca, Tugba; Kaya, Onur; Aktas, Recep Aykut

    2016-01-01

    Brucellosis, a zoonosis that is common worldwide, is endemic in many countries, primarily those of the Mediterranean region (including Turkey). Human brucellosis is a systemic infection with a wide clinical spectrum. Although hepatic involvement is very common during the course of chronic brucellosis, hepatic abscess is a very rare complication of Brucella spp. infection. We present a case of hepatic abscess caused by Brucella melitensis, which resembled the clinical presentation of surgical acute abdomen. © The American Society of Tropical Medicine and Hygiene.

  13. Acute Abdomen Caused by Brucellar Hepatic Abscess

    PubMed Central

    Koca, Yavuz Savas; Barut, Ibrahim; Koca, Tugba; Kaya, Onur; Aktas, Recep Aykut

    2016-01-01

    Brucellosis, a zoonosis that is common worldwide, is endemic in many countries, primarily those of the Mediterranean region (including Turkey). Human brucellosis is a systemic infection with a wide clinical spectrum. Although hepatic involvement is very common during the course of chronic brucellosis, hepatic abscess is a very rare complication of Brucella spp. infection. We present a case of hepatic abscess caused by Brucella melitensis, which resembled the clinical presentation of surgical acute abdomen. PMID:26526924

  14. Basic interventional radiology in the abdomen.

    PubMed

    Calero García, R; Garcia-Hidalgo Alonso, M I

    2016-05-01

    This article describes the different basic nonvascular interventional techniques in the abdomen that all general radiologists should be familiar with. It explains the indications and approaches for the different procedures (punctures, biopsies, drainage of collections, cholecystostomies, and nephrostomies). It also discusses the advantages and disadvantages of the different imaging techniques that can be used to guide these procedures (ultrasound, CT, and fluoroscopy) as well as the possible complications that can develop from each procedure. Finally, it shows the importance of following up patients clinically and of taking care of catheters.

  15. Multidetector computed tomography angiography of the abdomen.

    PubMed

    Güven, Koray; Acunaş, Bülent

    2004-10-01

    Multidetector computed tomography (MDCT) angiography has provided excellent opportunities for advancement of computed tomography (CT) technology and clinical applications. It has a wide range of applications in the abdomen including vascular pathologies either occlusive or aneurysmal; enables the radiologist to produce vascular mapping that clearly show tumor invasion of vasculature and the relationship of vessels to mass lesions. MDCTA can be used in preoperative planning for hepatic resection, preoperative evaluation and planning for liver transplantation. MDCTA can also provide extremely valuable information in the evaluation of ischemic bowel disease, active Crohn disease, the extent and location of collateral vessels in cirrhosis.

  16. Acute abdomen caused by brucellar hepatic abscess.

    PubMed

    Ibis, Cem; Sezer, Atakan; Batman, Ali K; Baydar, Serkan; Eker, Alper; Unlu, Ercument; Kuloglu, Figen; Cakir, Bilge; Coskun, Irfan

    2007-10-01

    Brucellosis is a zoonotic infection that is transmitted from animals to humans by ingestion of infected food products, direct contact with an infected animal, or aerosol inhalation. The disease is endemic in many countries, including the Mediterranean basin, the Middle East, India, Mexico, Central and South America and, central and southwest Asia. Human brucellosis is a systemic infection with a wide clinical spectrum. Although hepatic involvement is very common during the course of chronic brucellosis, hepatic abscess is a very rare complication of Brucella infection. We present a case of hepatic abscess caused by Brucella, which resembled the clinical presentation of surgical acute abdomen.

  17. [Acute abdomen as initial manifestation of meningococcemia].

    PubMed

    Tomezzoli, Silvana; Juárez, María del V; Rossi, Santiago I; Lema, Diego A; Barbaro, Cristian R; Fiorini, Sandra

    2008-06-01

    Abdominal pain as an initial symptom of meningococcemia is an infrequent entity, rarely described in literature. We present a case of a 4 year-old, male, previously healthy child with a 24 hour history of fever and abdominal pain. He is admitted in a surgical unit with a diagnosis of acute abdomen for surgical resolution. The clinical course turns unfavorably, and patient presents signs of severe sepsis. Urgent laparotomy is performed, observing little brownish fluid and mesenteric adenitis. He then exhibits palpable purpuric rapidly progressive lesions in lower extremities, progressing to septic shock. Later, Neisseria meningitidis serogroup B is isolated from blood cultures. The aim of this article is drawing attention to a nontypical form of manifestation of meningococcemia, as a delayed diagnosis and treatment has an impact on morbidity and mortality among the pediatric population.

  18. Triage and approach to the acute abdomen.

    PubMed

    Mazzaferro, Elisa M

    2003-02-01

    The presentation of a patient with acute abdominal pain often is both a diagnostic and therapeutic challenge for the veterinary practitioner. Rapid physical examination and assessment of the patient's cardiovascular status are critical to initiating appropriate and often aggressive medical management as diagnostic tests are being performed. A number of diagnostic tests can be performed, including complete blood count, serum biochemistry profile, serum amylase and lipase, abdominal radiographs, abdominal ultrasound, abdominal paracentesis or diagnostic peritoneal lavage, cytology, and fluid analysis. In some cases, surgical exploration may be indicated, depending on each patient's clinical signs and response to therapy. Of the most important aspects of medical management of the patient with acute abdominal pain is to maintain oxygen delivery to tissues and to treat aggressively for pain or discomfort. The initial triage and approach to the patient with acute abdomen are discussed.

  19. Infant botulism mimicking an acute abdomen.

    PubMed

    Pisanti, R; Vitiello, R; Formicola, S; Pisanti, A

    2009-12-01

    Botulism is the acute, flaccid paralysis caused by a neurotoxin produced by Clostridium botulinum. In the infant, clinical symptoms are usually unspecific such as poor feeding, weak suck, feeble cry, drooling, followed by a symmetric, descending, flaccid paralysis beginning with the cranial nerve musculature. The initial symptoms of the disease are often similar to several diseases and therefore differential diagnosis is very difficult and rarely suspected by the physician. Since 2004 only 22 cases of infant botulism have been reported in Italy. Since most paediatricians are unfamiliar with the clinical manifestations of infant botulism, the diagnosis can be easily missed. Hence the disease may well be underestimated and underreported. We report a clinical case of botulism presenting initially with abdominal distention, thereby mimicking acute abdomen.

  20. [Treatment of enteric fistula in open abdomen].

    PubMed

    Evenson, R A; Fischer, J E

    2006-07-01

    Formation of enteric fistulas frequently complicates the open abdomen in patients who have sustained traumatic injury. The post-traumatic subset of patients with enterocutaneous fistula enjoy better than average recovery. To optimize this recovery, a systematic management approach is required. Patients must first be stabilized with nutritional support, control of sepsis, and special wound management systems to prevent further deterioration of the abdominal wall. Investigation of the origin, course, and characteristics of the fistula provides information about its likelihood to close without operation. Definitive operative therapy may be necessary to resolve the fistula and close the abdominal wall. Finally, healing support includes nutritional support and physical and occupational therapies to restore patients to pre-injury states.

  1. Trunk, abdomen, and pressure sore reconstruction.

    PubMed

    Rubayi, Salah; Chandrasekhar, Bala S

    2011-09-01

    After reading this article, the participant should be able to: 1. Describe the principles of wound closure, torso reconstruction, and pressure sore reconstruction. 2. Outline standard options to treat defects of the chest, abdomen, and back and pressure ulcers in all anatomical areas. 3. Manage and prevent pressure ulcers. Chest wall reconstruction is indicated following tumor resection, radiation wound breakdown, or intrathoracic sepsis. Principles of wound closure and chest wall stabilization, where indicated, are discussed. Principles of abdominal wall reconstruction continue to evolve with the introduction of newer bioprosthetics and the application of functional concepts for wound closure. The authors illustrate these principles using commonly encountered clinical scenarios and guidelines to achieve predictable results. Pressure ulcers continue to be devastating complications to patients' health and a functional hazard when they occur in the bedridden, in patients with spinal cord injuries, and in patients with neuromuscular disease. Management of pressure ulcers is also very expensive. The authors describe standard options to treat defects of the chest, abdomen, and back and pressure ulcers in all anatomical areas. A comprehensive understanding of principles and techniques will allow practitioners to approach difficult issues of torso reconstruction and pressure sores with a rational confidence and an expectation of generally satisfactory outcomes. With pressure ulcers, prevention remains the primary goal. Patient education and compliance coupled with a multidisciplinary team approach can reduce their occurrence significantly. Surgical management includes appropriate patient selection, adequate débridement, soft-tissue coverage, and use of flaps that will not limit future reconstructions if needed. Postoperatively, a strict protocol should be adapted to ensure the success of the flap procedure. Several myocutaneous flaps commonly used for the surgical

  2. Does dragonfly's abdomen flexion help with fast turning maneuvers?

    NASA Astrophysics Data System (ADS)

    Liu, Geng; Li, Chengyu; Dong, Haibo; Flow Simulation Research Group Team

    2013-11-01

    Dragonflies are able to achieve fast turning maneuvers during take-off flights. Both asymmetric wing flapping and abdomen flexion have been observed during the fast turning. It's widely thought that the asymmetric wing beats are responsible of producing the aerodynamic moment needed for the body rotation. However, the dynamic effect of the abdomen flexion is not clear yet. In this study, an integrated experimental and computational approach is used to study the underlying dynamic effect of dragonfly abdomen flexion. It's found that dragonfly abdomen tended to bend towards the same side as the body reorienting to. Quantitative analysis have shown that during take-off turning maneuver the abdomen flexion can modulate the arm of force by changing the position of the center of mass relative to the thorax. As a result, roll and yaw moments produced by the wing flapping can be enhanced. This work is supported by NSF CBET-1313217. This work is supported by NSF CBET-1313217.

  3. Microbial colonization of open abdomen in critically ill surgical patients.

    PubMed

    Rasilainen, Suvi Kaarina; Juhani, Mentula Panu; Kalevi, Leppäniemi Ari

    2015-01-01

    This study was designed to describe the time-course and microbiology of colonization of open abdomen in critically ill surgical patients and to study its association with morbidity, mortality and specific complications of open abdomen. A retrospective cohort analysis was done. One hundred eleven consecutive patients undergoing vacuum-assisted closure with mesh as temporary abdominal closure method for open abdomen were analyzed. Microbiological samples from the open abdomen were collected. Statistical analyses were performed using Fisher's exact test for categorical variables. Mann-Whitney U test was used when comparing number of temporary abdominal closure changes between colonized and sterile patients. Kaplan-Meier analysis was done to calculate cumulative estimates for colonization. Cox regression analyses were performed to analyze risk factors for colonization. Microbiological samples were obtained from 97 patients. Of these 76 (78 %) were positive. Sixty-one (80 %) patients were colonized with multiple micro-organisms and 27 (36 %) were cultured positive for candida species. The duration of open abdomen treatment adversely affected the colonization rate. Thirty-three (34 %) patients were colonized at the time of laparostomy. After one week of open abdomen treatment 69, and after two weeks 76 patients were colonized with cumulative colonization estimates of 74 % and 89 %, respectively. Primary fascial closure rate was 80 % (61/76) and 86 % (18/21) for the colonized and sterile patients, respectively. The rate of wound complications did not significantly differ between these groups. Microbial colonization of open abdomen is associated with the duration of open abdomen treatment. Wound complications are common after open abdomen, but colonization does not seem to have significant effect on these. The high colonization rate described herein should be taken into account when primarily sterile conditions like acute pancreatitis and aortic aneurysmal rupture

  4. Sensibility of the abdomen after abdominoplasty.

    PubMed

    Farah, Andréia Bufoni; Nahas, Fabio Xerfan; Ferreira, Lydia Masako; Mendes, José de Arimatéia; Juliano, Yara

    2004-08-01

    Abdominal skin hypesthesia may occur after abdominoplasty. The purpose of this study was to find out (1) which sensibility modalities are decreased and (2) which areas of the abdominal wall are affected, so that patients can be warned preoperatively about this condition. Forty patients were divided in two groups of 20 patients each. In the control group, patients had no previous abdominal incisions. The sensibility evaluation of patients from the experimental group was made from 12 to 60 months after abdominoplasty, with an average of 31.5 months. These patients were divided into two groups of 10 patients each, a short-term follow-up group (12 to 30 months postoperatively) and a long-term follow-up group (31 to 60 months postoperatively). The abdominal skin was divided into 12 areas; nine were above the abdominoplasty incision and three were below it. Sensibility to superficial touch, superficial pain, and hot and cold modalities was recorded as positive in all areas by a variable number of patients of the experimental group. However, in area 8 (hypogastric area), a statistically significant number of patients had decreased sensibility in all sensibility modalities (Fisher's test and t test). Patients in the experimental group also showed decreased sensibility to hot and cold temperature in area 11 (pubic area). Sensibility to pressure decreased significantly in all areas of the abdomen when compared with the control group (t test). When patients of the short-term follow-up group were compared with those of the long-term follow-up group, there was no statistically significant difference for all modalities of sensibility in the areas studied, except for area 5. In this area it was found that long-term follow-up patients recovered sensibility to cold and hot temperatures. These findings help plastic surgeons to orient their patients about possible risk of exposure to injuries in the areas with decreased sensibility after abdominoplasty. Most importantly, as these

  5. The acute abdomen in the newborn.

    PubMed

    de la Hunt, M N

    2006-06-01

    The acute abdomen in the newborn provides challenging problems from many aspects, not only with regard to diagnosis, resuscitation and treatment, but also now with prenatal management. Most conditions are uncommon and treatment in specialist centres enables concentration of appropriate resources and expertise. Co-morbidity is common, particularly in the preterm or low birth weight infant. A multi-disciplinary team of surgeons, anaesthetists, neonatologists, radiologists, cardiologists, obstetricians, nurses, physiotherapists and other health professionals experienced in dealing with extremely small infants will provide the best outcome. The infant should be resuscitated and, as soon as conditions permit, transferred to a specialist surgical centre with intravenous fluids, gastric tube drainage and circulatory, respiratory and general support as needed. This involves close liaison within healthcare networks and readily available patient transfer facilities. Surgery itself should be carried out in a theatre fully equipped for neonatal surgery. A gentle touch is essential because of the fragility of the tissues, and painstaking care should be taken with blood loss.

  6. Inflammatory pseudotumours in the abdomen and pelvis: a pictorial essay.

    PubMed

    Sedlic, Tony; Scali, Elena P; Lee, Wai-Kit; Verma, Sadhna; Chang, Silvia D

    2014-02-01

    Inflammatory pseudotumours are uncommonly encountered lesions in the abdomen and pelvis that often present with variable and nonspecific imaging features. They may mimic other more common lesions, including malignancy. Within the appropriate clinical context, inflammatory pseudotumours merit consideration in the differential diagnosis of soft-tissue masses within the abdomen and pelvis. A preoperative diagnosis of inflammatory pseudotumour, established through biopsy, may help to differentiate this benign entity from malignancy. In this article, we reviewed the imaging features of inflammatory pseudotumours of the abdomen and pelvis, including liver, spleen, bowel, retroperitoneum, kidney, bladder, uterus, and adnexa. Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  7. Benign Multicystic Peritoneal Mesothelioma: A Rare Tumour of the Abdomen

    PubMed Central

    Somasundaram, Soundappan; Khajanchi, Monty; Vaja, Tejas; Jajoo, Bhushan; Dey, Amit Kumar

    2015-01-01

    Benign multicystic peritoneal mesothelioma: a rare tumor of the abdomen, is a diagnostic dilemma. This report emphasizes the importance of diagnostic laparoscopy in the diagnosis of the tumour. PMID:25866695

  8. Percutaneous endoscopic gastrostomy in patients with an open abdomen.

    PubMed

    Block, E F; Cheatham, M L; Bee, T K

    2001-09-01

    Percutaneous endoscopic gastrostomy is a commonly performed procedure for enteral access. In the past decade surgeons have used the open abdomen technique with increased frequency for the treatment of intra-abdominal compartment syndrome. Because these patients often have associated malnutrition long-term enteral access is complicated by the massive ventral hernia. We reviewed the records of two patients with an open abdomen who needed long-term enteral access. Both patients had a large midabdominal soft tissue defect, which posed a concern about the technique for gastrostomy creation. Both patients underwent percutaneous endoscopic gastrostomy. In each case the entrance site was located on a portion of intact abdominal wall lateral to the open abdomen tissue defect. No intraoperative or postoperative complications were noted. We conclude that percutaneous endoscopic gastrostomy can be safely performed in patients with an open abdomen. Adherence to standard principles of performing percutaneous endoscopic gastrostomy allows for enteral access in these patients.

  9. Update on open abdomen management: achievements and challenges.

    PubMed

    Ivatury, Rao R

    2009-06-01

    The open abdomen technique is one of the greatest advances in recent times and has enormous application in the daily management of the critically ill or injured patient. It results in tremendous benefits to the initial resuscitation of these patients but also brings on many challenges beyond those that might be expected from the primary illness or injury. Recent advances in the management of the open abdomen have provided the means to overcome the challenges and reap the benefits.

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

    PubMed

    Kääriäinen, M; Kuokkanen, H

    2013-01-01

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

  11. The open abdomen: definitions, management principles, and nutrition support considerations.

    PubMed

    Friese, Randall S

    2012-08-01

    The use of the "open abdomen" as a technique in the management of the complex surgical patient stems from the concept of damage control. Damage control principles underscore the importance of an abbreviated laparotomy focused on control of hemorrhage and gastrointestinal contamination in patients presenting with significant physiologic compromise. Definitive repair of injuries is postponed and the abdomen is temporarily "closed" using one of a number of different techniques. The ultimate goal is formal abdominal fascial closure within 48-72 hours of the initial laparotomy. Frequently, daily trips to the operating room are required for incremental closure of the abdominal fascia. However, in some cases, fascial closure is not possible secondary to ongoing visceral edema and loss of the peritoneal domain. In these cases, the patient is left with an "open abdomen" until skin grafting over the exposed peritoneal organs can be performed. Patients with an open abdomen have peritoneal contents exposed to the atmosphere and require a complex dressing to maintain fascial domain and provide protection to exposed organs. These patients are typically critically ill and managed in the intensive care unit early in the disease process. The open abdomen has become an important tool for the management of physiologically unstable patients requiring emergent abdominal surgical procedures. These patients present unique challenges to the critical care and nutrition support teams. Careful attention to fluid and electrolyte management, meticulous wound care, prevention of enteroatmospheric fistula, and individualized nutrition support therapy are essential to successful recovery in this patient population.

  12. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique.

    PubMed

    Kyriazanos, Ioannis D; Manatakis, Dimitrios K; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5-3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of "intentional open abdomen" was described and both clinical entities share common pathophysiological and clinical pathways ("postoperative open abdominal wall"). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as "frozen abdomen," where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the "Coliseum technique" for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of "malignant" frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair.

  13. Torsion of a Wandering Spleen Presenting as Acute Abdomen

    PubMed Central

    Chauhan, Narvir Singh; Kumar, Satish

    2016-01-01

    Summary Background Wandering spleen is a rare condition which if uncorrected, can result in torsion and infarction. Clinical presentation of a wandering spleen can vary from asymptomatic abdominal mass to acute abdominal pain. Radiological investigations play a pivotal role in diagnosis as the clinical diagnosis is usually impossible. Case Report We present a case of wandering spleen with torsion and complete infarction that occurred in a 32-year-old multiparous female. The diagnosis was established preoperatively on colour Doppler and CT of the abdomen with subsequent confirmation on surgery. Conclusions Wandering spleen is a rare clinical condition which can present as acute abdomen. An increased awareness of this entity together with the timely use of ultrasound and CT of the abdomen can play an important role in preoperative diagnosis and surgical management. PMID:27057261

  14. Ovarian Vein Thrombosis Presenting as Acute Abdomen in Puerperium

    PubMed Central

    Mannini, Luca; Aldinucci, Martina; Ghizzoni, Viola; Fambrini, Massimiliano

    2016-01-01

    Postpartum Ovarian Vein Thrombosis (POVT) is a rare, but serious condition that causes slow quadrant pain in the postpartum period. POVT must be considered in the differential diagnosis of postpartum acute abdomen. We hereby report a case on a 36-year-old Italian woman who developed an acute abdomen a week after spontaneous vaginal delivery. She had persistent fever and constipation. Diagnosis of POVT was made with an abdominal Computed Tomography (CT) and treatment with heparin and broad-spectrum antibiotics were started. After 72 hours, the patient was switched from low molecular weight heparin to oral anticoagulant treatment. After 5 months a complete recanalization was demonstrated by abdomen CT and the treatment was stopped 6 months after diagnosis. POVT is a diagnosis of exclusion in the puerperium. This case illustrated that POVT may also occur in low risk patient. PMID:27042537

  15. [A young child with acute abdomen and iron deficiency anemia].

    PubMed

    Schlapbach, L; Liniger, B; Schibli, S; Cholewa, D

    2006-05-31

    The case of a 20 month-old girl that was admitted to the emergency ward because of worsening of her general condition in the setting of acute non-bloody gastroenteritis is reported. The clinical examination revealed signs of severe dehydration and a prominent tender abdomen. Laboratory evaluation showed leucocytosis, elevated C-reactive protein and severe hypochromic microcytic anemia. Abdominal X-ray revealed diffuse meteorism. The child underwent laparascopic evaluation. A perforated Meckel's diverticulum was found. Perforation and anemia due to occult bleeding are unusual presentations of Meckel's diverticulum. The differential diagnosis of children presenting with an acute abdomen with special focus on Meckel's diverticulum is discussed.

  16. New indications in the approach to the pendulous abdomen.

    PubMed

    Planas, J; Morais, B B

    1999-01-01

    The appearance of the superficial liposuction technique has permitted the surgeon to advance in his indications for treating localized lipodystrophy, without skin resection. With the cutaneous retraction phenomenon that follows superficial liposuction, pendulous abdomen, which was once treated by classical dermolipectomies, can now be treated with liposuction alone, obtaining satisfactory results. The authors recommend this form of treatment for patients with pendulous abdomen and with good skin quality, with few or no stretch marks, and with little or no diastasis of the rectoabdominal musculature.

  17. The open abdomen: practical implications for the practicing surgeon.

    PubMed

    Burlew, Clay Cothren

    2012-12-01

    The open abdomen is a necessary sequela after damage-control surgery or abdominal compartment syndrome. Management of the patient in the intensive care unit continues to evolve, with considerations of fluid resuscitation, enteral nutrition, and supportive care. Management of the abdominal contents incorporates several basic techniques and considerations: appropriate temporary covering, enteric injury repair in most patients, placement of an anastomosis in an area of the abdomen with minimal manipulation without exposure to the atmosphere, acquiring enteral access for initiation of enteral nutrition, and ultimate abdominal closure. An understanding of these complex factors is instrumental for the practicing surgeon.

  18. Role of CT in the acute nontraumatic abdomen.

    PubMed

    Taourel, P; Pradel, J; Fabre, J M; Cover, S; Senéterre, E; Bruel, J M

    1995-04-01

    The diagnostic workup of the acute abdomen always begins with a precise clinical history, a complete physical examination, and careful reading of plain films. Commonly performed additional imaging studies include contrast examination and, more recently, ultrasound. CT offers the advantage of allowing a comprehensive diagnostic evaluation of both solid and hollow viscera in neoplastic as well as in inflammatory and vascular disorders.

  19. Acute abdomen secondary to complete tubular colonic duplication

    PubMed Central

    Castejón-Casado, Javier; Muñoz Miguelsanz, MA; Diaz, E. Moreno; Gomez, M. Garcia; Garcia, MA Padilla; Valade, R. Fernandez

    2014-01-01

    We report the case of a 6-month-old infant who presented with a complete duplication of the large intestine, debuting clinically with acute abdomen and severe metabolic disorders. We discuss the pathogenesis and morphology of the lesions, diagnostic difficulties and peculiarities of surgical treatment. PMID:25197196

  20. Abdominal Tuberculosis with an Acute Abdomen: Our Clinical Experience

    PubMed Central

    Dey, Ramprasad; Bhattacharya, Ujjwal

    2014-01-01

    Introduction: Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is a great mimicker and is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to involved sites and surgical pathology. The study also discusses the indications and extent of surgical intervention. Materials and Methods: Seventy new cases of Abdominal Tuberculosis (out of 718 cases of acute abdomen) were diagnosed and treated over a period of three years in the surgical ward of Calcutta National Medical College. Macroscopic appearance of abdominal tissues during surgery suggested the diagnosis of tuberculosis. The diagnosis was confirmed by histopathology and tissue culture. All patients were subsequently treated with a full course of antitubercular drugs (ATD). Results: The clinical presentations of acute abdomen included acute intestinal obstruction, perforative peritonitis and acute appendicitis etc. Terminal ileum and ileocaecal region were predominantly involved. The most common pathology was intestinal stricture with or without perforation. Most of the patients (approx 78.5%) required emergency surgery as a therapeutic intervention. A two-stage procedure was preferred in peritonitis and sepsis. Most of the remaining patients (12.8%) required surgery after initial conservative treatment for the first few days. Undiagnosed Abdominal Tuberculosis represents a notable percentage (10%) of patients who present with an acute abdomen as a surgical emergency. Conclusion: Abdominal Tuberculosis is very difficult to diagnose and diagnosis is often delayed till an acute abdomen is presented with. Almost all patients needed surgical intervention. Irrespective of surgery, all patients of abdominal tuberculosis require a

  1. Nitrogen balance, protein loss, and the open abdomen.

    PubMed

    Cheatham, Michael L; Safcsak, Karen; Brzezinski, Stacy J; Lube, Matthew W

    2007-01-01

    Goal-directed nutritional support is essential to improving morbidity and mortality. Open abdominal decompression is similarly crucial to the successful treatment of intra-abdominal hypertension and abdominal compartment syndrome. The open abdomen, however, places the patient at risk for potentially significant fluid, electrolyte, and presumably protein losses from the exposed viscera. Although nutritional protein assessments are frequently utilized to measure urinary nitrogen, these calculations do not consider the loss of protein from the open abdomen. We hypothesize that accurate assessment of nitrogen balance in the patient requiring an open abdomen must include either a measurement or estimation of abdominal fluid nitrogen loss. Prospective, observational cohort study. Adult surgical/trauma intensive care unit of a level I trauma center. Surgical/trauma patients requiring laparotomy. Serial 24-hr collections of urine and abdominal fluid protein were performed to characterize abdominal fluid protein loss and evaluate the clinical effect of accounting for abdominal fluid nitrogen as part of nitrogen balance calculations. Nitrogen intake correlates with urinary nitrogen loss but not with abdominal fluid nitrogen loss. Abdominal fluid nitrogen loss is significant and remains relatively stable in the early postoperative period. Nutritional calculations that fail to account for abdominal fluid nitrogen loss significantly overestimate actual nitrogen balance by an average of 3.5 g/24 hrs. The open abdomen represents a significant source of protein/nitrogen loss in the critically ill. Failure to account for this loss in nutritional calculations may lead to underfeeding and inadequate nutritional support with a direct effect on patient outcome. Although direct measurement of abdominal fluid protein loss may be optimal, an estimate of 2 g of nitrogen per liter of abdominal fluid output should be included in the nitrogen balance calculations of any patient with an open

  2. Magnetic Sensing through the Abdomen of the Honey bee.

    PubMed

    Liang, Chao-Hung; Chuang, Cheng-Long; Jiang, Joe-Air; Yang, En-Cheng

    2016-03-23

    Honey bees have the ability to detect the Earth's magnetic field, and the suspected magnetoreceptors are the iron granules in the abdomens of the bees. To identify the sensing route of honey bee magnetoreception, we conducted a classical conditioning experiment in which the responses of the proboscis extension reflex (PER) were monitored. Honey bees were successfully trained to associate the magnetic stimulus with a sucrose reward after two days of training. When the neural connection of the ventral nerve cord (VNC) between the abdomen and the thorax was cut, the honey bees no longer associated the magnetic stimulus with the sucrose reward but still responded to an olfactory PER task. The neural responses elicited in response to the change of magnetic field were also recorded at the VNC. Our results suggest that the honey bee is a new model animal for the investigation of magnetite-based magnetoreception.

  3. Laparoscopic debridement of recurrent pancreatic abscesses in the hostile abdomen.

    PubMed

    Haan, James M; Scalea, Thomas M

    2006-06-01

    Recurrent necrotizing pancreatitis in the frozen or hostile abdomen remains a challenge. Percutaneous drainage is useful in these cases but often fails if there is significant pancreatic necrosis. We describe a technique for laparoscopic drainage of necrotic pancreas. The preexisting percutaneous drainage tract was sequentially dilated and a working thoracoscope was placed via a Hasson cannula. A pulsatile irrigation system was used to open the cavity for visualization and to wash away obvious necrotic debris. Working sequentially using the irrigation jet flow for debridement and visualization, we opened the entire tract and debrided a majority of the necrotic tissue. A large drainage tube was placed to allow the egress of any residual infection. Three patients to date have been treated with the above technique with no intraoperative complications. All three patients did well initially postoperatively and had adequate drainage. One patient developed a delayed pancreatic pseudocyst. Laparoscopic debridement via percutaneous drainage tract is a useful technique in the hostile abdomen.

  4. Burst abdomen: an unusual complication of silicosis in pregnancy

    PubMed Central

    Sivabalasubramaniam, Gajatheepan; Sagili, Haritha; Dasari, Papa; Gowda, Mamatha

    2015-01-01

    We present a case of silicosis in a 37-year-old pregnant woman, a second gravida with previous caesarean section. She was referred to our hospital at 42 weeks of gestation with breathlessness and oligohydramnios. She had worked in a glass and talc powder factory for 11 years and was diagnosed as having silicosis 2 years prior; she was on treatment. Following admission, she was evaluated for dyspnoea and underwent emergency Caesarean section for poor cervical dilation. She developed a burst abdomen on the third postoperative day with loops of gangrenous bowel protruding outside the abdomen. Emergency laparotomy with ileal resection and ileostomy was carried out. She was discharged on day 14 and is on follow-up. To the best of our knowledge, this is the first case of silicosis in pregnancy presenting with an unusual complication. PMID:26109620

  5. Magnetic Sensing through the Abdomen of the Honey bee

    PubMed Central

    Liang, Chao-Hung; Chuang, Cheng-Long; Jiang, Joe-Air; Yang, En-Cheng

    2016-01-01

    Honey bees have the ability to detect the Earth’s magnetic field, and the suspected magnetoreceptors are the iron granules in the abdomens of the bees. To identify the sensing route of honey bee magnetoreception, we conducted a classical conditioning experiment in which the responses of the proboscis extension reflex (PER) were monitored. Honey bees were successfully trained to associate the magnetic stimulus with a sucrose reward after two days of training. When the neural connection of the ventral nerve cord (VNC) between the abdomen and the thorax was cut, the honey bees no longer associated the magnetic stimulus with the sucrose reward but still responded to an olfactory PER task. The neural responses elicited in response to the change of magnetic field were also recorded at the VNC. Our results suggest that the honey bee is a new model animal for the investigation of magnetite-based magnetoreception. PMID:27005398

  6. Percutaneous endoscopic gastrostomy in the open abdomen patient.

    PubMed

    Fei, Jeffrey Zhaoke; DeMuro, Jonas P

    2013-09-01

    Nutrition support of critically ill patients is an integral element to their multimodal care. We describe the placement of a percutaneous endoscopic gastrostomy (PEG) for long-term enteral access in a patient with an open abdomen. To our knowledge, this is the third successfully reported case that demonstrates the viability of PEG in this uncommon population. In critically ill and malnourished surgical patients with contraindications for immediate abdominal closure, PEG should be strongly considered as a procedure for enteral feedings.

  7. [Acute abdomen caused by eosinophilic enteritis: six observations].

    PubMed

    Martínez-Ubieto, Fernando; Bueno-Delgado, Alvaro; Jiménez-Bernadó, Teresa; Santero Ramírez, María Pilar; Arribas-Del Amo, Dolores; Martínez-Ubieto, Javier

    2013-01-01

    Eosinophilic enteritis is a rather rare condition characterized by infiltration of the gastrointestinal tract by eosinophils; as a casue of acute abdomen it is really exceptional. The etiology is unclear and its description in the literature is sparse, but associations have been made with collagen vascular disease, inflammatory bowel disease, food allergy and parasitic infections as it was confirmed in one of our pathologic studies. From 1997 to 2011 six cases of eosinophilic enteritis that involved a small bowel segment were diagnosed. A partial resection by an irreversible necrosis was necessary in three of them; in the other three only a biopsy was necessary due to the inflammatory aspect of the affected loop causing the acute abdomen. Eosinophilic enteritis can originate acute abdomen processes where an urgent surgical treatment is necessary. The intraoperative aspect can be from a segment of small bowel with inflammatory signs up to a completely irrecoverable loop, where removing of the affected segment is the correct treatment, which can be done laparoscopically.

  8. Lassa fever presenting as acute abdomen: a case series.

    PubMed

    Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O

    2013-04-19

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.

  9. Lassa fever presenting as acute abdomen: a case series

    PubMed Central

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024

  10. [Acute abdomen secondary to spontaneous uterine rupture associated with pyometra].

    PubMed

    Ortiz-Mendoza, Carlos Manuel

    2006-01-01

    A 71-year-old female with rheumatoid arthritis and chronic use of corticosteroids presented to the emergency room with 2 weeks of urinary symptoms, abdominal pain and a mass located in hypo-mesogastrium and both flanks. An X-ray film of the abdomen showed that bowels were displaced by the mass. Laboratory studies showed thrombocytosis (549,000/mm(3)) and leukocytosis (41,800/mm(3)). Several hours after her arrival the patient developed acute abdomen and surgery was indicated. A urinary catheter drained 2100 ml of urine and the abdominal mass was reduced in size but did not disappear. Surgery demonstrated that the urinary bladder covered the fundus and the anterior face of the uterus, where extensive necrosis and a 3-cm perforation were found; 400 ml of foul-smelling pus was drained from the uterine cavity. Due to necrosis, a hysterectomy was performed. The histopathological report indicated necrosis, atrophic cervicitis and endometritis; pus culture developed Escherichia coli and Proteus vulgaris. Despite administration of broad-spectrum antibiotics, the patient developed severe sepsis and died 11 days postoperatively. During a literature review, only one similar case was found. Acute abdomen due to uterine perforation secondary to pyometra and associated with chronic use of corticosteroids is a rare complication.

  11. Hotel NHS and the acute abdomen - admit first, investigate later.

    PubMed

    Aryal, K; Bhowmick, A; Beveridge, A J; Scott, N A

    2009-12-01

    To determine the financial consequences of a policy of admission first, followed by definitive investigation for patients with an admission diagnosis of suspected acute abdomen. Over a 1-month period, 122 patients were admitted with a suspected surgical diagnosis of acute abdomen (55 men, 67 women); age range 16-95 years (median: 56.5). Based on surgical operation required (n = 36), death after admission (n = 6, three postoperative deaths) and/or severe surgical illness (n = 17), 56 required surgical inpatient admission, while 66 did not. The patients who did not require admission spent significantly shorter time in hospital than those who required admission (median: 5 days vs. 8.5 days; p = 0.0000). Total hospital hotel and investigation cost (not including ITU or theatre costs) for all 122 patients was 330,468 pounds. Overall, 205,468 pounds was consumed by these 56 patients who required admission, while 125,000 pounds was spent on 66 patients whose clinical course did not justify admission; 92% of which was spent on hospital hotel costs and 8% on the cost of imaging and/or endoscopy. On a national basis, emergency General Surgery admissions account for 1000 Finished Consultant Episodes per 100,000 population. The findings of this study suggest that this equates to a national NHS spend of 650 million pounds each year, for the hotel costs of patients that could arguably avoid surgical admission altogether. Continuing to admit patients with a suspected acute abdomen first and then requesting definitive investigation makes neither clinical nor economic sense.

  12. MR Evaluation of the Nontraumatic Acute Abdomen with CT Correlation.

    PubMed

    Bannas, Peter; Pickhardt, Perry J

    2015-11-01

    Cross-sectional imaging plays a crucial role in the triage of patients with acute abdominal pain. Ionizing radiation exposure is a recognized drawback of computed tomography (CT), the primary imaging technique. MR imaging is a promising alternative to CT; it provides excellent image quality with high-contrast resolution without the disadvantages of ionizing radiation and iodinated contrast. This article provides a basic overview of the typical MR findings of the most frequent disease entities encountered in the setting of the nontraumatic acute abdomen, including direct comparison with CT findings to familiarize the readers with these same findings on MR.

  13. Follicular dendritic cell sarcoma of the abdomen: the imaging findings.

    PubMed

    Kang, Tae Wook; Lee, Soon Jin; Song, Hye Jong

    2010-01-01

    Follicular dendritic cell sarcoma is a rare neoplasm that originates from follicular dendritic cells in lymphoid follicles. This disease usually involves the lymph nodes, and especially the head and neck area. Rarely, extranodal sites may be affected, including tonsil, the oral cavity, liver, spleen and the gastrointestinal tract. We report here on the imaging findings of follicular dendritic cell sarcoma of the abdomen that involved the retroperitoneal lymph nodes and colon. It shows as a well-defined, enhancing homogenous mass with internal necrosis and regional lymphadenopathy.

  14. Acute abdomen: An uncommon presentation of a common intestinal nematode

    PubMed Central

    Rizvi, Ghazala; Rawat, Vinita; Pandey, Hari Shankar; Kumar, Mukesh

    2015-01-01

    Enterobius vermicularis is a common parasitic infection of the intestine which is rarely symptomatic. It is unusual to find it in the wall or outside the gastrointestinal tract. We encountered five such cases where we observed the worm outside the lumen of the intestine. The pathological findings and the clinical features are discussed. This case series highlight that E. vermicularis can be the cause of pathology within the abdomen and should be considered in the differential diagnosis of some commonly encountered abdominal conditions. PMID:26629456

  15. Abdomen: Retroperitoneum, peritoneum, gastrointestinal tract, kidney, and adrenal gland

    SciTech Connect

    Suen, K.C.

    1987-01-01

    In this book the author explores aspiration biopsy as it can be applied to lesions of the retroperitoneum, gastrointestinal tract, kidney, peritoneum, and adrenal gland. With experience from two different institutions - one an acute general care hospital, the other a cancer referral center - Dr. Suen has achieved in creating a text that reflects a wide range of experience. Throughout the work, Dr. Suen stresses pattern recognition of cytologic material. And a chapter on unusual and interesting lesions is included. Contents: Introduction and General Considerations; Abdomen Imaging Techniques; Clinical Relevance; Indentification of Normal ABC; retroperitoneum; Gastrointestinal Tract; Kidney; Adrenal Gland; Unusual Lesions; Immunocytochemistry and Electron Microscopy; Index.

  16. Management of fistulae in patients with open abdomen.

    PubMed

    Curtis, Kristine; Judson, Karen

    Intestinal fistulae formation in the open abdomen is a rare, but devastating and complex complication for patients. Often, there will be no spontaneous healing or closure of the fistulae. Effective wound care is essential to contain fistulae effluent, protect surrounding tissue and skin, and promote granulation, and patient comfort and mobility. Management options include the use of wound management pouches and negative pressure wound therapy. Effective wound care needs to be underpinned by adequate nutrition, and fluid and electrolyte management. Despite the challenges involved in providing effective care for these patients, this aspect of nursing practice can be extremely rewarding.

  17. Ballistic trauma to the abdomen: shell fragments versus bullets.

    PubMed

    Georgi, B A; Massad, M; Obeid, M

    1991-05-01

    Two-hundred ninety-nine patients who sustained penetrating ballistic trauma to the abdomen were divided into two groups: Group A consisted of 133 patients with shell fragment injuries from mortar artillery and Group B of 166 patients with bullet injuries from rifles and automatic or semiautomatic weapons. Both groups were analyzed retrospectively in order to compare the extent of injury and outcome. In Group A, the findings at laparotomy were negative in 15 of 133 patients (10%) compared with 9 of 166 patients (5%) in Group B (p less than 0.05). The most commonly injured abdominal organs in Group A were the colon (42%), liver (22%), small bowel (20%), stomach (14%), diaphragm (11%), spleen (10%), major vessels (40%) [corrected], and kidney (9%). The abdominal organs commonly injured in Group B were the colon (50%), small bowel (41%), liver (33%), major vessels (20%), diaphragm (17%), stomach (15%), spleen (15%), and kidney (15%). Associated extra-abdominal injuries were present in 26% of Group A patients and in 21% of Group B patients (p greater than 0.05) [corrected]. Major postoperative complications occurred in 7.5% and 8.4% of the patients in Group A and Group B, respectively (p less than 0.05). Perioperative mortality was 2.3% in Group A versus 7.2% in Group B (p less than 0.01). Our data suggest that high energy bullets to the abdomen cause higher tissue penetration and a greater blast effect than shell fragments.

  18. Surgical strategies for management of the open abdomen.

    PubMed

    Regner, Justin L; Kobayashi, Leslie; Coimbra, Raul

    2012-03-01

    Since the mid-1990s the surgical community has seen a surge in the prevalence of open abdomens (OAs) reported in the surgical literature and in clinical practice. The OA has proven to be effective in decreasing mortality and immediate postoperative complications; however, it may come at the cost of delayed morbidity and the need for further surgical procedures. Indications for leaving the abdomen open have broadened to include damage control surgery, abdominal compartment syndrome, and abdominal sepsis. The surgical options for management of the OA are now more diverse and sophisticated, but there is a lack of prospective randomized controlled trials demonstrating the superiority of any particular method. Additionally, critical care strategies for optimization of the patient with an OA are still being developed. Review of the literature suggests a bimodal distribution of primary closure rates, with early closure dependent on postoperative intensive care management and delayed closure more affected by the choice of the temporary abdominal closure technique. Invariably, a small fraction of patients requiring OA management fail to have primary fascial closure and require some form of biologic fascial bridge with delayed ventral hernia repair in the future.

  19. Torsion of a wandering spleen presenting as a case of acute abdomen.

    PubMed

    Iqbal, Muhammad; Tareen, Muhammad Adil; Sohail, Uzma

    2009-02-01

    Wandering spleen is a rare cause of acute abdomen. Generally, it remains asymptomatic, it may present clinically as a painless mobile mass or rarely as an acute abdomen when the wandering spleen twists on its pedicle, resulting in splenic congestion, infarction with or without involvement of neighbouring visceras. Here, we present an unusual case of torsion of a wandering spleen, which resulted in congestive splenomegaly and small bowel obstruction as a rare case of acute abdomen.

  20. Acute abdomen as atypical presentation of brucellosis: report of two cases and review of literature.

    PubMed Central

    al Faraj, S

    1995-01-01

    Abdominal involvement in brucellosis is seen in the acute, subacute and chronic disease. It is not typical, however, that acute abdomen is the presenting feature of brucellosis. In this paper, two cases of serologically diagnosed brucellosis are reported, both presenting initially with acute abdomen and fever. In brucella-endemic regions of the world, brucellosis has to be considered in the differential diagnosis of acute abdomen and fever. With definitive diagnosis, unnecessary laparotomy can be avoided. PMID:7769602

  1. The larval abdomen of the enigmatic Nannochoristidae (Mecoptera, Insecta).

    PubMed

    Fraulob, Maximilian; Wipfler, Benjamin; Hünefeld, Frank; Pohl, Hans; Beutel, Rolf G

    2012-03-01

    External and internal structures of the larval abdomen of Nannochorista are described in detail, with emphasis on the posterior segments. The results are compared with conditions found in other groups of Antliophora, especially the mecopteran subgroups Boreidae and Pistillifera. Like the entire postcephalic body, the larval abdomen of Nannochorista is extremely slender and nearly cylindrical. The anterior segments are largely unmodified. The surface is smooth and lacks any protuberances or prolegs. The term "cloaca" for the posterior membranous pouch of Nannochorista sp. is morphologically unjustified. A list of muscles of segments IX and X is presented. The abdominal musculature was partly homologized following Snodgrass. The muscles of segment X are highly modified. They move the membranous pouch, the anal papillae, and the terminal lobes. The presence of these structures is likely an adaptation to the specific aquatic life style of nannochoristid larvae. The anal papillae are possibly homologous to the 4-lobed terminal attachment apparatus of larvae of Caurinus (Boreidae) and Pistillifera (Panorpidae, Bittacidae, Choristidae) but this is uncertain. The specific condition in both groups, i.e. two retractile papillae with tracheae and Malpighian tubules in Nannochoristidae, and a 4-lobed exposed attachment device in Pistillifera + Boreidae (groundplan) are very likely autapomorphic for both groups, respectively. A slender abdomen with smooth surface is very likely plesiomorphic within Antliophora and Mecopterida. This condition is found in Trichoptera (partim), Nannochoristidae, Siphonaptera, and many basal groups of Diptera. An eruciform or scarabaeiform body shape with a soft, largely unsclerotised cuticle is probably a synapomorphy of Boreidae and Pistillifera. The presence of ventral protuberances resembling prolegs on the anterior segments is an autapomorphy of the latter group. The homology of paired or unpaired terminal appendages of segment X is

  2. Staged reconstruction after gunshot wounds to the abdomen.

    PubMed

    Cohen, M; Morales, R; Fildes, J; Barrett, J

    2001-07-01

    Immediate closure of abdominal incisions after exploration and treatment of gunshot wounds is not always feasible or advisable. Significant bowel edema after massive fluid resuscitation might preclude primary closure, whereas any attempt to close under tension might result in complications ranging from wound dehiscence, infection, and necrosis to the abdominal compartment syndrome with abdominal, cardiopulmonary, and renal complications. For these difficult cases, the open technique has been recommended. The abdomen is left open and is closed when the patient's condition permits. When immediate wound approximation is not possible, temporary coverage can be achieved with a mesh, patch, or a split-thickness skin graft and the definitive reconstruction is deferred for a more optimal time. The purpose of this retrospective study is to report the authors' experience with staged abdominal wall reconstruction after gunshot wounds. From 1989 to 1998, 1933 patients underwent exploratory laparotomy for penetrating wounds to the abdomen. Twenty-nine patients in grave condition and with multiple medical problems were comanaged by the Trauma and Plastic Surgery Services at Cook County Hospital with the following protocol: The abdomen was initially left open and exposed viscera were covered with a variety of methods, including a Gore-Tex patch (W. L. Gore and Associates, Inc., Flagstaff, Ariz.). A split-thickness graft was subsequently placed on the granulation tissue over viscera at an average of 14 days after the last laparotomy. These planned ventral hernias were definitively treated at an average of 7 months after the skin grafting procedure, primarily using the components separation technique. In 24 patients, the fascia was closed primarily without tension, while five patients required the use of synthetic mesh to restore fascial continuity. Nine patients underwent closure of a colostomy or repair of fistulas simultaneously with abdominal wall reconstruction. One patient

  3. [Acute abdomen from ruptured adrenal pheochromocytoma: case report].

    PubMed

    Bronzino, P; Abbo, L; Barisone, P; Dezzani, C; Genovese, A M; Iannucci, P; Ippoliti, M; Sacchi, M; Aimo, I

    2005-01-01

    The pheochromocytoma is a very rare neoplasm, which originates in 98% of cases in the adrenal medulla; it is often bilateral in familial syndromes. It is more frequent in syndromes like MEN2, von Hippel-Lindau disease, and neuofribromatosis type 1. In this article the Authors report a case of a young woman with a large adrenal pheochromocytoma, that presented by an acute abdomen; the treatment was explorative laparotomy with unilateral adrenalectomy. Therapy of this tumour is founded on surgery, plus chemiotherapy radiotherapy or treatment with 131I-MIBG (iodine-131-metaiodobenzylguanidine in malignant cases (10%). According with the absence of a correlation between pathological findings and clinical behaviour, a long-term follow up is indispensable.

  4. The acute abdomen in the immune compromised host

    PubMed Central

    Power, Niall

    2008-01-01

    Abstract Recent advances in transplantation, oncology and AIDS therapy have greatly increased life expectancies of patients diagnosed with malignancy, auto-immune disorders and organ failure. However, as this immune compromised population grows, complications of such therapies have become a major source of morbidity and mortality. Classical clinical and laboratory evidence of intra-abdominal pathology may be absent in the immune compromised host. Consequently, the radiologist is increasingly called upon to diagnose acute intra-abdominal complications associated with immunodeficiency. This review explores the aetiology of the acute abdomen in the immune compromised host. The typical radiological appearances of the commonest conditions are illustrated. The challenges and limitations in the radiological diagnosis of these conditions are discussed. PMID:18442955

  5. [Acute abdomen with actinomycosis of the colon: A case report].

    PubMed

    García-Zúñiga, Beatriz; Jiménez-Pastrana, Marco Tulio

    2016-01-01

    Actinomyces infection is a chronic inflammatory process that can sometimes, clinically and radiographically, closely mimic a malignant tumour, which may lead to giving a delayed or inappropriate treatment. Male 41 years old, with no previous history, with abdominal pain of one month onset, as well as weight loss, intermittent fever and diarrhoea. He developed acute abdomen and underwent surgery, finding a tumour in the distal ileum with necrosis and punctiform perforations. A resection was performed on the affected part of the ileum and colon, as well as an ileostomy using Hartmann's procedure. Actinomycosis is a disease that must be considered by the surgeon when faced with a clinical picture of subacute onset with intermittent fever, weight loss, abdominal pain, and even anaemia in patients with abdominal and retroperitoneal abscesses or previous history of surgery. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  6. Abd-B suppresses lepidopteran proleg development in posterior abdomen.

    PubMed

    Tomita, Shuichiro; Kikuchi, Atsumi

    2009-04-15

    Pterygotes lack abdominal appendages except for pleuropods and prolegs. The larvae of some holometabolous insects develop prolegs, which are used for locomotion. We analyzed the role of the homeotic genes abd-A and Abd-B in lepidopteran proleg development using mutant analysis and embryonic RNAi in the silkworm Bombyx mori. The E(Mu) mutant developed extra prolegs in its posterior abdomen and showed the misexpression of both genes, suggesting their involvement in proleg formation. The depletion of Abd-B by embryonic RNAi caused the development of extra prolegs on all segments posterior to A6, indicating the suppressive function of Abd-B. The abd-A RNAi animals failed to develop prolegs. These results indicate that abd-A and Abd-B are involved in proleg development in B. mori.

  7. Perforated jejunal diverticulum: a rare case of acute abdomen

    PubMed Central

    Sehgal, Rishabh; Cheung, Cherry X.; Hills, Tristram; Waris, Aqueel; Healy, Donagh; Khan, Tahir

    2016-01-01

    Jejunal pseudo-diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of the mesenteric aspect of the bowel. They are asymptomatic in the majority of cases; however, they can present with a wide spectrum of non-specific symptoms such as chronic abdominal discomfort, postprandial flatulence, diarrhoea, malabsorption and steattorhoea. In up to 15% of cases, more serious acute complications may arise such as the development of intestinal obstruction, haemorrhage or as in our case, localized peritonitis secondary to perforation. Perforation carries an overall mortality rate of up to 40% and exploratory laparotomy followed by copious lavage with segmental resection and primary anastomosis remains the mainstay of managing such sequalae of jejunal pseudo-diverticulosis. Our case report highlights the importance of maintaining a high clinical suspicion of a perforated jejunal diverticulum in an elderly patient presenting with an acute abdomen. PMID:27765806

  8. Snowboarding injuries of the abdomen: comparison with skiing injuries.

    PubMed

    Machida, T; Hanazaki, K; Ishizaka, K; Nakamura, M; Kobayashi, O; Shibata, H; Nakafuji, H; Amano, J

    1999-01-01

    A retrospective study was conducted to identify the characteristics of snowboarding injury of the abdomen in comparison with those of alpine skiing injuries. Between December 1988 and April 1997, 1579 patients were treated for snowboarding injuries and 9108 patients were treated after skiing accidents. 19 patients (1.2%) in snowboarding and 64 (0.7%) in skiing had abdominal injuries. The abdominal injury rate in snowboarders was significantly higher than that in skiers. Snowboarders with abdominal injuries were similar to skiers with respect to epidemiology but the patterns of injury in the two groups showed several distinct differences. Riding mistakes after jumping for the snowboarders (31.6%) was significantly higher than that for the skiers (0%). The main organs involved in snowboarding and skiing injuries were kidney, liver and spleen. The incidence of solitary renal injury in snowboarding (68.4%) was significantly higher than that in skiing (29.7%).

  9. The insect abdomen--a heartbeat manager in insects?

    PubMed

    Tartes, U; Vanatoa, A; Kuusik, A

    2002-11-01

    Different possibilities of coordination between circulation, respiration and abdominal movements were found in pupae of Pieris brassicae, Tenebrio molitor, Galleria mellonella and Leptinotarsa decemlineata. Coordination principles depend on metabolic rate: the need to support circulation with abdominal movements appears only at higher metabolic rates. Integration between different abdominal movements and circulation depends on species, on physiological state and, supposedly, on internal morphology. At low metabolic rates, there is no need for a very intensive hemolymph flow, and the dorsal vessel is capable of initiating and/or maintaining necessary hemolymph flow. Starting from a certain metabolic level, it is possible that the abdomen is used to accelerate hemolymph flow in the case of a large amount of hemolymph. When the necessary flow speed has been reached, relatively weak pulsation of the dorsal vessel with accessory pulsatile organs and diaphragms can easily maintain the necessary flow intensity. Heart activity may sometimes be initiated by abdominal movements via cardiac reflex or mechanical excitation. Sometimes, when heart function is weakened by histolysis, the abdomen may temporarily take over the main circulatory function or occasionally contribute to acceleration of low-speed hemolymph flow. In this case the functions are simultaneous and may be triggered by some mediator(s). In active adult insects the whole body is moving, and hence hemolymph circulates and the tracheal system is effectively ventilated by a whole body ensemble consisting of the dorsal vessel, moving organs, body appendages and accessory pulsatile organs. The mechanism of autocirculation (analogous to autoventilation in gas exchange) is a probable mechanism in circulation in adult insects.

  10. [Errors and difficulties in the diagnosis and management of acute and chronic abdomen in children].

    PubMed

    Sabetay, C; Singer, I; Zavate, A; Ciobanu, O; Cârstoiu, E; Stoica, A; Maloş, Anca; Farcaş, I; Kamel, J; Hams, I; Kastrati, A

    2002-01-01

    The authors are reviewing on a lot of 2844 cases between 1996 and 2000 the difficult problems of differential diagnosis between acute surgical abdomen in children and intestinal tuberculosis, abdominal tumors and inflammatory diseases such as acute osteomielitis. They are presenting 13 particular cases in which the acute abdomen diagnosis was difficult or even omitted.

  11. Subperitoneal extension of disease processes between the chest, abdomen, and the pelvis.

    PubMed

    Osman, Sherif; Moshiri, Mariam; Robinson, Tracy J; Gunn, Martin; Lehnert, Bruce; Sundarkumar, Dinesh; Katz, Douglas S

    2015-08-01

    The subserous space is a large, anatomically continuous potential space that interconnects the chest, abdomen, and pelvis. The subserous space is formed from areolar and adipose tissue, and contains branches of the vascular, lymphatic, and nervous systems. As such, it provides one large continuous space in which many disease processes can spread between the chest, abdomen, and the pelvis.

  12. Development of a Reusable, Rate-Sensitive Abdomen for the Hybrid III Family of Dummies.

    PubMed

    Rouhana, S W; Elhagediab, A M; Walbridge, A; Hardy, W N; Schneider, L W

    2001-11-01

    The objective of this work was to develop a reusable, rate-sensitive dummy abdomen with abdominal injury assessment capability. The primary goal for the abdomen developed was to have good biofidelity in a variety of loading situations that might be encountered in an automotive collision. This paper presents a review of previous designs for crash dummy abdomens, a description of the development of the new abdomen, results of testing with the new abdomen and instrumentation, and suggestions for future work. The biomechanical response targets for the new abdomen were determined from tests of the mid abdomen done in a companion biomechanical study. The response of the abdominal insert is an aggregate response of the dummy's entire abdominal area and does not address differences in upper versus lower abdominal response, solid versus hollow organs, or organ position or mobility. While the abdomen developed has demonstrated good biofidelity in rigid bar, seat belt and airbag loading situations, some work remains to be done before it can be used in crash testing.

  13. Geographic variation in resource allocation to the abdomen in geometrid moths

    NASA Astrophysics Data System (ADS)

    Kivelä, Sami M.; Välimäki, Panu; Carrasco, David; Mäenpää, Maarit I.; Mänttäri, Satu

    2012-08-01

    A resource allocation trade-off is expected when resources from a common pool are allocated to two or more traits. In holometabolous insects, resource allocation to different functions during metamorphosis relies completely on larval-derived resources. At adult eclosion, resource allocation to the abdomen at the expense of other body parts can be seen as a rough estimate of resource allocation to reproduction. Theory suggests geographic variation in resource allocation to the abdomen, but there are currently no empirical data on it. We measured resource allocation to the abdomen at adult eclosion in four geometrid moths along a latitudinal gradient. Resource (total dry material, carbon, nitrogen) allocation to the abdomen showed positive allometry with body size. We found geographic variation in resource allocation to the abdomen in each species, and this variation was independent of allometry in three species. Geographic variation in resource allocation to the abdomen was complex. Resource allocation to the abdomen was relatively high in partially bivoltine populations in two species, which fits theoretical predictions, but the overall support for theory is weak. This study indicates that the geographic variation in resource allocation to the abdomen is not an allometric consequence of geographic variation in resource acquisition (i.e., body size). Thus, there is a component of resource allocation that can evolve independently of resource acquisition. Our results also suggest that there may be intraspecific variation in the degree of capital versus income breeding.

  14. Geographic variation in resource allocation to the abdomen in geometrid moths.

    PubMed

    Kivelä, Sami M; Välimäki, Panu; Carrasco, David; Mäenpää, Maarit I; Mänttäri, Satu

    2012-08-01

    A resource allocation trade-off is expected when resources from a common pool are allocated to two or more traits. In holometabolous insects, resource allocation to different functions during metamorphosis relies completely on larval-derived resources. At adult eclosion, resource allocation to the abdomen at the expense of other body parts can be seen as a rough estimate of resource allocation to reproduction. Theory suggests geographic variation in resource allocation to the abdomen, but there are currently no empirical data on it. We measured resource allocation to the abdomen at adult eclosion in four geometrid moths along a latitudinal gradient. Resource (total dry material, carbon, nitrogen) allocation to the abdomen showed positive allometry with body size. We found geographic variation in resource allocation to the abdomen in each species, and this variation was independent of allometry in three species. Geographic variation in resource allocation to the abdomen was complex. Resource allocation to the abdomen was relatively high in partially bivoltine populations in two species, which fits theoretical predictions, but the overall support for theory is weak. This study indicates that the geographic variation in resource allocation to the abdomen is not an allometric consequence of geographic variation in resource acquisition (i.e., body size). Thus, there is a component of resource allocation that can evolve independently of resource acquisition. Our results also suggest that there may be intraspecific variation in the degree of capital versus income breeding.

  15. A restless abdomen and propriospinal myoclonus like at sleep onset: an unusual overlap syndrome

    PubMed Central

    Baiardi, Simone; La Morgia, Chiara; Mondini, Susanna; Cirignotta, Fabio

    2015-01-01

    We report for the first time the association between restless abdomen, a phenotypic variant of restless legs syndrome in which symptoms are limited to the abdomen, and propriospinal myoclonus at sleep onset causing severe insomnia. The treatment with a low-dosage of dopaminergic drug (pramipexole) induced the immediate disappearance of both symptoms, which was documented by video-polysomnography. PMID:25820108

  16. Management of the open abdomen: from initial operation to definitive closure.

    PubMed

    Campbell, Andre; Chang, Michael; Fabian, Timothy; Franz, Michael; Kaplan, Mark; Moore, Frederick; Reed, R Lawrence; Scott, Bradford; Silverman, Ronald

    2009-11-01

    The open abdomen is a relatively new and increasingly common strategy for the management of abdominal emergencies in both trauma and general surgery. The use of an abbreviated laparotomy can reduce mortality associated with conditions such as abdominal compartment syndrome; however, the resulting open abdomen is a complex clinical problem. Modern techniques and technologies are now available that allow for improved management of the open abdomen and the progressive reduction of the fascial defect. Indeed, recent evidence indicates that a large proportion of patients treated with open abdomen can now be closed within the initial hospitalization. These techniques and technologies include the appropriate use of negative pressure therapy and synthetic or biologic repair materials. It is essential that general and trauma surgeons understand the core principles underlying the need for and management of the open abdomen. Toward this goal, an Open Abdomen Advisory Panel was established to identify core principles in the management of the open abdomen and to develop a set of recommendations based on the best available evidence. This review presents the principles and recommendations identified by the Open Abdomen Advisory Panel and provides brief case studies for the illustration of these concepts.

  17. Elephantiasis nostras verrucosa on the legs and abdomen with morbid obesity in an Indian lady.

    PubMed

    Sarma, Podila S; Ghorpade, Ashok

    2008-12-15

    Elephantiasis nostras verrucosa (ENV) of the legs and abdomen in a morbidly obese woman with multiple medical problems is reported. The diagnosis was suggested by the classical clinical features and confirmed by histopathology. The patient succumbed due to her multisystem diseases. Elephantiasis nostras verrucosa involving the abdomen is uncommon and has been reported only five times in the past.

  18. International consensus conference on open abdomen in trauma.

    PubMed

    Chiara, Osvaldo; Cimbanassi, Stefania; Biffl, Walter; Leppaniemi, Ari; Henry, Sharon; Scalea, Thomas M; Catena, Fausto; Ansaloni, Luca; Chieregato, Arturo; de Blasio, Elvio; Gambale, Giorgio; Gordini, Giovanni; Nardi, Guiseppe; Paldalino, Pietro; Gossetti, Francesco; Dionigi, Paolo; Noschese, Giuseppe; Tugnoli, Gregorio; Ribaldi, Sergio; Sgardello, Sebastian; Magnone, Stefano; Rausei, Stefano; Mariani, Anna; Mengoli, Francesca; di Saverio, Salomone; Castriconi, Maurizio; Coccolini, Federico; Negreanu, Joseph; Razzi, Salvatore; Coniglio, Carlo; Morelli, Francesco; Buonanno, Maurizio; Lippi, Monica; Trotta, Liliana; Volpi, Annalisa; Fattori, Luca; Zago, Mauro; de Rai, Paolo; Sammartano, Fabrizio; Manfredi, Roberto; Cingolani, Emiliano

    2016-01-01

    A part of damage-control laparotomy is to leave the fascial edges and the skin open to avoid abdominal compartment syndrome and allow further explorations. This condition, known as open abdomen (OA), although effective, is associated with severe complications. Our aim was to develop evidence-based recommendations to define indications for OA, techniques for temporary abdominal closure, management of enteric fistulas, and methods of definitive wall closure. The literature from 1990 to 2014 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-analyses] protocol. Seventy-six articles were reviewed by a panel of experts to assign grade of recommendations (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development, and Evaluation] system, and an international consensus conference was held. OA in trauma is indicated at the end of damage-control laparotomy, in the presence of visceral swelling, for a second look in vascular injuries or gross contamination, in the case of abdominal wall loss, and if medical treatment of abdominal compartment syndrome has failed (GoR B, LoE II). Negative-pressure wound therapy is the recommended temporary abdominal closure technique to drain peritoneal fluid, improve nursing, and prevent fascial retraction (GoR B, LoE I). Lack of OA closure within 8 days (GoR C, LoE II), bowel injuries, high-volume replacement, and use of polypropylene mesh over the bowel (GoR C, LoE I) are risk factors for frozen abdomen and fistula formation. Negative-pressure wound therapy allows to isolate the fistula and protect the surrounding tissues from spillage until granulation (GoR C, LoE II). Correction of fistula is performed after 6 months to 12 months. Definitive closure of OA has to be obtained early (GoR C, LoE I) with direct suture, traction devices, component separation with or without mesh. Biologic meshes are an option for wall reinforcement if bacterial

  19. Ultrasound scanning of the acute abdomen by surgeons in training.

    PubMed Central

    Williams, R. J.; Windsor, A. C.; Rosin, R. D.; Mann, D. V.; Crofton, M.

    1994-01-01

    Ultrasound is widely used in the investigation of abdominal symptoms. Its increasing popularity may lead to pressure on radiological services, diagnostic delay and prolonged hospital stay. Immediate imaging performed by radiologists can contribute useful information in acute emergencies. This study assessed the accuracy and value of abdominal ultrasonography when carried out by admitting surgeons. Three surgical registrars were first instructed for two half days by a consultant radiologist. Patients with acute symptoms were scanned at the time of initial presentation using an Aloka SSD-620 scanner with 3.5 and 5 MHz probes. A total of 205 scans was performed--124 of the upper and 81 of the lower abdomen. Immediate ultrasound provided information that contributed to the establishment or refutal of a diagnosis in 138 patients (67.3%), predominantly by confirming or excluding hepatobiliary disease, tubo-ovarian pathology or aortic aneurysms and in blunt abdominal trauma. The diagnosis was altered in a small proportion (7.8%). Scanning proved unhelpful in 62 patients and misleading in five. Findings concurred with those of a radiologist in 86% of the 139 patients subsequently scanned. Abdominal ultrasound is a useful tool in the hands of surgeons dealing with emergencies and may occasionally provide vital information. If access to radiological facilities is delayed, ultrasound by the admitting surgeon could lead to improved patient management and cost savings. PMID:8074382

  20. [Wandering spleen: an unusual cause of acute abdomen].

    PubMed

    Mattioni, Laura; Peña, María Elena; Ringa, Maximiliano; Schlottmann, Francisco; Bugari, Gustavo

    2017-01-01

    Wandering spleen syndrome is a rare condition in which absence or laxity of splenic fixing elements predisposes to an unusual location in the abdomen and an increasing risk of twisting and infarction. Its etiology may be congenital or acquired and clinical presentation is variable. Diagnosis is based on clinical suspicion, laboratory and imaging. Surgery is the only definitive treatment for this pathology. We report the case of a 23 year old woman with a history of recurrent episodes of abdominal pain in the left upper quadrant since childhood. On physical examination she was afebrile, hemodynamically stable, with marked abdominal tenderness in the left upper quadrant. Ultrasonography showed homogeneous splenomegaly. Abdominal CT-scan presented an enlarged, eutopic spleen, with swirling and congestion of hilum vessels. Splenic ischemia due to organ torsion was suspected. Exploratory laparoscopy was performed showing an 18 cm in diameter spleen free in left upper quadrant, with varicose veins in the periphery and without fixing ligaments. Laparoscopic splenectomy was completed. The pathology report showed ischemic necrosis of the organ. The patient progressed favorably and was discharged on the third postoperative day.

  1. Ultrasound Dopplerography of abdomen pathology using statistical computer programs

    NASA Astrophysics Data System (ADS)

    Dmitrieva, Irina V.; Arakelian, Sergei M.; Wapota, Alberto R. W.

    1998-04-01

    The modern ultrasound dopplerography give us the big possibilities in investigation of gemodynamical changes in all stages of abdomen pathology. Many of researches devoted to using of noninvasive methods in practical medicine. Now ultrasound Dopplerography is one of the basic one. We investigated 250 patients from 30 to 77 ages, including 149 men and 101 women. The basic diagnosis of all patients was the Ischaemic Pancreatitis. The Second diagnoses of pathology were the Ischaemic Disease of Heart, Gypertension, Atherosclerosis, Diabet, Vascular Disease of Extremities. We researched the abdominal aorta and her branches: Arteria Mesenterica Superior (AMS), truncus coeliacus (TC), arteria hepatica communis (AHC), arteria lienalis (AL). For investigation we use the following equipment: ACUSON 128 XP/10c, BIOMEDIC, GENERAL ELECTRIC (USA, Japan). We analyzed the following componetns of gemodynamical changes of abdominal vessels: index of pulsation, index of resistance, ratio of systol-dystol, speed of blood circulation. Statistical program included the following one: 'basic statistic's,' 'analytic program.' In conclusion we determined that the all gemodynamical components of abdominal vessels had considerable changes in abdominal ischaemia than in normal situation. Using the computer's program for definition degree of gemodynamical changes, we can recommend the individual plan of diagnostical and treatment program.

  2. Computed tomography and magnetic resonance imaging of the acute abdomen.

    PubMed

    Shaff, M I; Tarr, R W; Partain, C L; James, A E

    1988-04-01

    CT is a noninvasive investigation that in many instances is more sensitive in elucidating intra-abdominal and retroperitoneal disease than is conventional radiography. With modern scanners, the procedure is rapid and efficient and suitable for the most severely ill and infirm. The scans are easily interpretable, and the anatomic and morphologic depiction of disease is readily understood by those with surgical training. Information regarding the state of the bowel wall, mesentery, and intraperitoneal and retroperitoneal structures is displayed in greater detail than by any other diagnostic imaging modality. The use of intravenous contrast medium is rarely essential. The concentration of iodinated contrast needed for opacification of the bowel is no greater than 2 per cent to 5 per cent and will not complicate bowel surgery, as would standard upper gastrointestinal or barium enema studies. Abscess, free air, calcium, and intraperitoneal fluid are very sensitively detected. CT is extremely useful in aiding surgical decision making in the acute abdomen and is complementary to or has replaced conventional studies.

  3. Abdomen and spinal cord segmentation with augmented active shape models.

    PubMed

    Xu, Zhoubing; Conrad, Benjamin N; Baucom, Rebeccah B; Smith, Seth A; Poulose, Benjamin K; Landman, Bennett A

    2016-07-01

    Active shape models (ASMs) have been widely used for extracting human anatomies in medical images given their capability for shape regularization of topology preservation. However, sensitivity to model initialization and local correspondence search often undermines their performances, especially around highly variable contexts in computed-tomography (CT) and magnetic resonance (MR) images. In this study, we propose an augmented ASM (AASM) by integrating the multiatlas label fusion (MALF) and level set (LS) techniques into the traditional ASM framework. Using AASM, landmark updates are optimized globally via a region-based LS evolution applied on the probability map generated from MALF. This augmentation effectively extends the searching range of correspondent landmarks while reducing sensitivity to the image contexts and improves the segmentation robustness. We propose the AASM framework as a two-dimensional segmentation technique targeting structures with one axis of regularity. We apply AASM approach to abdomen CT and spinal cord (SC) MR segmentation challenges. On 20 CT scans, the AASM segmentation of the whole abdominal wall enables the subcutaneous/visceral fat measurement, with high correlation to the measurement derived from manual segmentation. On 28 3T MR scans, AASM yields better performances than other state-of-the-art approaches in segmenting white/gray matter in SC.

  4. Fetal demise by umbilical cord around abdomen and stricture.

    PubMed

    Tan, Shun-Jen; Chen, Chi-Huang; Wu, Gwo-Jang; Chen, Wei-Hwa; Chang, Cheng-Chang

    2010-01-01

    Umbilical cord abnormalities are accepted as conditions associated with intrauterine fetal demise (IUFD), and umbilical cord stricture is most frequently encountered. In addition, although cord entanglement with multiple loops rarely increases the perinatal mortality, it is associated with a significant increase in variable kind of morbidity such as growth restriction. We describe a 27-year-old woman, with a missed abortion history at about 10 weeks' gestation in her first pregnancy, who presented to our outpatient department at 34 4/7 weeks of gestation due to decreased fetal activity during the preceding week. No fetal heart activity and blood flow had been detected by ultrasonography and pulsed-wave Doppler. A demised fetus with umbilical cord stricture and three loops around abdomen was delivered and was weighted 1,830 g that was below the tenth percentile for the gestational age. Either umbilical cord stricture or entanglement around the body can affect the development of the fetus and even be lethal. The former might play a more important role in this case. Their etiology and the sequence of the events are still undetermined, and additional evaluation such as autopsy and further research may be needed. In addition, counsel and frequent fetal surveillance should be done in patients with previous IUFD attributed to cord stricture during next pregnancy because of undetermined risk of recurrence.

  5. Routine Measurement of Serum Amylase in Acute Abdomen.

    PubMed

    Ghimire, R; Thapa, A S; Karki, D; Shrestha, D K

    2014-01-01

    Acute abdominal pain is a common condition presenting to both the emergency department (ED) and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series. A prospective observational study was performed from 15th May 2014 - 15th Nov 2014 (6 months) at Department of Surgery of Kathmandu medical College Teaching Hospital; Kathmandu. All consecutive patients presented at emergency department and required admissions in surgical ward were included. A multivariate analysis was performed to assess the level of serum amylase in various diseases presenting with acute abdominal pain including acute pancreatitis. Overall, 318 patients were included during a period of 6 months among them 48 patients were excluded. 34 cases (12.6 %) were diagnosed of acute pancreatitis. three cases (1.1%) of non pancreatic pathology with raised serum amylase level (> 1000 U\\L). Routine assessment of serum amylase is helpful in excluding differential diagnosis of patient presenting with acute abdomen and this study identified serum amylase as a good screening tool if done in cases with clinical suspicion.

  6. Acute abdomen: Rare and unusual presentation of right colic xanthogranulomatosis

    PubMed Central

    Addario Chieco, Paola; Antolino, Laura; Giaccaglia, Valentina; Centanini, Francesca; Cunsolo, Gaetano Vincenzo; Sparagna, Alessandra; Uccini, Stefania; Ziparo, Vincenzo

    2014-01-01

    Xanthogranulomatous inflammation (XGI) is a disease of unknown origin, most frequently described in the kidney and gallbladder; its localization in the colorectal tract is extremely rare. The extension of the typical inflammatory process to the surrounding tissues may lead to misdiagnosis as cancer. We report the case of a 56-year-old woman presenting to the Emergency Department with pain, increased levels of α1 and α2 proteins and C-reactive protein (17.5 mg/dL; normal value 0-0.5), and a palpable mass, localized in the right lower quadrant of the abdomen. A computed tomography scan showed a large right cecal mass with necrotic areas, local inflammation of retroperitoneal fat, and enlargement of local lymph nodes. Because of the high suspicion of colic abscess as well as malignancy and worsening of the clinical condition, the patient underwent right colectomy after 4 d of antibiotic treatment. Pathology revealed xanthogranulomatous inflammation involving the ileocecal valve. We review the reports of large bowel tract XGI in the international literature. PMID:25024630

  7. Endoluminal contrast for abdomen and pelvis magnetic resonance imaging.

    PubMed

    Gupta, Mohit K; Khatri, Gaurav; Bailey, April; Pinho, Daniella F; Costa, Daniel; Pedrosa, Ivan

    2016-07-01

    Magnetic resonance (MR) imaging of the abdomen and pelvis can be limited for assessment of different conditions when imaging inadequately distended hollow organs. Endoluminal contrast agents may provide improved anatomic definition and detection of subtle pathology in such scenarios. The available routes of administration for endoluminal contrast agents include oral, endorectal, endovaginal, intravesicular, and through non-physiologic accesses. Appropriate use of endoluminal contrast agents requires a thorough understanding of the clinical indications, available contrast agents, patient preparation, and interaction of the contrast agent with the desired MR imaging protocol. For example, biphasic oral enteric contrast agents are preferred in MR enterography as their signal properties on T1- and T2-weighted imaging allow for evaluation of both intraluminal and bowel wall pathology. In specific situations such as with MR enterography, MR defecography, and accurate local staging of certain pelvic tumors, the use of an endoluminal contrast agent is imperative in providing adequate diagnostic imaging. In other clinical scenarios, the use of an endoluminal contrast agent may serve as an indispensable problem-solving tool.

  8. Automatically Pairing Measured Findings across Narrative Abdomen CT Reports

    PubMed Central

    Sevenster, Merlijn; Bozeman, Jeffrey; Cowhy, Andrea; Trost, William

    2013-01-01

    Radiological measurements are one of the key variables in widely adopted guidelines (WHO, RECIST) that standardize and objectivize response assessment in oncology care. Measurements are typically described in free-text, narrative radiology reports. We present a natural language processing pipeline that extracts measurements from radiology reports and pairs them with extracted measurements from prior reports of the same clinical finding, e.g., lymph node or mass. A ground truth was created by manually pairing measurements in the abdomen CT reports of 50 patients. A Random Forest classifier trained on 15 features achieved superior results in an end-to-end evaluation of the pipeline on the extraction and pairing task: precision 0.910, recall 0.878, F-measure 0.894, AUC 0.988. Representing the narrative content in terms of UMLS concepts did not improve results. Applications of the proposed technology include data mining, advanced search and workflow support for healthcare professionals managing radiological measurements. PMID:24551406

  9. Movement Analysis of Flexion and Extension of Honeybee Abdomen Based on an Adaptive Segmented Structure.

    PubMed

    Zhao, Jieliang; Wu, Jianing; Yan, Shaoze

    2015-01-01

    Honeybees (Apis mellifera) curl their abdomens for daily rhythmic activities. Prior to determining this fact, people have concluded that honeybees could curl their abdomen casually. However, an intriguing but less studied feature is the possible unidirectional abdominal deformation in free-flying honeybees. A high-speed video camera was used to capture the curling and to analyze the changes in the arc length of the honeybee abdomen not only in free-flying mode but also in the fixed sample. Frozen sections and environment scanning electron microscope were used to investigate the microstructure and motion principle of honeybee abdomen and to explore the physical structure restricting its curling. An adaptive segmented structure, especially the folded intersegmental membrane (FIM), plays a dominant role in the flexion and extension of the abdomen. The structural features of FIM were utilized to mimic and exhibit movement restriction on honeybee abdomen. Combining experimental analysis and theoretical demonstration, a unidirectional bending mechanism of honeybee abdomen was revealed. Through this finding, a new perspective for aerospace vehicle design can be imitated. © The Author 2015. Published by Oxford University Press on behalf of the Entomological Society of America.

  10. Movement Analysis of Flexion and Extension of Honeybee Abdomen Based on an Adaptive Segmented Structure

    PubMed Central

    Zhao, Jieliang; Wu, Jianing; Yan, Shaoze

    2015-01-01

    Honeybees (Apis mellifera) curl their abdomens for daily rhythmic activities. Prior to determining this fact, people have concluded that honeybees could curl their abdomen casually. However, an intriguing but less studied feature is the possible unidirectional abdominal deformation in free-flying honeybees. A high-speed video camera was used to capture the curling and to analyze the changes in the arc length of the honeybee abdomen not only in free-flying mode but also in the fixed sample. Frozen sections and environment scanning electron microscope were used to investigate the microstructure and motion principle of honeybee abdomen and to explore the physical structure restricting its curling. An adaptive segmented structure, especially the folded intersegmental membrane (FIM), plays a dominant role in the flexion and extension of the abdomen. The structural features of FIM were utilized to mimic and exhibit movement restriction on honeybee abdomen. Combining experimental analysis and theoretical demonstration, a unidirectional bending mechanism of honeybee abdomen was revealed. Through this finding, a new perspective for aerospace vehicle design can be imitated. PMID:26223946

  11. The management of the open abdomen in trauma and emergency general surgery: part 1-damage control.

    PubMed

    Diaz, Jose J; Cullinane, Daniel C; Dutton, William D; Jerome, Rebecca; Bagdonas, Richard; Bilaniuk, Jaroslaw W; Bilaniuk, Jarolslaw O; Collier, Bryan R; Como, John J; Cumming, John; Griffen, Maggie; Gunter, Oliver L; Kirby, John; Lottenburg, Larry; Mowery, Nathan; Riordan, William P; Martin, Niels; Platz, Jon; Stassen, Nicole; Winston, Eleanor S

    2010-06-01

    The open abdomen technique, after both military and civilian trauma, emergency general or vascular surgery, has been used in some form for the past 30 years. There have been several hundred citations on the indications and the management of the open abdomen. Eastern Association for the Surgery of Trauma practice management committee convened a study group to organize the world's literature for the management of the open abdomen. This effort was divided into two parts: damage control and the management of the open abdomen. Only damage control is presented in this study. Part 1 is divided into indications for the open abdomen, temporary abdominal closure, staged abdominal repair, and nutrition support of the open abdomen. A literature review was performed for more than 30 years. Prospective and retrospective studies were included. The reviews and case reports were excluded. Of 1,200 articles, 95 were selected. Seventeen surgeons reviewed the articles with four defined criteria. The Eastern Association for the Surgery of Trauma primer was used to grade the evidence. There was only one level I recommendation. A patient with documented abdominal compartment syndrome should undergo decompressive laparotomy. The open abdomen technique remains a heroic maneuver in the care of the critically ill trauma or surgical patient. For the best outcomes, a protocol for the indications, temporary abdominal closure, staged abdominal reconstruction, and nutrition support should be in place.

  12. Improving abdomen tumor low-dose CT images using a fast dictionary learning based processing

    NASA Astrophysics Data System (ADS)

    Chen, Yang; Yin, Xindao; Shi, Luyao; Shu, Huazhong; Luo, Limin; Coatrieux, Jean-Louis; Toumoulin, Christine

    2013-08-01

    In abdomen computed tomography (CT), repeated radiation exposures are often inevitable for cancer patients who receive surgery or radiotherapy guided by CT images. Low-dose scans should thus be considered in order to avoid the harm of accumulative x-ray radiation. This work is aimed at improving abdomen tumor CT images from low-dose scans by using a fast dictionary learning (DL) based processing. Stemming from sparse representation theory, the proposed patch-based DL approach allows effective suppression of both mottled noise and streak artifacts. The experiments carried out on clinical data show that the proposed method brings encouraging improvements in abdomen low-dose CT images with tumors.

  13. Commentary on Predictors of Failed Primary Abdominal Closure in the Trauma Patient with an Open Abdomen

    DTIC Science & Technology

    2013-05-01

    initial TAC after index laparotomy, nutrition sup- port in patients with an open abdomen , methods for ongoing TAC to include fascial-based and negative...trauma patient with an open abdomen " 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Lundy J. B., 5d. PROJECT NUMBER...Z39-18 Commentary on ‘‘Predictors of Failed Primary Abdominal Closure in the Trauma Patient with an Open Abdomen ’’ Jonathan B. Lundy, MD Damage

  14. Quantification of the thorax-to-abdomen breathing ratio for breathing motion modeling.

    PubMed

    White, Benjamin M; Zhao, Tianyu; Lamb, James; Bradley, Jeffrey D; Low, Daniel A

    2013-06-01

    The purpose of this study was to develop a methodology to quantitatively measure the thorax-to-abdomen breathing ratio from a 4DCT dataset for breathing motion modeling and breathing motion studies. The thorax-to-abdomen breathing ratio was quantified by measuring the rate of cross-sectional volume increase throughout the thorax and abdomen as a function of tidal volume. Twenty-six 16-slice 4DCT patient datasets were acquired during quiet respiration using a protocol that acquired 25 ciné scans at each couch position. Fifteen datasets included data from the neck through the pelvis. Tidal volume, measured using a spirometer and abdominal pneumatic bellows, was used as breathing-cycle surrogates. The cross-sectional volume encompassed by the skin contour when compared for each CT slice against the tidal volume exhibited a nearly linear relationship. A robust iteratively reweighted least squares regression analysis was used to determine η(i), defined as the amount of cross-sectional volume expansion at each slice i per unit tidal volume. The sum Ση(i) throughout all slices was predicted to be the ratio of the geometric expansion of the lung and the tidal volume; 1.11. The Xiphoid process was selected as the boundary between the thorax and abdomen. The Xiphoid process slice was identified in a scan acquired at mid-inhalation. The imaging protocol had not originally been designed for purposes of measuring the thorax-to-abdomen breathing ratio so the scans did not extend to the anatomy with η(i) = 0. Extrapolation of η(i)-η(i) = 0 was used to include the entire breathing volume. The thorax and abdomen regions were individually analyzed to determine the thorax-to-abdomen breathing ratios. There were 11 image datasets that had been scanned only through the thorax. For these cases, the abdomen breathing component was equal to 1.11 - Ση(i) where the sum was taken throughout the thorax. The average Ση(i) for thorax and abdomen image datasets was found to be 1.20

  15. The Reversal of Stoma Following Open Abdomen Management.

    PubMed

    Yetişir, Fahri; Şarer, AkgünEbru; Acar, H Zafer; Çiftciler, Erdinç

    2016-06-01

    Bowel stoma formation is very often required during open abdomen (OA) management; we aim to report our stoma reversal series following OA management retrospectively. A retrospective analysis of 31 patients who underwent the reversal of the stoma created during OA management between January 2008 and September 2014 was performed. Twenty-eight of these 31 patients were included in this study. The stoma-related complications are more common after OA management during waiting time interval for reversal. At this time interval, patients with jejunostomy had more stoma-related complications than patients with ileostomy (p = 0.008) and colostomy. (p = 0.001). Waiting time interval was shorter for reversal of jejunostomy than reversal of ileostomy (p = 0.014) and colostomy (p = 0.001). Operation time for jejunostomy (p = 0.016) and colostomy reversal (p = 0.001) were significantly longer than the ileostomy reversal. There was no difference between early and late reversal of stoma regarding morbidity and mortality. The stoma-related complications are more common following OA management during waiting time interval for stoma reversal. The reversal time is more critical for this kind of patients especially with life-threatening complicated jejunostomy. For loop stoma created during OA management, the reversal may be performed after average 50 days without increasing morbidity and mortality. The reversal of end stoma created during OA management has high morbidity. If it is possible, loop stoma should be preferred during OA management.

  16. Zones of Adhesion of the Abdomen: Implications for Abdominoplasty.

    PubMed

    Taylor, D Alastair

    2017-02-01

    The elucidation of the superficial fascial system (SFS) by Lockwood in 1991 has been the cornerstone of our understanding of abdominal excisional dynamics for the last 25 years. The SFS can be used for closure and, appropriately mobilized, for tension transmission in abdominoplasty, and lower body lifts. The pattern of SFS adhesion to muscle fascia and the zones of adhesion was also described but there are inconsistencies between the description and clinical experience. This study was performed to better describe the pattern of subcutaneous tissue adhesion to the trunk. Twenty pre-abdominoplasty patients were studied. A series of points were marked around the trunk and the skin moved in four opposing directions. The excursions were measured and the median plotted on a diagram. Two fresh cadavers were also dissected, removing all subcutaneous tissue circumferentially from the trunk muscle fascia and marking the strength of the adhesion with a colored pin. Three grades of adhesion were mapped. In the current study, maximal laxity was shown in the mid-lower abdomen and the anterior and lateral chest. Laxity was limited in the anterior and posterior midlines, over the lower back, and the lateral upper thigh. The cadaver dissection mapped adhesion which correlated with the skin laxity diagram. The detailed skin adhesion map better explains features of surface anatomy. Incorporating this understanding a tension vector of abdominoplasty closure obliquely inwards is proposed to maximally harvest the laxity of the anterior and lateral chest and to create further lowering and narrowing of the waist. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  17. Spontaneous perforation of acalculous gall bladder presenting as acute abdomen.

    PubMed

    Goenka, Usha; Majumder, Shounak; Banerjee, Pinaki; Kapoor, Nisha; Nandi, Subhabrata; Sethy, Pradeepta K; Goenka, Mahesh K

    2012-10-01

    Acute abdominal pain is commonly encountered in the emergency department (ED), but a diagnosis of gall bladder perforation (GBP) is rarely considered in the absence of predisposing factors. This article will highlight the risk factors, diagnosis, and management of GBP, a rare but potentially life-threatening biliary pathology. A 73-year-old diabetic man presented to the ED with a 12-h history of severe upper abdominal pain. He was hemodynamically stable, but abdominal examination showed distention, guarding, and diffuse tenderness. Abdominal X-ray study showed mildly distended small bowel loops without any air-fluid levels. Abdominal sonography revealed mild ascites and pericholecystic fluid collection but no gall bladder calculi. Laboratory reports documented a white blood cell count of 13,700/mm(3) and elevated serum amylase of 484 IU/L. A contrast-enhanced computed tomography (CT) scan of the abdomen suggested discontinuity of the gall bladder wall along with fluid accumulation in the pericholecystic, perihepatic, right subphrenic, and right paracolic spaces. In view of the possibility of spontaneous GBP developing as a complication of acute acalculous cholecystitis, laparotomy was planned. At surgery, several liters of bile-stained peritoneal fluid were aspirated and inspection of the gall bladder revealed a perforation at the fundus. After cholecystectomy, the patient had an uneventful recovery. The diagnosis of spontaneous gall bladder perforation should be considered in elderly patients presenting to the ED with symptoms and signs of peritonitis even in the absence of pre-existing gall bladder disease. Abdominal CT scan is an invaluable tool for the diagnosis, and early surgical intervention is usually life-saving. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Fetal ultrasound biometry: 2. Abdomen and femur length reference values.

    PubMed

    Kurmanavicius, J; Wright, E M; Royston, P; Zimmermann, R; Huch, R; Huch, A; Wisser, J

    1999-02-01

    To create reliable reference ranges and calculate Z scores for fetal abdomen and femur ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy. A prospective, cross-sectional study. Obstetric clinics (outpatient and delivery units) at the University Hospital of Zurich. The study data were obtained from 6557 pregnant women. Only the first ultrasound examination between 12 and 42 weeks of each fetus with certainly established gestational age was used for analysis. No exclusions were made on the grounds of small-for-date birthweight, prematurity or other events several weeks after the examination. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each parameter. A total of 5807 mean abdominal diameters and abdominal circumferences were derived from fetal transverse and anterio-posterior fetal abdominal diameter measurements. Fetal femur length was measured in 5860 instances. The charts, tables and regression formulae of the biometrical measurements are presented. A comparison of our charts with others showed no significant difference. Only Merz's centiles for abdominal biometry were lower and for femur length higher than ours. An application to calculate Z scores was developed using Excel (Microsoft Corporation, USA); the macros are presented in detail in the Figure 6 footnote. We have presented centile charts, tables and formulae for fetal abdominal diameter and circumference and femur length derived from a large and minimally selected sample size in a carefully designed cross-sectional study. Complete tables and regression formulae to calculate reference ranges and Z scores are presented to use in computer-aided evaluation of fetal ultrasound biometry.

  19. The effect of the abdomen deformation on the longitudinal stability of flying insects

    NASA Astrophysics Data System (ADS)

    Choi, Sang-Yeon; Kim, Joong-Kwan; Han, Jong-seob; Han, Jae-Hung

    2015-03-01

    In this paper, we derive longitudinal nonlinear equations of motion of a hovering insect with deformable abdomen to investigate the effect of the abdominal motion to the longitudinal dynamics. The blade-element theory, which is based on experimentally obtained aerodynamic coefficients, is used for the periodic force and moment excitation to the system. Here, we focus on the role of the deformable abdomen to investigate whether or not the flexible body is a decisive factor to the longitudinal flight dynamic stability. Three cases: 1) rigid connection between the thorax and abdomen, 2) flexible connection, and 3) active connection with a feedback control, are compared to check the role of the abdomen deformation on the longitudinal flight dynamic stability, by examining eigenvalues of the linearized system model of each case. The results show that an active control of the abdominal angle can stabilize the longitudinal flight dynamics of the insect modeled in this study.

  20. [Acupuncture and tuina clinical thoughts of "treating the back from abdomen" for low back pain].

    PubMed

    Liu, Jinlong; Li, Rui

    2015-07-01

    In clinical treatment, it is found that certain patients always have some positive reaction points those are relevant with low back pain in the abdomen area. When the simple treatment on the low back is ineffective, the efficacy could be significantly improved if acupuncture or tuina is performed at the abdomen areas, which is called "regulating yin to treat yang", or "treating the back from abdomen". In this paper, with the diagnosis and treatment method of "treating the back from abdomen" for low back pain as principal line, the detailed manipulation is explained for low back pain that is induced by TCM meridian diseases or modern anatomy, which could open the methods for clinical treatment of low back pain and enrich the therapeutic options.

  1. Critical Structure for Telescopic Movement of Honey bee (Insecta: Apidae) Abdomen: Folded Intersegmental Membrane

    PubMed Central

    Zhao, Jieliang; Yan, Shaoze; Wu, Jianing

    2016-01-01

    The folded intersegmental membrane is a structure that interconnects two adjacent abdominal segments; this structure is distributed in the segments of the honey bee abdomen. The morphology of the folded intersegmental membrane has already been documented. However, the ultrastructure of the intersegmental membrane and its assistive role in the telescopic movements of the honey bee abdomen are poorly understood. To explore the morphology and ultrastructure of the folded intersegmental membrane in the honey bee abdomen, frozen sections were analyzed under a scanning electron microscope. The intersegmental membrane between two adjacent terga has a Z–S configuration that greatly influences the daily physical activities of the honey bee abdomen. The dorsal intersegmental membrane is 2 times thicker than the ventral one, leading to asymmetric abdominal motion. Honey bee abdominal movements were recorded using a high-speed camera and through phase-contrast computed tomography. These movements conformed to the structural features of the folded intersegmental membrane. PMID:27456912

  2. Improved MR imaging of the upper abdomen with glucagon and gas.

    PubMed

    Weinreb, J C; Maravilla, K R; Redman, H C; Nunnally, R

    1984-10-01

    Magnetic resonance (MR) imaging studies of the upper abdomen have been difficult to interpret due to the frequent inability to differentiate between various structures, especially between the gastrointestinal tract and adjacent normal and pathological structures. Utilizing effervescent granules and intravenous glucagon, gas in the stomach and duodenum provides excellent contrast and results in improved MR imaging of the upper abdomen. This technique is useful in demonstrating both gastric and pancreatic morphology.

  3. Ectopic Spleen Presenting as Lump Abdomen: A Rare Case Report and Review of Literature

    PubMed Central

    Venkanna, Madipeddi; Kumar, Dodda Ramesh; Kumaraswamy, Boda; Reddy, Bachannagari Srinivas

    2015-01-01

    Ectopic spleen is due to failure of fusion of the mesogastrium and the lining body wall epithelium, resulting in lax or absent supporting ligaments of spleen, making it abnormally mobile. This case presented as lump abdomen with history of recurrent attacks of abdominal pain. Clinical diagnosis was unidentified abdominal mass. The radiological imaging was suggestive of the diagnosis, and the exploration of abdomen has clinched the diagnosis. PMID:26500956

  4. Open abdomen management: A review of its history and a proposed management algorithm

    PubMed Central

    Kreis, Barbara Elize; de Mol van Otterloo, Johan Coenraad Alexander; Kreis, Robert Walter

    2013-01-01

    In this review we look into the historical development of open abdomen management. Its indication has spread in 70 years from intra-abdominal sepsis to damage control surgery and abdominal compartment syndrome. Different temporary abdominal closure techniques are essential to benefit the potential advantages of open abdomen management. Here, we discuss the different techniques and provide a new treatment strategy, based on available evidence, to facilitate more consistent decision making and further research on this complicated surgical topic. PMID:23823991

  5. Pacifying the Open Abdomen with Concomitant Intestinal Fistula: A Novel Approach

    DTIC Science & Technology

    2009-05-08

    Ultimately, abdominal closure is desired but is not always possible. Accordingly, surgeons must be well versed in the application of a number of useful...wound in abdomens not amenable to delayed closure techniques. © 2010 Published by Elsevier Inc. KEYWORDS: Intestinal fistula; Open abdomen...placed directly on the bowel, or, alternatively, ne may place it over an underlying ring of colostomy paste Adapt Paste; Hollister International

  6. The Onset of Intra-Abdominal Adhesions During Closed-Abdomen Hyperthermic Intraperitoneal Chemotherapy.

    PubMed

    Lotti, Marco; Giulii Capponi, Michela; Campanati, Luca; Poiasina, Elia; Ansaloni, Luca; Poletti, Eugenio; Frigerio, Luigi

    2016-12-01

    Hyperthermic intraperitoneal chemotherapy (HIPEC) is delivered after cytoreductive surgery (CRS) in selected patients with peritoneal carcinomatosis. The closed-abdomen technique, preferred by many centers, prevents heat loss and drug spillage, but does not warrant homogeneous distribution of the perfusion fluid (PF). The hypothesized formation of intra-abdominal adhesions during the closed-abdomen perfusion period has never been described. From March 2014 to April 2016, 10 consecutive patients with peritoneal carcinomatosis, selected for CRS, underwent the Laparoscopy-Enhanced HIPEC technique to explore the abdominal cavity during the perfusion. The aim of the study was to investigate the incidence and the extent of intra-abdominal adhesions that are formed after CRS during the perfusion period of closed-abdomen HIPEC. During the perfusion, adhesions developed in 70% of the patients. Adhesions developed mainly in the period between the closure of the abdomen and the subsequent filling of the abdomen with the PF. After their first division, during the following perfusion period, adhesions between the bowel and the abdominal wall reformed in 3 patients (30%). Intra-abdominal adhesions are frequently formed during closed-abdomen HIPEC and can hamper the adequate circulation of the PF. The Laparoscopy-Enhanced technique enables the early detection and the division of any intra-abdominal adhesions.

  7. Management of the open abdomen using combination therapy with ABRA and ABThera systems

    PubMed Central

    Mukhi, Alfin N.; Minor, Samuel

    2014-01-01

    Background The open abdomen is an increasingly used technique that is applied in a wide variety of clinical situations. The ABThera Open Abdomen Negative Pressure Therapy System is one of the most common and successful temporary closure systems, but it has limited ability to close the fascia in approximately 30% of patients. The abdominal reapproximation anchor system (ABRA) is a dynamic closure system that seems ideal to manage patients who may not achieve primary fascial closure with ABThera alone. We report on the use of the ABRA in conjunction with the ABThera in patients with an open abdomen. Methods We retrospectively analyzed patients with an open abdomen managed with the ABThera and ABRA between January 2007 and December 2012 at the Halifax Infirmary, QEII Health Science Centre, Halifax, Nova Scotia. Results Sixteen patients had combination therapy using the ABRA and ABThera systems for treatment of the open abdomen. After removing patients who died prior to closure, primary fascial closure was achieved in 12 of 13 patients (92%). Conclusion We observed a high rate of primary fascial closure in patients with an open abdomen managed with the ABThera system in conjuction with the ABRA. Applying mechanical traction in addition to the ABThera should be considered in patients predicted to be at high risk for failure to achieve primary fascial closure. PMID:25265104

  8. Components separation technique is feasible for assisting delayed primary fascial closure of open abdomen.

    PubMed

    Rasilainen, S K; Mentula, P J; Leppäniemi, A K

    2016-03-01

    The goal after open abdomen treatment is to reach primary fascial closure. Modern negative pressure wound therapy systems are sometimes inefficient for this purpose. This retrospective chart analysis describes the use of the 'components separation' method in facilitating primary fascial closure after open abdomen. A total of 16 consecutive critically ill surgical patients treated with components separation during open abdomen management were analyzed. No patients were excluded. Primary fascial closure was achieved in 75% (12/16). Components separation was performed during ongoing open abdomen treatment in 7 patients and at the time of delayed primary fascial closure in 9 patients. Of the former, 3/7 (43%) patients reached primary fascial closure, whereas all 9 patients in the latter group had successful fascial closure without major complications (p = 0.019). Components separation is a useful method in contributing to successful primary fascial closure in patients treated for open abdomen. Best results were obtained when components separation was performed simultaneously with primary fascial closure at the end of the open abdomen treatment. © The Finnish Surgical Society 2015.

  9. Abdomen-thigh contact during forward reaching tasks in obese individuals.

    PubMed

    Singh, Bhupinder; Brown, Thomas D; Callaghan, John J; Yack, H John

    2013-10-01

    During seated forward reaching tasks in obese individuals, excessive abdominal tissue can come into contact with the anterior thigh. This soft tissue apposition acts as a mechanical restriction, altering functional biomechanics at the hip, and causing difficulty in certain daily activities such as bending down, or picking up objects from the floor. The purpose of the study was to investigate the contact forces and associated moments exerted by the abdomen on the thigh during seated forward-reaching tasks in adult obese individuals. Ten healthy subjects (age 58.1 ± 4.4) with elevated BMI (39.04 ± 5.02) participated in the study. Contact pressures between the abdomen and thigh were measured using a Tekscan Conformat pressure-mapping sensor during forward-reaching tasks. Kinematic and force plate data were obtained using an infrared motion capture system. The mean abdomen-thigh contact force was 10.17 ± 5.18% of body weight, ranging from 57.8 N to 200 N. Net extensor moment at the hip decreased by mean 16.5 ± 6.44% after accounting for the moment generated by abdomen-thigh tissue contact. In obese individuals, abdomen-thigh contact decreases the net moment at the hip joint during seated forward-reaching activities. This phenomenon should be taken into consideration for accurate biomechanical modeling in these individuals.

  10. Gross anatomy of superficial fascia and future localised fat deposit areas of the abdomen in foetus

    PubMed Central

    Kumar, Pramod; Pandey, Arvind Kumar; Kumar, Brijesh; Aithal, K. S.; Dsouza, Antony Sylvan

    2013-01-01

    Background: The development and popularity of body contouring procedures such as liposuction and abdominoplasty has renewed interest in the anatomy of the superficial fascia and subcutaneous fat deposits of the abdomen. The study of anatomy of fascia and fetal adipose tissue was proposed as it may be of value in understanding the possible programing of prevention of obesity. Objectives: The present study was undertaken to understand the gross anatomy of superficial fascia of abdomen and to study the gross anatomy of future localized fat deposits (LFDs) area of abdomen in fetus. Materials and Methods: Four fetus (two male & two female) of four month of intrauterine life were dissected. Attachments & layers of superficial fascia and future subcutaneous fat deposit area of upper and lower abdomen were noted. Results: Superficial fascia of the abdomen was multi layered in mid line and number of layers reduced laterally as in adult. The future abdominal LFD (localized fat deposits) area in fetus shows brownish-white blubbary tissue without well-defined adult fat lobules. Conclusion: The attachment and gross anatomy of superficial fascia of the fetus was similar to that in adults. The future LFD areas showed brownish white blubbary tissue with ill-defined fat lobules. PMID:24459344

  11. Sonographic findings of localized Castleman disease of the abdomen and pelvis.

    PubMed

    Zhou, Wei; Zhan, Weiwei; Zhou, Jianqiao; Zhu, Ying; Yao, Jiejie

    2015-09-01

    The purpose of this study was to sonographically evaluate the diagnosis of localized Castleman disease in the abdomen and pelvis. This was a retrospective analysis of 18 cases of Castleman disease localized in the abdomen and pelvis. The following features of the lesions were assessed on sonography (US): location, size, margin, echogenicity, echotexture, intralesional cystic necrosis, intralesional calcification, posterior acoustic enhancement, and blood supply. Of the 18 tumors, 16 were located in the abdomen and 2 were located in the pelvis close to iliac vessels. The most frequent appearance of localized Castleman disease in the abdomen and pelvis on US was of a single, well-defined, hypoechoic solid mass with no intralesional cystic necrosis. The internal echotexture was homogeneous in 4 cases and heterogeneous in 14 cases, with thin hyperechoic septa (n = 14) or calcifications (n = 3). Posterior acoustic enhancement was seen in 17 of the 18 cases (94%). Ninety-four percent of the lesions (17/18) had marked vascularity on color Doppler US. Localized Castleman disease in the abdomen and pelvis usually appears on US as a heterogeneously hypoechoic lesion containing thin septa, and more commonly than not, demonstrates posterior acoustic enhancement and marked vascularity. © 2014 Wiley Periodicals, Inc.

  12. Quantitative Susceptibility Mapping in the Abdomen as an Imaging Biomarker of Hepatic Iron Overload

    PubMed Central

    Sharma, Samir D.; Hernando, Diego; Horng, Debra E.; Reeder, Scott B.

    2014-01-01

    Purpose The purpose of this work was to develop and demonstrate feasibility and initial clinical validation of quantitative susceptibility mapping (QSM) in the abdomen as an imaging biomarker of hepatic iron overload. Theory In general, QSM is faced with the challenges of background field removal and dipole inversion. Respiratory motion, the presence of fat, and severe iron overload further complicate QSM in the abdomen. We propose a technique for QSM in the abdomen that addresses these challenges. Methods Data were acquired from 10 subjects without hepatic iron overload and 33 subjects with known or suspected iron overload. The proposed technique was used to estimate the susceptibility map in the abdomen, from which hepatic iron overload was measured. As a reference, spin-echo data were acquired for R2-based LIC estimation. Liver R2* was measured for correlation with liver susceptibility estimates. Results Correlation between susceptibility and R2-based LIC estimation was R2 = 0.76 at 1.5T and R2 = 0.83 at 3T. Further, high correlation between liver susceptibility and liver R2* (R2 = 0.94 at 1.5T; R2 = 0.93 at 3T) was observed. Conclusion We have developed and demonstrated initial validation of QSM in the abdomen as an imaging biomarker of hepatic iron overload. PMID:25199788

  13. Gross anatomy of superficial fascia and future localised fat deposit areas of the abdomen in foetus.

    PubMed

    Kumar, Pramod; Pandey, Arvind Kumar; Kumar, Brijesh; Aithal, K S; Dsouza, Antony Sylvan

    2013-09-01

    The development and popularity of body contouring procedures such as liposuction and abdominoplasty has renewed interest in the anatomy of the superficial fascia and subcutaneous fat deposits of the abdomen. The study of anatomy of fascia and fetal adipose tissue was proposed as it may be of value in understanding the possible programing of prevention of obesity. The present study was undertaken to understand the gross anatomy of superficial fascia of abdomen and to study the gross anatomy of future localized fat deposits (LFDs) area of abdomen in fetus. Four fetus (two male & two female) of four month of intrauterine life were dissected. Attachments & layers of superficial fascia and future subcutaneous fat deposit area of upper and lower abdomen were noted. Superficial fascia of the abdomen was multi layered in mid line and number of layers reduced laterally as in adult. The future abdominal LFD (localized fat deposits) area in fetus shows brownish-white blubbary tissue without well-defined adult fat lobules. The attachment and gross anatomy of superficial fascia of the fetus was similar to that in adults. The future LFD areas showed brownish white blubbary tissue with ill-defined fat lobules.

  14. Open abdomen treatment for septic patients with gastrointestinal fistula: from fistula control to definitive closure.

    PubMed

    Ren, Jianan; Yuan, Yujie; Zhao, Yunzhao; Gu, Guosheng; Wang, Gefei; Chen, Jun; Fan, Chaogang; Wang, Xinbo; Li, Jieshou

    2014-04-01

    The use of open abdomen in the management of gastrointestinal fistula complicated with severe intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal fistula and underwent open abdomen treatment were retrospectively reviewed. Various materials such as polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous fistula closure occurred in 16 patients with secondary fistula recorded in six patients. Besides, wound complications occurred in 13 patients with two cases for pulmonary infection. Within a 12-month follow-up period after definitive closure, no additional fistula was recorded excluding planned ventral hernia repair. Open abdomen treatment was effective for gastrointestinal fistula complicated by severe intra-abdominal infection. A delayed and deliberate operative strategy aiming at fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.

  15. Update on the management of non-obstetric acute abdomen in pregnant patients.

    PubMed

    Barber-Millet, Sebastián; Bueno Lledó, José; Granero Castro, Pablo; Gómez Gavara, Immaculada; Ballester Pla, Neus; García Domínguez, Rafael

    2016-05-01

    Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Magnetic material in head, thorax, and abdomen of Solenopsis substituta ants: A ferromagnetic resonance study

    NASA Astrophysics Data System (ADS)

    Abraçado, L. G.; Esquivel, D. M. S.; Alves, O. C.; Wajnberg, E.

    2005-08-01

    Ferromagnetic resonance temperature dependence is used to study the magnetic material in smashed head, thorax, and abdomen of Solenopsis substituta ants. These three body parts present the five lines previously observed in other social insects. The magnetic material content is slightly higher in heads with antennae than in abdomen with petiole. Isolated nanoparticle diameters were estimated as 12.5 ± 0.1 and 11.0 ± 0.2 nm in abdomen with petiole and head with antennae, respectively. The presence of linear chains of these particles or large ellipsoidal particles are suggested. A bulk-like magnetite particle was observed in the thorax. The Curie-Weiss, the structural-electronic and ordering transition temperatures were obtained in good agreement with those proposed for magnetite nanoparticles.

  17. Magnetic material in head, thorax, and abdomen of Solenopsis substituta ants: a ferromagnetic resonance study.

    PubMed

    Abraçado, L G; Esquivel, D M S; Alves, O C; Wajnberg, E

    2005-08-01

    Ferromagnetic resonance temperature dependence is used to study the magnetic material in smashed head, thorax, and abdomen of Solenopsis substituta ants. These three body parts present the five lines previously observed in other social insects. The magnetic material content is slightly higher in heads with antennae than in abdomen with petiole. Isolated nanoparticle diameters were estimated as 12.5 +/- 0.1 and 11.0 +/- 0.2 nm in abdomen with petiole and head with antennae, respectively. The presence of linear chains of these particles or large ellipsoidal particles are suggested. A bulk-like magnetite particle was observed in the thorax. The Curie-Weiss, the structural-electronic and ordering transition temperatures were obtained in good agreement with those proposed for magnetite nanoparticles.

  18. A phantom pig abdomen as an alternative for testing robotic surgical systems: our experience.

    PubMed

    Ristolainen, Asko; Colucci, Gianluca; Kruusmaa, Maarja

    2013-11-01

    The use of animals for testing and validating new medical devices and surgical techniques has raised ethical issues for a long time. Following the introduction of the Three Rs principle, significant efforts have been made to achieve a reduction in the numbers of animals used in testing. Nevertheless, the number of large animals used for testing purposes is still too high. This article describes a potential alternative to the use of large animals in the early phase of the development of surgical equipment -- a high-definition phantom pig abdomen. The phantom pig abdomen was developed from computed tomography scans by using affordable materials, and it was used with two different robotic platforms. It permitted the testing of minimally-invasive robotic pancreatic enucleation, with or without intraoperative ultrasound guidance. The phantom pig abdomen has proven to be a realistic tool, with the potential to reduce the cost and time-frame of the experiments.

  19. Current status of the open abdomen treatment for intra-abdominal infection.

    PubMed

    Yuan, Yujie; Ren, Jianan; He, Yulong

    2013-01-01

    The open abdomen has become an important approach for critically ill patients who require emergent abdominal surgical interventions. This treatment, originating from the concept of damage control surgery, was first applied in severe traumatic patients. The ultimate goal is to achieve formal abdominal fascial closure by several attempts and adjuvant therapies (fluid management, nutritional support, skin grafting, etc.). Up to the present, open abdomen therapy becomes matured and is multistage-approached in the management of patients with severe trauma. However, its application in patients with intra-abdominal infection still presents great challenges due to critical complications and poor clinical outcomes. This review focuses on the specific use of the open abdomen in such populations and detailedly introduces current concerns and advanced progress about this therapy.

  20. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies.

    PubMed Central

    Bucknall, T E; Cox, P J; Ellis, H

    1982-01-01

    Burst abdomen and incisional herniation are continuing problems for the general surgeon. A prospective study was carried out to define the extent of the problem. Over five years from 1975 to 1980 a total of 1129 major laparotomy wounds in adults were assessed at regular intervals for 12 months after operation. There were 19 burst abdomens (1.7%) and 84 incisional hernias (7.4%). The introduction of the mass-closure technique reduced the incidence of burst abdomen from over 3% in 1975 to 0.95% in 1979. It did not, however, improve the rate for incisional hernias, which was 7.6% in 1979. Many factors are associated with incisional herniation: old age, male sex, obesity, bowel surgery, type of suture, chest infection, abdominal distension, and, most important, wound infection. More work is needed to find the ideal method of wound closure, and efforts should be made to eliminate wound infection. PMID:6279229

  1. Alternativen beim Pflanzenschutz?

    NASA Astrophysics Data System (ADS)

    Mendgen, Kurt

    1983-05-01

    The control of plant diseases may be improved by influencing the development of a parasite in its host. The role of elicitors and inducers for the induction of the plant's defense reactions and the use of hyperparasites is discussed as a part of an integrated pest management system of rust fungi.

  2. Effects of manual lymph drainage for abdomen on the brain activity of subjects with psychological stress

    PubMed Central

    Shim, Jung-Myo; Yeun, Young-Ran; Kim, Hye-Young; Kim, Sung-Joong

    2017-01-01

    [Purpose] The present study investigated the effects of manual lymph drainage for abdomen on electroencephalography in subjects with psychological stress. [Subjects and Methods] Twenty-eight subjects were randomly allocated to undergo a 20-min session of either manual lymph drainage or abdominal massage on a bed. [Results] Analysis of electroencephalograms from the manual lymph drainage group showed a significant increase in relaxation, manifested as an increase in average absolute, relative alpha activity and a decrease in relative gamma activity. [Conclusion] Our results suggest that the application of manual lymph drainage from the abdomen provides acute neural effects that increase relaxation in subjects with psychological stress. PMID:28356638

  3. Skeletal remains of mummified foetus for 36 years in mother's abdomen

    PubMed Central

    Gedam, B.S.; Shah, Yunus; Deshmukh, Shahaji; Bansod, Prasad Y.

    2014-01-01

    Lithopedion is a rare event that occurs in 0.0054% of all gestations.1 According to one report there are only about 330 known cases of stone baby in the world (Gang sung, Min Lee et al., 2010). About 1.5–1.8% of the abdominal babies develop into lithopedion. We report a 60-year-old female with pain and lump in lower abdomen since 2 months. Possibility of tumour was on evaluation. Eventually a mass containing foetal skeleton was found in her abdomen which was traced to her pregnancy 36 years back. PMID:25647606

  4. Torsion of a wandering spleen. A rare cause of acute abdomen.

    PubMed

    Jude, Nwashilli N; Onochie, Nwajei C

    2015-12-01

    Wandering spleen is a rare condition that accounts for less than 0.25% of all indications for splenectomy. It is characterized by ectopic localization of the spleen owing to the lack or weakening of its ligaments. Torsion is the most common complication due to its long pedicle and high mobility, which may result in acute abdomen. We report a case of torsion in a wandering spleen in a 28-year-old male presenting with an acute abdomen that was treated by splenectomy.

  5. Record of a gregarine (Apicomplexa: Neogregarinida) in the abdomen of the termite Coptotermes gestroi (Isoptera, Rhinotermitidae).

    PubMed

    Costa-Leonardo, Ana Maria; Casarin, Fabiana E; Constantini, Joice P

    2008-02-01

    Coptotermes gestroi is an exotic species of termite that is a pest of great economical importance in Brazil. This paper relates the occurrence of a coelomic gregarine (Apicomplexa: Neogregarinida) in the abdomen of the foraging workers recently collected from field colonies of this termite. The termite hosts presented large, white abdomens because they carried 1 up to 3 cysts of gregarines filled with numerous lemon-shaped spores. Earlier developmental stages of this gregarine were not observed in the scanning microscope preparations nor in the histological slides of the infected termites. However, the lemon-shaped spores suggest a parasite gregarine of Mattesia genus, family Lipotrophidae.

  6. Ruptured Gall Bladder containing Stones following Blunt Trauma Abdomen: A Rare Presentation of Hemodynamic Instability.

    PubMed

    Goel, V; Kumar, N; Soni, N

    2015-01-01

    Gall bladder injuries are seen in 2% of patients undergoing laparotomy for blunt trauma abdomen. Isolated gall bladder injury is a rare event with associated presence of stones is even rarer. The associated visceral injuries lead to intraoperative identification in most cases. Here we present a case of 30 years old male with isolated gall bladder laceration following blunt abdominal trauma. The diagnosis of gallbladder perforation after blunt injury may be suspected in patients with signs of an acute abdomen and hypotension that is not explained by blood loss. Early suspicion and prompt exploration is imperative. Cholecystectomy is an adequate treatment for the condition.

  7. An umbilical venous catheter complication presented as acute abdomen: case report.

    PubMed

    Oztan, Mustafa O; Ilhan, Ozkan; Abay, Elif; Koyluoglu, Gokhan

    2016-12-01

    Umbilical venous catheterization has become a widely accepted intravenous route for premature babies. These catheters allow administration of parenteral nutrition and medication and facilitate blood sampling. Besides these benefits, they also have significant potential complications like portal vein thrombosis, infection, vascular or hepatic injury, arrhythmia and sepsis. One of the rare but important complication is extravasation of the fluids due to misplacement of the catheter. The typical symptoms of this condition are sudden deterioration, hepatic enlargement, hematocrit drop, hypotension and abdominal distension. We herein present a premature newborn with unusual acute abdomen findings suggesting a surgical pathology after the extravasation of total parenteral nutrition into the abdomen.

  8. Surgery for acute abdomen and MEFV mutations in patients with FMF.

    PubMed

    Samli, Hale; Içduygu, Fadime Mutlu; Ozgöz, Asuman; Akbulut, Gökhan; Hekimler, Kuyas; Imirzalioglu, Necat

    2009-01-01

    Familial Mediterranean Fever (FMF) is an autosomal recessive disease characterized by recurrent fever, peritonitis, arthritis, pleuritis, and secondary amyloidosis. In the current study, we sought to determine the frequency of acute surgical abdominal intervention and MEFV gene mutations in FMF patients. A total of 159 patients were referred to our department with a diagnosis of FMF. Twenty-six patients (16.4%) had a history of surgical intervention. Of these, 17 (10.7%) were operated on due to appendicitis, and 9 (5.7%) were operated on due to other acute abdomen reasons. Genomic DNA was isolated from the blood samples, and in the isolated DNA samples, 12 MEFV gene mutations were studied. Mutation frequency was detected to be 80.8% in the patients with acute abdomen surgery intervention and 56.4% in the patients without acute abdomen surgical intervention. Upon mutational evaluation of these patients, we noted that the M694V (40.5%) and E148Q (21.4%) mutations occurred most frequently. The MEFV gene mutation frequency in FMF patients with acute abdomen surgical intervention was significantly higher than that in patients without such intervention. Increased mutation scanning in FMF patients will significantly decrease unnecessary surgical interventions in this patient group.

  9. Linking magnetite in the abdomen of honey bees to a magnetoreceptive function

    PubMed Central

    Lambinet, Veronika; Hayden, Michael E.; Reigl, Katharina; Gomis, Surath

    2017-01-01

    Previous studies of magnetoreception in honey bees, Apis mellifera, focused on the identification of magnetic material, its formation, the location of the receptor and potential underlying sensory mechanisms, but never directly linked magnetic material to a magnetoreceptive function. In our study, we demonstrate that ferromagnetic material consistent with magnetite plays an integral role in the bees' magnetoreceptor. Subjecting lyophilized and pelletized bee tagmata to analyses by a superconducting quantum interference device generated a distinct hysteresis loop for the abdomen but not for the thorax or the head of bees, indicating the presence of ferromagnetic material in the bee abdomen. Magnetic remanence of abdomen pellets produced from bees that were, or were not, exposed to the 2.2-kOe field of a magnet while alive differed, indicating that magnet exposure altered the magnetization of this magnetite in live bees. In behavioural two-choice field experiments, bees briefly exposed to the same magnet, but not sham-treated control bees, failed to sense a custom-generated magnetic anomaly, indicating that magnet exposure had rendered the bees' magnetoreceptor dysfunctional. Our data support the conclusion that honey bees possess a magnetite-based magnetoreceptor located in the abdomen. PMID:28330921

  10. Evaluation of the Display Format of Clarke’s Trauma Program for Wounds to the Abdomen

    DTIC Science & Technology

    1988-09-14

    provide prophylactic antibiotic coverage. Evacuate urgently for Iaparotomy and prepare patient for the possibility of a temporary colostomy ...NOTATION 17. COSATI CODES FIELD GROUP SUB-GROUP 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) Computer based...diagnosis; artificial intelligence; Abdomen; Trauma; Hospital corpsmen 19. ABSTRACT (Continue on reverse if necessary and identify by block

  11. Medical Student Satisfaction in Learning the Physical Exam of the Abdomen.

    ERIC Educational Resources Information Center

    Dalessandri, Kathie M.; Guernsey, James M.

    1990-01-01

    A study evaluated a teaching model in which contact between medical students, patients, and physicians was maximized. Each student (n=96) learned the physical examination of the abdomen and genitourinary system through contact with four patients, a plastic model, and five physicians. Students appreciated the interaction and physician role models.…

  12. Daily and seasonal patterns in abdomen color in Diaphoria citri (Hemiptera: Psyllidae)

    USDA-ARS?s Scientific Manuscript database

    Diaphorina citri Kuwayama, a psyllid vector of huanglongbing (citrus greening disease), exhibits three more or less distinct abdomen colors in the adult psyllid: gray/brown, blue/green, and orange/yellow. We explored the daily (in individuals in the laboratory) and seasonal (in a field population) p...

  13. Spontaneous rupture of pyometra manifesting as an acute abdomen: a case report.

    PubMed

    Singh, Alpana; Mundhra, Rajlaxmi; Agarwal, Tannavi; Radhakrishnan, Gita

    2015-07-01

    Spontaneous perforation of pyometra is a rare entity with a reported incidence in the range of 0.01-0.05%. The clinical picture is similar to peritonitis arising from intestinal perforation and commonly the correct diagnosis is only made perioperatively. We report a case in an elderly postmenopausal woman presenting with an acute abdomen.

  14. Analysis of Acoustic Access to the Prostate Through the Abdomen and Perineum for Extracorporeal Ablation

    NASA Astrophysics Data System (ADS)

    Hall, Timothy L.; Hempel, Christopher R.; Sabb, Brian J.; Roberts, William W.

    2010-03-01

    As part of the development of a noninvasive treatment for BPH using histotripsy, this study aimed to measure acoustic access for extracorporeal ablation of the prostate. Both transabdominal and transperineal approaches were considered. The objective was to measure the size and shape of a transducer aperture that could target the prostate without obstruction. CT images obtained from 17 subjects >56 years of age were used to create 3D reconstructions of the lower abdomen and pelvis. Target locations on the urethra at the base, mid, and apex in the prostate were marked along with a transrectal imaging probe. Evenly space rays spanning were traced from each target location towards the perineum and separately towards the abdomen with the maximum x-ray density encountered along each path recorded. The overall free aperture through the perineum was found to be a triangular shaped region bounded by the lower bones of the pelvis and the transrectal probe varying significantly in size between subjects. The free aperture through the abdomen was wedge shaped limited by the pubis also with great subject to subject variability. Average unblocked fractions of an f/1 transducer to target base, veru, and apex through the perineum were 77.0%, 94.4%, and 99.6%, respectively. Averages targeting through the abdomen were 86.1%, 52.3%, and 11.0%. Acoustic access to the prostate for through the perineum was judged to be feasible.

  15. Critical Structure for Telescopic Movement of Honey bee (Insecta: Apidae) Abdomen: Folded Intersegmental Membrane.

    PubMed

    Zhao, Jieliang; Yan, Shaoze; Wu, Jianing

    2016-01-01

    The folded intersegmental membrane is a structure that interconnects two adjacent abdominal segments; this structure is distributed in the segments of the honey bee abdomen. The morphology of the folded intersegmental membrane has already been documented. However, the ultrastructure of the intersegmental membrane and its assistive role in the telescopic movements of the honey bee abdomen are poorly understood. To explore the morphology and ultrastructure of the folded intersegmental membrane in the honey bee abdomen, frozen sections were analyzed under a scanning electron microscope. The intersegmental membrane between two adjacent terga has a Z-S configuration that greatly influences the daily physical activities of the honey bee abdomen. The dorsal intersegmental membrane is 2 times thicker than the ventral one, leading to asymmetric abdominal motion. Honey bee abdominal movements were recorded using a high-speed camera and through phase-contrast computed tomography. These movements conformed to the structural features of the folded intersegmental membrane. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America.

  16. Medical Student Satisfaction in Learning the Physical Exam of the Abdomen.

    ERIC Educational Resources Information Center

    Dalessandri, Kathie M.; Guernsey, James M.

    1990-01-01

    A study evaluated a teaching model in which contact between medical students, patients, and physicians was maximized. Each student (n=96) learned the physical examination of the abdomen and genitourinary system through contact with four patients, a plastic model, and five physicians. Students appreciated the interaction and physician role models.…

  17. A rare cause of acute abdomen: tumor rupture of nonpalpable testis

    PubMed Central

    Yıldız, Turan; İlçe, Zekeriya; Gündüz, Yasemin; Çakırsoy, Gözde Çakar

    2016-01-01

    Undescended testicle is the most common congenital anomaly among males. Testicular tumor develops in 3–5% of the boys with a complaint of undescended testicle. The clinical presentation of malignant intra-abdominal testicular tumors ranges from asymptomatic cases to acute abdomen. In this study, we present a child with testicular tumor rupture which is observed very rarely. A 16-year-old boy presented 24 hours after the sudden onset of right lower quadrant pain, nausea, vomiting and fever. On physical examination, extensive tenderness in the abdomen and abdominal guarding were found. The right testicle was not palpable. The serum white blood cell count was elevated. Ultrasonography and abdominal computerized tomography scan demonstrated a perforated, hyperdense mass with free fluid in the abdomen. The preoperative alpha fetoprotein level was found to be increased. We performed surgery with laparoscopy and a perforated right intraabdominal testicle was found in the right iliac fossa. The mass was excised. Histopathological examination revealed a yolk sac tumor. Ruptured nonpalpable testicular tumors are very rare. To our knowledge, this is the first adolescent case reported so far. Testicular tumor rupture should be considered in patients with nonpalpable testicle and acute abdomen. Laparoscopy may be performed in differential diagnosis and treatment of these patients. PMID:27738401

  18. Care of the open abdomen after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies.

    PubMed

    Dell, Deena Damsky; Held-Warmkessel, Jeanne; Jakubek, Pamela; O'Mara, Tina

    2014-07-01

    A patient with a mucinous appendiceal cancer presents to the surgeon complaining of abdominal discomfort and nausea. Having undergone a prior right hemicolectomy, the patient has been disease free and on surveillance with clinical and carcinogenic antigen (CEA) monitoring. The CEA was noted to be elevated and a computed tomography scan revealed peritoneal nodules throughout the abdomen with a presumptive diagnosis of pseudomyxoma peritonei (progressive peritoneal implants from a mucinous primary). Several therapeutic options were offered and the patient selected to undergo cytoreductive surgery (CRS) with the potential to receive hyperthermic interoperative chemotherapy (HIPEC). Extensive resection was performed, including removal of the entire greater omentum, partial gastrectomy, and total pelvic exenteration with end colostomy and ileal conduit. Reassessment of the peritoneal cavity after the resections revealed almost complete cytoreduction. HIPEC was performed with mitomycin C and, after drainage and abdominal washing, the intestinal segments were anastomosed and the abdominal wall closed. Seven days postoperatively, an acute abdomen with septic shock developed as a result of a leak from the ileocolonic anastomosis. The patient returned to the operating room and an exploratory laparotomy, a small bowel resection, a resection of the ileocolonic anastomosis, and an abdominal washout were performed. Edema of the bowel caused by peritonitis resulting from the anastomotic leak necessitated delayed closure of the abdominal wall. A temporary abdominal closure using the ABThera™ Open Abdomen Negative Pressure Therapy system was applied and the abdomen was eventually closed.

  19. [Giant appendiceal mucocele during laparotomy for acute abdomen. Report of a case and brief review].

    PubMed

    Caiazzo, P; Comentale, A; Rampone, B; Di Lascio, P; Morlino, A; Pastore, M; Del Vecchio, G; Tramutoli, P R

    2010-01-01

    The authors describe a case of giant appendiceal mucocele, secondary to a mucinous neoplasm of the appendix, diagnosed during laparotomy for acute abdomen. By a review of the literature they stress the rarity of this lesion, the particular onset in their case as acute complication of appendiceal neoplasm with rupture of the intestinal wall, the difficulties of diagnosis and management in emergency.

  20. VAWCM-Instillation Improves Delayed Primary Fascial Closure of Open Septic Abdomen

    PubMed Central

    Ji, Zhenling; Liu, Shengli; Wang, Baochai; Zheng, Yu; Gu, Guosheng; Wang, Xinbo; Li, Jieshou

    2014-01-01

    Background. Failure to achieve delayed primary fascial closure (DPFC) is one of the main complications of open abdomen (OA), certainly when abdominal sepsis is present. This retrospective cohort study aims to evaluate the effect of combined therapy of vacuum-assisted mesh-mediated fascial traction and topical instillation (VAWCM-instillation) on DPFC in the open septic abdomen. Methods. The patients with abdominal sepsis who underwent OA using VAWCM were included and divided into the instillation and noninstillation (control) groups. The DPFC rate and other outcomes were compared between the two groups. Results. Between 2007 and 2013, 73 patients with open septic abdomen were treated with VAWCM-instillation and 61 cases with VAWCM-only. The DPFC rate in the instillation group was significantly increased (63% versus 41%, P = 0.011). The mortality with OA was similar (24.6% versus 23%, P = 0.817) between the two groups. However, time to DPFC (P = 0.003) and length of stay in hospital (P = 0.022) of the survivals were significantly decreased in the instillation group. In addition, VAWCM-instillation (OR 1.453, 95% CI 1.222–4.927, P = 0.011) was an independent influencing factor related to successful DPFC. Conclusions. VAWCM-instillation could improve the DPFC rate but could not decrease the mortality in the patients with open septic abdomen. PMID:25548553

  1. VAWCM-Instillation Improves Delayed Primary Fascial Closure of Open Septic Abdomen.

    PubMed

    Tao, Qingsong; Ren, Jianan; Ji, Zhenling; Liu, Shengli; Wang, Baochai; Zheng, Yu; Gu, Guosheng; Wang, Xinbo; Li, Jieshou

    2014-01-01

    Background. Failure to achieve delayed primary fascial closure (DPFC) is one of the main complications of open abdomen (OA), certainly when abdominal sepsis is present. This retrospective cohort study aims to evaluate the effect of combined therapy of vacuum-assisted mesh-mediated fascial traction and topical instillation (VAWCM-instillation) on DPFC in the open septic abdomen. Methods. The patients with abdominal sepsis who underwent OA using VAWCM were included and divided into the instillation and noninstillation (control) groups. The DPFC rate and other outcomes were compared between the two groups. Results. Between 2007 and 2013, 73 patients with open septic abdomen were treated with VAWCM-instillation and 61 cases with VAWCM-only. The DPFC rate in the instillation group was significantly increased (63% versus 41%, P = 0.011). The mortality with OA was similar (24.6% versus 23%, P = 0.817) between the two groups. However, time to DPFC (P = 0.003) and length of stay in hospital (P = 0.022) of the survivals were significantly decreased in the instillation group. In addition, VAWCM-instillation (OR 1.453, 95% CI 1.222-4.927, P = 0.011) was an independent influencing factor related to successful DPFC. Conclusions. VAWCM-instillation could improve the DPFC rate but could not decrease the mortality in the patients with open septic abdomen.

  2. Infarction of a polyp within a mesenteric cyst: An unusual presentation as an acute abdomen.

    PubMed

    Gon, Sonia; Majumdar, Bipasa; Bhattacharyya, Aditi; Das, Tushar K; Chatterjee, Indranil

    2010-04-01

    A case of mesenteric cyst in a five-year-old male child who presented with acute abdomen due to an infarcted polyp present within the cyst is reported. To the best of our knowledge, such an event has never been reported in the literature previously.

  3. Infarction of a polyp within a mesenteric cyst: An unusual presentation as an acute abdomen

    PubMed Central

    Gon, Sonia; Majumdar, Bipasa; Bhattacharyya, Aditi; Das, Tushar K.; Chatterjee, Indranil

    2010-01-01

    A case of mesenteric cyst in a five-year-old male child who presented with acute abdomen due to an infarcted polyp present within the cyst is reported. To the best of our knowledge, such an event has never been reported in the literature previously. PMID:20975788

  4. Partitioning of the contributions of rib cage and abdomen to ventilation in ankylosing spondylitis

    PubMed Central

    Grimby, Gunnar; Fugl-Meyer, Axel R.; Blomstrand, Ann

    1974-01-01

    Grimby, G., Fugl-Meyer, A. R., and Blomstrand, A. (1974).Thorax,29, 179-184. Partitioning of the contributions of rib cage and abdomen to ventilation in ankylosing spondylitis. The relative contributions of the rib cage and abdomen to ventilation were studied in the sitting position in patients with ankylosing spondylitis, using measurements of changes in the anteroposterior diameters. The functional impairment of the spine and adjacent joints was also evaluated. In most patients vital capacity and total lung capacity were reduced, but functional residual capacity was normal. The relative contribution of the rib cage to ventilation was reduced at rest compared to normal subjects, and decreased further during hyperventilation induced by rebreathing. The end-expiratory level of the abdomen decreased more markedly during hyperventilation than in normal subjects and even the end-inspiratory level of the abdomen increased somewhat. The findings are consistent with a reduced mobility of the ribs and a greater than normal excursion of the diaphragm during breathing. PMID:4831523

  5. A rare cause of acute abdomen in adults: Parasitic infection-related acute appendicitis.

    PubMed

    Küpeli, Aydın Hakan; Özdemir, Murat; Topuz, Sezgin; Sözütek, Alper; Paksoy, Tuğba

    2015-01-01

    Ascaris lumbricoides is a common parasitic disease all over the world, especially in less developed countries. Acute appendicitis related to parasitic infection is a rare condition. Parasitic infections should be kept in mind in patients who are admitted to the emergency department with acute abdomen, especially in endemic areas.

  6. A rare cause of acute abdomen: tumor rupture of nonpalpable testis.

    PubMed

    Yıldız, Turan; İlçe, Zekeriya; Gündüz, Yasemin; Çakırsoy, Gözde Çakar

    2016-09-01

    Undescended testicle is the most common congenital anomaly among males. Testicular tumor develops in 3-5% of the boys with a complaint of undescended testicle. The clinical presentation of malignant intra-abdominal testicular tumors ranges from asymptomatic cases to acute abdomen. In this study, we present a child with testicular tumor rupture which is observed very rarely. A 16-year-old boy presented 24 hours after the sudden onset of right lower quadrant pain, nausea, vomiting and fever. On physical examination, extensive tenderness in the abdomen and abdominal guarding were found. The right testicle was not palpable. The serum white blood cell count was elevated. Ultrasonography and abdominal computerized tomography scan demonstrated a perforated, hyperdense mass with free fluid in the abdomen. The preoperative alpha fetoprotein level was found to be increased. We performed surgery with laparoscopy and a perforated right intraabdominal testicle was found in the right iliac fossa. The mass was excised. Histopathological examination revealed a yolk sac tumor. Ruptured nonpalpable testicular tumors are very rare. To our knowledge, this is the first adolescent case reported so far. Testicular tumor rupture should be considered in patients with nonpalpable testicle and acute abdomen. Laparoscopy may be performed in differential diagnosis and treatment of these patients.

  7. Linking magnetite in the abdomen of honey bees to a magnetoreceptive function.

    PubMed

    Lambinet, Veronika; Hayden, Michael E; Reigl, Katharina; Gomis, Surath; Gries, Gerhard

    2017-03-29

    Previous studies of magnetoreception in honey bees, Apis mellifera, focused on the identification of magnetic material, its formation, the location of the receptor and potential underlying sensory mechanisms, but never directly linked magnetic material to a magnetoreceptive function. In our study, we demonstrate that ferromagnetic material consistent with magnetite plays an integral role in the bees' magnetoreceptor. Subjecting lyophilized and pelletized bee tagmata to analyses by a superconducting quantum interference device generated a distinct hysteresis loop for the abdomen but not for the thorax or the head of bees, indicating the presence of ferromagnetic material in the bee abdomen. Magnetic remanence of abdomen pellets produced from bees that were, or were not, exposed to the 2.2-kOe field of a magnet while alive differed, indicating that magnet exposure altered the magnetization of this magnetite in live bees. In behavioural two-choice field experiments, bees briefly exposed to the same magnet, but not sham-treated control bees, failed to sense a custom-generated magnetic anomaly, indicating that magnet exposure had rendered the bees' magnetoreceptor dysfunctional. Our data support the conclusion that honey bees possess a magnetite-based magnetoreceptor located in the abdomen.

  8. Computed tomography of the brain, chest, and abdomen in the preoperative assessment of non-small cell lung cancer.

    PubMed Central

    Grant, D; Edwards, D; Goldstraw, P

    1988-01-01

    The benefit to be gained from carrying out computed tomography of brain and abdomen in addition to the chest has been evaluated retrospectively in 114 consecutive patients with non-small cell lung cancer who, on the basis of history, clinical examination, chest radiography, and bronchoscopy had been considered potentially operable. Computed tomography of the chest showed potentially inoperable tumour in 37 patients, of whom 25 had tumour confined to the chest. Three patients were shown to have malignant disease within the mediastinum and abdomen; five within the mediastinum and brain; and four within the mediastinum, abdomen, and brain. Computed tomography of the abdomen disclosed deposits in nine patients, but in only two were the abnormalities restricted to the abdomen. Computed tomography of the brain showed metastases in 10 patients, of whom only one had metastatic disease confined to the brain. Thus three patients had isolated deposits in the abdomen and brain. In 12 patients the identification of metastases in the abdomen and brain removed the need for mediastinoscopy. Preoperative computed tomography of the abdomen and brain detected occult metastases in 15 patients (13%) in this study. In three patients the extrathoracic abnormality proved the only contraindication to surgery, but in the other 12 it provided valuable corroborative evidence of incurability and facilitated the assessment of the mediastinal abnormality. PMID:2851880

  9. Normal sonographic anatomy of the abdomen of coatis (Nasua nasua Linnaeus 1766).

    PubMed

    Ribeiro, Rejane G; Costa, Ana Paula A; Bragato, Nathália; Fonseca, Angela M; Duque, Juan C M; Prado, Tales D; Silva, Andrea C R; Borges, Naida C

    2013-06-23

    The use of ultrasound in veterinary medicine is widespread as a diagnostic supplement in the clinical routine of small animals, but there are few reports in wild animals. The objective of this study was to describe the anatomy, topography and abdominal sonographic features of coatis. The urinary bladder wall measured 0.11 ± 0.03 cm. The symmetrical kidneys were in the left and right cranial quadrant of the abdomen and the cortical, medullary and renal pelvis regions were recognized and in all sections. The medullary rim sign was visualized in the left kidney of two coatis. The liver had homogeneous texture and was in the cranial abdomen under the rib cage. The gallbladder, rounded and filled with anechoic content was visualized in all coatis, to the right of the midline. The spleen was identified in the left cranial abdomen following the greater curvature of the stomach. The parenchyma was homogeneous and hyperechogenic compared to the liver and kidney cortex. The stomach was in the cranial abdomen, limited cranially by the liver and caudo-laterally by the spleen. The left adrenal glands of five coatis were seen in the cranial pole of the left kidney showing hypoechogenic parenchyma without distinction of cortex and medulla. The pancreas was visualized in only two coatis. The left ovary (0.92 cm x 0.56 cm) was visualized on a single coati in the caudal pole of the kidney. The uterus, right adrenal, right ovary and intestines were not visualized. Ultrasound examination of the abdomen of coatis may be accomplished by following the recommendations for dogs and cats. It is possible to evaluate the anatomical and topographical relationships of the abdominal organs together with the knowledge of the peculiarities of parenchymal echogenicity and echotexture of the viscera.

  10. Normal sonographic anatomy of the abdomen of coatis (Nasua nasua Linnaeus 1766)

    PubMed Central

    2013-01-01

    Background The use of ultrasound in veterinary medicine is widespread as a diagnostic supplement in the clinical routine of small animals, but there are few reports in wild animals. The objective of this study was to describe the anatomy, topography and abdominal sonographic features of coatis. Results The urinary bladder wall measured 0.11 ± 0.03 cm. The symmetrical kidneys were in the left and right cranial quadrant of the abdomen and the cortical, medullary and renal pelvis regions were recognized and in all sections. The medullary rim sign was visualized in the left kidney of two coatis. The liver had homogeneous texture and was in the cranial abdomen under the rib cage. The gallbladder, rounded and filled with anechoic content was visualized in all coatis, to the right of the midline. The spleen was identified in the left cranial abdomen following the greater curvature of the stomach. The parenchyma was homogeneous and hyperechogenic compared to the liver and kidney cortex. The stomach was in the cranial abdomen, limited cranially by the liver and caudo-laterally by the spleen. The left adrenal glands of five coatis were seen in the cranial pole of the left kidney showing hypoechogenic parenchyma without distinction of cortex and medulla. The pancreas was visualized in only two coatis. The left ovary (0.92 cm x 0.56 cm) was visualized on a single coati in the caudal pole of the kidney. The uterus, right adrenal, right ovary and intestines were not visualized. Conclusions Ultrasound examination of the abdomen of coatis may be accomplished by following the recommendations for dogs and cats. It is possible to evaluate the anatomical and topographical relationships of the abdominal organs together with the knowledge of the peculiarities of parenchymal echogenicity and echotexture of the viscera. PMID:23800301

  11. The First Report of an Intraperitoneal Free-Floating Mass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child.

    PubMed

    Uygun, Ibrahim; Aydogdu, Bahattin; Okur, Mehmet Hanifi; Otcu, Selcuk

    2012-01-01

    A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen.

  12. FDG-PET/CT Limited to the Thorax and Upper Abdomen for Staging and Management of Lung Cancer

    PubMed Central

    Postema, Jan W. A.; Schreurs, Wendy M. J.; Lafeber, Albert; Hendrickx, Baudewijn W.; Oyen, Wim J. G.; Vogel, Wouter V.

    2016-01-01

    Purpose This study evaluates the diagnostic accuracy of [F-18]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) of the chest/upper abdomen compared to the generally performed scan from head to upper thighs, for staging and management of (suspected) lung cancer in patients with no history of malignancy or complaints outside the thorax. Methods FDG-PET/CT scans of 1059 patients with suspected or recently proven lung cancer, with no history of malignancy or complaints outside the thorax, were analysed in a retrospective multi-centre trial. Suspect FDG-avid lesions in the chest and upper abdomen, the head and neck area above the shoulder line and in the abdomen and pelvis below the caudal tip of the liver were noted. The impact of lesions detected in the head and neck area and abdomen and pelvis on additional diagnostic procedures, staging and treatment decisions was evaluated. Results The head and neck area revealed additional suspect lesions in 7.2%, and the abdomen and pelvis in 15.8% of patients. Imaging of the head and neck area and the abdomen and pelvic area showed additional lesions in 19.5%, inducing additional diagnostic procedures in 7.8%. This resulted in discovery of additional lesions considered malignant in 10.7%, changing patient management for lung cancer in 1.2%. In (suspected) lung cancer, PET/CT limited to the chest and upper abdomen resulted in correct staging in 98.7% of patients, which led to the identical management as full field of view PET in 98.8% of patients. Conclusion High value of FDG-PET/CT for staging and correct patient management is already achieved with chest and upper abdomen. Findings in head and neck area and abdomen and pelvis generally induce investigations with limited or no impact on staging and treatment of NSCLC, and can be interpreted accordingly. PMID:27556809

  13. FDG-PET/CT Limited to the Thorax and Upper Abdomen for Staging and Management of Lung Cancer.

    PubMed

    Arens, Anne I J; Postema, Jan W A; Schreurs, Wendy M J; Lafeber, Albert; Hendrickx, Baudewijn W; Oyen, Wim J G; Vogel, Wouter V

    2016-01-01

    This study evaluates the diagnostic accuracy of [F-18]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) of the chest/upper abdomen compared to the generally performed scan from head to upper thighs, for staging and management of (suspected) lung cancer in patients with no history of malignancy or complaints outside the thorax. FDG-PET/CT scans of 1059 patients with suspected or recently proven lung cancer, with no history of malignancy or complaints outside the thorax, were analysed in a retrospective multi-centre trial. Suspect FDG-avid lesions in the chest and upper abdomen, the head and neck area above the shoulder line and in the abdomen and pelvis below the caudal tip of the liver were noted. The impact of lesions detected in the head and neck area and abdomen and pelvis on additional diagnostic procedures, staging and treatment decisions was evaluated. The head and neck area revealed additional suspect lesions in 7.2%, and the abdomen and pelvis in 15.8% of patients. Imaging of the head and neck area and the abdomen and pelvic area showed additional lesions in 19.5%, inducing additional diagnostic procedures in 7.8%. This resulted in discovery of additional lesions considered malignant in 10.7%, changing patient management for lung cancer in 1.2%. In (suspected) lung cancer, PET/CT limited to the chest and upper abdomen resulted in correct staging in 98.7% of patients, which led to the identical management as full field of view PET in 98.8% of patients. High value of FDG-PET/CT for staging and correct patient management is already achieved with chest and upper abdomen. Findings in head and neck area and abdomen and pelvis generally induce investigations with limited or no impact on staging and treatment of NSCLC, and can be interpreted accordingly.

  14. Acute abdomen due to torsion of the wandering spleen in a patient with Marfan Syndrome.

    PubMed

    Leci-Tahiri, Laura; Tahiri, Afrim; Bajrami, Rifat; Maxhuni, Mehmet

    2013-08-05

    Wandering spleen is a very rare defect characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the upper left abdomen. Patient symptomatology is variable and ranges from mere feeling of an abdominal lump to sudden abdominal pain due to infarction. Patients may have subacute to chronic abdominal or gastrointestinal complaints. Because of nonspecific symptoms, clinical diagnosis can be difficult; hence, imaging plays an important role. A major complication is splenic torsion, which is the cause of acute abdomen. We present a case of acute abdominal pain due to torsion of wandering spleen in a patient with Marfan Syndrome, valvular heart disease, and vertebral anomalies. Preoperative diagnosis was made on the basis of ultrasonography and computed tomography, which was later confirmed on surgery, and treated successfully.

  15. Spontaneous perforation of pyometra presenting as acute abdomen: a rare condition with considerable mortality.

    PubMed

    Yin, Wan-Bin; Wei, Yan-Hua; Liu, Guang-Wei; Zhao, Xiao-Tang; Zhang, Mao-Shen; Hu, Ji-Lin; Zhang, Nan-Yang; Lu, Yun

    2016-04-01

    Pyometra is an uncommon and potentially lethal disease that occurs mainly in postmenopausal women. Spontaneous perforation of pyometra presenting as acute abdomen is an extremely rare complication of pyometra, and the patients are always admitted to the emergency department. An additional case is reported herein. In addition, a literature review was performed between 1949 and 2015. A correct preoperative diagnosis was made in 21.05% of all the cases. Of all cases, 25.71% were associated with malignant disease. The mortality rate of spontaneous perforation of pyometra is 31.88%. Thus, it should be considered in the differential diagnosis of acute abdomen in elderly women. Total hysterectomy along with bilateral salpingo-oophorectomy is the preferred treatment. Administration of broad-spectrum antibiotics and postoperative intensive care support are essential to reduce the high mortality.

  16. CT evaluation of the acute abdomen: bowel pathology spectrum of disease.

    PubMed

    Johnson, G L; Johnson, P T; Fishman, E K

    1996-08-01

    CT has become the primary imaging modality for the evaluation of the patient with clinical symptoms of an acute abdomen and a confusing clinical picture. Because these patients may have a range of various pathologies, CT has been used successfully to define the presence of disease and localize it to a specific organ or organ system. In this article, we review the various processes that resulted in acute abdomen focusing on the small bowel and colon. Specific entities discussed include appendicitis, diverticulitis, Crohn disease, and ulcerative colitis. Other less common processes, including pseudomembranous colitis, intussusception, and bowel ischemia are also discussed. The specific role of CT scanning and specific CT signs are discussed and addressed. The value of CT in relationship to other modalities and clinical evaluation is discussed and key statistics provided.

  17. [An approach to operative treatment for acute abdomen complicated by malignant hemopathy].

    PubMed

    Min, B; Gu, D; Ding, X

    1997-01-01

    The experience of operative treatment in 14 cases of acute abdomen complicated by malignant hemopathy was reported. Primary diseases consisted of AL, NHL, MM, MH and MDS-RA, 13 cases of them were at progressing stage. The acute abdominal conditions included acute appendicitis, acute pancreatitis, acute cholecystitis, peritonitis secondary to intestinal perforation, intestinal obstruction, primary peritonitis and ileocecal syndrome. The type of acute abdomen was related with primary desease and chemotherapy. 8 cases were operated and 2 of them died of complications after operation. Biopsy of excised tissue showed tumor cells in 2 cases. The rate of correllation between preoper active and postoperative diagnosis was 62.5%. These findings suggest that malignant infiltration in the viscera, duration of abdominal pain before operation and the change of blood picture are the major factors for determining operative indication and the postoperative prognosis.

  18. [Clinical case--voluminous diaphragmatic hernia--surgically acute abdomen: diagnostic and therapeutical challenges].

    PubMed

    Dumitrescu, D; Savlovschi, C; Borcan, R; Pantu, H; Serban, D; Gradinaru, S; Smarandache, G; Trotea, T; Branescu, C; Musat, L; Comandasu, M; Priboi, M; Baldir, M; Sandolache, B; Oprescu, S

    2011-01-01

    We present the case of a 58-year old male patient admitted in the surgery section of the University Emergency Hospital of Bucharest and diagnosed with acute abdomen. The minimal clinical-paraclinical investigation (i.e., thorax-pulmonary Xray, biological probes) raises questions as to the differentiated diagnosis and other associated diseases, also suggesting the existence of voluminous diaphragmatic hernia. The CT thorax-abdomen examination confirms the diaphragmatic hernia suspicion, with intra-thorax ascent of the colon up to the anterior C4 level, but does not explain the abdominal suffering; thus we suspected a biliary ileus or acute appendicitis. Medial laparotomy was imperative. Intrasurgically peritonitis was noticed located by gangrenous acute apendicitis, perforated, with coprolite, for which apendictomy and lavage-drainage pf the peritoneal cavity was performed. Post-surgical status: favourable to recovery.

  19. The Clinical anatomy of the physical examination of the abdomen: A comprehensive review.

    PubMed

    Bilal, Muhammad; Voin, Vlad; Topale, Nitsa; Iwanaga, Joe; Loukas, Marios; Tubbs, R Shane

    2017-04-01

    Physical examination of the abdomen is an essential skill. Knowledge of its clinical anatomy and application is vital for making diagnoses. Misinterpretation of anatomy during examination can have serious consequences. This review addresses understanding of the anatomy, methodology, and complications of abdominal physical examination. It includes particular reference to modern technology and investigations. Physical examination is performed for diagnostic purposes. However, the art of physical examination is declining as more and more clinicians rely on newer technology. This can have regrettable consequences: negligence, waste of time and resources, and deterioration of clinical skills. With a sound knowledge of clinical anatomy, and realization of the importance of physical examination of the abdomen, clinician, and patients alike can benefit. Clin. Anat. 30:352-356, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  20. Strangulated adenoma of the liver: a unique cause of acute abdomen.

    PubMed

    Portinari, Mattia; Liboni, Alberto; Feo, Carlo V

    2014-03-20

    Hepatic adenomas are uncommon benign tumours of the liver which may eventually present with acute onset following rupture of the lesion and haemorrhage. We present here a unique case of strangulated adenoma of the liver presenting as acute abdomen. A 27-year-old woman taking oral contraceptives, presented to the emergency department with abdominal pain, palpable abdominal mass, fever, and neutrophilia. An abdominal ultrasound showed a 3-cm hepatic nodule and an 11-cm mesogastric mass. Computed tomography of the abdomen revealed a 2.3-cm liver adenoma and a 13-cm pedunculated mass of the liver showing no contrast enhancement suggestive of pedicle torsion with ischemia of the mass. The patient underwent an emergent open resection of the strangulated liver mass, she recovered without complications, and was discharged home after three days. Final pathology confirmed an hepatocellular adenoma with areas of necrosis and hemorrhage. The clinical significance of the disease is discussed.

  1. Occult diaphragmatic injury from stab wounds to the lower chest and abdomen.

    PubMed

    Madden, M R; Paull, D E; Finkelstein, J L; Goodwin, C W; Marzulli, V; Yurt, R W; Shires, G T

    1989-03-01

    Ninety-five patients with stab wounds to the lower chest and abdomen underwent routine abdominal exploration. Eighteen of these patients had diaphragmatic injury and in five patients it was the only injury found. Isolated diaphragmatic injury in asymptomatic patients cannot be reliably delineated by either serial physical examination or peritoneal lavage. Delayed recognition of incarcerated diaphragmatic hernia after stab wounds to the lower left chest and upper abdomen has an associated mortality rate of 36%. The anatomic area of concern can be defined as stab wounds that penetrate the left side of the chest below the fourth intercostal space anteriorly, the sixth intercostal space laterally, and the tip of the scapula posteriorly. Exploratory laparotomy is necessary in these patients until a reliable nonoperative method is established that can exclude injuries to the diaphragm.

  2. Mechanical response of the herniated human abdomen to the placement of different prostheses.

    PubMed

    Hernández-Gascón, Belén; Peña, Estefanía; Grasa, Jorge; Pascual, Gemma; Bellón, Juan M; Calvo, Begoña

    2013-05-01

    This paper describes a method designed to model the repaired herniated human abdomen just after surgery and examine its static mechanical response to the maximum intra-abdominal pressure provoked by a physiological movement (standing cough). The model is based on the real geometry of the human abdomen bearing a large incisional hernia with several anatomical structures differentiated by MRI. To analyze the outcome of hernia repair, the surgical procedure was simulated by modeling a prosthesis placed over the hernia. Three surgical meshes with different mechanical properties were considered: an isotropic heavy-weight mesh (Surgipro®), a slightly anisotropic light-weight mesh (Optilene®), and a highly anisotropic medium-weight mesh (Infinit®). Our findings confirm that anisotropic implants need to be positioned such that the most compliant axis of the mesh coincides with the craneo-caudal direction of the body.

  3. Acute Abdomen Due to Penicillium marneffei: An Indicator of HIV Infection in Manipur State.

    PubMed

    Ghalige, Hemanth Sureshwara; Sahoo, Biswajeet; Sharma, Sanjeeb; Devi, Khuraijam Ranjana; Singh Th, Sudhir Chandra

    2014-09-01

    Opportunistic infection in HIV disease often present to clinicians in an atypical manner testing clinical acumen. Here, we report a case of Penicilliosis marneffei (PM) infection presenting to surgical emergency as acute abdomen with undiagnosed HIV status in advanced AIDS, chief complaints being prolonged fever and diffuse abdominal pain. Radiologic imaging showed non-specific mesenteric and retroperitoneal lymphadenopathy. Fine needle aspiration cytology (FNAC) of the lymph node was done and subjected to direct microscopy, gram staining and culture on Sabouraud's dextrose agar (SDA) which showed Penicillium marneffei. He was then treated with intravenous amphotericin. This case is reported for its rarity and unusual presentation to sensitise clinicians and microbiologists to consider PM as an aetiology in acute abdomen in high risk individuals, more so, in patients from north-east India.

  4. Detailed anatomy of the abdomen and pelvis of the visible human female.

    PubMed

    Bajka, M; Manestar, M; Hug, J; Székely, G; Haller, U; Groscurth, P

    2004-04-01

    We report on a virtual anatomical preparation of the abdomen and pelvis of the Visible Human Female (VHF) for laparoscopic surgery training. The detailed cross-sectional image data set from the U.S. National Library of Medicine was used as the basis to build an exemplary model of the female abdomen and pelvis. Segmentation software was developed to delineate organ outlines and more than 300 structures of interest, including organs, blood vessels, bones, muscles, and ligaments, have been segmented and three-dimensionally reconstructed. Analyzing the normal anatomy we found several variations and pathologies of the VHF, such as missing muscles (gemellus superior, psoas minor), additional veins as well as spondylophytes (vertebral column, pubic bone), and colon diverticula. The complete data set may be viewed on the home page of the project (http://www.vision.ee.ethz.ch/projects/Lasso/start.html).

  5. Jejunal Diverticulitis Ascending to the Duodenum as a Rare Cause of Acute Abdomen

    PubMed Central

    Fresow, Robert; Kamusella, Peter; Talanow, Roland; Andresen, Reimer

    2014-01-01

    We present the case of a 73 year-old Caucasian male with acute abdominal pain, peritonism and vomiting. Due to the severity of symptoms a CT examination of the abdomen was performed. The scans revealed multiple jejunal diverticula, wall thickening of the duodenum and jejunum, and free peritoneal fluid. No clear signs of mesenteric infarction, free abdominal air or abscess formation were seen. An additional exploratory laparotomy was conducted to confirm the CT findings and rule out the need for resection of small bowel. Since the results were matching, conservative therapy was scheduled and the patient recovered well. Jejunal diverticulitis is a rare cause of acute abdomen, however has to be considered as a differential diagnosis to more common entities. It usually stays localized, while in our case the inflammation ascended to the duodenum. CT is the modality of choice to diagnose and rule out potentially life threatening complications. PMID:25302248

  6. Advanced stage ovarian juvenile granuloza cell tumor causing acute abdomen: a case report.

    PubMed

    Bedir, Recep; Mürtezaoğlu, Afşin Rahman; Calapoğlu, Ahmet Salih; Şehitoğlu, İbrahim; Yurdakul, Cüneyt

    2014-09-01

    Ovary juvenile granulosa cell tumors (JGCT) are rare sex cord-stromal tumors that are most commonly encountered in prepubertal girls. These tumors can be of the adult type (95%) and juvenile type (5%). The main causes of complaint are abdominal distention and abdominal pain. Definitive diagnosis is confirmed by histopathologal and immunohistochemical examinations. A 10-year old girl presented with massive abdominal distention, acute abdomen findings and ascites. Abdominopelvic magnetic resonance imaging showed masses with multiple cysts and solid components in the left ovary. Tumor markers were normal, but serum estradiol level was elevated. The patient underwent mass resection with left salpingo-oophorectomy and total omentectomy. Final histopathological diagnosis was JGCT. We herein reporte an extremely rare case of advanced stage JGCT causing massive ascites and acute abdomen.

  7. Definitive identification of magnetite nanoparticles in the abdomen of the honeybee Apis mellifera

    NASA Astrophysics Data System (ADS)

    Desoil, M.; Gillis, P.; Gossuin, Y.; Pankhurst, Q. A.; Hautot, D.

    2005-01-01

    The biogenic magnetic properties of the honeybee Apis mellifera were investigated with a view to understanding the bee's physiological response to magnetic fields. The magnetisations of bee abdomens on one hand, and heads and thoraxes on the other hand, were measured separately as functions of temperature and field. Both the antiferromagnetic responses of the ferrihydrite cores of the iron storage protein ferritin, and the ferrimagnetic responses of nanoscale magnetite (Fe3O4) particles, were observed. Relatively large magnetite particles (ca. 30 nm or more), capable of retaining a remanent magnetisation at room temperature, were found in the abdomens, but were absent in the heads and thoraxes. In both samples, more than 98% of the iron atoms were due to ferritin.

  8. Spontaneous Perforation of Pyometra Presented as an Acute Abdomen: A Case Report

    PubMed Central

    Saha, Pradip Kumar; Gupta, Pratiksha; Mehra, Reeti; Goel, Poonam; Huria, Anju

    2008-01-01

    Spontaneous perforation of pyometra is a rare pathologic condition that presents as diffuse peritonitis. This report describes an interesting case of spontaneous uterine perforation that mimicked gut perforation clinically and was finally diagnosed at exploratory laparotomy. Although rare, perforation of pyometra should be kept as one of the differential diagnosis in an elderly woman with an acute abdomen. A high index of suspicion is required to make a correct preoperative diagnosis, which allows early intervention, thus reducing morbidity and mortality. PMID:18324325

  9. [Acute abdomen due to cytomegalovirus in AIDS patients. Apropos 2 cases].

    PubMed

    Ferré, C; Mascaró, J; Benasco, C; Ramos, E; Pérez, J L; Podzamczer, D

    1994-07-09

    Two cases of acute abdomen--because of acute appendicitis and paralytic ileus--due to cytomegalovirus infection in AIDS patients are reported. In both patients evolution was subacute and cytomegalic inclusions were seen in the histologic examination of the surgical samples. The two patients died after surgery. The possibility of cytomegalovirus infection must be kept in mind in AIDS patients who undergo urgent abdominal laparatomy and early treatment should be instituted.

  10. Role of Definitive Radiation Therapy in Carcinoma of Unknown Primary in the Abdomen and Pelvis

    SciTech Connect

    Kelly, Patrick; Das, Prajnan; Varadhachary, Gauri R.; Fontanilla, Hiral P.; Krishnan, Sunil; Delclos, Marc E.; Jhingran, Anuja; Eifel, Patricia J.; Crane, Christopher H.

    2012-04-01

    Objectives: Carcinoma of unknown primary (CUP) in the abdomen and pelvis is a heterogeneous group of cancers with no standard treatment. Considered by many to be incurable, these patients are often treated with chemotherapy alone. In this study, we determined the effectiveness of radiation therapy in combination with chemotherapy in patients with CUP in the abdomen and pelvis. Patients and Methods: Medical records were reviewed for 37 patients with CUP treated with radiation therapy for disease located in the soft tissues and/or nodal basins of the abdomen and pelvis at University of Texas M.D. Anderson Cancer between 2002 and 2009. All patients underwent chemotherapy, either before or concurrent with radiation therapy. Patients were selected for radiation therapy on the basis of histologic type, disease extent, and prior therapy response. Twenty patients underwent definitive radiation therapy (defined as radiation therapy targeting all known disease sites with at least 45 Gy) and 17 patients underwent palliative radiation therapy. Only 6 patients had surgical resection of their disease. Patient and treatment characteristics were extracted and the endpoints of local disease control, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity incidence were analyzed. Results: The 2-year PFS and OS rates for the entire cohort were 32% and 57%, respectively. However, in patients treated with definitive radiation therapy, the rates were 48% and 76%, and 7 patients lived more than 3 years after treatment with no evidence of disease progression. Nevertheless, radiation-associated toxicity was significant in this cohort, as 40% experienced Grade 2 or higher late toxicities. Conclusions: The use of definitive radiation therapy should be considered in selected patients with CUP in the soft tissues or nodal basins of the abdomen and pelvis.

  11. [Combined penetrating wounds of the heart, abdomen and trunk--case report].

    PubMed

    Martinović, Zeljko; Martinović, Cvita

    2010-01-01

    This is an overview of a forty-year-old male with combined penetrating knife inflicted stab wounds to the left chest, heart, abdomen and trunk. Presented are clinical manifestations, course of first aid and overall surgical help given to the injured with multiple stab wounds. Efficiency of rapid diagnostics and surgical approach to penetrating stab wound of the heart is pointed out. Postoperative course and definitive outcome of treatment are presented.

  12. Bare area of the spleen: a constant CT feature of the ascitic abdomen

    SciTech Connect

    Vibhakar, S.D.; Bellon, E.M.

    1984-05-01

    On computed tomographic (CT) scans of the abdomen in patients with ascites, there is one consistently recognizable area of the spleen that is not surrounded by fluid. This area, designated the bare area of the spleen, is related anatomically to the upper anterior part of the left kidney, specifically the Gerota fascia. Awareness of this relation enables differentiation of intraperitoneal fluid from pleural fluid on cross-sectional CT images.

  13. Rare case of urinary bladder agenesis--multislice CT abdomen imaging.

    PubMed

    Indiran, Venkatraman; Chokkappan, Kabilan; Gunaseelan, Emmanuel

    2013-02-01

    Complete agenesis of urinary bladder is an extremely rare anomaly with only a few live cases reported so far. In most of the instances death occurs early as it may be incompatible with life. Here we report a case of adolescent female with urinary bladder and unilateral renal agenesis, who presented with a rather unusual presentation of incontinence, for a computed tomography (CT) examination. Other congenital abnormalities visualised in the CT abdomen are also discussed.

  14. Anatomy for the acupuncturist--facts & fiction 2: The chest, abdomen, and back.

    PubMed

    Peuker, Elmar; Cummings, Mike

    2003-09-01

    Anatomy knowledge, and the skill to apply it, is arguably the most important facet of safe and competent acupuncture practice. The authors believe that an acupuncturist should always know where the tip of their needle lies with respect to the relevant anatomy so that vital structures can be avoided and so that the intended target for stimulation can be reached. This article reviews clinically relevant anatomy for somatic needling of the chest and abdomen.

  15. Blunt liver injury with intact ribs under impacts on the abdomen: a biomechanical investigation.

    PubMed

    Shao, Yu; Zou, Donghua; Li, Zhengdong; Wan, Lei; Qin, Zhiqiang; Liu, Ningguo; Zhang, Jianhua; Zhong, Liangwei; Huang, Ping; Chen, Yijiu

    2013-01-01

    Abdominal trauma accounts for nearly 20% of all severe traffic injuries and can often result from intentional physical violence, from which blunt liver injury is regarded as the most common result and is associated with a high mortality rate. Liver injury may be caused by a direct impact with a certain velocity and energy on the abdomen, which may result in a lacerated liver by penetration of fractured ribs. However, liver ruptures without rib cage fractures were found in autopsies in a series of cases. All the victims sustained punches on the abdomen by fist. Many studies have been dedicated to determining the mechanism underlying hepatic injury following abdominal trauma, but most have been empirical. The actual process and biomechanism of liver injury induced by blunt impact on the abdomen, especially with intact ribs remained, are still inexhaustive. In order to investigate this, finite element methods and numerical simulation technology were used. A finite element human torso model was developed from high resolution CT data. The model consists of geometrically-detailed liver and rib cage models and simplified models of soft tissues, thoracic and abdominal organs. Then, the torso model was used in simulations in which the right hypochondrium was punched by a fist from the frontal, lateral, and rear directions, and in each direction with several impact velocities. Overall, the results showed that liver rupture was primarily caused by a direct strike of the ribs induced by blunt impact to the abdomen. Among three impact directions, a lateral impact was most likely to cause liver injury with a minimum punch speed of 5 m/s (the momentum was about 2.447 kg.m/s). Liver injuries could occur in isolation and were not accompanied by rib fractures due to different material characteristics and injury tolerance.

  16. Honey bees (Apis mellifera ligustica) swing abdomen to dissipate residual flying energy landing on a wall

    NASA Astrophysics Data System (ADS)

    Zhao, Jieliang; Huang, He; Yan, Shaoze

    2017-03-01

    Whether for insects or for aircrafts, landing is one of the indispensable links in the verification of airworthiness safety. The mechanisms by which insects achieve a fast and stable landing remain unclear. An intriguing example is provided by honeybees (Apis mellifera ligustica), which use the swinging motion of their abdomen to dissipate residual flying energy and to achieve a smooth, stable, and quick landing. By using a high-speed camera, we observed that touchdown is initiated by honeybees extending their front legs or antennae and then landing softly on a wall. After touchdown, they swing the rest of their bodies until all flying energy is dissipated. We suggested a simplified model with mass-spring dampers for the body of the honeybee and revealed the mechanism of flying energy transfer and dissipation in detail. Results demonstrate that body translation and abdomen swinging help honeybees dissipate residual flying energy and orchestrate smooth landings. The initial kinetic energy of flying is transformed into the kinetic energy of the abdomen's rotary movement. Then, the kinetic energy of rotary movement is converted into thermal energy during the swinging cycle. This strategy provides more insight into the mechanism of insect flying, which further inspires better design on aerial vehicle with better landing performance.

  17. Immobilization effect of air-injected blanket (AIB) for abdomen fixation

    SciTech Connect

    Ko, Young Eun; Suh, Yelin; Ahn, Seung Do; Lee, Sang-wook; Shin, Seong Soo; Kim, Jong Hoon; Choi, Eun Kyung; Yi, Byong Yong

    2005-11-15

    A new device for reducing the amplitude of breathing motion by pressing a patient's abdomen using an air-injected blanket (AIB) for external beam radiation treatments has been designed and tested. The blanket has two layers sealed in all four sides similar to an empty pillow made of urethane. The blanket is spread over the patient's abdomen with both ends of the blanket fixed to the sides of the treatment couch or a baseboard. The inner side, or patient side, of the blanket is thinner and expands more than the outer side. When inflated, the blanket balloons and effectively puts an even pressure on the patient's abdomen. Fluoroscopic observation was performed to verify the usefulness of AIB for patients with lung, breast cancer, or abdominal cancers. Internal organ movement due to breathing was monitored and measured with and without AIB. With the help of AIB, the average range of diaphragm motion was reduced from 2.6 to 0.7 cm in the anterior-to-posterior direction and from 2.7 to 1.3 cm in the superior-to-inferior direction. The motion range in the right-to-left direction was negligible, for it was less than 0.5 cm. These initial testing demonstrated that AIB is useful for reducing patients' breathing motion in the thoracic and abdominal regions comfortably and consistently.

  18. Allatostatin-like immunoreactivity in the abdomen of the locust Schistocerca gregaria.

    PubMed

    Skiebe, Petra; Biserova, Natalia M; Vedenina, Varvara; Börner, Jana; Pflüger, Hans-Joachim

    2006-07-01

    A polyclonal antibody against allatostatin 1 (AST-1) of cockroach Diploptera punctata was used to investigate the distribution of AST-like immunoreactivity within the abdomen of the locust, Schistocerca gregaria. In the abdominal ganglia, AST-like immunoreactivity was found in both cell bodies and neuropile. In ganglia 6 and 7, staining was found in serial homologous cell bodies in anterior dorsolateral and dorsomedial, and posterior ventrolateral and ventromedial locations. In the terminal ganglion, the numerous immunoreactive somata were smaller in size than those in the unfused ganglia. The combination of backfill experiments with immunocytochemistry showed that, in abdominal ganglion 7, one neuron of the ventromedian cell body cluster and two of the ventrolateral cluster innervated the oviduct, which itself was covered with a dense mesh of AST-immunoreactive varicosities. Combining electron microscopy with immunohistochemistry revealed AST-like immunoreactivity in dense-core vesicles located in neurohaemal-like terminals lacking structures normally found in synapses. A mesh of AST-immunoreactive varicosities was also found on the muscles of the spermatheca and the spermathecal duct. In addition, a mesh of strongly stained varicosities was present in the distal perisympathetic organs (neurohaemal organs in the abdomen) and on the lateral heart nerves (a putative neurohaemal release zone). These data indicate that AST is an important neuroactive substance that is probably involved in multiple tasks in the control of the locust abdomen.

  19. Proneural and abdominal Hox inputs synergize to promote sensory organ formation in the Drosophila abdomen.

    PubMed

    Gutzwiller, Lisa M; Witt, Lorraine M; Gresser, Amy L; Burns, Kevin A; Cook, Tiffany A; Gebelein, Brian

    2010-12-15

    The atonal (ato) proneural gene specifies a stereotypic number of sensory organ precursors (SOP) within each body segment of the Drosophila ectoderm. Surprisingly, the broad expression of Ato within the ectoderm results in only a modest increase in SOP formation, suggesting many cells are incompetent to become SOPs. Here, we show that the SOP promoting activity of Ato can be greatly enhanced by three factors: the Senseless (Sens) zinc finger protein, the Abdominal-A (Abd-A) Hox factor, and the epidermal growth factor (EGF) pathway. First, we show that expression of either Ato alone or with Sens induces twice as many SOPs in the abdomen as in the thorax, and do so at the expense of an abdomen-specific cell fate: the larval oenocytes. Second, we demonstrate that Ato stimulates abdominal SOP formation by synergizing with Abd-A to promote EGF ligand (Spitz) secretion and secondary SOP recruitment. However, we also found that Ato and Sens selectively enhance abdominal SOP development in a Spitz-independent manner, suggesting additional genetic interactions between this proneural pathway and Abd-A. Altogether, these experiments reveal that genetic interactions between EGF-signaling, Abd-A, and Sens enhance the SOP-promoting activity of Ato to stimulate region-specific neurogenesis in the Drosophila abdomen. Copyright © 2010 Elsevier Inc. All rights reserved.

  20. Expansion and Evaluation of Data Characterizing the Structural Behavior of the Pediatric Abdomen

    PubMed Central

    Lamp, John F.; Salzar, Robert; Kerrigan, Jason; Parent, Daniel; Lopez-Valdez, Francisco; Lau, Sabrina; Lessley, David; Kent, Richard; Luck, Jason; Loyd, Andre; Bass, Cameron

    2010-01-01

    Despite the importance of abdominal injuries in children involved in motor vehicle collisions, only two papers have reported experimental data quantifying the pediatric abdominal response to belt loading. One developed and characterized a porcine model of the pediatric abdomen and the other presented a series of tests performed on a single pediatric (7-year-old female) post-mortem human subject (PMHS) and used the data to evaluate the efficacy of the porcine model. The current paper presents the results from an additional pediatric (6-year-old female) PMHS test series and an expanded evaluation of the porcine model using the combined PMHS data. The two PMHS exhibited remarkably similar abdominal stiffness, both by level (upper and lower) and by rate (quasi-static and ∼2 m/s dynamic). Both PMHS and swine exhibited the same stiffness trend by abdominal level (lower stiffer than upper: 3444 N reaction force at 30.5 mm of displacement compared to 1756 N in the 6-year-old dynamic tests). The magnitude of lower abdomen stiffness was slightly less in the swine than in the PMHS (the average dynamic PMHS response was 1086 N greater than the porcine envelopes at 30.5 mm displacement) while the upper abdomen PMHS responses fit within the porcine response envelope. PMID:21050594

  1. Expansion and evaluation of data characterizing the structural behavior of the pediatric abdomen.

    PubMed

    Lamp, John F; Salzar, Robert; Kerrigan, Jason; Parent, Daniel; Lopez-Valdez, Francisco; Lau, Sabrina; Lessley, David; Kent, Richard; Luck, Jason; Loyd, Andre; Bass, Cameron

    2010-01-01

    Despite the importance of abdominal injuries in children involved in motor vehicle collisions, only two papers have reported experimental data quantifying the pediatric abdominal response to belt loading. One developed and characterized a porcine model of the pediatric abdomen and the other presented a series of tests performed on a single pediatric (7-year-old female) post-mortem human subject (PMHS) and used the data to evaluate the efficacy of the porcine model. The current paper presents the results from an additional pediatric (6-year-old female) PMHS test series and an expanded evaluation of the porcine model using the combined PMHS data. The two PMHS exhibited remarkably similar abdominal stiffness, both by level (upper and lower) and by rate (quasi-static and ∼2 m/s dynamic). Both PMHS and swine exhibited the same stiffness trend by abdominal level (lower stiffer than upper: 3444 N reaction force at 30.5 mm of displacement compared to 1756 N in the 6-year-old dynamic tests). The magnitude of lower abdomen stiffness was slightly less in the swine than in the PMHS (the average dynamic PMHS response was 1086 N greater than the porcine envelopes at 30.5 mm displacement) while the upper abdomen PMHS responses fit within the porcine response envelope.

  2. Acute Abdomen Caused by an Infected Mesenteric Cyst in the Ascending Colon: A Case Report

    PubMed Central

    Kim, Eun-Ji; Ahn, Byung-Kwon; Baek, Sung-Uhn

    2011-01-01

    Mesenteric cysts are rare intra-abdominal tumors. Mesenteric cysts are usually asymptomatic and are incidentally detected during physical or radiological examination. Although uncommon, complications such as infection, bleeding, torsion, rupture and intestinal obstruction cause an acute abdomen. Spontaneous infection is a very rare complication. We present a case of infected mesenteric cysts in the ascending colon, which caused an acute abdomen. A 26-year-old woman was admitted to our hospital with acute abdominal pain. She had a painful mass in the right abdomen on physical examination. Abdominal computed tomography showed a hypodense cystic mass with septation at the mesenteric region of the ascending colon. A laparotomy revealed two cystic tumors at the mesenteric region of the ascending colon. She underwent a right hemicolectomy. The two cysts were filled with a yellowish turbid fluid. The walls of both two cysts were lined with a thin fibrotic membrane without any epithelial cell. They were diagnosed as psuedocysts with E. coli infection. Mesenferic cysts may cause life-threatening complications. Mesenteric cyst, even if it is asymptomatic and was diagnosed incidentally, should be removed completely. PMID:21829771

  3. Acute abdomen caused by an infected mesenteric cyst in the ascending colon: a case report.

    PubMed

    Kim, Eun-Ji; Lee, Seung-Hyun; Ahn, Byung-Kwon; Baek, Sung-Uhn

    2011-06-01

    Mesenteric cysts are rare intra-abdominal tumors. Mesenteric cysts are usually asymptomatic and are incidentally detected during physical or radiological examination. Although uncommon, complications such as infection, bleeding, torsion, rupture and intestinal obstruction cause an acute abdomen. Spontaneous infection is a very rare complication. We present a case of infected mesenteric cysts in the ascending colon, which caused an acute abdomen. A 26-year-old woman was admitted to our hospital with acute abdominal pain. She had a painful mass in the right abdomen on physical examination. Abdominal computed tomography showed a hypodense cystic mass with septation at the mesenteric region of the ascending colon. A laparotomy revealed two cystic tumors at the mesenteric region of the ascending colon. She underwent a right hemicolectomy. The two cysts were filled with a yellowish turbid fluid. The walls of both two cysts were lined with a thin fibrotic membrane without any epithelial cell. They were diagnosed as psuedocysts with E. coli infection. Mesenferic cysts may cause life-threatening complications. Mesenteric cyst, even if it is asymptomatic and was diagnosed incidentally, should be removed completely.

  4. Abdomen - swollen

    MedlinePlus

    ... your health care provider. When to Contact a Medical Professional Call your health care provider if: The abdominal swelling is getting worse and ... a physical exam and ask questions about your medical history, such as when the problem ... health care provider will also ask about other symptoms you may ...

  5. Management of the open abdomen during the global war on terror.

    PubMed

    Riha, Gordon M; Kiraly, Laszlo N; Diggs, Brian S; Cho, S David; Fabricant, Loic J; Flaherty, Stephen F; Kuehn, Reed; Underwood, Samantha J; Schreiber, Martin A

    2013-01-01

    To evaluate factors that are predictive of delayed abdominal closure in patients injured during military conflict. Seventy-one patients managed with an open abdomen were identified from records at Landstuhl Regional Medical Center from 2005 and 2006. Follow-up data were available from Walter Reed Army Medical Center. Records were reviewed through all echelons of care. Ordinal logistic regression was used to predict delayed abdominal closure. Patients sustained injury from blunt (n = 2), penetrating (n = 30), and blast (n = 39) mechanisms. The median Injury Severity Score was 25 (interquartile range, 17-34). Abdominal injury was observed in 85% of patients, and 48% underwent a massive transfusion. The median time to transfer to the United States was 5.3 days (interquartile range, 4.3-6.8 days). Abdomens were definitively closed downrange (11%), at Landstuhl Regional Medical Center (33%), or at Walter Reed Army Medical Center (56%). The median time until abdominal closure was 13 days (interquartile range, 4-40 days) in 2005 compared with 4 days (interquartile range, 1-14.5 days) in 2006 (P = .02). The multivariate model identified massive transfusion (odds ratio, 3.9), presence of complications (odds ratio, 5.1), and an injury date in 2005 (odds ratio, 3.4) as independently predictive variables for later abdominal closure. Massive transfusion, occurrence of complications, and earlier injury date were predictive of delayed abdominal closure in casualties managed with an open abdomen. These data suggest an evolving approach to the management of severely injured combat casualties that involves earlier abdominal closure.

  6. Patient-specific dose estimation for pediatric abdomen-pelvis CT

    NASA Astrophysics Data System (ADS)

    Li, Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Frush, Donald P.

    2009-02-01

    The purpose of this study is to develop a method for estimating patient-specific dose from abdomen-pelvis CT examinations and to investigate dose variation across patients in the same weight group. Our study consisted of seven pediatric patients in the same weight/protocol group, for whom full-body computer models were previously created based on the patients' CT data obtained for clinical indications. Organ and effective dose of these patients from an abdomen-pelvis scan protocol (LightSpeed VCT scanner, 120-kVp, 85-90 mA, 0.4-s gantry rotation period, 1.375-pitch, 40-mm beam collimation, and small body scan field-of-view) was calculated using a Monte Carlo program previously developed and validated for the same CT system. The seven patients had effective dose of 2.4-2.8 mSv, corresponding to normalized effective dose of 6.6-8.3 mSv/100mAs (coefficient of variation: 7.6%). Dose variations across the patients were small for large organs in the scan coverage (mean: 6.6%; range: 4.9%-9.2%), larger for small organs in the scan coverage (mean: 10.3%; range: 1.4%-15.6%), and the largest for organs partially or completely outside the scan coverage (mean: 14.8%; range: 5.7%-27.7%). Normalized effective dose correlated strongly with body weight (correlation coefficient: r = -0.94). Normalized dose to the kidney and the adrenal gland correlated strongly with mid-liver equivalent diameter (kidney: r = -0.97; adrenal glands: r = -0.98). Normalized dose to the small intestine correlated strongly with mid-intestine equivalent diameter (r = -0.97). These strong correlations suggest that patient-specific dose may be estimated for any other child in the same size group who undergoes the abdomen-pelvis scan.

  7. [CT and MRI features of Castleman's disease of the abdomen and pelvis].

    PubMed

    Xiao, Lu; Zhang, Zhong-lin; Liu, Yu-bao; Liu, Zai-yi; Li, Jing-lei; Yu, Yuan-xin; Xie, Shu-fei

    2011-01-01

    To analyze the CT/MRI features of Castleman's disease of the abdomen and pelvis. CT/MRI images of 6 cases of pathologically confirmed Castleman's disease of the abdomen and pelvis were retrospectively reviewed. All the patients received plain CT scan and dynamic enhanced scan, and one had an additional MR scan. One case was identified as the disseminated type with multicentric enlarged lymph nodes and hepatosplenomegaly, and 5 cases were found to have localized type, of which 3 had retroperitoneal, 1 had mesentery and 1 had pelvic lesions. On CT scan, all the 5 cases with localized lesions showed single, round or ellipse soft tissue masses, with intra-tumoral calcification in 2 cases, fascial thickening around the mass in 3 cases, and satellite nodules in 4 cases. Enhanced scanning revealed obvious enhancement in the arterial phase and continuous enhancement in the portal vein and delayed phase in all the lesions, with an attenuation pattern similar to that of large vessels; enlarged blood vessels within or around the mass were displayed in each case. In 4 cases, the intra-tumoral radial or fissured non-enhanced areas in early stage of enhancement were gradually filled up as the scan time was delayed. The patient receiving MRI showed hypo-intensity on T(1)WI and hyper-intensity on T(2)WI, presenting with an enhancement feature similar to that of CT. Castleman's disease in the abdomen and pelvis is rare and liable to misdiagnosis, but its characteristic imaging features can help in the diagnosis and differential diagnosis.

  8. Use of computed tomography abdomen and pelvis for investigation of febrile neutropenia in adult haematology patients.

    PubMed

    Lim, H Y; Ashby, M; Williams, B; Grigg, A

    2016-11-01

    We retrospectively evaluated the use of computed tomography abdomen and pelvis (CTAP) in febrile neutropenic autologous stem cell transplant (ASCT) and acute myeloid leukaemia (AML) patients. CTAP was more common in ASCT patients (59%) compared with AML (31%; P  < 0.001). Although abnormal findings were reported in 51%, only 10% resulted in therapy change (addition of anaerobic antibiotic/bowel rest), which would have otherwise been instituted based on clinical grounds. CTAP in these patients rarely provide useful information unsuspected clinically. © 2016 Royal Australasian College of Physicians.

  9. Wandering spleen in a child with symptoms of acute abdomen: ultrasonographic diagnosis. Case report.

    PubMed

    Ayaz, Umit Yasar; Dilli, Alper; Ayaz, Sevin; Api, Arman

    2012-03-01

    We report the initial and follow-up ultrasonography (US) findings in a pediatric case of wandering spleen with symptoms of acute abdomen, as a rare entity. A four-year-old boy was referred with complaints of blunt abdominal pain, vomiting and fatigue. US detected an oval- shaped, mildly enlarged spleen with inferomedial displacement. In right lateral decubitus, the spleen showed further medial displacement. Five months later, control US revealed further enlargement of the displaced spleen. Seven months later, due to acute torsion of the spleen, splenectomy was performed.

  10. Abdomen: normal variations and benign conditions resulting in uptake on FDG-PET/CT.

    PubMed

    Zukotynski, Katherine; Kim, Chun K

    2014-04-01

    The increasing use of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in oncology has led to: improved sensitivity and specificity in detecting localized and metastatic disease, increased ability to target biopsies to the site of most aggressive disease, and development of a noninvasive biomarker to assess prognosis and effects of therapy. However, for correct interpretation of FDG-PET/CT studies, an understanding of both normal and abnormal imaging appearances commonly encountered in oncology patients is important. This article discusses commonly seen normal variations and benign findings on FDG-PET/CT of the abdomen.

  11. Acute abdomen in a case with noncommunicating rudimentary horn and unicornuate uterus.

    PubMed

    Atmaca, Rusen; Germen, Aysegul Tezcan; Burak, Feza; Kafkasli, Ayse

    2005-01-01

    Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.

  12. Acute Abdomen in a Case With Noncommunicating Rudimentary Horn and Unicornuate Uterus

    PubMed Central

    Germen, Aysegul Tezcan; Burak, Feza; Kafkasli, Ayse

    2005-01-01

    Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein. PMID:15984720

  13. [Excision of mid-lower rectal carcinoma through abdomen and anogenital space].

    PubMed

    Wei, F; Zhu, B; Hou, S

    1995-07-01

    28 men with male mid and lower rectal carcinoma were treated by dissecting sigmoid colon and rectum in the abdomen through the anogenital space, which refers to the potential coronoid space located between the deep transverse perineal muscles and anal sphincter muscles. The rectal segment was pulled out through the anogenital space to accomplish resection and anastomosis outside the pelvic cavity. Follow-up for 9-57 months showed that 26 cases (92.9%) survived without recurrence of carcinoma and 1 had local recurrence. The advantages of the procedure include clear exploration, minimal trauma, super-lower anastomoses under direct vision, good recovery of defecating function, and less contamination of pelviccavity.

  14. Rare case of an abdominal mass presenting as acute abdomen: torsion of the vermiform appendix.

    PubMed

    Kilincaslan, Huseyin; Gedik, Ahmet Hakan; Bilici, Mustafa; Cakir, Secil

    2013-04-01

    Torsion of the vermiform appendix is a rarely observed acute abdominal emergency. The clinical manifestations are similar to acute appendicitis. It should be included in the differential diagnosis if a patient presents with intermittent abdominal pain and an acute abdominal emergency. Here, we describe a 4-year-old male patient with a mass located in the right lower abdominal quadrant, whose clinical findings were consistent with an acute abdomen. The gangrenous appendix was found in the pelvic cavity and its stump was twisted clockwise. A 1.5-cm fecalith was detected in the appendix lumen and appendectomy was performed. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  15. A Torted Ruptured Intra-abdominal Testicular Seminoma Presenting As An Acute Abdomen

    PubMed Central

    Nickalls, Oliver James; Tan, Char Loo; Thian, Yee Liang

    2015-01-01

    The susceptibility of the undescended testis to malignant transformation is well documented. The most common location of the undescended testis is within the inguinal canal, with only a minority located within the abdominal cavity. When a testicular mass develops, the risk of torsion increases. We describe a large intra-abdominal testicular seminoma that had undergone torsion, rupture and haemorrhage, presenting as an acute abdomen. A 30 year old man presented to the emergency department with right iliac fossa pain. Computed tomography in the emergency department showed haemoperitoneum and a torted large left testicular mass, likely malignant. The patient underwent laparotomy and excision of the mass. Histologic examination revealed a grossly enlarged seminomatous testis which had torted and ruptured. While pre-operative imaging diagnosis of an intra-abdominal testicular seminoma has been published, reports are few. To the best of the author’s knowledge pre-operative imaging diagnosis of a malignant testicular mass with torsion and intra-abdominal haemorrhage presenting as an acute abdomen has not been described before. PMID:27200173

  16. [Efficacy of intestinal splinting in hostile abdomen secondary to postoperative flanges in pediatric patients].

    PubMed

    Bracho-Blanchet, Eduardo; Langarica-Bulos, Mónica; Dávila-Pérez, Roberto; Fernández-Portilla, Emilio; Zalles-Vidal, Cristian; Nieto-Zermeño, Jaime

    2016-10-01

    Objetivo: Mostrar la eficacia de la FI para prolongar el tiempo libre de oclusión intestinal quirúrgica en niños con abdomen hostil secundario a bridas posquirúrgicas. Método: Análisis retrospectivo de FI por abdomen hostil de 2000 a 2011 y su seguimiento a largo plazo. Comparamos el tiempo libre de oclusión quirúrgica antes y después de la FI. Resultados: Se incluyeron 20 FI en 19 pacientes. Predominaron las causas congénitas, la mediana de edad en la cirugía fue de 6 meses, todos tenían cirugías previas con mediana de tres, y dos de ellas fueron por oclusión intestinal previa. La férula se quitó a los 28 días (mediana). Con un seguimiento de 1-183 meses, hubo una recurrencia de oclusión quirúrgica. El tiempo libre de oclusión quirúrgica posferulización fue significativamente mayor que el preferulización mediante la prueba de Wilcoxon, con un valor Z = -3.594; p = < 0.0001. Conclusiones: Esta es la segunda serie exclusiva en niños que muestra que la FI es eficaz para prolongar el tiempo libre de oclusión quirúrgica.

  17. A Torted Ruptured Intra-abdominal Testicular Seminoma Presenting As An Acute Abdomen.

    PubMed

    Nickalls, Oliver James; Tan, Char Loo; Thian, Yee Liang

    2015-12-01

    The susceptibility of the undescended testis to malignant transformation is well documented. The most common location of the undescended testis is within the inguinal canal, with only a minority located within the abdominal cavity. When a testicular mass develops, the risk of torsion increases. We describe a large intra-abdominal testicular seminoma that had undergone torsion, rupture and haemorrhage, presenting as an acute abdomen. A 30 year old man presented to the emergency department with right iliac fossa pain. Computed tomography in the emergency department showed haemoperitoneum and a torted large left testicular mass, likely malignant. The patient underwent laparotomy and excision of the mass. Histologic examination revealed a grossly enlarged seminomatous testis which had torted and ruptured. While pre-operative imaging diagnosis of an intra-abdominal testicular seminoma has been published, reports are few. To the best of the author's knowledge pre-operative imaging diagnosis of a malignant testicular mass with torsion and intra-abdominal haemorrhage presenting as an acute abdomen has not been described before.

  18. Relationship of the Cold-Heat Sensation of the Limbs and Abdomen with Physiological Biomarkers

    PubMed Central

    Lee, JeongHoon; Kim, GaYul; Song, JiYeon

    2016-01-01

    The present study explored the relationship between the regional Cold-Heat sensation, the key indicator of the Cold-Heat patterns in traditional East Asian medicine (TEAM), and various biomarkers in Korean population. 734 apparently healthy volunteers aged 20 years and older were enrolled. Three scale self-report questions on the general thermal feel in hands, legs, and abdomen were examined. We found that 65% of women tended to perceive their body, particularly their hands and legs, to be cold, versus 25% of men. Energy expenditure and temperature load at resting state were lower in women, independently of body mass index (BMI). Those with warm hands and warm legs had a 0.74 and 0.52 kg/m2 higher BMI than those with cold hands and cold legs, respectively, regardless of age, gender, and body weight. Norepinephrine was higher, whereas the dynamic changes in glucose and insulin during an oral glucose tolerance test were lower in those with cold extremities, particularly hands. No consistent differences in biomarkers were found for the abdominal dimension. These results suggest that gender, BMI, the sympathetic nervous system, and glucose metabolism are potential determinants of the Cold-Heat sensation in the hands and legs, but not the abdomen. PMID:27818698

  19. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper.

    PubMed

    Sartelli, Massimo; Abu-Zidan, Fikri M; Ansaloni, Luca; Bala, Miklosh; Beltrán, Marcelo A; Biffl, Walter L; Catena, Fausto; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Demetrashvili, Zaza; Demetriades, Demetrios; Diaz, Jose J; Di Saverio, Salomone; Fraga, Gustavo P; Ghnnam, Wagih; Griffiths, Ewen A; Gupta, Sanjay; Hecker, Andreas; Karamarkovic, Aleksandar; Kong, Victor Y; Kafka-Ritsch, Reinhold; Kluger, Yoram; Latifi, Rifat; Leppaniemi, Ari; Lee, Jae Gil; McFarlane, Michael; Marwah, Sanjay; Moore, Frederick A; Ordonez, Carlos A; Pereira, Gerson Alves; Plaudis, Haralds; Shelat, Vishal G; Ulrych, Jan; Zachariah, Sanoop K; Zielinski, Martin D; Garcia, Maria Paula; Moore, Ernest E

    2015-01-01

    The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.

  20. Abdomen disease diagnosis in CT images using flexiscale curvelet transform and improved genetic algorithm.

    PubMed

    Sethi, Gaurav; Saini, B S

    2015-12-01

    This paper presents an abdomen disease diagnostic system based on the flexi-scale curvelet transform, which uses different optimal scales for extracting features from computed tomography (CT) images. To optimize the scale of the flexi-scale curvelet transform, we propose an improved genetic algorithm. The conventional genetic algorithm assumes that fit parents will likely produce the healthiest offspring that leads to the least fit parents accumulating at the bottom of the population, reducing the fitness of subsequent populations and delaying the optimal solution search. In our improved genetic algorithm, combining the chromosomes of a low-fitness and a high-fitness individual increases the probability of producing high-fitness offspring. Thereby, all of the least fit parent chromosomes are combined with high fit parent to produce offspring for the next population. In this way, the leftover weak chromosomes cannot damage the fitness of subsequent populations. To further facilitate the search for the optimal solution, our improved genetic algorithm adopts modified elitism. The proposed method was applied to 120 CT abdominal images; 30 images each of normal subjects, cysts, tumors and stones. The features extracted by the flexi-scale curvelet transform were more discriminative than conventional methods, demonstrating the potential of our method as a diagnostic tool for abdomen diseases.

  1. Evaluation of polypropylene mesh coated with biological hydrogels for temporary closure of open abdomen.

    PubMed

    Deng, Youming; Ren, Jianan; Chen, Guopu; Li, Guanwei; Guo, Kun; Hu, Qiongyuan; Wu, Xiuwen; Wang, Gefei; Gu, Guosheng; Li, Jieshou

    2016-08-01

    Polypropylene mesh, as a temporary abdominal closure device, may cause mechanical intestine injury and inflammatory response. Chitosan/gelatin hydrogel has excellent biocompatibility, soft and elastic properties. This work is to assess the effects of the chitosan/gelatin hydrogel coated polypropylene mesh on open abdomen wounds. Histological analysis and detection of healing-related factors were conducted to evaluate the inflammation and wound healing process. After 1-day implantation in a murine model of open abdomen, the coated polypropylene mesh, compared with simple polypropylene mesh, demonstrated well protection of the intestine serosa. After 14-day implantation, it reduced the inflammation response by down-regulating the cytokines interleukin-6 and tumor necrosis factor-α, and up-regulating the anti-inflammatory factor interleukin-10. Meanwhile, the composite stimulated granulation tissue growth, and promoted matrix deposition and angiogenesis after 7 and 14 days. In conclusion, the modified temporary abdominal closure composite could significantly protect the intestines from mechanical damage and accelerate wound healing. © The Author(s) 2016.

  2. The open abdomen: temporary closure with a modified negative pressure therapy technique.

    PubMed

    Hougaard, Helene T; Ellebaek, Mark; Holst, Uffe T; Qvist, Niels

    2014-06-01

    The most common indications for an open abdomen (OA) are abdominal compartment syndrome, damage control surgery, diffuse peritonitis and wound dehiscence, and often require a temporary abdominal closure (TAC). The different TAC methods that are currently available include skin closure techniques, mesh products and negative pressure therapy (NPT) systems. For this study, we retrospectively reviewed records of 115 OA patients treated with the commercially available NPT systems (V.A.C.(®) Abdominal Dressing System and ABThera™ Open Abdomen Negative Pressure Therapy System) using a new method of applying the system - the narrowing technique - over a 5-year period. Endpoints included fascial closure and 30-day mortality rates and presence of enteroatmospheric fistulas. Secondary closure of the fascia was obtained in 92% (106/115) of the patients with a mortality rate of 17% (20/115) and a fistula rate of 3·5% (4/115). The use of the narrowing technique to apply NPT may explain the high closure rates observed in the patient population of this study. Further studies are necessary to compare the different methods and to evaluate the long-term outcomes.

  3. Characterization of muscles associated with the articular membrane in the dorsal surface of the crayfish abdomen.

    PubMed

    Sohn, J; Mykles, D L; Cooper, R L

    2000-10-01

    The anatomy, physiology, and biochemistry of the dorsal membrane muscle (DMA) and the superficial extensor muscle accessory head (SEAcc) in the abdomen of the crayfish, Procambarus clarkii and lobster, Homarus americanus, are reported. These muscles have not been previously characterized physiologically or biochemically. The anatomy was originally described by Pilgrim and Wiersma (1963. J Morph 113:453-587). The arrangement of these muscles varies depending on the abdominal segment. The function of the dorsal membrane muscle is to retract the thin articulating membrane joining the cuticular segments so that the dorsal membrane does not evert during extension of the abdomen. Consequently, the articular membrane does not protrude, and thus potential damage to the membrane is minimized. Examination of nerve terminal morphology revealed strings of varicosities, usually only associated with tonic terminals. The electrophysiological data indicate that there are at least four tonic excitatory and one inhibitory motor neuron innervating these muscles. Facilitation indices and fatigue-resistance indicate physiologically the tonic nature of innervation. Anti-GABA antibodies demonstrate the anatomical presence of an inhibitor motor neuron. The SDS electrophoretic analysis of myofibrillar proteins and Western blots of key protein isoforms for these muscles in crayfish and lobsters also indicate that the DMA and SEAcc muscles are tonic phenotype. J. Exp. Zool. 287:353-377, 2000. Copyright 2000 Wiley-Liss, Inc.

  4. Abdomen aigu sur une torsion de rate ectopique: à propos d'un cas

    PubMed Central

    Khalid, Elhattabi; Fatimazahra, Bensardi; Rachid, Lefriyekh; Abdelaziz, Fadil; Mohamed, Lahkim; Nadia, Benissa; Driss, Khaiz; Saad, Berrada; Najib, Zerouali Ouariti

    2012-01-01

    La rate ectopique est une entité rare dont l'incidence est mal connue. La torsion de son pédicule est une complication grave, qui doit bénéficier d'un diagnostic précoce; évitant ainsi la splénectomie surtout chez des patients jeunes. Nous rapportons le cas d'une patiente âgée de 39 ans; admise aux urgences dans un tableau d'abdomen aigu chirurgical, l'examen clinique, l’échographie et la tomodensitométrie abdominale ont contribué au diagnostic de torsion d'une rate ectopique en position hypogastrique, la splénectomie a été réalisée devant la découverte peropératoire de taches de nécrose sur la rate tordue. Le diagnostic de torsion d'une rate ectopique doit être suspecté devant l'association d'un abdomen aigu et la palpation d'une masse abdominale. L’échographie et la tomodensitométrie abdominale confirment le diagnostic. Le traitement est chirurgical; il consiste en une splénopexie qui est plus approprié. En présence de nécrose, la splénectomie doit être réalisée aussi bien par voie laparoscopique que par laparotomie. PMID:22655096

  5. Inflammatory myofibroblastic tumor presenting as acute abdomen: report of one case.

    PubMed

    Wen, Hsiu-Huei; Cheng, Kui-Lin; Hung, Yau-Kan; Chang, Pei-Yeh

    2007-01-01

    Inflammatory myofibroblastic tumor (IMT) is a very rare benign tumor composed of myofibroblastic spindle cells of uncertain etiology, which can occur at any age and affect any organ system. More and more cases of IMT in children have been described in pediatric literature in recent years. However, this tumor occurring intraabdominally in children has rarely been reported in Taiwan. Here we present a 1-year-9-month-old boy who had fever and abdominal pain only for 2 days, symptoms mimicking acute abdomen. After imaging study, a huge tumor nearly 10 cm in diameter was incidentally found over the right abdomen with unknown origin and nature. After surgical removal of the tumor, IMT was confirmed by the pathological findings. It is very difficult to make an accurate preoperative diagnosis on this tumor according to past experience, so the role of pathological diagnosis with immunohistochemical study becomes important. This case illustrates that IMT should be considered as a possible cause of intra-abdominal mass in children who have fever of unknown origin.

  6. [Uncommon etiology of acute abdomen in pediatric age: the torsion of spleen].

    PubMed

    Marinaccio, F; Caldarulo, E; Nobili, M; Magistro, D; Marinaccio, M

    2005-01-01

    The torsion of spleen on its vascular shank represents an uncommon problem, responsible of acute and chronic pain. The mobile spleen is fixed only through hilus vessels the gastrosplenic ligament. The incidence is unknow, greater in the male with an M:F ratio 6.1 in the first ten years of life, even if an episode of intrauterine torsion has been reported. The diagnosis can be performed with ultrasonography, angiography, scintigraphy and CT scan. There are reported two cases: male of 2.5 years female of 14 years who presented with recurrent pain to the left side, vomit diarrhoea and fever. Objectively a palpable mass was present. Ultrasonography and angio-CT scan of abdomen revealed splenomegaly, ptosis of the spleen and malrotation with signs of obstruction of the vessels. The treatment in both cases was splenectomy. The spleen appeared rotated on its shank and increased of volume, deprived of anatomical structures of fixation. The histological report confirmed the haemorrhagic infarction. The excessive mobility of the spleen, from insufficiency or absence of the ligamentous attachments is case of abdominal pain or acute abdomen, that can complicate with the infarction of the spleen. Angio-CT scan, in the cases here reported, has shown to greater sensibility in comparison to the ultrasonography. The Authors believe that the video-laparoscopic splenopexy, when the diagnosis is made of "wandering spleen" with painful repeated episodes, can be finalized, to the preservation of organ.

  7. Stage IVB endometrial cancer confined to the abdomen: is chemotherapy superior to radiotherapy?

    PubMed

    Cirik, D Akdag; Karalok, A; Ureyen, I; Tasci, T; Koc, S; Turan, T; Tulunay, G

    2016-01-01

    To determine the impact of clinical variables and adjuvant therapy on survival in patients with Stage IVB endometrial cancer (EC) confined to abdomen. A total of 65 patients were included. Curative chemotherapy was defined as using only chemotherapy (platin based) or sandwich therapy. Patients receiving only radiotherapy had standard pelvic radiotherapy and extended-field radiotherapy when necessary. The optimal cytoreduction was achieved in 89.3% of patients. With a median follow-up of 18 months, two-year progression free survival (PFS) and overall survival (OS) were calculated as 33.4% and 42.2%, respectively. Optimal cytoreduction provided more longer PFS and OS compared to suboptimal cytoreduction. In univariate analysis, curative chemotherapy instead of radiotherapy improved the two-year PFS and two-year OS. Type of adjuvant therapy, tumor grade, and peritoneal cytology were found as the independent prognostic factors for PFS. Peritoneal cytology, adnexal involvement, and adjuvant therapy were independent prognostic factor for OS. Curative chemotherapy significantly improved both two-year PFS and OS in patients with Stage IVB endometrial disease confined to abdomen over only radiotherapy.

  8. The effect of different temporary abdominal closure materials on the growth of granulation tissue after the open abdomen.

    PubMed

    Yuan, Yujie; Ren, Jianan; Zhang, Weiwei; Chen, Jun; Li, Jieshou

    2011-10-01

    Temporary abdominal closure (TAC) is often performed after an open abdomen to prevent postoperative complications. Reducing the time of TAC and performing a skin grafting as early as possible would improve the outcome of open abdomen. This study was designed to evaluate the effects of different TAC materials and topically applied exogenous growth factors on the growth of granulation tissue covered on the wound areas after the open abdomen. Healthy Sprague-Dawley rats were randomly assigned to four groups of six animals each. Twenty-four hours after induction of peritonitis and intra-abdominal hypertension by intraperitoneal injection of nitrogen, relaparotomies were done. The abdomen was then closed with polyethylene sheet or polypropylene mesh plus growth factor (or not). On the seventh day after TAC surgery, TAC materials were removed, and granulation tissue on the wound surface was assessed microscopically. Microvascular densities, thickness of granulation tissue, and fibroblast counts were also measured. Microvascular densities, thickness of granulation tissue, and fibroblast counts were the highest for polypropylene mesh closure plus recombinant bovine basic fibroblast growth factor (rbFGF) followed by polypropylene mesh plus recombinant human growth hormone (rhGH) and polypropylene mesh alone, with polyethylene sheet alone being the least. Polypropylene mesh could promote the growth of granulation tissue after the open abdomen. Topical application of rhGH or rbFGF further hastens the process, with the effect of rbFGF being the greatest.

  9. Investigation of abdomen surface deformation due to life excitation: implications for implant selection and orientation in laparoscopic ventral hernia repair.

    PubMed

    Szymczak, Czesław; Lubowiecka, Izabela; Tomaszewska, Agnieszka; Smietański, Maciej

    2012-02-01

    Ventral hernia is a common medical problem. Statistically there are around 10% recurrences of the sickness. The authors' former investigation proved edges of the hernia orifice displacements to be one of the factors causing recurrence. Thus, experimental investigation of the abdomen surface deformation due to some normal activities of people is studied. Eight slim, healthy people were asked to extremely stretch their abdomens. Bending, stretching and expiration were considered. The deformations registration was made by two cameras located in front of the patient on both sides. Special calculation procedure was used in order to transform characteristic point displacements to strains of abdomen in different directions. The extreme strains, their localization and directions are identified. The study proves that the highest strains, bigger than 25% on average, appear in the upper part of the central vertical line of the abdomen and in lower sides in semi-vertical direction. The lowest strains, smaller than 7%, occur in a horizontal line situated low in the abdomen. For each patient similar zones of smaller or bigger strains are identified, however a wide discrepancy of the strain values obtained for different patients is stated. For example the strains in lower part in semi-vertical direction for one patient equals 9% and for another 134%! The acquired conclusions may be useful for surgeons in finding practical solutions to dilemmas concerning the choice of an implant (elastic or stiff) for a specific ventral hernia, its proper connection with fascia and orientation in the abdomen. Copyright © 2011 Elsevier B.V. All rights reserved.

  10. Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs

    PubMed Central

    Benoit, Laurent; Cheynel, Nicolas; Ortega-Deballon, Pablo; Giacomo, Giovanni Di; Chauffert, Bruno; Rat, Patrick

    2008-01-01

    Exposure of the surgical team to toxic drugs during hyperthermic intraperitoneal chemotherapy (HIPEC) remains a matter of great concern. In closed-abdomen HIPEC operating room staffs are not exposed to drugs, but the distribution of the heated liquid within the abdomen is not optimal. In open-abdomen HIPEC, the opposite is true. Even though the open-abdomen method is potentially more effective, it has not become a standard procedure because of the risk of exposure of members of the team to drugs. We present a new technique (closed HIPEC with open abdomen) which ensures protection against potentially contaminating exposure to liquids, vapours and aerosols, and allows permanent access to the whole abdominal cavity. Its principle is to extend the abdominal surgical wound upwards with a sort of “glove-box”. The cutaneous edges of the laparotomy are stapled to a latex «wall expander». The expander is draped over a special L-section metal frame placed above the abdomen. A transparent cover containing a « hand-access » port like those used in laparoscopic surgery is fixed inside the frame. In 10 patients, this device proved to be hermetic both for liquids and vapours. Intra-abdominal temperature was maintained between 42 and 43°C during most of the procedure. The whole abdominal cavity was accessible to the surgeon allowing optimal exposure of all peritoneal surfaces. This technique allows optimal HIPEC while limiting the potential toxic effects for the surgical, medical and paramedical teams. PMID:17929098

  11. Radiation dose reduction in thoracic and abdomen-pelvic CT using tube current modulation: a phantom study.

    PubMed

    Sabarudin, Akmal; Mustafa, Zakira; Nassir, Khadijah Mohd; Hamid, Hamzaini Abdul; Sun, Zhonghua

    2015-01-01

    This phantom study was designed to compare the radiation dose in thoracic and abdomen-pelvic CT scans with and without use of tube current modulation (TCM). Effective dose (ED) and size-specific dose estimation (SSDE) were calculated with the absorbed doses measured at selective radiosensitive organs using a thermoluminescence dosimeter-100 (TLD-100). When compared to protocols without TCM, the ED and SSDE were reduced significantly with use of TCM for both the thoracic and abdomen-pelvic CT. With use of TCM, the ED was 6.50±0.29 mSv for thoracic and 6.01±0.20 mSv for the abdomen-pelvic CT protocols. However without use of TCM, the ED was 20.07±0.24 mSv and 17.30±0.41 mSv for the thoracic and abdomen-pelvic CT protocols, respectively. The corresponding SSDE was 10.18±0.48 mGy and 11.96±0.27 mGy for the thoracic and abdomen-pelvic CT protocols with TCM, and 31.56±0.43 mGy and 33.23±0.05 mGy for thoracic and abdomen-pelvic CT protocols without TCM, respectively. The highest absorbed dose was measured at the breast with 8.58±0.12 mGy in the TCM protocols and 51.52±14.72 mGy in the protocols without TCM during thoracic CT. In the abdomen-pelvic CT, the absorbed dose was highest at the skin with 9.30±1.28 mGy and 29.99±2.23 mGy in protocols with and without use of TCM, respectively. In conclusion, the TCM technique results in significant dose reduction; thus it is to be highly recommended in routine thoracic and abdomen-pelvic CT. PACS numbers: 87.57.Q-, 87.57.qp, 87.53.Bn.

  12. Radiation dose reduction in thoracic and abdomen-pelvic CT using tube current modulation: a phantom study.

    PubMed

    Sabarudin, Akmal; Mustafa, Zakira; Nassir, Khadijah Mohd; Hamid, Hamzaini Abdul; Sun, Zhonghua

    2014-01-08

    This phantom study was designed to compare the radiation dose in thoracic and abdomen-pelvic CT scans with and without use of tube current modulation (TCM). Effective dose (ED) and size-specific dose estimation (SSDE) were calculated with the absorbed doses measured at selective radiosensitive organs using a thermoluminescence dosimeter-100 (TLD-100). When compared to protocols without TCM, the ED and SSDE were reduced significantly with use of TCM for both the thoracic and abdomen-pelvic CT. With use of TCM, the ED was 6.50 ± 0.29 mSv for thoracic and 6.01 ± 0.20 mSv for the abdomen-pelvic CT protocols. However without use of TCM, the ED was 20.07 ± 0.24 mSv and 17.30 ± 0.41 mSv for the thoracic and abdomen-pelvic CT protocols, respectively. The corresponding SSDE was 10.18 ± 0.48 mGy and 11.96 ± 0.27 mGy for the thoracic and abdomen-pelvic CT protocols with TCM, and 31.56 ± 0.43 mGy and 33.23 ± 0.05 mGy for thoracic and abdomen-pelvic CT protocols without TCM, respectively. The highest absorbed dose was measured at the breast with 8.58 ± 0.12 mGy in the TCM protocols and 51.52 ± 14.72 mGy in the protocols without TCM during thoracic CT. In the abdomen-pelvic CT, the absorbed dose was highest at the skin with 9.30 ± 1.28mGy and 29.99 ± 2.23 mGy in protocols with and without use of TCM, respectively. In conclusion, the TCM technique results in significant dose reduction; thus it is to be highly recommended in routine thoracic and abdomen-pelvic CT.

  13. miR-965 controls cell proliferation and migration during tissue morphogenesis in the Drosophila abdomen.

    PubMed

    Verma, Pushpa; Cohen, Stephen M

    2015-07-30

    Formation of the Drosophila adult abdomen involves a process of tissue replacement in which larval epidermal cells are replaced by adult cells. The progenitors of the adult epidermis are specified during embryogenesis and, unlike the imaginal discs that make up the thoracic and head segments, they remain quiescent during larval development. During pupal development, the abdominal histoblast cells proliferate and migrate to replace the larval epidermis. Here, we provide evidence that the microRNA, miR-965, acts via string and wingless to control histoblast proliferation and migration. Ecdysone signaling downregulates miR-965 at the onset of pupariation, linking activation of the histoblast nests to the hormonal control of metamorphosis. Replacement of the larval epidermis by adult epidermal progenitors involves regulation of both cell-intrinsic events and cell communication. By regulating both cell proliferation and cell migration, miR-965 contributes to the robustness of this morphogenetic system.

  14. The control of EGF signaling and cell fate in the Drosophila abdomen.

    PubMed

    Gebelein, Brian

    2008-01-01

    How cells integrate both patterning and signaling information to select between distinct cell fates is a fundamental problem in developmental biology. In this short review, I focus on recent findings of how the Hox and senseless patterning genes regulate epidermal growth factor (EGF) signaling and cell fate within the Drosophila abdomen. In Li-Kroeger et al., we described how a Hox and Senseless transcription factor competition functions as a molecular switch on a cis-regulatory element in the rhomboid (rho) gene to control EGF signaling within the peripheral nervous system (PNS). Here, I discuss an additional implication of these findings: that rho contains at least two cis-regulatory elements to control EGF secretion from the PNS, each to induce a different cell fate.

  15. Severe acute abdomen caused by symptomatic Meckel's diverticulum in three children with trisomy 18.

    PubMed

    Hayashi, Anri; Kumada, Tomohiro; Furukawa, Oki; Nozaki, Fumihito; Hiejima, Ikuko; Shibata, Minoru; Kusunoki, Takashi; Fujii, Tatsuya

    2015-10-01

    Meckel's diverticulum (MD) is the most prevalent congenital anomaly of the gastrointestinal tract and often presents a diagnostic challenge. Patients with trisomy 18 frequently have MD, but the poor prognosis and lack of consensus regarding management for neonates has meant that precise information on the clinical manifestations in infants and children with MD is lacking. We describe the cases of three children with trisomy 18 who developed symptomatic MD. Intussusception was diagnosed in Patient 1, intestinal volvulus in Patient 2, and gastrointestinal bleeding in Patient 3. All three patients underwent surgical treatment and only the Patient 1 died due to pulmonary hypertensive crisis. The other two patients experienced no further episodes of abdominal symptoms. In patients with trisomy 18, although consideration of postoperative complications and prognosis after surgical treatment is necessary, symptomatic MD should carry a high index of suspicion in patients presenting with acute abdomen.

  16. [A case of wandering spleen: a rare cause of acute abdomen].

    PubMed

    Salem, Jean F; Tannouri, Fadi; Salem, Fouad

    2011-01-01

    We present the case of a 17-year-old patient known to have an asymptomatic ectopic spleen, who presented with an acute abdomen. Clinical symptoms and ultrasound led to suspect an acute appendicitis, confirmed later on by pathology. Twenty-four hours after the appendectomy, the patient complained of an abdominal pain of acute onset. Torsion of the pedicle of the ectopic spleen was suspected. Imaging studies supported this diagnosis, and an urgent splenectomy was performed. Did the torsion happen by simple coincidence 24 hours after appendectomy, knowing that the spleen has been asymptomatic for 17 years, or was it precipitated by the surgical intervention? Should we have removed the ectopic spleen during the appendectomy? This is the first report of a case of torsion of a wandering spleen after a laparotomy; a review of the literature is done in order to explain the physiopathology of the disease, and to propose its management.

  17. Safety of enteral feeding in patients with open abdomen, upper gastrointestinal bleed, and perforation peritonitis.

    PubMed

    Guillaume, Alexandra; Seres, David S

    2012-08-01

    Provision of enteral nutrition (EN) has historically been withheld after major abdominal operations until bowel activity returns. Evidence suggests that EN is safe in critically ill patients with a variety of illnesses, specifically after abdominal surgery. There is a strong association between poor nutrition status and worse outcomes in critically ill patients. The fear has been that EN, by virtue of increased luminal pressure or demand to the splanchnic circulation, may compromise the integrity of anastomotic repairs and place patients at risk for complications. In this review, the authors analyze the safety of EN in the setting of the open abdomen, upper gastrointestinal bleeding, and perforation peritonitis, with evidence from published clinical trials and meta-analyses.

  18. Jejunal intussusception: a rare cause of an acute abdomen in adults.

    PubMed

    Patel, Sonali; Eagles, Natasha; Thomas, Peter

    2014-05-28

    Abdominal pain secondary to intussusception is a common presentation in the paediatric population but rare in adults. Diagnosis is often difficult due to non-specific signs and symptoms. Adult intussusception presents more insidiously with intermittent abdominal pain and signs and symptoms of an acute abdomen are rare. In children, the aetiological factor is usually idiopathic, whereas intussusception in adults is more commonly due to an underlying pathology giving rise to a lead point. Consequently the treatment of choice is different-while it is supportive in children, surgical management is typically indicated in adults. In addition, the causes of a lead point precipitating adult intussusception are different depending on whether they arise from the small or large bowel. This report presents a case of jejunal intussusception in a 30-year-old man with a characteristic CT scan who required exploratory laparotomy and small bowel resection. 2014 BMJ Publishing Group Ltd.

  19. Jejunal intussusception: a rare cause of an acute abdomen in adults

    PubMed Central

    Patel, Sonali; Eagles, Natasha; Thomas, Peter

    2014-01-01

    Abdominal pain secondary to intussusception is a common presentation in the paediatric population but rare in adults. Diagnosis is often difficult due to non-specific signs and symptoms. Adult intussusception presents more insidiously with intermittent abdominal pain and signs and symptoms of an acute abdomen are rare. In children, the aetiological factor is usually idiopathic, whereas intussusception in adults is more commonly due to an underlying pathology giving rise to a lead point. Consequently the treatment of choice is different—while it is supportive in children, surgical management is typically indicated in adults. In addition, the causes of a lead point precipitating adult intussusception are different depending on whether they arise from the small or large bowel. This report presents a case of jejunal intussusception in a 30-year-old man with a characteristic CT scan who required exploratory laparotomy and small bowel resection. PMID:24872480

  20. An Extremely Rare Case of Lower Urinary Tract Symptoms: Floating Benign Mesenchymal Mass in Abdomen

    PubMed Central

    Akin, Yigit; Yilmaz, Mehmet Ogur

    2017-01-01

    A 48-year-old man admitted to the urology outpatient clinic with major symptoms of right-side pain and intermittent lower urinary tract symptoms (LUTSs) such as low urine flow rate, dysuria, and frequency. Uroflowmetry showed low urine flow, and laboratory tests revealed no pathology. Ultrasound (US) showed a 7 cm calcific mass above the bladder and a kidney cyst with a diameter of 5.3 cm in the upper pole of the right kidney. Enhanced computed tomography confirmed the US findings. Laparoscopic transperitoneal renal cyst decortication was performed. There was no sign of additional tumors. An independent mass in the abdomen was diagnosed, and the mass was removed. Based on the pathology, the diagnosis was a benign mesenchymal calcific mass. This is the first report of LUTSs due to a free benign mesenchymal mass in the published literature. PMID:28326221

  1. A rare cause of acute abdomen: spontaneous common hepatic duct perforation.

    PubMed

    Pülat, Hüseyin; Karaköse, Oktay; Benzin, Mehmet Fatih; Sabuncuoğlu, Mehmet Zafer; Çetin, Recep

    2016-01-01

    Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gallstone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult.

  2. Clues to vascular disorders at non-contrast CT of the chest, abdomen, and pelvis.

    PubMed

    Esterson, Yonah B; Berkowitz, Jennifer L; Friedman, Barak; Hines, John J; Shah, Priya K; Grimaldi, Gregory M

    2017-04-01

    Non-contrast chest CT scans are commonly performed while CT scans of the abdomen and pelvis are performed in a select subset of patients; those with limited renal function, an allergy to iodinated contrast, in the setting of suspected renal calculus, retroperitoneal hematoma, common duct calculus, abdominal aortic aneurysm with or without rupture, and in patients undergoing a PET-CT scan. In the absence of intravenous contrast, vascular structures may prove challenging to evaluate, yet their assessment is an important component of every non-contrast CT examination. We describe the key imaging features of both arterial and venous pathology, and review clues and common associated non-vascular findings, which can help the radiologist identify vascular disorders at non-contrast CT. Briefly, alternative imaging options are discussed.

  3. Radiation exposure contribution of the scout abdomen radiograph in common pediatric fluoroscopic procedures.

    PubMed

    Rao, Anil G; Simmons, Cephus E; Thacker, Paul G; Collins, Heather; Ritenour, E Russell; Hill, Jeanne G

    2016-08-01

    Contrast enema, voiding cystourethrography and upper gastrointestinal studies are the most common fluoroscopic procedures in children. Scout abdomen radiographs have been routinely obtained prior to fluoroscopy and add to the radiation exposure from these procedures. Elimination of unnecessary routine scout radiographs in select studies might significantly reduce radiation exposure to children and improve the overall benefit-to-risk ratio of these fluoroscopic procedures. To determine the radiation exposure contribution of the preliminary/scout abdomen radiographs with respect to the radiation exposure of the total procedure. We retrospectively collected demographic information and radiation exposure values of dose area product (in Gy-cm(2)) and entrance air kerma (in mGy) - initially for the scout abdomen radiographs done prior to fluoroscopy and subsequently the total procedural radiation values (the combined values of the scout radiograph and fluoroscopic radiation exposure) - in children who underwent contrast enemas, voiding cystourethrograms and upper gastrointestinal studies in a 4-month period. The radiation parameters, including fluoroscopy time, dose area product and entrance air kerma, were available in the log book maintained in the fluoroscopy suite. Fluoroscopy procedures were performed on a single fluoroscopy machine using four frames per second pulse rate and other radiation-minimizing techniques. Usage of the grid to obtain scout radiographs was also recorded. The proportion of radiation exposure from the scout radiograph relative to that of the total procedure was calculated by dividing the individual parameters of the scout to the total procedural values and multiplied by 100 to express these values as a percentage. We calculated mean, median and range and performed statistical analysis of the data. A total of 151 procedures performed on 71 males and 80 females qualified for the study. The age range of the patients was 2 days to 18 years, with

  4. Deflection measurement system for the hybrid iii six-year-old biofidelic abdomen.

    PubMed

    Gregory, T Stan; Howes, Meghan K; Rouhana, Stephen W; Hardy, Warren N

    2012-01-01

    Motor vehicle collisions are the leading cause of death for children ages 5 to 14. Enhancement of child occupant protection is partly dependent on the ability to accurately assess the interaction of child-size occupants with restraint systems. Booster seat design and belt fit are evaluated using child anthropomorphic test devices, such as the Hybrid III 6-year-old dummy., A biofidelic abdomen for the Hybrid III 6-year-old dummy is being developed by the Ford Motor Company to enhance the dummy’s ability to assess injury risk and further quantify submarining risk by measuring abdominal deflection. A practical measurement system for the biofidelic abdominal insert has been developed and demonstrated for three dimensional determination of abdominal deflection. Quantification of insert deflection is achieved via differential signal measurement using electrodes mounted within a conductive medium. Signal amplitude is proportional to the distance between the electrodes. A microcontroller is used to calculate distances between ventral electrodes and a dorsal electrode in three dimensions. This system has been calibrated statically, and its performance demonstrated in a series of sled tests. Deflection measurements from the instrumented abdominal insert indicate performance differences between two booster seat designs, yielding an average peak anterior to posterior displacement of the abdomen of 1.0 ± 3.4 mm and 31.2 ± 7.2 mm for the seats, respectively. Implementation of a 6-year-old abdominal insert with the ability to evaluate submarining potential will likely help safety researchers further enhance booster seat design and interaction with vehicle restraint systems , and help to further understand child occupant injury risk in automobile collisions.

  5. SU-E-T-566: Comparison of VMAT and IMRT for Whole Abdomen Radiation Therapy (WART)

    SciTech Connect

    Briere, TM; Huh, WW; Hayes-Jordan, A; McAleer, MF; Anderson, P

    2014-06-01

    Purpose: Whole Abdomen Radiation Therapy (WART) is used in the treatment of desmoplastic small round cell tumors as well as other tumors with peritoneal dissemination. Intensity modulated radiation therapy (IMRT) is conventionally used to cover the multiple planning target volumes (PTVs) while sparing nearby critical structures, but this approach often requires two isocenters and ≥20 individual treatment fields. Four-field volumetric arc therapy (VMAT) can produce clinically similar treatment plans with the potential to reduce treatment time substantially. Here we examine treatment times and plan robustness for patients undergoing WART. Methods: Twenty patients undergoing WART at our institution were included in this study. Twelve IMRT and 8 VMAT plans utilized upper and lower abdominal isocenters and met similar dose constraints. Treatment times were tabulated from start of daily kV imaging to beam delivery end. Daily treatment couch coordinates were also recorded. From these couch coordinates, difference between actual and planned separation between isocenters was computed. Plan robustness with regard to PTV coverage within the region of field overlap was analyzed for 3 VMAT and 3 IMRT plans assuming a 2σ deviation in isocenter location. Results: The average treatment time for VMAT was 15 minutes shorter than for IMRT (27 minutes vs. 42 minutes). The average deviation in isocenter separation was 0.0 – 0.1 cm in each direction, with a standard deviation of 0.2 – 0.3 cm. Compared with IMRT plans, VMAT plans showed similar loss in PTV coverage for increasing isocenter displacement and similar dose inhomogeneity with decreasing isocenter displacement. Conclusion: Use of VMAT results in substantial time-savings for 2-isocenter whole abdomen radiotherapy plans. VMAT plans show robustness similar to IMRT with respect to isocenter displacement. VMAT should be considered for these very complicated treatments to minimize risk of patient movement during therapy and

  6. Whole-abdomen radiotherapy for non-Hodgkin's lymphoma using twice-daily fractionation

    SciTech Connect

    Liauw, Stanley L.; Yeh, Alexander M.; Morris, Christopher G.; Olivier, Kenneth R.; Mendenhall, Nancy Price . E-mail: mendenan@shands.ufl.edu

    2006-12-01

    Purpose: To report the tolerability and efficacy of twice-daily whole-abdomen irradiation (WAI) for non-Hodgkin's lymphoma (NHL). Methods and Materials: Of 123 patients treated for NHL with WAI, 37% received previous chemotherapy, 28% received WAI as part of comprehensive lymphatic irradiation (CLI), and 32% received WAI for palliation. The median dose to the whole abdomen was 25.0 Gy, followed by a median tumor boost of 9.8 Gy in 58 patients. Fractionation was 1.0 Gy once daily (54%) or 0.8 Gy twice daily (46%). Blood counts were measured weekly. Results: At a median follow-up of 4.3 years, local control was 72% and overall survival was 55% at 5 years. Median time of WAI was 42 days for once-daily treatment and 32 days for twice-daily treatment. Patients receiving twice-daily WAI did not have a significantly higher rate of acute side effects (e.g., nausea, diarrhea, platelet or red blood cell toxicity). Overall, acute thrombocytopenia was the most frequent side effect of treatment; 24 of 96 patients (25%) with available hematologic data had Grade 3+ toxicity. There was no acute Grade 3 gastrointestinal toxicity and no late small bowel obstruction. Multiple regression indicated that patients with four or less involved sites and disease size {<=}6 cm had improved local control and overall survival. Conclusions: Twice-daily WAI using 0.8 Gy/fraction does not appear to have any greater toxicity compared with once-daily treatment using 1 Gy/fraction. Small doses per fraction (0.8-1 Gy/fx) are effective, tolerated well in the acute setting, and associated with a low rate of late toxicity.

  7. Solitary fibrous tumors in abdomen and pelvis: imaging characteristics and radiologic-pathologic correlation.

    PubMed

    Li, Xue-Ming; Reng, Jing; Zhou, Peng; Cao, Ying; Cheng, Zhu-Zhong; Xiao, Yan; Xu, Guo-Hui

    2014-05-07

    To describe the imaging features of solitary fibrous tumors (SFTs) in the abdomen and pelvis, and the clinical and pathologic correlations. Fifteen patients with pathologically confirmed SFTs in the abdomen and pelvis were retrospectively studied with imaging techniques by two radiologists in consensus. Patients underwent unenhanced and contrast-enhanced imaging, as follows: 3 with computed tomography (CT) and magnetic resonance imaging (MRI) examination, 8 with CT examination only, and 4 with MRI examination only. Image characteristics such as size, shape, margin, attenuation or intensity, and pattern of enhancement were analyzed and correlated with the microscopic findings identified from surgical specimens. In addition, patient demographics, presentation, and outcomes were recorded. Of the 15 patients evaluated, local symptoms related to the mass were found in 11 cases at admission. The size of the mass ranged from 3.4 to 25.1 cm (mean, 11.5 cm). Nine cases were round or oval, 6 were lobulated, and 10 displaced adjacent organs. Unenhanced CT revealed a heterogeneous isodense mass in 7 cases, homogeneous isodense mass in 3 cases, and punctuated calcification in one case. On MRI, most of the lesions (6/7) were heterogeneous isointense and heterogeneous hyperintense on T1-weighted images and T2-weighted images, respectively. All tumors showed moderate to marked enhancement. Heterogeneous enhancement was revealed in 11 lesions, and 7 of these had cysts, necrosis, or hemorrhage. Early nonuniform enhancement with a radial area that proved to be a fibrous component was observed in 4 lesions, which showed progressive enhancement in the venous and delayed phase. No statistical difference in the imaging findings was observed between the histologically benign and malignant lesions. Three patients had local recurrence or metastasis at follow-up. Abdominal and pelvic SFTs commonly appeared as large, solid, well-defined, hypervascular masses with variable degrees of necrosis

  8. Evaluation of the open abdomen classification system: a validity and reliability analysis.

    PubMed

    Bjarnason, Thordur; Montgomery, Agneta; Acosta, Stefan; Petersson, Ulf

    2014-12-01

    Classification of the open abdomen (OA) status is essential for clinical studies on the subject and may help to improve OA therapy. This is a validity and reliability analysis of the OA classification proposed by the World Society of the Abdominal Compartment Syndrome in 2013. Prospective data on 111 consecutive OA patients treated with vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) was used. For validity analysis, OA grades were compared with fascial closure and mortality. For reliability analysis, operative reports were graded by three external raters on two different occasions and the results compared. Instructions for use of the classification were constructed and studied by the external raters beforehand. The in-hospital mortality rate was 30 % (33/111). The delayed primary fascial closure rate was 89 % (85/95). Most complex grade (p = 0.033), deteriorating grade (p = 0.045), enteric leak (p = 0.001), and enteroatmospheric fistula (p = 0001) were associated with worse clinical outcomes, while initial grade, grade 1A only, contamination, fixation, and frozen abdomen were not. A floor effect was observed, with 20 % of patients receiving the lowest grade throughout OA period. Inter-rater reliability, expressed as intra-class correlation coefficient (ICC), was 0.77, 0.76, and 0.88 (95 % confidence interval 0.66-0.84, 0.65-0.84, and 0.81-0.92, respectively) and test-retest reliability 1.0, 0.99, and 0.95, respectively. More complex OA grades were associated with worse clinical outcomes. However, favorable clinical results with the VAWCM technique caused many patients to receive the lowest grade, thus causing a floor effect and lower validity. Inter-rater and test-retest reliability was 'good' to 'very good'.

  9. Optimization of an Arterialized Venous Fasciocutaneous Flap in the Abdomen of the Rat

    PubMed Central

    Mota-Silva, Eduarda; Pais, Diogo; Iria, Inês; Videira, Paula A.; Tanganho, David; Alves, Sara; Mascarenhas-Lemos, Luís; Martins Ferreira, José; Ferraz-Oliveira, Mário; Vassilenko, Valentina; O’Neill, João Goyri

    2017-01-01

    Background: Although numerous experimental models of arterialized venous flaps (AVFs) have been proposed, no single model has gained widespread acceptance. The main aim of this work was to evaluate the survival area of AVFs produced with different vascular constructs in the abdomen of the rat. Methods: Fifty-three male rats were divided into 4 groups. In group I (n = 12), a 5-cm-long and 3-cm-wide conventional epigastric flap was raised on the left side of the abdomen. This flap was pedicled on the superficial caudal epigastric vessels caudally and on the lateral thoracic vein cranially. In groups II, III, and IV, a similar flap was raised, but the superficial epigastric artery was ligated. In these groups, AVFs were created using the following arterial venous anastomosis at the caudal end of the flap: group II (n = 13) a 1-mm-long side-to-side anastomosis was performed between the femoral artery and vein laterally to the ending of the superficial caudal epigastric vein. In group III (n = 14), in addition to the procedure described for group II, the femoral vein was ligated medially. Finally, in group IV (n = 14), the superficial caudal epigastric vein was cut from the femoral vein with a 1-mm-long ellipse of adjacent tissue, and an end-to-side arterial venous anastomosis was established between it and the femoral artery. Results: Seven days postoperatively, the percentage of flap survival was 98.89 ± 1.69, 68.84 ± 7.36, 63.84 ± 10.38, 76.86 ± 13.67 in groups I–IV, respectively. Conclusion: An optimized AVF can be produced using the vascular architecture described for group IV. PMID:28894657

  10. Higher incidence of injection site reactions after subcutaneous bortezomib administration on the thigh compared with the abdomen.

    PubMed

    Kamimura, Tomohiko; Miyamoto, Toshihiro; Yokota, Noriko; Takashima, Shuichiro; Chong, Yong; Ito, Yoshikiyo; Akashi, Koichi

    2013-02-01

    Subcutaneous (sc) rather than intravenous administration of bortezomib (Bor) is becoming more common for treating multiple myeloma (MM) because scBor results in lower incidence and severity of peripheral neuropathy and has equivalent efficacy. Bor is an irritant cytotoxic agent when it leaks out; therefore, it is recommended that injections of scBor should be rotated among eight different sites on the abdomen and thigh. However, detailed information about injection site reaction (ISR) has not been sufficiently documented. We retrospectively analyzed the incidence and severity of ISR following scBor administration in 15 Japanese patients with MM. Grade 1 ISR occurred following 40 of 158 (25.3%) scBor injections in ten patients, whereas grade 2 ISRs occurred following seven injections (4.4%) in five patients. Five patients did not develop ISR. Of note, grade 2 ISR was documented in 6 of 65 (9.2%) thigh injections but only in 1 of 93 (1.1%) abdominal injections. These data show that grade 2 ISRs were more common in the thigh compared with the abdomen possibly because the thigh contains lesser adipose tissue than the abdomen. Grade 2 ISRs resolved without any sequela within a median of 7 d. scBor administration on the abdomen instead of the thigh should be considered, especially for emaciated patients, because ISR rapidly resolves within the interval before the next injection even if it occurs. © 2012 John Wiley & Sons A/S.

  11. PET/CT for Head and Neck Squamous Cell Carcinoma: Should We Routinely Include the Head and Abdomen?

    PubMed

    Yankevich, Uliyana; Hughes, Marion A; Rath, Tanya J; Fakhran, Saeed; Alhilahi, Lea M; Seungwon, Kim W; Branstetter, Barton F

    2017-04-01

    The purpose of our study was to determine the diagnostic and therapeutic yield of the head and abdomen portions of PET/CT scans of patients with head and neck squamous cell cancer (HNSCC) to determine whether these areas should be routinely included with PET/CT of the neck and chest. Patients with pathologically proven HNSCC who underwent full-body PET/CT were evaluated for metastases to the head, chest, and abdomen. Medical records were reviewed to determine whether the head and abdominal findings changed the clinical management, beyond the findings in the neck and chest. Five hundred ninety-eight patients who underwent 1625 PET/CT scans were included. All studies included the head, neck, and chest. For 542 of 598 patients (91%), the PET/CT scans included the abdomen. Two of 598 patients (0.3%) had distant calvarial metastases. Neither of the calvarial metastases changed patient management. Twelve of 542 patients (2.2%) had abdominal metastases. For 10 of 542 patients (1.8%), the abdominal findings changed patient management. Thoracic metastases were found in 82 of 598 patients (13.7%). The total rate of distant metastases to the head and abdomen in patients with thoracic metastatic disease was 12.2% (10/82), whereas in patients without thoracic metastases, it was 0.8% (4/460). Routine extension of PET/CT scans to include the head and abdomen in patients with HNSCC is not indicated. For patients without evidence of thoracic metastases, routine PET/CT examinations should include the neck and chest only.

  12. Early definitive fracture fixation is safely performed in the presence of an open abdomen in multiply injured patients.

    PubMed

    Glass, Nina E; Burlew, Clay Cothren; Hahnhaussen, Jens; Weckbach, Sebastian; Pieracci, Fredric M; Moore, Ernest E; Stahel, Philip F

    2017-08-15

    To investigate the safety and feasibility of performing definitive fracture fixation in multiply injured patients in the presence of an open abdomen after laparotomy. Retrospective observational cohort study. Level-I academic trauma center. Adult polytrauma patients with presence of an open abdomen after "damage control" laparotomy and associated major fractures of long bones, acetabulum, pelvis or spine, requiring surgical repair (n=81). Timing of definitive fracture fixation in relation to the timing of abdominal wall closure. Incidence of orthopedic surgical site infections. In During a 15-year time-window from January 1, 2000 until December 31, 2014, we identified a cohort of 294 consecutive polytrauma patients with an open abdomen after laparotomy. Surgical fixation of associated fractures was performed after the index laparotomy in 81 patients. In group 1 (n=32), fracture fixation occurred significantly sooner despite a concurrent open abdomen, compared to group 2 (n=49) with abdominal wall closure prior to fixation (mean 4.4 vs 11.8 days; P=0.01). The incidence of orthopaedic surgical site infections requiring a surgical revision was significantly lower in group 1 (3.1%) compared to group 2 (30.6%; P=0.002). Definitive fracture fixation in the presence of an open abdomen is performed safely and associated with a significant decrease in clinically relevant surgical site infections, compared to delaying fracture fixation until abdominal wall closure. These data suggest that the strategy of imposing a time delay in orthopaedic procedures while awaiting abdominal wall closure is unjustified. Therapeutic level III.

  13. Thermal territories of the abdomen after caesarean section birth: infrared thermography and analysis.

    PubMed

    Childs, C; Siraj, M R; Fair, F J; Selvan, A N; Soltani, H; Wilmott, J; Farrell, T

    2016-09-01

    To develop and refine qualitative mapping and quantitative analysis techniques to define 'thermal territories' of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening. Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the bedside on the first two days after elective caesarean section. Target recruitment: six women in each of three body mass index (BMI) categories (normal, 18.5-24.9 kg/m²; overweight 25-29.9 kg/m²; obese ≥30 kg/m²). Additionally, women presenting to the ward with wound infection were eligible for inclusion in the study. Perspectives on the use of thermal imaging and its practicality were also explored via semi-structured interviews and analysed using thematic content analysis. We recruited 20 women who had all undergone caesarean section. From the booking BMI, eight women were obese (including two women with infected wounds), seven women were overweight and five women had a normal BMI. Temperature (ºC) profiling and pixel clustering segmentation (hierarchical clustering-based segmentation, HCS) revealed characteristic features of thermal territories between scar and adjacent regions. Differences in scar thermal intensity profiles exist between healthy scars and infected wounds; features that have potential for wound surveillance. The maximum temperature differences (∆T) between healthy skin and the wound site exceed 2º C in women with established wound infection. At day two, two women had a scar thermogram with features observed in the 'infected' wound thermogram. Thermal imaging at early and later times after caesarean birth is feasible and acceptable. Women reported potential benefits of the technique for future wound infection screening. Thermal intensity profiling and HCS for pixel

  14. Comparison of virtual unenhanced CT images of the abdomen under different iodine flow rates.

    PubMed

    Li, Yongrui; Li, Ye; Jackson, Alan; Li, Xiaodong; Huang, Ning; Guo, Chunjie; Zhang, Huimao

    2017-01-01

    To assess the effect of varying iodine flow rate (IFR) and iodine concentration on the quality of virtual unenhanced (VUE) images of the abdomen obtained with dual-energy CT. 94 subjects underwent unenhanced and triphasic contrast-enhanced CT scan of the abdomen, including arterial phase, portal venous phase, and delayed phase using dual-energy CT. Patients were randomized into 4 groups with different IFRs or iodine concentrations. VUE images were generated at 70 keV. The CT values, image noise, SNR and CNR of aorta, portal vein, liver, liver lesion, pancreatic parenchyma, spleen, erector spinae, and retroperitoneal fat were recorded. Dose-length product and effective dose for an examination with and without plain phase scan were calculated to assess the potential dose savings. Two radiologists independently assessed subjective image quality using a five-point scale. The Kolmogorov-Smirnov test was used first to test for normal distribution. Where data conformed to a normal distribution, analysis of variance was used to compare mean HU values, image noise, SNRs and CNRs for the 4 image sets. Where data distribution was not normal, a nonparametric test (Kruskal-Wallis test followed by stepwise step-down comparisons) was used. The significance level for all tests was 0.01 (two-sided) to allow for type 2 errors due to multiple testing. The CT numbers (HU) of VUE images showed no significant differences between the 4 groups (p > 0.05) or between different phases within the same group (p > 0.05). VUE images had equal or higher SNR and CNR than true unenhanced images. VUE images received equal or lower subjective image quality scores than unenhanced images but were of acceptable quality for diagnostic use. Calculated dose-length product and estimated dose showed that the use of VUE images in place of unenhanced images would be associated with a dose saving of 25%. VUE images can replace conventional unenhanced images. VUE images are not affected by varying iodine

  15. Experimental model of tympanic colic (acute abdomen) in chinchillas (Chinchilla lanigera)

    PubMed Central

    Martinez-Pereira, Malcon Andrei; Franceschi, Raphaela da Cunha; Coelho, Bárbara Paranhos; Fünkler, Gustavo da Rosa

    2014-01-01

    Digestive disorders caused by sudden changes in diet or inappropriate diet are among the most common disorders of the digestive system. Cecal or intestinal tympany, one consequence of inappropriate diet, is characterized by the accumulation of gases, marked distension of the cecum and colon and the induction of inflammatory processes. To know the effects of intestinal tympany on the enteric plexuses, we developed a method of experimental tympanic colic (TC) in the Chinchilla lanigera. This species was used in view of its susceptibility to TC. TC was induced with a diet rich in alfalfa associated with grain overload for two weeks. Physical and clinical examination including the von Frey test confirmed the diagnosis. The chinchillas with acute abdomen were treated with 1% ketoprofen and resumption of a balanced diet. Necropsy and histopathological analysis showed tympany-induced alterations mainly in the cecum and colon. After treatment, the control conditions were restored. The TC protocol is proposed as an experimental approach designed to aid the study of the effects of acute intestinal inflammation and obstruction caused by an inappropriate diet. PMID:25324875

  16. Application of high-frequency ultrasound for the detection of surgical anatomy in the rodent abdomen.

    PubMed

    Chen, J Y; Chen, H L; Wu, S H; Tsai, T C; Lin, M F; Yen, C C; Hsu, W H; Chen, W; Chen, C M

    2012-02-01

    Rats are used extensively in abdominal disease research. To monitor disease progress in vivo, high-frequency ultrasound (HFU) can be a powerful tool for obtaining high-resolution images of biological tissues. However, there is a paucity of data regarding the correlation between rat anatomy and corresponding HFU images. Twenty-four adult male Sprague-Dawley (SD) rats underwent abdominal scans using HFU (40 MHz) surgical procedures to identify abdominal organs and major vessels as well as in situ scanning to confirm the imaging results. The results were compared with those of human abdominal organs in ultrasonographic scans. The rat liver, paired kidneys, stomach, intestines, and major blood vessels were identified by HFU and the ultrasonic morphologies of the liver and kidneys showed clear differences between rats and humans. Clinically relevant anatomical structures were identified using HFU imaging of the rat abdomen, and these structures were compared with the corresponding structures in humans. Increased knowledge with regard to identifying the anatomy of rat abdominal organs by ultrasound will allow scientists to conduct more detailed intra-abdominal research in rodents. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. Local Metric Learning in 2D/3D Deformable Registration With Application in the Abdomen

    PubMed Central

    Chou, Chen-Rui; Mageras, Gig; Pizer, Stephen

    2015-01-01

    In image-guided radiotherapy (IGRT) of disease sites subject to respiratory motion, soft tissue deformations can affect localization accuracy. We describe the application of a method of 2D/3D deformable registration to soft tissue localization in abdomen. The method, called registration efficiency and accuracy through learning a metric on shape (REALMS), is designed to support real-time IGRT. In a previously developed version of REALMS, the method interpolated 3D deformation parameters for any credible deformation in a deformation space using a single globally-trained Riemannian metric for each parameter. We propose a refinement of the method in which the metric is trained over a particular region of the deformation space, such that interpolation accuracy within that region is improved. We report on the application of the proposed algorithm to IGRT in abdominal disease sites, which is more challenging than in lung because of low intensity contrast and nonrespiratory deformation. We introduce a rigid translation vector to compensate for nonrespiratory deformation, and design a special region-of-interest around fiducial markers implanted near the tumor to produce a more reliable registration. Both synthetic data and actual data tests on abdominal datasets show that the localized approach achieves more accurate 2D/3D deformable registration than the global approach. PMID:24771575

  18. Childhood motocross truncal injuries: high-velocity, focal force to the chest and abdomen

    PubMed Central

    Kennedy, Raelene D; Potter, D Dean; Osborn, John B; Zietlow, Scott; Zarroug, Abdalla E; Moir, Christopher R; Ishitani, Michael B; McIntosh, Amy

    2012-01-01

    Objectives To review the need for operative intervention and critical care services for motocross truncal injuries in children. Design cohort Retrospective review of patients identified via the hospital trauma registry. Setting Our Level 1 Pediatric Trauma Center serves five motocross tracks. These patients require frequent medical care for injuries. Participants All patients ≤17 years of age with truncal injuries sustained during motocross activities, between 2000 and 2011, were identified through the trauma registry. Primary and secondary outcome measures Operative intervention, intensive care unit (ICU) admission, length of stay, morbidity and demographics were reviewed. Results Motocross injured 162 children. Thirty (18.5%) were thoracic or abdominal injuries. Operative intervention was required in eight (27%) patients. Mean injury severity score (ISS) was 11.8. ICU admission was required in 50% and average hospital length of stay was 4.1 days. The most common injuries include pulmonary contusion, pneumothorax, spleen and liver lacerations. 13% of subjects suffered truncal injury from motocross on more than one occasion. Conclusions Paediatric motocross-related truncal injuries are significant. Surgical intervention is required in 27% of patients. The lower ISS incurred from motocross combined with high surgical and ICU admission rates suggests focal high-impact injuries to the chest and abdomen. Despite significant injury, 13% of motocross patients suffer recurrent injuries. Parents and children need injury prevention education. PMID:23166134

  19. Childhood motocross truncal injuries: high-velocity, focal force to the chest and abdomen.

    PubMed

    Kennedy, Raelene D; Potter, D Dean; Osborn, John B; Zietlow, Scott; Zarroug, Abdalla E; Moir, Christopher R; Ishitani, Michael B; McIntosh, Amy

    2012-01-01

    To review the need for operative intervention and critical care services for motocross truncal injuries in children. DESIGN COHORT: Retrospective review of patients identified via the hospital trauma registry. Our Level 1 Pediatric Trauma Center serves five motocross tracks. These patients require frequent medical care for injuries. All patients ≤17 years of age with truncal injuries sustained during motocross activities, between 2000 and 2011, were identified through the trauma registry. Operative intervention, intensive care unit (ICU) admission, length of stay, morbidity and demographics were reviewed. Motocross injured 162 children. Thirty (18.5%) were thoracic or abdominal injuries. Operative intervention was required in eight (27%) patients. Mean injury severity score (ISS) was 11.8. ICU admission was required in 50% and average hospital length of stay was 4.1 days. The most common injuries include pulmonary contusion, pneumothorax, spleen and liver lacerations. 13% of subjects suffered truncal injury from motocross on more than one occasion. Paediatric motocross-related truncal injuries are significant. Surgical intervention is required in 27% of patients. The lower ISS incurred from motocross combined with high surgical and ICU admission rates suggests focal high-impact injuries to the chest and abdomen. Despite significant injury, 13% of motocross patients suffer recurrent injuries. Parents and children need injury prevention education.

  20. Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

    PubMed Central

    Yamada, Takahiro; Ando, Nanako; Shibata, Naoshi; Suitou, Motomu; Takagi, Hiroshi; Matsunami, Kazutoshi; Ichigo, Satoshi

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required. PMID:25628913

  1. An infected urachal cyst presenting as an acute abdomen – A case report

    PubMed Central

    Qureshi, Khalid; Maskell, David; McMillan, Colin; Wijewardena, Chandana

    2013-01-01

    INTRODUCTION An infected urachal cyst is one of a spectrum of presentations of urachal pathology, all of which are rare in adulthood. PRESENTATION OF CASE We report the case of a 45-year-old obese Russian lady who presented with a 2-week history of suprapubic pain radiating to the right iliac fossa. Although previously fit and well, she had a history of 17 miscarriages. Both USS and CT suggested a complicated inflammatory mass in the lower abdomen. Ultimately the diagnosis was made by laparotomy, which revealed an abscess of an urachal cyst. The infected cyst and bladder dome were excised. The patient made a good recovery with an uneventful follow up. DISCUSSION Urachal cysts are the commonest type of urachal anomaly. Infection is the usual mode of presentation amongst adult cases otherwise the condition usually remains asymptomatic. An infected urachal cyst is an important diagnosis to make as complications include sepsis, fistula formation, and rupture leading to peritonitis. Treatment is by complete excision, however, techniques have been debated. CONCLUSION This is a rare but important diagnosis however we recommend that in patients with atypical histories, it should be included in the differential diagnosis. PMID:23728387

  2. Left-sided transmesocolic herniation of small bowel in an otherwise unaffected abdomen.

    PubMed

    Agarwal, Akshay Anand; Sonkar, Abhinav Arun; Singh, Kul Ranjan; Rai, Anurag

    2015-05-15

    Transmesocolic hernia is an uncommon type of internal hernia with incidence ranging from approximately 5-10%. To the best of our knowledge, this is the first reported case of a transmesocolic hernia through a gap within the descending mesocolon presenting clinically as an intestinal obstruction. A 75-year-old man was admitted with clinical features of intestinal obstruction. An abdominal X-ray showed multiple small bowel loops with air fluid levels. Contrast-enhanced CT of the abdomen revealed small bowel obstruction not only on the right, but also on the left side of the collapsed descending colon. Emergency surgery was performed. Strangulated bowel loops with gangrenous changes were resected and double-barrel ileostomy was carried out. The postoperative period was uneventful. Restoration of bowel was performed after 6 weeks. Preoperative diagnosis of bowel obstruction caused by a transmesocolic hernia remains difficult despite the currently available imaging techniques. Prompt surgery can prevent serious complications such as peritonitis and sepsis.

  3. Jejunal Diverticulosis Presented with Acute Abdomen and Diverticulitis Complication: A Case Report

    PubMed Central

    Fidan, Nurdan; Mermi, Esra Ummuhan; Acay, Mehtap Beker; Murat, Muammer; Zobaci, Ethem

    2015-01-01

    Summary Background Jejunal diverticulosis is a rare, usually asymptomatic disease. Its incidence increases with age. If symptomatic, diverticulosis may cause life-threatening acute complications such as diverticulitis, perforation, intestinal hemorrhage and obstruction. In this report, we aimed to present a 67-year-old male patient with jejunal diverticulitis accompanying with abdominal pain and vomiting. Case Report A 67-year-old male patient complaining of epigastric pain for a week and nausea and fever for a day presented to our emergency department. Ultrasonographic examination in our clinic revealed diverticulum-like images with thickened walls adjacent to the small intestine loops, and increase in the echogenicity of the surrounding mesenteric fat tissue. Contrast-enhanced abdominal computed tomography showed multiple diverticula, thickened walls with showing contrast enhancement and adjacent jejunum in the left middle quadrant, increased density of the surrounding mesenteric fat tissue, and mesenteric lymph nodes. The patient was hospitalized by general surgery department with the diagnosis of jejunal diverticulitis. Conservative intravenous fluid administration and antibiotic therapy were initiated. Clinical symptoms regressed and the patient was discharged from hospital after 2 weeks. Conclusions In cases of diverticulitis it should be kept in mind that in patients with advanced age and pain in the left quadrant of the abdomen, diverticular disease causing mortality and morbidity does not always originate from the colon but might also originate from the jejunum. PMID:26715947

  4. Hox-mediated regulation of doublesex sculpts sex-specific abdomen morphology in Drosophila.

    PubMed

    Wang, Wei; Yoder, John H

    2012-06-01

    Hox transcription factors are deeply conserved proteins that guide development through regulation of diverse target genes. Furthermore, alteration in Hox target cis-regulation has been proposed as a major mechanism of animal morphological evolution. Crucial to understanding how homeotic genes sculpt the developing body and contribute to the evolution of form is identification and characterization of regulatory targets. Because target specificity is achieved through physical or genetic interactions with cofactors or co-regulators, characterizing interactions between homeotic genes and regulatory partners is also critical. In Drosophila melanogaster, sexually dimorphic abdominal morphology results from sex-specific gene regulation mediated by the Hox protein Abdominal-B (Abd-B) and products of the sex-determination gene doublesex (dsx). Together these transcription factors regulate numerous sex-specific characters, including pigmentation, cuticle morphology, and abdominal segment number. We show Dsx expression in the developing D. melanogaster pupal abdomen is spatiotemporally dynamic, correlating with segments that undergo sexually dimorphic morphogenesis. Furthermore, our genetic analyses show Dsx expression is Abd-B dependent. Doublesex and Abd-B are not only requisite co-regulators of sexually dimorphic abdominal morphology. We propose that dsx is itself a transcriptional target of Abd-B. These data present a testable hypothesis about the evolution of sexually dimorphic segment number in Diptera. Copyright © 2012 Wiley Periodicals, Inc.

  5. The first flea with fully distended abdomen from the Early Cretaceous of China.

    PubMed

    Gao, Taiping; Shih, Chungkun; Rasnitsyn, Alexandr P; Xu, Xing; Wang, Shuo; Ren, Dong

    2014-08-27

    Fleas, the most notorious insect ectoparasites of human, dogs, cats, birds, etc., have recently been traced to its basal and primitive ancestors during the Middle Jurassic. Compared with extant fleas, these large basal fleas have many different features. Although several fossil species with transitional morphologies filled the evolutionary blank, the early evolution of these ectoparasites is still poorly known. Here we report a new flea with transitional characters, Pseudopulex tanlan sp. nov., assigned to Pseudopulicidae, from the Lower Cretaceous Yixian Formation of Liaoning Province, China. Different from the previously described pseudopulicids, P. tanlan has relatively smaller body size but lacking any ctenidia on the tibiae or body, while the male with comparatively smaller and shorter genitalia. On the other hand, P. tanlan has some characters similar to the transitional fleas of saurophthirids, such as, a small head, short compacted antennae, small pygidium and many stiff setae covering the body. Even though other possibilities can not be ruled out, the female specimen with extremely distended abdomen suggests that it might have consumed its last meal before its demise. Compared with other reported female flea fossils, we calculate and estimate that P. tanlan sp. nov. might have consumed 0.02 milliliter (ml) of blood, which is about 15 times of the intake volume by extant fleas. These new findings further support that fleas had evolved a broad diversity by the Early Cretaceous.

  6. [Acute abdomen in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome].

    PubMed

    Petrić, Aleksandra; Stefanović, Milan; Vukomanović, Predrag; Zivadinović, Radomir; Tubić, Aleksandra; Janjić, Zoran

    2008-09-01

    Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a malformation of female genital tract (incidence 1 in 4000 female newborn children). It appears as a result of a disorder in the development of Millerian cannals. Etiology is unknown. Syndrome MRKH is the most frequent cause of primary amenorrhoea (90%). Patients with MRKH have a normal female phenotype, with normal pubic hairness and thelarche, and female karyotype (46XX) followed by primary amenorrhoea. Hormonal status corresponds to healthy women, where the appearance of ovarian tumors and tumors on rudiment parts of uterus is possible. We presented a case of acute abdomen in a patient with previously not diagnosed MRKH. The diagnosis was done during the operation. Small pelvis and an abdominal part were filled with torquated tumor lump, where ovaries, oviducts, uterus or something resembling rudiment of uterus were not recognized through careful examination. Furthemore, the patient had a short, dead-end vagina. Tumorectomy was done and hystopathological finding showed the presence of vascular leiomyoma. The diagnosis of complex syndromes, such as MRKH, can, despite modern diagnostics, be absent for non-medical and psycho-social reasons. We can expect ovarian and uterine pathology on hypoplastic structures in these patients, as well as in healthy women. Vascular leiomyoma in the patients with MRKH was not found in the available literature.

  7. Outcomes of primary fascial closure after open abdomen for nontrauma emergency general surgery patients.

    PubMed

    O'Meara, Lindsay; Ahmad, Sarwat B; Glaser, Jacob; Diaz, Jose J; Bruns, Brandon R

    2015-12-01

    Emergency general surgery patients are increasingly being managed with an open abdomen (OA). Factors associated with complications after primary fascial closure (PFC) are unknown. Demographic and operative variables for all emergency general surgery patients managed with OA at an academic medical center were prospectively examined from June to December 2013. Primary outcome was complication requiring reoperation. Of 58 patients, 37 managed with OA achieved PFC. Of these, 14 needed re-exploration for dehiscence, compartment syndrome, infection, or other. Complications after PFC were not associated with age, type of operative intervention, time to closure, re-explorations, comorbidities, or mortality. Complications correlated with higher body mass index (P = .02), skin closure (P = .04), plasma infusion (P = .01), and less intraoperative bleeding (P = .05). Deep surgical site infection correlated with fascial dehiscence (P = .02). Reoperation after PFC was more likely in obese and nonhemorrhagic patients. Recognition of these factors and strategies to reduce surgical site infection may improve outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored.

    PubMed

    Beardsley, Christian; Furtado, Ruelan; Mosse, Charles; Gananadha, Sivakumar; Fergusson, James; Jeans, Phil; Beenen, Edwin

    2014-08-01

    A laparotomy is still considered mandatory for patients without previous abdominal surgery presenting with a small bowel obstruction (SBO) because of a perceived high incidence of underlying lesions. However, there is no evidence in literature to support this assumption. We analyzed the etiology of SBO in this subgroup of patients to establish the need for a mandatory laparotomy. A retrospective analysis was conducted over a 5-year period. Basic demographics, radiology results, operative findings, and outpatient investigations were analyzed. Of 689 patients presenting with an SBO, a total of 62 patients, 9.0%, had a virgin abdomen. A known underlying disease (inflammatory bowel disease, malignancy) was the cause in 13 patients. The remaining 49 patients had adhesions in 75.5% and a newly diagnosed malignancy in 10.2% as a cause. Adhesions are by far the most likely cause of SBO in patients without previous abdominal surgery followed by a small number of newly diagnosed malignancies. Both prevalences are in equal proportion to patients with previous abdominal surgery. A trial of nonoperative management may therefore be justified. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Management of spontaneously ruptured hepatocellular carcinoma and hemoperitoneum manifested as acute abdomen in the emergency room.

    PubMed

    Hsueh, Kuan-Chun; Fan, Hsiu-Lung; Chen, Teng-Wei; Chan, De-Chuan; Yu, Jyh-Cherng; Tsou, Shung-Sheng; Chang, Tzu-Ming; Hsieh, Chung-Bao

    2012-11-01

    Spontaneously ruptured hepatocellular carcinoma (HCC) with hemoperitoneum has a poor prognosis, especially in cases of cirrhosis. Patients usually present to emergency rooms (ERs) with acute abdomen. The aim of the present study was to determine the factors affecting mortality and to compare the prognosis of conservative treatment, transcatheter arterial embolization (TAE), or hepatectomy in these situations. Fifty-four patients with spontaneously ruptured HCC diagnosed between January 2004 and August 2010 were enrolled in this retrospective review of clinical data. Grouping by survival or mortality, univariate and multivariate analyses of factors affecting 30-day mortality, and long-term survival were conducted. The outcomes of the various treatments were analyzed. After primary fluid resuscitation in the ER, 6 of 54 patients underwent conservative treatment. Emergency hepatectomy was performed on 19 patients; TAE was used for 29 patients, 18 of whom received staged hepatectomy thereafter. Poor liver function, prolonged international normalized ratio (INR), and conservative treatment were associated with increased 30-day mortality. Logistic regression analysis of cumulative survival revealed that INR ≥ 1.4, multiple intrahepatic HCC, and conservative treatment were related to poorer long-term survival. The patients who received hepatectomy, either immediate or staged after TAE, had higher survival rates of 85.2 % at 30 days and 62.2 % at 1 year. The treatment of ruptured HCC should be tailored to the individual case. Prolonged survival is possible in patients with preserved liver function through curative liver resection. Emergency physicians, radiologists, and surgeons play essential roles in managing these patients.

  10. Studying the Physiology of Tadpoles through their Naturally Transparent Abdomen Walls

    NASA Astrophysics Data System (ADS)

    Naitoh, T.; Yamashita, M.; Wassersug, R.

    Because their development is external and they grow rapidly, anurans (frogs and toads) have been important model species in studies of how spaceflight affects vertebrate development. However the long term effects of spaceflight on post embryonic stages have barely been studied in these, or for that matter, any other vertebrate species. Tadpoles of certain species have naturally transparent skin covering a large portion of their ventral abdomen wall. Consequently viscera and visceral movements can be observed through this window without any invasive treatment to the animals. Respiration rate (as measured by buccal floor movements), heart rate, and gut motility are all indices of physiological state that can be observed in unconstrained larvae of these particular anuran species. We are using changes in these physiological variables to study the responses of tadpoles to changes in their external environment. Our study of the physiological responses of these tadpoles to microgravity has been selected as a candidate spaceflight experiment (to be housed in the Canadian Aquatic Research Facility). Ground-based studies with these same larvae are currently underway. Those experiments make use of stepwise changes in temperature as a stimulus to document the effect of temperature on intestinal motility in tadpoles. The scope of our studies on gravitational physiology and key issues in post- embryonic development of anurans are the focus of our presentation. This research is a prelude to raising a vertebrate through a complete life cycle in the space environment.

  11. Multidetector CT of blunt traumatic venous injuries in the chest, abdomen, and pelvis.

    PubMed

    Holly, Brian P; Steenburg, Scott D

    2011-01-01

    Venous injuries as a result of blunt trauma are rare. Even though current protocols for multidetector computed tomography (CT) of patients with trauma are designed to evaluate primarily the solid organs and arteries, blunt venous injuries may nevertheless be identified, or at least suspected, on the basis of the multidetector CT findings. Venous injuries are associated with high morbidity and mortality rates. Diagnosis of a possible venous injury is crucial because the physical findings of a venous injury are nonspecific and may be absent. This article aims to make the radiologist aware of various venous injuries caused by blunt trauma and to provide helpful hints to aid in the identification of venous injuries. Multidetector CT technology, in combination with interactive manipulation of the raw dataset, can be useful in the creation of multiplanar reconstructed images and in the identification of a venous injury caused by blunt trauma. Familiarity with direct and indirect signs of venous injuries, as well as with examples of blunt traumatic venous injuries in the chest, abdomen, and pelvis, will help in the diagnosis of these injuries.

  12. Fetal behavioral responses to the touch of the mother's abdomen: A Frame-by-frame analysis.

    PubMed

    Marx, Viola; Nagy, Emese

    2017-05-01

    The aim of the present study was to examine whether fetuses respond to the touching of the mother's abdomen, and if they do, whether they differentiate based on familiarity and the source of the touch, utilizing 3D real-time (4D) sonography. Behavioral responses of 28 fetuses (20th to 33rd week of gestation; N=15 in the 2nd and N=13 in the 3rd trimester) were frame-by-frame coded using a coding system comprising 20 codes and were analyzed in four conditions, during the touch of the (1) mother, (2) the father, (3) the stranger and in a (4) no-touch, control condition. Fetuses showed differential responses to the touch, in particular in the duration of their reaching out to touch the uterus wall in the four conditions, and self-touch, dependent on the gestational age of the fetus. Fetuses in the 3rd trimester touched the uterus wall significantly longer than fetuses in the 2nd trimester did, when the mother touched compared to the control condition. At the same time, fetuses in the 3rd trimester also touched themselves less during the mother's touch, compared when the stranger touched and also compared to the control condition. This differential response of the older fetuses might be due to the maturation of the central nervous system, and may indicate the emergence of a proprioceptive self-awareness by the 3rd trimester. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. One of the Rare Causes of Acute Abdomen Leading to Subileus: Jejunal Diverticulitis

    PubMed Central

    Aydın, Elçin; Yerli, Hasan; Avcı, Tevfik; Yılmaz, Tuğbahan; Gülay, Hüseyin

    2016-01-01

    Background: Jejunal diverticulitis is one of the rare causes of acute abdomen generally seen in the elderly. Jejunal diverticulosis was defined as the herniation of the mucosa and the submucosa from the inside of the muscular layer of the bowel wall on the mesenteric side of the intestine. Case Report: We presented the intraoperative and pathological findings of a 69-year-old male patient who had presented with complaints about abdominal pain, nausea, and vomiting and been operated upon due to subileus and peritonitis induced by large-sized jejunal diverticulitis, along with his computed tomography (CT) findings. Conclusion: Jejunal diverticulitis is uncommon and may be a disease which might be difficult to diagnose when it develops on the basis of the large-sized diverticula resembling intestinal ansae. To the best of our knowledge, the computed tomography and intraoperative findings of a case in which partial resection is applied to the jejunum due to subileus have not been previously presented in the literature. PMID:27308082

  14. Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin.

    PubMed

    Yamada, Takahiro; Ando, Nanako; Shibata, Naoshi; Suitou, Motomu; Takagi, Hiroshi; Matsunami, Kazutoshi; Ichigo, Satoshi; Imai, Atsushi

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required.

  15. MR imaging of the abdomen and pelvis in infants, children, and adolescents.

    PubMed

    Darge, Kassa; Anupindi, Sudha A; Jaramillo, Diego

    2011-10-01

    Recent developments in magnetic resonance (MR) imaging have profoundly changed the investigation of abdominal and pelvic disease in pediatrics. Motion reduction techniques, such periodically rotated overlapping parallel lines with enhanced reconstruction, or PROPELLER, have resulted in reliable imaging with quiet breathing. Faster imaging sequences minimize artifact and allow for more efficient studies. Diffusion-weighted imaging has become increasingly important in the evaluation of neoplastic disease, depicting disease with increased cellularity and helping to differentiate benign from malignant masses. MR enterography helps visualize intra- and extraluminal bowel pathologic conditions. MR cholangiopancreatography can depict congenital and acquired causes of pancreatic and biliary abnormalities. MR urography is an effective technique for a one-stop-shop evaluation of structural urinary tract abnormality and renal function. Three-dimensional acquisitions allow volumetric display of structures from multiple angles. Specialized techniques allow quantification of iron and fat in the viscera in children with hemolytic anemia and obesity, respectively. This article covers current techniques and strategies to perform and optimize MR imaging of the abdomen and pelvis in infants, children, and adolescents and describes important practical applications. © RSNA, 2011.

  16. Subserous lymphangioma of the sigmoid colon: an uncommon cause of acute abdomen in pediatric patients.

    PubMed

    Fernandes, Bianca Furlan; Moraes, Érika Neves de Souza; de Oliveira, Francini Rossetto; Benevides, Gabriel Núncio; Felipe-Silva, Aloísio; Ferreira, Cristiane Rúbia; de Alcântara, Paulo Sérgio Martins; Tokeshi, Flavio; Martinês, João Augusto Dos Santos; Ferronato, Ângela Espósito

    2015-01-01

    Lymphangioma is a rare, benign lesion derived from a malformation of the lymphatic system, which is more frequently found in the head, neck, and axilla. However, it may be present anywhere in the body, and the diagnosis involves adults as children with some distinct clinical features among them. In pediatric patients, abdominal cystic lymphangioma occurs mostly in the mesentery presenting abdominal pain, intestinal obstruction, or, more rarely, hemorrhage. The authors report the case of a child with a short-course history of fever, abdominal pain, and constipation. The physical examination disclosed the presence of an abdominal mass and signs of peritoneal irritation. Imaging was consistent with a cystic lesion compressing the sigmoid colon and laterally displacing the remaining loops. Exploratory laparotomy was undertaken, and a sigmoidectomy, followed by Hartman's colostomy, was performed. Histological examination revealed the nature of the lesion as a cystic lymphangioma. The authors highlight the clinical features of this entity and call attention to this disease in the differential diagnosis of acute abdomen or abdominal pain, mainly in pediatric patients.

  17. Experimental model of tympanic colic (acute abdomen) in chinchillas (Chinchilla lanigera).

    PubMed

    Martinez-Pereira, Malcon Andrei; Franceschi, Raphaela da Cunha; Coelho, Bárbara Paranhos; Fünkler, Gustavo da Rosa; Zancan, Denise Maria

    2014-09-01

    Digestive disorders caused by sudden changes in diet or inappropriate diet are among the most common disorders of the digestive system. Cecal or intestinal tympany, one consequence of inappropriate diet, is characterized by the accumulation of gases, marked distension of the cecum and colon and the induction of inflammatory processes. To know the effects of intestinal tympany on the enteric plexuses, we developed a method of experimental tympanic colic (TC) in the Chinchilla lanigera. This species was used in view of its susceptibility to TC. TC was induced with a diet rich in alfalfa associated with grain overload for two weeks. Physical and clinical examination including the von Frey test confirmed the diagnosis. The chinchillas with acute abdomen were treated with 1% ketoprofen and resumption of a balanced diet. Necropsy and histopathological analysis showed tympany-induced alterations mainly in the cecum and colon. After treatment, the control conditions were restored. The TC protocol is proposed as an experimental approach designed to aid the study of the effects of acute intestinal inflammation and obstruction caused by an inappropriate diet.

  18. Improved regression models for ventilation estimation based on chest and abdomen movements

    PubMed Central

    Liu, Shaopeng; Gao, Robert; He, Qingbo; Staudenmayer, John; Freedson, Patty

    2012-01-01

    Non-invasive estimation of minute ventilation is important for quantifying the intensity of physical activity of individuals. In this paper, several improved regression models are presented, based on the measurement of chest and abdomen movements from sensor belts worn by subjects (n = 50) engaged in 14 types of physical activities. Five linear models involving a combination of 11 features were developed, and the effects of different model training approaches and window sizes for computing the features were investigated. The performance of the models was evaluated using experimental data collected during the physical activity protocol. The predicted minute ventilation was compared to the criterion ventilation measured using a bidirectional digital volume transducer housed in a respiratory gas exchange system. The results indicate that the inclusion of breathing frequency and the use of percentile points instead of interdecile ranges over a 60-second window size reduced error by about 43%, when applied to the classical two degrees-of-freedom model. The mean percentage error of the minute ventilation estimated for all the activities was below 7.5%, verifying reasonably good performance of the models and the applicability of the wearable sensing system for minute ventilation estimation during physical activity. PMID:22173273

  19. Human abdomen recognition using camera and force sensor in medical robot system for automatic ultrasound scan.

    PubMed

    Bin Mustafa, Ammar Safwan; Ishii, Takashi; Matsunaga, Yoshiki; Nakadate, Ryu; Ishii, Hiroyuki; Ogawa, Kouji; Saito, Akiko; Sugawara, Motoaki; Niki, Kiyomi; Takanishi, Atsuo

    2013-01-01

    Physicians use ultrasound scans to obtain real-time images of internal organs, because such scans are safe and inexpensive. However, people in remote areas face difficulties to be scanned due to aging society and physician's shortage. Hence, it is important to develop an autonomous robotic system to perform remote ultrasound scans. Previously, we developed a robotic system for automatic ultrasound scan focusing on human's liver. In order to make it a completely autonomous system, we present in this paper a way to autonomously localize the epigastric region as the starting position for the automatic ultrasound scan. An image processing algorithm marks the umbilicus and mammary papillae on a digital photograph of the patient's abdomen. Then, we made estimation for the location of the epigastric region using the distances between these landmarks. A supporting algorithm distinguishes rib position from epigastrium using the relationship between force and displacement. We implemented these algorithms with the automatic scanning system into an apparatus: a Mitsubishi Electric's MELFA RV-1 six axis manipulator. Tests on 14 healthy male subjects showed the apparatus located the epigastric region with a success rate of 94%. The results suggest that image recognition was effective in localizing a human body part.

  20. Chronic abdominal pain as the initial manifestation of pancreatic injury due to remote blunt trauma of the abdomen.

    PubMed

    Gholson, C F; Sittig, K; Favrot, D; McDonald, J C

    1994-09-01

    Three patients were admitted with severe abdominal pain that began after an asymptomatic latent period following blunt trauma to the abdomen. During initial medical evaluation 3 months to 1 year after the trauma, serum amylase levels were normal or minimally elevated, and computed tomography scanning revealed edema and/or pseudocyst formation in the tail of the pancreas. Pancreatography showed ductal stenosis or obstruction in the midbody of the pancreas in each patient. At surgery, chronic pancreatitis in the tail was clearly demarcated from the normal head of the gland. Distal pancreatectomy was curative. Blunt traumatic pancreatic ductal injury may occur without typical immediate posttraumatic acute pancreatitis. Chronic distal pancreatitis following an asymptomatic latent period may culminate in delayed admission months to years after the initial injury. Endoscopic retrograde cholangiopancreatography should be considered for evaluation of patients with chronic abdominal pain and prior blunt trauma to the abdomen.

  1. Can vacuum-assisted closure and instillation therapy (VAC-Instill therapy) play a role in the treatment of the infected open abdomen?

    PubMed

    D'Hondt, M; D'Haeninck, A; Dedrye, L; Penninckx, F; Aerts, R

    2011-03-01

    Severe superimposed infection during open abdomen treatment with development of intra-abdominal sepsis is a challenging complication associated with high mortality rates. We report our experience with VAC-Instill therapy (KCI, San Antonio, USA) used for treatment of an infected open abdomen following pancreatic surgery. A literature search revealed no analogous case reports using VAC-Instill therapy for treatment of an infected laparostomy. The encouraging result of the case presented seems to indicate that VAC-Instill therapy could be used as adjunctive treatment in the management of the infected open abdomen when traditional therapy fails to control the infection.

  2. Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy - a systematic review.

    PubMed

    Acosta, Stefan; Björck, Martin; Petersson, Ulf

    2017-01-01

    The aim of this paper was to review the literature on vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies. A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure". Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias. A high primary fascial closure rate can be achieved with the vacuum-assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-trauma patients, in need of prolonged open abdomen therapy.

  3. SU-F-I-40: Impact of Scan Length On Patient Dose in Abdomen/pelvis CT Diagnosis

    SciTech Connect

    Park, I; Song, J; Kim, K

    2016-06-15

    Purpose: To analysis the impact of scan length on patient doses in abdomen/pelvis CT diagnosis of each hospital. Methods: Scan length of 7 hospitals from abdomen/pelvis CT diagnosis was surveyed in Korea. Surveyed scan lengths were additional distance above diaphragm and distance below pubic symphysis except for standard scan range between diaphragm and pubic symphysis. Patient dose was estimated for adult male and female according to scan length of each hospital. CT-Expo was used to estimate the patient dose under identical equipment settings (120 kVp, 100 mAs, 10 mm collimation width, etc.) except scan length. Effective dose was calculated by using tissue weighting factor of ICRP 103 recommendation. Increase rate of effective dose was calculated comparing with effective dose of standard scan range Results: Scan lengths of abdomen/pelvis CT diagnosis of each hospital were different. Also effective dose was increased with increasing the scan length. Generally increasing the distance above diaphragm caused increase of effective dose of male and female, but increasing the distance below pubic symphysis caused increase of effective dose of male. Conclusion: We estimated the patient dose according to scan length of each hospital in abdomen/pelvis CT diagnosis. Effective dose was increased by increasing the scan length because dose of organs with high tissue weighting factor such as lung, breast, testis were increased. Scan length is important factor on patient dose in CT diagnosis. If radiologic technologist interested in patient dose, decreasing the unnecessary scan length will decrease the risk of patients from radiation. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C0004).

  4. CT analysis of fat distribution superficial and deep to the Scarpa's fascial layer in the mid and lower abdomen.

    PubMed

    Harley, O J H; Pickford, M A

    2013-04-01

    Mismatches in the thickness of subcutaneous fat at the level of the umbilicus and suprapubic region can result in an unsightly bulge and an unfavourable result following standard abdominoplasty. This problem can be avoided by thinning the abdominoplasty flap. This study was carried out to assess the thickness of the subcutaneous fat layer at the level of the umbilicus and the supra-pubic region. Measurements of full thickness fat and the depth of Scarpa's fascia separating superficial and sub-Scarpa fat layers were taken from the CT scans in 69 women; mean age 52 years (range 30-79). The thickness of the skin and abdominal wall fat was an average of 7 mm thicker (max 22 mm; p < 0.05). The thickness of the fat layer superficial to Scarpa's fascia was an average of 19 mm at mid abdomen and 22 mm in the lower abdomen (p < 0.05). The thickness of the fat layer deep to Scarpa's fascia was 14 mm in the mid abdomen and 5 mm in the lower abdomen (p < 0.05). In 55% of patients the difference in thickness of the mid abdominal and lower abdominal fat was greater than 5 mm, a difference that could lead to a noticeable mismatch and therefore an unfavourable outcome. Results of this study suggest that selectively thinning the fat layer deep to Scarpa's fascia would address potential mismatches and preserve the Scarpa's fascia layer in more than 50% of cases, therefore allowing wounds to be closed with an effective deep tension layer. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Spill your guts! Perceptions of Trauma Association of Canada member surgeons regarding the open abdomen and the abdominal compartment syndrome.

    PubMed

    Kirkpatrick, Andrew W; Laupland, Kevin B; Karmali, Shahzeer; Bergeron, Eric; Stewart, T Charyk; Findlay, Christie; Parry, N; Khetarpal, Suneel; Evans, D

    2006-02-01

    To survey surgeon opinion regarding the management of the open abdomen (OA) and abdominal compartment syndrome (ACS) to assess current practice and direct future prospective clinical studies. Opinions of self-designated trauma, general, pediatric, and vascular surgeons belonging to the Trauma Association of Canada (TAC), were surveyed through a mixed-mode (mail and Web based) questionnaire. Among 102 eligible candidates, 86 (84%) responded; 83% did regular trauma call, 45% regular critical care call being a separate call 79% of the time; 79% worked in centers serving >500,000 people; the median year of practice entry was 1997. There was no standard definition of what constituted an "open abdomen", preferred time for re-operation, or preferred method for alternate fascial closure, although 90% reported having not closing the fascia after a trauma laparotomy. Being "physically unable" was reported as an indication twice as often as objective measures of airway or bladder pressures. The decision to proceed with OA was reported as rarely or never being made preoperatively by 78% of respondents. None reported an institutional policy regarding OA. Eighty-four percent reported (re)opening an abdomen for primary ACS, 46% for secondary ACS, 28% for tertiary ACS. Self-assessed familiarity for the ACS was 6/7 on a Likert scale. Physical examination was reported as a diagnostic criterion for ACS by 66%, and used to screen by 21% of respondents. There is no consensus regarding definition, functional indications, or management of an open abdomen in the perceptions of Canadian trauma providers despite a high self reported level of familiarity with the abdominal compartment syndrome. This is an area of practice with potential and requirements for further multi-center study.

  6. Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases

    PubMed Central

    Lim, Siew Fung; Lee, Song Liang; Chiow, Adrian Kah Heng; Foo, Chek Siang; Wong, Andrew Siang Yih; Tan, Su-Ming

    2012-01-01

    Summary Background: The acute abdomen accounts for up to 40% of all emergency surgical hospital admissions and a large proportion are secondary to gastrointestinal perforation. Studies have shown the superiority of the abdominal CT over upright chest radiographs in demonstrating free intraperitoneal air. Spontaneous perforated pyometra is a rare cause of the surgical acute abdomen with free intraperitoneal air. Only 38 cases have been reported worldwide. Case Report: We report 2 cases of spontaneously perforated pyometra in our hospital’s general surgery department. Both underwent exploratory laparotomy: one had a total hysterectomy and bilateral salpingo-oophorectomy, while the other had an evacuation of the uterine cavity, primary repair of uterine perforation and a peritoneal washout. A literature search was conducted and all reported cases reviewed in order to describe the clinical presentations and management of the condition. Of the 40 cases to date, including 2 of our cases, the most common presenting symptoms were abdominal pain (97.5%), fever (37.5%) and vomiting (25.0%). The main indication for exploratory laparotomy was pneumoperitoneum (97.5%). Conclusions: Pyometra is an unusual but serious condition in elderly women presenting with an acute abdomen. A high index of suspicion is needed to make the appropriate diagnosis. PMID:23569488

  7. Differential diagnosis of pelvic cystic lesions caused by hemorrhage from inflammatory abscess using CT attenuation in women with acute abdomen.

    PubMed

    Sato, Kazuko; Kajihara, Takeshi; Miki, Akinori; Hirabayashi, Eriko; Shintani, Daisuke; Niitsu, Mamoru; Ishihara, Osamu; Itakura, Atsuo

    2015-11-01

    To determine the efficacy of computed tomography (CT) attenuation of cystic lesions measured on an image browsing system to distinguish abscess from hematoma in women with acute abdomen. The medical records of female patients of reproductive age with acute abdomen who were treated over a 7-year period in a single center and who had undergone laparotomy or laparoscopic surgery and preoperative pelvic CT scanning were retrospectively analyzed to identify those with hematoma or abscess cyst formation. Nineteen patients with tubo-ovarian abscess (abscess group) and six patients with hematoma (hematoma group) formation in the pelvis were included in the analysis. The preoperative CT images of the tubo-ovarian cyst were retrospectively investigated on the basis of cyst attenuation. CT attenuation of the cyst measured by both two gynecologists could be used to clearly distinguish inflammatory disease with abscess formation from bleeding disease with hematoma. CT attenuation on a picture archiving and communication system can distinguish hematoma from abscess in women with acute abdomen. This may significantly contribute to making differential diagnosis without interpretation by a medical radiologist.

  8. Abscess of urachal remnants presenting with acute abdomen: a case series

    PubMed Central

    2012-01-01

    Introduction Urachal diseases are rare and may develop from a congenital anomaly in which a persistent or partial reopening of the fetal communication between the bladder and the umbilicus persists. The most frequently reported urachal anomalies in adults are infected urachal cyst and urachal carcinoma. The diagnosis of this entity is not always easy because of the rarity of these diseases and the atypical symptoms at presentation. Imaging techniques, such as ultrasonography and computed tomography have a significant role in recognizing the presence of urachus-derived lesions. Cases presentations Case presentation 1: A 25-year-old Arab-Berber man presented with a 10-day history of progressive lower abdominal pain accompanied by fever, vomiting, and low urinary tract symptoms to our emergency department. Laboratory data revealed leucocytosis. The diagnosis of an acute peritonitis was made initially. Abdominal ultrasonography revealed a hypoechoic tract from the umbilicus to the abdominal wall, and the diagnosis was rectified (infected urachal remnants). The patient was initially treated with intravenous antibiotics in combination with a percutaneous drainage. Afterwards an extraperitoneal excision of the urachal remnant including a cuff of bladder was performed. The histological analysis did not reveal a tumor of the urachal remnant. Follow-up examinations a few months later showed no abnormality. Case presentation 2: A 35-year-old Arab-Berber man, without prior medical history with one week of abdominal pain, nausea and vomiting, associated with fever but without lower urinary tract symptoms visited our emergency department. Laboratory data revealed leucocytosis. Abdominal ultrasonography was not conclusive. Computed tomography of the abdomen was the key to the investigation and the diagnosis of an abscess of urachal remnants was made. The patient underwent the same choice of medical-surgical treatment as previously described for case one, with a good follow

  9. Prehospital advanced trauma life support for critical penetrating wounds to the thorax and abdomen.

    PubMed

    Pons, P T; Honigman, B; Moore, E E; Rosen, P; Antuna, B; Dernocoeur, J

    1985-09-01

    The role of advanced trauma life support (ATLS) in the prehospital care of the critically injured is highly controversial. This study analyzes the efficacy of ATLS in the management of critical penetrating wounds of the thorax and abdomen. In the 2 1/2-year period ending July 1984, 203 consecutive patients underwent emergency laparotomy or thoracotomy for gunshot and stab wounds. All patients were treated in the field by advanced paramedics (EMT-P). For gunshot wounds the mean time (+/- S.E.M.) responding to the scene was 4.5 (+/- 0.29) minutes, on the scene 10.1 (+/- 0.41) minutes, and returning to the hospital 6.4 (+/- 0.32) minutes. For stab wounds the mean time responding to the scene was 4.8 (+/- 0.21) minutes, on the scene 9.5 (+/- 0.37) minutes, and returning to the hospital 5.7 (+ 0.30) minutes. The number of intravenous lines started averaged 1.8 per patient. Eighty-one patients had PASG applied and 28 patients underwent endotracheal intubation (21 orally, seven nasally). Thirty-three patients had no obtainable blood pressure, of whom six survived (18%). One hundred sixty (94%) of the remaining 170 patients who had any initial blood pressure survived. One hundred nine (55%) patients had an increase in BP greater than or equal to 10 mm Hg (average, 35.6 mm Hg), 64 (32%) had no significant change, and 25 (13%) had a fall greater than or equal to 10 mm Hg (average, 24.2 mm Hg) from the field to the emergency department. Twenty (80%) of the 25 patients with a fall in blood pressure survived.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?

    PubMed

    Kisacik, Bunyamin; Kalyoncu, Umut; Erol, M Fatih; Karadag, Omer; Yildiz, Mustafa; Akdogan, Ali; Kaptanoglu, Bugra; Hayran, Mutlu; Ureten, Kemal; Ertenli, Ihsan; Kiraz, Sedat; Calguneri, Meral

    2007-12-01

    This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6 +/- 8.1 years (range 2-33 years) and all were on colchicine therapy with a mean colchicine dosage of 1.2 +/- 0.4 mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93 ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12 +/- 0.96] vs 0.095 [0.01-0.80] p < 0.001, respectively). PCT levels higher than 0.5 ng/ml were found in 11% (3/28) of FMF patients compared to 62% (18/29) of acute appendicitis patients (p < 0.001). Our results suggest that PCT could be a useful test in the differentiation of abdominal FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.

  11. The abdomen of Drosophila: does planar cell polarity orient the neurons of mechanosensory bristles?

    PubMed

    Fabre, Caroline C G; Casal, José; Lawrence, Peter A

    2008-04-30

    In the adult abdomen of Drosophila, the shafts of mechanosensory bristles point consistently from anterior to posterior. This is an example of planar cell polarity (PCP); some genes responsible for PCP have been identified. Each adult bristle is made by a clone of four cells, including the neuron that innervates it, but little is known as to how far the formation or positions of these cells depends on PCP. The neurons include a single dendrite and an axon; it is not known whether the orientation of these processes is influenced by PCP. We describe the development of the abdominal mechanosensory bristles in detail. The division of the precursor cell gives two daughters, one (pIIa) divides to give rise to the bristle shaft and socket cell and the other (pIIb) generates the neuron, the sheath and the fifth cell. Although the bristles and their associated shaft and socket cells are consistently oriented, the positioning and behaviour of the neuron, the sheath and the fifth cell, as well as the orientation of the axons and the dendritic paths, depend on location. For example, in the anterior zone of the segment, the axons grow posteriorly, while in the posterior zone, they grow anteriorly. Manipulating the PCP genes can reverse bristle orientation, change the path taken by the dendrite and the position of the cell body of the neuron. However, the paths taken by the axon are not affected. PCP genes, such as starry night and dachsous orient the bristles and position the neuronal cell body and affect the shape of the dendrites. However, these PCP genes do not appear to change the paths followed by the sensory axons, which must, therefore, be polarised by other factors.

  12. Diversity of wing patterns and abdomen-generated substrate sounds in 3 European scorpionfly species.

    PubMed

    Hartbauer, Manfred; Gepp, Johannes; Hinteregger, Karin; Koblmüller, Stephan

    2015-08-01

    In the genus Panorpa (Insecta: Mecoptera), also known as scorpionflies, premating behavior includes repeated sequences of slow wing movements (waving, fanning, flagging) which are accompanied by rapid abdomen vibrations that generate substantial substrate-borne sound. It is still unknown whether wing patterns or vibratory signals contain information about species identity, sex and/or the quality of potential mating partners. Besides species-specific pheromones, these multimodal signals may be of particular importance for the maintenance of reproductive isolation in sympatrically occurring scorpionfly species. Here, we analyzed phyologenetic relationships among, and the pattern of forewings as well as substrate-borne sound in 3 different sympatric Central-European scorpionfly species (P. communis, P. germanica, and P. alpina). Divergence time estimates, based on 879 bp of the mitochondrial COI gene, indicate longstanding separate evolutionary histories for the studied Panorpa species. Morphological analysis revealed that wing length as an indicator of body size increased in the following order: P. alpina < P. germanica < P. communis. Individuals can be assigned to the correct species and sex with high accuracy just by evaluation of the number of dark spots and the proportion of wing pigmentation. Despite high variability of interpulse period at an individual level, across species analysis revealed a positive correlation of average interpulse period as well as mean signal amplitude with forewing length. These results suggest wing patterns, but less likely vibratory signals, to contain information about species identity. Furthermore, receivers may be able to estimate the body size of a signaler solely on the basis of substrate-borne sound. © 2014 The Authors. Insect Science published by Wiley Publishing Asia Pty Ltd on behalf of Institute of Zoology, Chinese Academy of Sciences.

  13. Tremulatory and abdomen vibration signals enable communication through air in the stink bug Euschistus heros.

    PubMed

    Kavčič, Andreja; Cokl, Andrej; Laumann, Raúl A; Blassioli-Moraes, Maria Carolina; Borges, Miguel

    2013-01-01

    Communication by substrate-borne mechanical signals is widespread among animals but remains one of their least understood communication channels. Past studies of vibrational communication in insects have been oriented predominantly to communication during mating, showing that species- and sex-specific vibrational signals enable recognition and localization of potential mates on continuous solid substrates. No special attention has been paid to vibrational signals with less obvious specificity as well as to the possibility of vibrational communication across substrates that are not in physical contact. We aimed to reinvestigate emission of the aforementioned vibrational signals transmitted through a plant in the stink bug Euschistus heros (Pentatomidae: Pentatominae) and to check whether individuals are able to communicate across adjecent, physically separated substrates. We used laser vibrometry for registration of substrate-borne vibrational signals on a bean plant. Using two bean plants separated for 3 to 7 cm between two most adjacent leaves, we investigated the possibility of transmission of these signals through air. Our study showed that males and females of E. heros communicate using tremulatory, percussion and buzzing signals in addition to the previously described signals produced by vibrations of the abdomen. Contrary to the latter, the first three signal types did not differ between sexes or between pentatomid species. Experiments with two physically separated plants showed significant searching behaviour and localization of vibrational signals of an E. heros male or a female, in response to abdominal vibration produced signals of a pair duetting on the neighbouring plant, in comparison to control where no animals were on the neighbouring plant. We also confirmed that transmission through air causes amplitude and frequency decay of vibrational signals, which suggests high-amplitude, low-frequency tremulatory signals of these stink bugs their most

  14. CT chest abdomen pelvis doses in Scotland: has the DRL had its day?

    PubMed Central

    McVey, S; Gentle, D; Hince, A J; MacDonald, N; McCallum, S

    2014-01-01

    Objective: This article reports on a pilot study designed to collect dose data representative of current CT chest abdomen pelvis (CAP) practice in Scotland, make any immediately obvious interventions and to identify if the current UK diagnostic reference level (DRL) of 940 mGy cm is still appropriate. The aims are to identify if a Scotland-wide picture archiving and communication system (PACS)–based dose audit of a number of CT examinations is likely to have value in terms of optimization of patient doses and to comment on the significance of the results in terms of future optimization strategies. Methods: Dose audit of CT CAP examinations at 32 different scanner sites across Scotland using accepted data collection and analysis methods. The minimum sample size was 30. Results: Results indicate that CT CAP doses are lower than those previously reported (median, 800 mGy cm, 75th percentile 840 mGy cm) but follow a distribution that is not in keeping with the concept of DRLs as presently understood or implemented. Conclusion: There is value in a PACS-based dose audit project to provide serial snapshots of patient doses as optimization efforts take place and to revise current knowledge about CT doses. In our opinion, the results call into question whether DRLs or the concept of “achievable dose” are suitable for devising optimization strategies once a certain degree of optimization has taken place. Advances in knowledge: The results reported here suggest that it may be time to take a different approach to optimization, concentrating on tools that are more refined than the DRL, which may have become more of a compliance tool than an aid to optimization. PMID:24971617

  15. Diffusion-weighted imaging of the abdomen: Impact of b-values on texture analysis features.

    PubMed

    Becker, Anton S; Wagner, Matthias W; Wurnig, Moritz C; Boss, Andreas

    2017-01-01

    The purpose of this work was to systematically assess the impact of the b-value on texture analysis in MR diffusion-weighted imaging (DWI) of the abdomen. In eight healthy male volunteers, echo-planar DWI sequences at 16 b-values ranging between 0 and 1000 s/mm(2) were acquired at 3 T. Three different apparent diffusion coefficient (ADC) maps were computed (0, 750/100, 390, 750 s/mm(2) /all b-values). Texture analysis of rectangular regions of interest in the liver, kidney, spleen, pancreas, paraspinal muscle and subcutaneous fat was performed on DW images and the ADC maps, applying 19 features computed from the histogram, grey-level co-occurrence matrix (GLCM) and grey-level run-length matrix (GLRLM). Correlations between b-values and texture features were tested with a linear and an exponential model; the best fit was determined by the smallest sum of squared residuals. Differences between the ADC maps were assessed with an analysis of variance. A Bonferroni-corrected p-value less than 0.008 (=0.05/6) was considered statistically significant. Most GLCM and GLRLM-derived texture features (12-18 per organ) showed significant correlations with the b-value. Four texture features correlated significantly with changing b-values in all organs (p < 0.008). Correlation coefficients varied between 0.7 and 1.0. The best fit varied across different structures, with fat exhibiting mostly exponential (17 features), muscle mostly linear (12 features) and the parenchymatous organs mixed feature alterations. Two GLCM features showed significant variability in the different ADC maps. Several texture features vary systematically in healthy tissues at different b-values, which needs to be taken into account if DWI data with different b-values are analyzed. Histogram and GLRLM-derived texture features are stable on ADC maps computed from different b-values.

  16. Tremulatory and Abdomen Vibration Signals Enable Communication through Air in the Stink Bug Euschistus heros

    PubMed Central

    Kavčič, Andreja; Čokl, Andrej; Laumann, Raúl A.; Blassioli-Moraes, Maria Carolina; Borges, Miguel

    2013-01-01

    Communication by substrate-borne mechanical signals is widespread among animals but remains one of their least understood communication channels. Past studies of vibrational communication in insects have been oriented predominantly to communication during mating, showing that species- and sex-specific vibrational signals enable recognition and localization of potential mates on continuous solid substrates. No special attention has been paid to vibrational signals with less obvious specificity as well as to the possibility of vibrational communication across substrates that are not in physical contact. We aimed to reinvestigate emission of the aforementioned vibrational signals transmitted through a plant in the stink bug Euschistus heros (Pentatomidae: Pentatominae) and to check whether individuals are able to communicate across adjecent, physically separated substrates. We used laser vibrometry for registration of substrate-borne vibrational signals on a bean plant. Using two bean plants separated for 3 to 7 cm between two most adjacent leaves, we investigated the possibility of transmission of these signals through air. Our study showed that males and females of E. heros communicate using tremulatory, percussion and buzzing signals in addition to the previously described signals produced by vibrations of the abdomen. Contrary to the latter, the first three signal types did not differ between sexes or between pentatomid species. Experiments with two physically separated plants showed significant searching behaviour and localization of vibrational signals of an E. heros male or a female, in response to abdominal vibration produced signals of a pair duetting on the neighbouring plant, in comparison to control where no animals were on the neighbouring plant. We also confirmed that transmission through air causes amplitude and frequency decay of vibrational signals, which suggests high-amplitude, low-frequency tremulatory signals of these stink bugs their most

  17. Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation.

    PubMed

    Nahabedian, Maurice Y; Dooley, William; Singh, Navin; Manson, Paul N

    2002-01-01

    The purpose of the present study was to determine whether contour abnormalities of the abdomen after breast reconstruction with abdominal flaps are related to the harvest of the rectus abdominis muscle. Abdominal contour was analyzed in 155 women who had breast reconstruction with abdominal flaps; 108 women had free transverse rectus abdominis muscle (TRAM) flaps, 37 had pedicled TRAM flaps, and 10 had deep inferior epigastric perforator (DIEP) flaps. The reconstruction was unilateral in 110 women and bilateral in 45 women. Three methods of muscle-sparing were used; they are classified as preservation of the lateral muscle, preservation of the medial and lateral muscle, or preservation of the entire muscle. One of these three methods of muscle-sparing was used in 91 women (59 percent) and no muscle-sparing was used in 64 women (41 percent). Postoperative contour abnormalities occurred in 15 woman and included epigastric fullness in five, upper bulge in three, and lower bulge in 10. One woman experienced two abnormalities, one woman experienced three, and no woman developed a hernia. Of these abnormalities, 11 occurred after the free TRAM flap, seven after the pedicled TRAM flap, and none after the DIEP flap. Bilateral reconstruction resulted in 11 abnormalities in nine women, and unilateral reconstruction resulted in seven abnormalities in six women. chi2 analysis of the free and pedicled TRAM flaps demonstrates that muscle-sparing explains the observed differences in upper bulge and upper fullness (p = 0.02), with a trend toward significance for lower bulge (p = 0.06). chi2 analysis of the free TRAM and DIEP flaps does not explain the observed difference in abnormal abdominal contour. Analysis of muscle-sparing and non-muscle-sparing methods demonstrates that the observed difference between the techniques is only explained for a lower bulge after the bilateral free TRAM flap (p = 0.04).

  18. Surgical management of late bullet embolization from the abdomen to the right ventricle: Case report.

    PubMed

    Alan Elison, Ramos Mayo; Jose Antonio, Diaz Elizondo; Hector, Segura Marin; Dolores, Lopez Garnica; Francisco Xavier, Treviño Garza

    2017-09-04

    Secondary embolus from gun projectile is a rare entity, it represents a clinical and therapeutic dilemma because the potential complications involving central and peripheral circulation. Each case reported in the literature represents a challenge because their unique and different clinical scenarios. We present the management of a 33-year-old man with past history of a gunshot wound on left flank with no evidence of any exit wounds, treated with exploratory laparotomy without removing the gunshot bullet from the abdomen. The patient presents 6 years later with non-productive cough and retrosternal pain with no other symptoms; the patient underwent a chest x-ray, electrocardiogram, thoracoabdominal CT, echocardiogram and cardiac catheterization and showed a bullet in the right ventricular floor. The projectile was extracted by sternotomy with extracorporeal circulation through the right atrium, without any complications. In 1834, Thomas David reported for the first time a wood-fragment embolization. There have been reported less than 200 cases including embolization of other materials; most of the gunshot bullet embolization cases reported on literature were reported after war. Clinical manifestations are associated with the anatomical site of embolism and mortality rate for a retained bullet is 6% associated with complication in 25% of cases. Mortality rate decreases to 1-2% if the bullet is removed. There are no established guidelines about the management of migrating foreign bodies or bullets, however, conservative, endovascular and surgical management have been proposed. In the cases of bullet embolization to the thoracic cavity, surgery represents a safe, low risk approach with high success rates. Copyright © 2017. Published by Elsevier Ltd.

  19. Diversity of wing patterns and abdomen-generated substrate sounds in 3 European scorpionfly species

    PubMed Central

    Hartbauer, Manfred; Gepp, Johannes; Hinteregger, Karin; Koblmüller, Stephan

    2016-01-01

    In the genus Panorpa (Insecta: Mecoptera), also known as scorpionflies, premating behavior includes repeated sequences of slow wing movements (waving, fanning, flagging) which are accompanied by rapid abdomen vibrations that generate substantial substrate-borne sound. It is still unknown whether wing patterns or vibratory signals contain information about species identity, sex and/or the quality of potential mating partners. Besides species-specific pheromones, these multimodal signals may be of particular importance for the maintenance of reproductive isolation in sympatrically occurring scorpionfly species. Here, we analyzed phyologenetic relationships among, and the pattern of forewings as well as substrate-borne sound in 3 different sympatric Central-European scorpionfly species (P. communis, P. germanica, and P. alpina). Divergence time estimates, based on 879 bp of the mitochondrial COI gene, indicate longstanding separate evolutionary histories for the studied Panorpa species. Morphological analysis revealed that wing length as an indicator of body size increased in the following order: P. alpina < P. germanica < P. communis. Individuals can be assigned to the correct species and sex with high accuracy just by evaluation of the number of dark spots and the proportion of wing pigmentation. Despite high variability of interpulse period at an individual level, across species analysis revealed a positive correlation of average interpulse period as well as mean signal amplitude with forewing length. These results suggest wing patterns, but less likely vibratory signals, to contain information about species identity. Furthermore, receivers may be able to estimate the body size of a signaler solely on the basis of substrate-borne sound. PMID:24818592

  20. Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

    PubMed Central

    Chen, Yu; Ye, Jinning; Song, Wu; Chen, Jianhui; Yuan, Yujie; Ren, Jianan

    2014-01-01

    Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62%) patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, P < 0.0001) and complication incidence (RR, 0.68, P < 0.0001). The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen. PMID:24987411

  1. Regulation of muscle stiffness during periodic length changes in the isolated abdomen of the hermit crab.

    PubMed

    Chapple, W D

    1997-09-01

    Reflex activation of the ventral superficial muscles (VSM) in the abdomen of the hermit crab, Pagurus pollicarus, was studied using sinusoidal and stochastic longitudinal vibration of the muscle while recording the length and force of the muscle and the spike times of three exciter motoneurons. In the absence of vibration, the interspike interval histograms of the two larger motoneurons were bimodal; cutting sensory nerves containing most of the mechanoreceptor input removed the short interval peak in the histogram, indicating that the receptors are important in maintaining tonic firing. Vibration of the muscle evoked a reflex increase in motoneuron frequency that habituated after an initial peak but remained above control levels for the duration of stimulation. Motoneuron frequency increased with root mean square (rms) stimulus amplitude. Average stiffness during stimulation was about two times the stiffness of passive muscle. The reflex did not alter muscle dynamics. Estimated transfer functions were calculated from the fast Fourier transform of length and force signals. Coherence was >0.9 for the frequency range of 3-35 Hz. Stiffness magnitude gradually increased over this range in both reflex activated and passive muscle; phase was between 10 and 20 degrees. Reflex stiffness decreased with increasing stimulus amplitudes, but at larger amplitudes, this decrease was much less pronounced; in this range stiffness was regulated by the reflex. The sinusoidal frequency at which reflex bursts were elicited was approximately 6 Hz, consistent with previous measurements using ramp stretch. During reflex excitation, there was an increase in amplitude of the short interval peak in the interspike interval histogram; this was reduced when the majority of afferent pathways was removed. A phase histogram of motoneuron firing during sinusoidal vibration had a peak at approximately 110 ms, also suggesting that an important component of the reflex is via direct projections from

  2. The optimization of acoustic fields for ablative therapies of tumours in the upper abdomen

    NASA Astrophysics Data System (ADS)

    Gélat, P.; ter Haar, G.; Saffari, N.

    2012-12-01

    High intensity focused ultrasound (HIFU) enables highly localized, non-invasive tissue ablation and its efficacy has been demonstrated in the treatment of a range of cancers, including those of the kidney, prostate and breast. HIFU offers the ability to treat deep-seated tumours locally, and potentially bears fewer side effects than more invasive treatment modalities such as resection, chemotherapy and ionizing radiation. There remains however a number of significant challenges which currently hinder its widespread clinical application. One of these challenges is the need to transmit sufficient energy through the ribcage to ablate tissue at the required foci whilst minimizing the formation of side lobes and sparing healthy tissue. Ribs both absorb and reflect ultrasound strongly. This sometimes results in overheating of bone and overlying tissue during treatment, leading to skin burns. Successful treatment of a patient with tumours in the upper abdomen therefore requires a thorough understanding of the way acoustic and thermal energy is deposited. Previously, a boundary element approach based on a Generalized Minimal Residual (GMRES) implementation of the Burton-Miller formulation was developed to predict the field of a multi-element HIFU array scattered by human ribs, the topology of which was obtained from CT scan data (Gélat et al 2011 Phys. Med. Biol. 56 5553-81). The present paper describes the reformulation of the boundary element equations as a least-squares minimization problem with nonlinear constraints. The methodology has subsequently been tested at an excitation frequency of 1 MHz on a spherical multi-element array in the presence of ribs. A single array-rib geometry was investigated on which a 50% reduction in the maximum acoustic pressure magnitude on the surface of the ribs was achieved with only a 4% reduction in the peak focal pressure compared to the spherical focusing case. This method was then compared with a binarized apodization approach

  3. Towards the optimisation of acoustic fields for ablative therapies of tumours in the upper abdomen

    NASA Astrophysics Data System (ADS)

    Gélat, P.; ter Haar, G.; Saffari, N.

    2013-08-01

    The efficacy of high intensity focused ultrasound (HIFU) for the non-invasive treatment of cancer has been demonstrated for a range of different cancers including those of the liver, kidney, prostate and breast. As a non-invasive focused therapy, HIFU offers considerable advantages over other techniques such as chemotherapy and surgical resection, in terms of its non-invasiveness and low risk of harmful side effects. There is, however, a number of significant challenges which currently hinder its widespread clinical application. One of these challenges is the need to transmit sufficient energy through the ribcage to induce tissue necrosis at the required foci whilst minimising the formation of side lobes and sparing healthy tissue. Ribs both absorb and reflect ultrasound strongly. As such, a common side effect of focusing ultrasound in regions located behind the rib cage is the overheating of bone and surrounding tissue, which can lead to skin burns. Successful treatment of a patient with tumours in the upper abdomen therefore requires a thorough understanding of the way acoustic and thermal energy are deposited. This is likely to rely on a treatment planning procedure in which optimal source velocity distributions are obtained so as to maximise a dose quantity at the treatment sites, whilst ensuring that this quantity does not exceed a specified threshold at other field locations, particularly on the surface of the ribs. Previously, a boundary element approach based on a Generalised Minimal Residual (GMRES) implementation of the Burton-Miller formulation was developed to predict the field of a multi-element HIFU array scattered by human ribs, the topology of which was obtained from CT scan data [1]. This work describes the reformulation of the boundary element equations as a least-squares minimisation problem with non-linear constraints. The methodology was subsequently tested at an excitation frequency of 100 kHz on a spherical multi-element array in the presence

  4. Open Abdomen Improves Survival in Patients With Peritonitis Secondary to Acute Superior Mesenteric Artery Occlusion.

    PubMed

    Ding, Weiwei; Wang, Kai; Liu, Baochen; Fan, Xinxin; Wang, Shikai; Cao, Jianmin; Wu, Xingjiang; Li, Jieshou

    2017-10-01

    Damage control surgery and open abdomen (OA) have been extensively used in the severe traumatic patients. However, there was little information when extended to a nontrauma setting. The purpose of this study was to evaluate whether the liberal use of OA as a damage control surgery adjunct improved the clinical outcome in acute superior mesenteric artery occlusion patients. A single-center, retrospective cohort review was performed in a national tertiary surgical referral center. Forty-four patients received OA (OA group) and 65 patients had a primary fascial closure (non-OA group) after diagnosed as peritonitis secondary to acute superior mesenteric artery occlusion from January, 2005 to June, 2016. Revascularization was achieved through endovascular aspiration embolectomy, open embolectomy, or percutaneous stent. No difference of bowel resection length was found between groups in the first emergency surgery. However, more non-OA patients (35.4%) required a second-look enterectomy to remove the residual bowel ischemia than OA patients (13.6%, P<0.05). OA was closed within a median of 7 days (4 to 15 d). There was a mean of 134 cm residual alive bowel in OA, whereas 96 cm in non-OA. More non-OA patients suffered from intra-abdominal sepsis (23.1% vs. 6.8%, P<0.01), intra-abdominal hypertension (31% vs. 0, P<0.01), and acute renal failure (53.8% vs. 31.8%, P<0.05) than OA group after surgery. Short-bowel syndrome occurred infrequently in OA than non-OA patients (9.1% vs. 36.9%, P<0.01). OA significantly decreased the 30-day (27.3% vs. 52.3%, P<0.01) and 1-year mortality rate (31.8 % vs. 61.5%, P<0.01) compared with non-OA group. Liberal use of OA, as a damage control adjunct avoided the development of intra-abdominal hypertension, reduced sepsis-related complication, and improved the clinical outcomes in peritonitis secondary to acute SMA occlusion.

  5. Detection of the Adamkiewicz artery in computed tomography of the thorax and abdomen.

    PubMed

    Guziński, Maciej; Bryl, Maciej; Ziemińska, Katarzyna; Wolny, Kamila; Sąsiadek, Marek; Garcarek, Jerzy S

    2017-01-01

    The great anterior radiculomedullary artery, also known as the artery of Adamkiewicz (AKA), is a small-caliber vessel which arises from the intercostal or lumbar arteries branching out from the aorta. The aim of this study was to evaluate detection of the AKA, as well as its level and side of origin, with multi-slice contrast enhanced computed tomography (MSCT) of the abdomen and thorax performed during everyday clinical practice, and to compare the results with the literature. The study retrospectively evaluated 200 consecutive MSCT images of the thoracic and thoracoabdominal aorta performed at Wroclaw Medical University's Department of General and Interventional Radiology and Neuroradiology as part of normal clinical work-ups. The CT examinations were performed with a 64-slice CT scanner. Arterial-phase images were analyzed for detection of the AKA and for anatomical variants of the AKA. Recognition of the AKA was achieved in 43 of 200 patients (21.5%). Out of these 43 cases, the AKA originated on the left side in 36 instances (83.7%) - a significantly higher number than on the right side (only in 6 cases, 14%); in one case (2.3%) it arose from both sides (p < 0.05, T-test). Most of the AKAs (24 cases, 55.8%) originated on the left side at level T11 or T12. In 13 patients (30.2%) the AKA arose from T11 or from T12 intercostal arteries. The origin of the AKA varied greatly and ranged from T5 (2.3%) to L2 (2.3%). The AKA is characterized by left-side lateralization and is associated with a wide range of origin, from T5 to L2. Detection of the AKA is, relatively speaking, rarely possible in routine clinical CT in the arterial phase - only in 1/5 of the patients. Therefore it is necessary to perform dedicated, individual arterial phase bolus tracking enhancement CT scans from the T5 to L3 level.

  6. Biomechanical response of the pediatric abdomen, part 1: development of an experimental model and quantification of structural response to dynamic belt loading.

    PubMed

    Kent, Richard; Stacey, Stephen; Kindig, Matthew; Forman, Jason; Woods, William; Rouhana, Stephen W; Higuchi, Kazuo; Tanji, Hiromasa; Lawrence, Schuyler St; Arbogast, Kristy B

    2006-11-01

    The abdomen is the second most commonly injured region in children using adult seat belts, but engineers are limited in their efforts to design systems that mitigate these injuries since no current pediatric dummy has the capability to quantify injury risk from loading to the abdomen. This paper develops a porcine (sus scrofa domestica) model of the 6-year-old human's abdomen, and then defines the biomechanical response of this abdominal model. First, a detailed abdominal necropsy study was undertaken, which involved collecting a series of anthropometric measurements and organ masses on 25 swine, ranging in age from 14 to 429 days (4-101 kg mass). These were then compared to the corresponding human quantities to identify the best porcine representation of a 6-year-old human's abdomen. This was determined to be a pig of age 77 days, and whole-body mass of 21.4 kg. The sub-injury, quasistatic response to belt loading of this porcine model compared well with pediatric human volunteer tests performed with a lap belt on the lower abdomen. A test fixture was designed to produce transverse, dynamic belt loading on the porcine abdomen. A detailed review of field cases identified the following test variables: loading location (upper/lower), penetration magnitude (23%-68% of initial abdominal depth), muscle tensing (yes/no), and belt penetration rate (quasistatic, dynamic 2.9 m/s - 7.8 m/s). Dynamic tests were performed on 47 post-mortem subjects. Belt tension and dorsal reaction force were cross-plotted with abdominal penetration to generate structural response corridors. Subcutaneous stimulation of the anterior abdominal muscle wall stiffened the quasistatic response significantly, but was of negligible importance in the dynamic tests. The upper abdomen exhibited stiffer response quasistatically, and also was more sensitive to penetration rate, with stiffness increasing significantly over the range of dynamic rates tested here. In contrast, the lower abdomen was relatively

  7. Automatic exposure control calibration and optimisation for abdomen, pelvis and lumbar spine imaging with an Agfa computed radiography system

    NASA Astrophysics Data System (ADS)

    Moore, C. S.; Wood, T. J.; Avery, G.; Balcam, S.; Needler, L.; Joshi, H.; Saunderson, J. R.; Beavis, A. W.

    2016-11-01

    The use of three physical image quality metrics, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and mean effective noise equivalent quanta (eNEQm) have recently been examined by our group for their appropriateness in the calibration of an automatic exposure control (AEC) device for chest radiography with an Agfa computed radiography (CR) imaging system. This study uses the same methodology but investigates AEC calibration for abdomen, pelvis and spine CR imaging. AEC calibration curves were derived using a simple uniform phantom (equivalent to 20 cm water) to ensure each metric was held constant across the tube voltage range. Each curve was assessed for its clinical appropriateness by generating computer simulated abdomen, pelvis and spine images (created from real patient CT datasets) with appropriate detector air kermas for each tube voltage, and grading these against reference images which were reconstructed at detector air kermas correct for the constant detector dose indicator (DDI) curve currently programmed into the AEC device. All simulated images contained clinically realistic projected anatomy and were scored by experienced image evaluators. Constant DDI and CNR curves did not provide optimized performance but constant eNEQm and SNR did, with the latter being the preferred calibration metric given that it is easier to measure in practice. This result was consistent with the previous investigation for chest imaging with AEC devices. Medical physicists may therefore use a simple and easily accessible uniform water equivalent phantom to measure the SNR image quality metric described here when calibrating AEC devices for abdomen, pelvis and spine imaging with Agfa CR systems, in the confidence that clinical image quality will be sufficient for the required clinical task. However, to ensure appropriate levels of detector air kerma the advice of expert image evaluators must be sought.

  8. The gap gene giant of Rhodnius prolixus is maternally expressed and required for proper head and abdomen formation.

    PubMed

    Lavore, Andrés; Pagola, Lucía; Esponda-Behrens, Natalia; Rivera-Pomar, Rolando

    2012-01-01

    The segmentation process in insects depends on a hierarchical cascade of gene activity. The first effectors downstream of the maternal activation are the gap genes, which divide the embryo in broad fields. We discovered a sequence corresponding to the leucine-zipper domain of the orthologue of the gene giant (Rp-gt) in traces from the genome of Rhodnius prolixus, a hemipteran with intermediate germ-band development. We cloned the Rp-gt gene from a normalized cDNA library and characterized its expression and function. Bioinformatic analysis of 12.5 kbp of genomic sequence containing the Rp-gt transcriptional unit shows a cluster of bona fide regulatory binding sites, which is similar in location and structure to the predicted posterior expression domain of the Drosophila orthologue. Rp-gt is expressed in ovaries and maternally supplied in the early embryo. The maternal contribution forms a gradient of scattered patches of mRNA in the preblastoderm embryo. Zygotic Rp-gt is expressed in two domains that after germ band extension are restricted to the head and the posterior growth zone. Parental RNAi shows that Rp-gt is required for proper head and abdomen formation. The head lacks mandibulary and maxillary appendages and shows reduced clypeus-labrum, while the abdomen lacks anterior segments. We conclude that Rp-gt is a gap gene on the head and abdomen and, in addition, has a function in patterning the anterior head capsule suggesting that the function of gt in hemipterans is more similar to dipterans than expected. Copyright © 2011. Published by Elsevier Inc.

  9. Automatic exposure control calibration and optimisation for abdomen, pelvis and lumbar spine imaging with an Agfa computed radiography system.

    PubMed

    Moore, C S; Wood, T J; Avery, G; Balcam, S; Needler, L; Joshi, H; Saunderson, J R; Beavis, A W

    2016-11-07

    The use of three physical image quality metrics, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and mean effective noise equivalent quanta (eNEQm) have recently been examined by our group for their appropriateness in the calibration of an automatic exposure control (AEC) device for chest radiography with an Agfa computed radiography (CR) imaging system. This study uses the same methodology but investigates AEC calibration for abdomen, pelvis and spine CR imaging. AEC calibration curves were derived using a simple uniform phantom (equivalent to 20 cm water) to ensure each metric was held constant across the tube voltage range. Each curve was assessed for its clinical appropriateness by generating computer simulated abdomen, pelvis and spine images (created from real patient CT datasets) with appropriate detector air kermas for each tube voltage, and grading these against reference images which were reconstructed at detector air kermas correct for the constant detector dose indicator (DDI) curve currently programmed into the AEC device. All simulated images contained clinically realistic projected anatomy and were scored by experienced image evaluators. Constant DDI and CNR curves did not provide optimized performance but constant eNEQm and SNR did, with the latter being the preferred calibration metric given that it is easier to measure in practice. This result was consistent with the previous investigation for chest imaging with AEC devices. Medical physicists may therefore use a simple and easily accessible uniform water equivalent phantom to measure the SNR image quality metric described here when calibrating AEC devices for abdomen, pelvis and spine imaging with Agfa CR systems, in the confidence that clinical image quality will be sufficient for the required clinical task. However, to ensure appropriate levels of detector air kerma the advice of expert image evaluators must be sought.

  10. [Dose reduction and image quality in MDCT of the upper abdomen: potential of an adaptive post-processing filter].

    PubMed

    Kröpil, P; Lanzman, R S; Walther, C; Röhlen, S; Godehardt, E; Mödder, U; Cohnen, M

    2010-03-01

    To evaluate the effects of a 2D non-linear adaptive post-processing filter (2D-NLAF) on image quality in dose-reduced multi-detector CT (MDCT) of the upper abdomen. MDCT of the upper abdomen was simulated on a 64-slice scanner using a multi-modal anthropomorphic phantom (CIRS, Norfolk, USA). While keeping the collimation (64 x 0.6 mm) and pitch (p = 1) unchanged, the tube current (100 - 500 mAs) and tube potential (80 - 140 kVp) were varied to perform MDCT as high dose (CTDI > 20), middle dose (CTDI 10 - 20) and low dose (CTDI < 10) level protocols. Four independent blinded radiologists evaluated axial images with a thickness of 7 and 3 mm with respect to the presentation of "mesenteric low contrast lesions", "liver veins", "liver cysts", "renal cysts" and "big vessels". The subjective image quality of original data and post-processed images using a 2D-NLAF (SharpViewCT, Linköping, Sweden) was graded on a 5-point scale (from "1" not visible to "5" excellent) and statistically analyzed. The effective dose (E) was estimated using commercial software (CT-EXPO). For all protocol groups, 2D-NLAF led to a significant improvement in subjective image quality for all examined lesions (p < 0.01), particularly at the protocols of middle dose (E: 5 - 8 mSv) and low dose level (E: 1 - 5 mSv). A maximum effect was seen in middle dose protocols for "low contrast lesions" (score "3.3" with filter versus "2.5" without) and "liver veins" ("4.5" versus "3.9"). The phantom study indicates a potential dose reduction of up to 50 % in MDCT of the upper abdomen by use of a 2D-NLAF, which should be further examined in clinical trails. Georg Thieme Verlag KG Stuttgart New York.

  11. Blood flow response in small intestinal loops at different depths during negative pressure wound therapy of the open abdomen.

    PubMed

    Lindstedt, Sandra; Hlebowicz, Joanna

    2013-08-01

    High closure rates of the open abdomen have been reported following negative pressure wound therapy (NPWT). However, the method has occasionally been associated with increased development of intestinal fistulae. We have previously shown that the application of NPWT to the open abdomen causes a decrease in microvascular blood flow in the small intestinal loop and the omentum adjacent to the visceral protective layer of the dressing. In this study we investigate whether the negative pressure affects only small intestinal loops lying directly below the dressing or if it also affects small intestinal loops that are not in direct contact with the dressing. Six pigs underwent midline incision and application of NPWT to the open abdomen. The microvascular blood flow was measured in four intestinal loops at different depths from the visceral protective layer, at two different locations: beneath the dressing and at the anterior abdominal wall, before and after the application of NPWT of -50, -70, -100, -120, -150 and -170 mmHg, using laser Doppler velocimetry. Negative pressures between -50 and -170 mmHg caused a significant decrease in the microvascular blood flow in the intestinal loops in direct contact with the visceral protective layer. A slight, but significant, decrease in blood flow was also seen in the intestinal loops lying beneath these loops. The decrease in microvascular blood flow increased with the amount of negative pressure applied. No difference in blood flow was seen in the intestinal loops lying deeper in the abdominal cavity. A decrease in blood flow was seen in the upper two intestinal loops located apically and anteriorly, but not in the lower two, indicating that this is a local effect and that pressure decreases with distance from the source. A long-term decrease in blood flow in the intestinal wall may induce ischaemia and secondary necrosis in the intestinal wall, which could promote the development of intestinal fistulae. We believe that NPWT of

  12. Pancreatic Volvulus with Wandering Spleen and Gastric Volvulus: An Unusual Triad for Acute Abdomen in a Surgical Emergency

    PubMed Central

    Gorsi, Ujjwal; Bhatia, Anmol; Gupta, Rajesh; Bharathi, Saranga; Khandelwal, Niranjan

    2014-01-01

    Wandering spleen is a rare clinical condition which occurs due to laxity or absence of the normal intraperitoneal ligaments that hold the spleen in place. Gastric volvulus and wandering spleen share a common etiology of absence or laxity of intraperitoneal ligaments. The occurrence of simultaneous pancreatic volvulus has never been described before in adolescence. Herein, we report a case having wandering spleen with torsion, and gastric and distal pancreatic volvulus, an unusual triad in acute abdomen in an emergency setting, which has never been described before to the best of our knowledge. PMID:24976284

  13. Pancreatic volvulus with wandering spleen and gastric volvulus: an unusual triad for acute abdomen in a surgical emergency.

    PubMed

    Gorsi, Ujjwal; Bhatia, Anmol; Gupta, Rajesh; Bharathi, Saranga; Khandelwal, Niranjan

    2014-01-01

    Wandering spleen is a rare clinical condition which occurs due to laxity or absence of the normal intraperitoneal ligaments that hold the spleen in place. Gastric volvulus and wandering spleen share a common etiology of absence or laxity of intraperitoneal ligaments. The occurrence of simultaneous pancreatic volvulus has never been described before in adolescence. Herein, we report a case having wandering spleen with torsion, and gastric and distal pancreatic volvulus, an unusual triad in acute abdomen in an emergency setting, which has never been described before to the best of our knowledge.

  14. A Giant Thoracic Duct Cyst as the Cause of Abdomen Pain: A Case Report and Review of the Literature

    PubMed Central

    Wan, Xinyue

    2015-01-01

    Thoracic duct cysts, which may be of congenital or degenerative origin, are very rare lesions. Most patients are asymptomatic, but when symptoms are present they include cough, dyspnea, dysphagia and chest pain. However, in this case report a 35-year-old male patient presented to us with intermittent abdomen pain. Clinical symptoms and radiographic findings helped to identify a giant thoracic duct cyst in this patient. Surgical resection of the cyst resolved the abdominal symptoms. This was the first case reported in the literature of a thoracic duct cyst with the symptoms of abdominal pain. PMID:26004105

  15. Improving abdomen tumor low-dose CT images using dictionary learning based patch processing and unsharp filtering.

    PubMed

    Chen, Yang; Yu, Fei; Luo, Limin; Toumoulin, Christine

    2013-01-01

    Reducing patient radiation dose, while maintaining a high-quality image, is a major challenge in Computed Tomography (CT). The purpose of this work is to improve abdomen tumor low-dose CT (LDCT) image quality by using a two-step strategy: a first patch-wise non linear processing is first applied to suppress the noise and artifacts, that is based on a sparsity prior in term of a learned dictionary, then an unsharp filtering aiming to enhance the contrast of tissues and compensate the contrast loss caused by the DL processing. Preliminary results show that the proposed method is effective in suppressing mottled noise as well as improving tumor detectability.

  16. PMHS impact response in 3 m/s and 8 m/s nearside impacts with abdomen offset.

    PubMed

    Miller, Carl S; Madura, Nathaniel H; Schneider, Lawrence W; Klinich, Kathleen D; Reed, Matthew P; Rupp, Jonathan D

    2013-11-01

    Lateral impact tests were performed using seven male post-mortem human subjects (PMHS) to characterize the force-deflection response of contacted body regions, including the lower abdomen. All tests were performed using a dual-sled, side-impact test facility. A segmented impactor was mounted on a sled that was pneumatically accelerated into a second, initially stationary sled on which a subject was seated facing perpendicular to the direction of impact. Positions of impactor segments were adjusted for each subject so that forces applied to different anatomic regions, including thorax, abdomen, greater trochanter, iliac wing, and thigh, could be independently measured on each PMHS. The impactor contact surfaces were located in the same vertical plane, except that the abdomen plate was offset 5.1 cm towards the subject. The masses of the sleds and the force- deflection characteristics of the energy-absorbing interface material between the sleds were set to provide the impactor sled with a velocity profile that matched the average driver door velocity history produced in a series of side NCAP tests. Impactor padding was also selected so that average ATD pelvis and thorax responses from the same series of side NCAP tests were reproduced when the ATD used in these tests was impacted using the average door-velocity history. Each subject was first impacted on one side of the body using an initial impactor speed of 3 m/s. If a post-test CT scan and strain-gage data revealed two or fewer non-displaced rib fractures, then the PMHS was impacted on the contralateral side of the body at a speed of 8 m/s or 10 m/s. The results of tests in the 3 m/s and 8 m/s conditions were used to develop force-deflection response corridors for the abdomen, force history response corridors for the pelvis (iliac wing and greater trochanter), the midthigh, and the thorax. Response corridors for the lateral acceleration of the pelvis were also developed. Future work will compare side impact ATD

  17. Acute abdomen in pregnancy due to isolated Fallopian tube torsion: The laparoscopic treatment of a rare case

    PubMed Central

    Sidiropoulou, Zacharoula; Setúbal, António

    2014-01-01

    In the last years, operative laparoscopy became a standard approach in gynaecology and general surgery. Even in pregnancy its use is becoming more widely accepted. In fact, it offers advantages similar to those in no pregnant women, associated with good maternal and fetal outcomes. Around 0.2% of pregnant women require abdominal surgery. The most common indications of laparoscopy in pregnancy are cholelithiasis complications, appendicitis, persistent ovarian cyst and adnexal torsion. Authors describe a very rare case of acute abdomen due to isolated Fallopian tube torsion in a 24th weeks pregnant woman, managed by laparoscopic salpingectomy. PMID:25405198

  18. In vitro dose measurements in a human cadaver with abdomen/pelvis CT scans

    SciTech Connect

    Zhang, Da; Padole, Atul; Li, Xinhua; Singh, Sarabjeet; Khawaja, Ranish Deedar Ali; Lira, Diego; Shi, Jim Q.; Otrakji, Alexi; Kalra, Mannudeep K.; Liu, Bob; Liu, Tianyu; Xu, X. George

    2014-09-15

    Purpose: To present a study of radiation dose measurements with a human cadaver scanned on a clinical CT scanner. Methods: Multiple point dose measurements were obtained with high-accuracy Thimble ionization chambers placed inside the stomach, liver, paravertebral gutter, ascending colon, left kidney, and urinary bladder of a human cadaver (183 cm in height and 67.5 kg in weight) whose abdomen/pelvis region was scanned repeatedly with a multidetector row CT. The flat energy response and precision of the dosimeters were verified, and the slight differences in each dosimeter's response were evaluated and corrected to attain high accuracy. In addition, skin doses were measured for radiosensitive organs outside the scanned region with OSL dosimeters: the right eye, thyroid, both nipples, and the right testicle. Three scan protocols were used, which shared most scan parameters but had different kVp and mA settings: 120-kVp automA, 120-kVp 300 mA, and 100-kVp 300 mA. For each protocol three repeated scans were performed. Results: The tube starting angle (TSA) was found to randomly vary around two major conditions, which caused large fluctuations in the repeated point dose measurements: for the 120-kVp 300 mA protocol this angle changed from approximately 110° to 290°, and caused 8% − 25% difference in the point dose measured at the stomach, liver, colon, and urinary bladder. When the fluctuations of the TSA were small (within 5°), the maximum coefficient of variance was approximately 3.3%. The soft tissue absorbed doses averaged from four locations near the center of the scanned region were 27.2 ± 3.3 and 16.5 ± 2.7 mGy for the 120 and 100-kVp fixed-mA scans, respectively. These values were consistent with the corresponding size specific dose estimates within 4%. The comparison of the per-100-mAs tissue doses from the three protocols revealed that: (1) dose levels at nonsuperficial locations in the TCM scans could not be accurately deduced by simply scaling the

  19. In vitro dose measurements in a human cadaver with abdomen/pelvis CT scans

    PubMed Central

    Zhang, Da; Padole, Atul; Li, Xinhua; Singh, Sarabjeet; Khawaja, Ranish Deedar Ali; Lira, Diego; Liu, Tianyu; Shi, Jim Q.; Otrakji, Alexi; Kalra, Mannudeep K.; Xu, X. George; Liu, Bob

    2014-01-01

    Purpose: To present a study of radiation dose measurements with a human cadaver scanned on a clinical CT scanner. Methods: Multiple point dose measurements were obtained with high-accuracy Thimble ionization chambers placed inside the stomach, liver, paravertebral gutter, ascending colon, left kidney, and urinary bladder of a human cadaver (183 cm in height and 67.5 kg in weight) whose abdomen/pelvis region was scanned repeatedly with a multidetector row CT. The flat energy response and precision of the dosimeters were verified, and the slight differences in each dosimeter's response were evaluated and corrected to attain high accuracy. In addition, skin doses were measured for radiosensitive organs outside the scanned region with OSL dosimeters: the right eye, thyroid, both nipples, and the right testicle. Three scan protocols were used, which shared most scan parameters but had different kVp and mA settings: 120-kVp automA, 120-kVp 300 mA, and 100-kVp 300 mA. For each protocol three repeated scans were performed. Results: The tube starting angle (TSA) was found to randomly vary around two major conditions, which caused large fluctuations in the repeated point dose measurements: for the 120-kVp 300 mA protocol this angle changed from approximately 110° to 290°, and caused 8% − 25% difference in the point dose measured at the stomach, liver, colon, and urinary bladder. When the fluctuations of the TSA were small (within 5°), the maximum coefficient of variance was approximately 3.3%. The soft tissue absorbed doses averaged from four locations near the center of the scanned region were 27.2 ± 3.3 and 16.5 ± 2.7 mGy for the 120 and 100-kVp fixed-mA scans, respectively. These values were consistent with the corresponding size specific dose estimates within 4%. The comparison of the per-100-mAs tissue doses from the three protocols revealed that: (1) dose levels at nonsuperficial locations in the TCM scans could not be accurately deduced by simply scaling the

  20. Selective non-operative management of stab wounds to the posterior abdomen is safe: the Pietermaritzburg experience.

    PubMed

    Kong, Victor; Oosthuizen, George; Sartorius, Benn; Clarke, Damian

    2015-09-01

    The selective non-operative management (SNOM) of stab injuries of the anterior abdomen is well established, but its application to the posterior abdomen remains controversial. A retrospective review of 1013 patients was undertaken at a major trauma service in South Africa over a five-year period. Ninety per cent of patients were males, and the mean age was 25 years. The mean time from injury to presentation was 4h and 73% of all injuries were inflicted by knives. A total of 9% (93) of patients required a laparotomy [Group A] and 82% (833) were successfully observed without the need for operative intervention [Group B]. CT imaging was performed on 52 patients (5%) who had haematuria [Group C], 25 (3%) who had neurological deficits [Group D], and 10 (1%) with retained weapon injuries [Group E]. The accuracy of physical examination for identifying the presence of organ injury was 88%. All observed patients who required laparotomy declared themselves within 24h. There were no mortalities as direct result of our current management protocol. Selective management based on active clinical observation and serial physical examination is safe, and when coupled with the judicious use of advanced imaging, is a prudent and reliable approach in a resource constrained environment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Implications of respiratory motion for the quantification of 2D MR spectroscopic imaging data in the abdomen

    NASA Astrophysics Data System (ADS)

    Schwarz, A. J.; Leach, M. O.

    2000-08-01

    Magnetic resonance spectroscopic imaging (MRSI) studies in the abdomen or breast are acquired in the presence of respiratory motion. This modifies the point spread function (PSF) and hence the reconstructed spectra. We evaluated the quantitative effects of both periodic and aperiodic motion on spectra localized by MRSI. Artefactual signal changes, both the modification of native to a voxel and spurious signals arising elsewhere, depend primarily upon the motion amplitude relative to the voxel dimension. A similar dependence on motion amplitude was observed for simple harmonic motion (SHM), quasi-periodic motion and random displacements. No systematic dependence upon the period or initial phase of SHM or on the array size was found. There was also no significant variation with motion direction relative to the internal and external phase-encoding directions. In measured excursion ranges of 20 breast and abdominal tumours, 70% moved ≤ 5 mm, while 30% moved 6-23 mm. The diaphragm and fatty tissues in the gut typically moved ~ 15-20 mm. While tumour/organ excursions less than half the voxel dimension do not substantially affect native signals, the bleeding in of strong lipid signals will be problematic in 1H studies. MRSI studies in the abdomen, even of relatively well-anchored tumours, are thus likely to benefit from the addition of respiratory triggering or other motion compensation strategies.

  2. SU-E-P-11: Comparison of Image Quality and Radiation Dose Between Different Scanner System in Routine Abdomen CT

    SciTech Connect

    Liao, S; Wang, Y; Weng, H

    2015-06-15

    Purpose To evaluate image quality and radiation dose of routine abdomen computed tomography exam with the automatic current modulation technique (ATCM) performed in two different brand 64-slice CT scanners in our site. Materials and Methods A retrospective review of routine abdomen CT exam performed with two scanners; scanner A and scanner B in our site. To calculate standard deviation of the portal hepatic level with a region of interest of 12.5 mm x 12.5mm represented to the image noise. The radiation dose was obtained from CT DICOM image information. Using Computed tomography dose index volume (CTDIv) to represented CT radiation dose. The patient data in this study were with normal weight (about 65–75 Kg). Results The standard deviation of Scanner A was smaller than scanner B, the scanner A might with better image quality than scanner B. On the other hand, the radiation dose of scanner A was higher than scanner B(about higher 50–60%) with ATCM. Both of them, the radiation dose was under diagnostic reference level. Conclusion The ATCM systems in modern CT scanners can contribute a significant reduction in radiation dose to the patient. But the reduction by ATCM systems from different CT scanner manufacturers has slightly variation. Whatever CT scanner we use, it is necessary to find the acceptable threshold of image quality with the minimum possible radiation exposure to the patient in agreement with the ALARA principle.

  3. Repeat acute abdomen and hemoperitoneum during the same pregnancy due to a ruptured ectopic treated by salpingostomy.

    PubMed

    Canelas, Caroline M; Shih, Richard D; Clayton, Lisa M; Giroski, Laura J; Alter, Scott M; Feinstein, Stacey; Learman, Lee A

    2017-06-01

    A leading cause of maternal mortality in the first trimester is hemorrhage due to a ruptured ectopic pregnancy. With the advent of tube salvage surgery, ectopic pregnancies can be removed while ensuring hemostasis and preserving the integrity of the fallopian tube. A major drawback of tube salvage surgery is the significant risk of persistent trophoblastic tissue being left behind. We report a case of a 30year old female who presented to the ED with acute abdomen and hemoperitoneum due to a ruptured ectopic pregnancy. She was treated with salpingostomy and the pathologic report confirmed removal of the ectopic pregnancy. After an initially uneventful post-operative recovery, she presented to the ED 27days later with signs of acute abdomen and hemoperitoneum. Surgical intervention confirmed a ruptured ectopic pregnancy in the same site as previous, and salpingectomy was performed, after which the patient recovered without complications. The increased risk of persistent trophoblastic tissue associated with tube salvage surgery can lead to subsequent reoperation for tubal rupture. Patients undergoing these procedures should be closely monitored in the following weeks and undergo serial β-hCG testing in order to confirm successful removal of the ectopic. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Acute Abdomen in the 17th Week of Twin Pregnancy due to Ovarian Torsion – A Late Complication of IVF

    PubMed Central

    Habek, D.; Bauman, R.; Rukavina Kralj, L.; Hafner, T.; Turudic, T.; Vujisic, S.

    2016-01-01

    Background: A 32-year-old woman with tubal factor infertility due to bilateral laparoscopic salpingectomy conceived twins with in vitro fertilization (IVF). She developed moderate ovarian hyperstimulation syndrome which was treated with anticoagulant therapy. The subsequent course of the twin pregnancy was normal until the 17th week of gestation when she presented to hospital because of a sharp pain in the right lower abdomen which ceased after admission. Case: Except for a single incident of vomiting, patient had no other subjective symptoms. The clinical examination showed tenderness of the lower right abdominal segment on palpation. The surgeon and the urologist found no signs of an acute surgical or urologic condition, and laboratory findings were within normal reference ranges for pregnant women. Two days after admission the pain reappeared; it was now much stronger and colic-like. The pain was initially located supraumbilically but subsequently spread diffusely across the lower abdomen. Abdominal guarding was present and laboratory findings showed an increase in inflammatory parameters. An enlarged and edematous right ovary was found on transvaginal ultrasound. Conclusion: Exploratory laparotomy via a vertical midline abdominal transection revealed a torqued necrotic right ovary with elements of inflammation and inflammatory adhesions involving the entire pelvis. The patient underwent right-sided ovariectomy and adhesiolysis. Recovered was normal and the patient was delivered of healthy twins in the 37th week of gestation. PMID:28017976

  5. Rapid volumetric T1 mapping of the abdomen using three-dimensional through-time spiral GRAPPA.

    PubMed

    Chen, Yong; Lee, Gregory R; Aandal, Gunhild; Badve, Chaitra; Wright, Katherine L; Griswold, Mark A; Seiberlich, Nicole; Gulani, Vikas

    2016-04-01

    To develop an ultrafast T1 mapping method for high-resolution, volumetric T1 measurements in the abdomen. The Look-Locker method was combined with a stack-of-spirals acquisition accelerated using three-dimensional (3D) through-time spiral GRAPPA reconstruction for fast data acquisition. A segmented k-space acquisition scheme was proposed and the time delay between segments for the recovery of longitudinal magnetization was optimized using Bloch equation simulations. The accuracy of this method was validated in a phantom experiment and in vivo T1 measurements were performed with 35 asymptomatic subjects on both 1.5 Tesla (T) and 3T MRI systems. Phantom experiments yielded close agreement between the proposed method and gold standard measurements for a large range of T1 values (200 to 1600 ms). The in vivo results further demonstrate that high-resolution T1 maps (2 × 2 × 4 mm(3)) for 32 slices can be achieved in a single clinically feasible breath-hold of approximately 20 s. The T1 values for multiple organs and tissues in the abdomen are in agreement with the published literature. A high-resolution 3D abdominal T1 mapping technique was developed, which allows fast and accurate T1 mapping of multiple abdominal organs and tissues in a single breath-hold. © 2015 Wiley Periodicals, Inc.

  6. Treatment of a case of emphysematous pyelonephritis that presented with acute abdomen and pneumoperitoneum: a case report.

    PubMed

    Park, Sang Hyun; Kim, Ki Hoon

    2015-08-01

    Emphysematous pyelonephritis is a severe, life-threatening infection of the renal parenchyma and perinephric tissues. This condition is primarily encountered in patients with diabetes mellitus or ureteral obstruction, and is characterized by the production of intrarenal and perinephric gas. Emphysematous pyelonephritis is associated with a high degree of morbidity and a high mortality rate. A 72-year-old woman with a history of diabetes mellitus, hypertension, and renal calculi was referred to our emergency department following 6 days of abdominal pain. She suddenly developed pain in the entire abdomen, and was transferred. Physical examination was a distended abdomen with hypoactive bowel sounds. The tenderness was diffuse, but was most prominent in the right upper abdominal quadrant; moreover, rebound tenderness was noted. Laboratory tests revealed a white blood cell count of 4,480/mm(3), platelet count of 17,000/mm(3), creatinine level of 1.64 mg/dl, and serum glucose level of 603 mg/dl. Abdominal computed tomography indicated the presence of free air in the intraperitoneal cavity and right perirenal space, hydronephrosis of the right kidney, and stones in the right distal ureter. After 1 hour, the vital signs changed and she appeared to become drowsy. Therefore, the patient was transferred to the operation room for laparotomy. On exploration of the abdomen, 1.5 L of pus-colored fluid was removed. Although the abdominal viscera and pelvic organs were examined, hollow viscus perforation site could not be observed. Moreover, tissue necrosis and a perforation site were identified at the superior border of the right kidney. Thus, emphysematous pyelonephritis was diagnosed and she underwent right radical nephrectomy. After the surgery, the patient was admitted to the intensive care unit for postoperative management. Follow-up CT performed after 10 days showed fluid collection and hematoma at the nephrectomy site. Hence, percutaneous drainage was performed. Another

  7. Accuracy Performance of the Medtronic NexSensor™ for 6 Days in an Inpatient Setting Using Abdomen and Buttocks Insertion Sites

    PubMed Central

    Peoples, Tim; Bailey, Timothy; Brazg, Ronald; Zisser, Howard C; Janowski, Bob; Huang, Suiying; Talbot, Cary; Yang, Qingqing

    2011-01-01

    Background Users of continuous glucose monitoring are concerned with product accuracy and choice of insertion site. The Medtronic NexSensor™ was evaluated for accuracy during 6 days of wear when inserted in the abdomen and buttocks areas. Methods Adults (ages 18–75) with type 1 diabetes wore two sensors simultaneously for 6 days, one each inserted in the abdomen and buttocks. Subjects underwent a frequent blood sampling study for 12 hours, during which time reference blood glucose values were obtained every 15 minutes and compared to sensor values. Results Sixty-three subjects were enrolled, and 61 subjects completed the study. The mean agreement rate between sensor and blood glucose values was 75.5% [95% confidence interval (CI), 69.5, 81.4] at the abdomen site, 73.8% (95% CI, 68.8, 78.8) at the buttocks site, and 75.6% (95% CI, 70.8, 80.4) when sensor and reference data were combined between sites. Over 90% of paired sensor-reference values on Clarke error grids were within the A and B ranges. The mean absolute relative differences were 17.1% at the abdomen site, 16.5% at the buttocks site, and 16.8% when sites were combined. Conclusion The NexSensor was accurate for inpatient, frequent-sample testing for 6 days when inserted into the abdomen and buttocks. The results of this study also provide evidence that both the abdomen and buttocks are suitable as sensor insertion sites. PMID:21527106

  8. Exoskeleton Morphology of Three Species of Preponini, with Discussion of Morphological Similarities among Neotropical Charaxinae (Lepidoptera: Nymphalidae)-III. Abdomen and Genitalia.

    PubMed

    Bonfantti, Dayana; Casagrande, Mirna Martins; Mielke, Olaf Hermann Hendrik

    2015-06-01

    The present paper is the final part of a study of the external morphology of Preponini, which compares the abdomen and genitalia of Archaeoprepona demophon demophon (Linnaeus, 1758), Archaeoprepona licomedes licomedes (Cramer, 1777) and Prepona pylene pylene Hewitson, [1854], through descriptions and illustrations. The results are compared with three other species, Prepona claudina annetta (Gray, 1832), Memphis moruus stheno Hübner, [1819] and Zaretis itys itylus (Westwood, 1850). The abdomen is commonly the most informative tagma for butterflies. In Charaxinae, this tagma supports diagnoses of both genera and species, besides providing a solid morphological base for recent molecular findings for Preponini.

  9. An overview of systems for CT- and MRI-guided percutaneous needle placement in the thorax and abdomen.

    PubMed

    Arnolli, Maarten M; Hanumara, Nevan C; Franken, Michel; Brouwer, Dannis M; Broeders, Ivo A M J

    2015-12-01

    Minimally invasive biopsies, drainages and therapies in the soft tissue organs of the thorax and abdomen are typically performed through a needle, which is inserted percutaneously to reach the target area. The conventional workflow for needle placement employs an iterative freehand technique. This article provides an overview of needle-placement systems developed to improve this method. An overview of systems for needle placement was assembled, including those found in scientific publications and patents, as well as those that are commercially available. The systems are categorized by function and tabulated. Over 40 systems were identified, ranging from simple passive aids to fully actuated robots. The overview shows a wide variety of developed systems with growing complexity. However, given that only a few systems have reached commercial availability, it is clear that the technical community is struggling to develop solutions that are adopted clinically. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

  10. [Spontaneous isolated dissection of the superior mesenteric artery: an uncommon cause of acute abdomen. A case report].

    PubMed

    Daghfous, A; Bouzaidi, K; Rezgui Marhoul, L

    2015-02-01

    Isolated spontaneous dissection of the superior mesenteric artery is the most common digestive artery dissection. It is a rare cause of acute abdomen. Only a few hundred cases have been reported in the literature. We report a 40-year-old man with a past medical history of high blood pressure who presented abdominal pain that was related to a spontaneous dissection of the superior mesenteric artery. Computed tomography revealed an isolated dissection of superior mesenteric artery. There were no evidence of bowel ischemia. We decided a conservative treatment and the outcome was favorable, without recurrent symptoms or disease progression. Based on this case report, we discuss the etiology of this vascular lesion and the contribution of computed tomography in the diagnosis, the therapeutic strategy and the follow-up of spontaneous dissection of superior mesenteric artery. Copyright © 2014. Published by Elsevier SAS.

  11. Technique for the direct measurement of DC-like magnetic biosignals demonstrated by the cold reflex of the abdomen.

    PubMed

    Schnabel, A; Thiel, F; Mueller, W; Burghoff, M

    2004-11-30

    Very low frequency dc-like signals, such as the cold reflex, could only be measured up to now by moving the subject repeatedly, up to the magnetic detector. PTB's novel magnetically shielded room BMSR 2, together with a low noise 16 channel SQUID magnetometer, allow the recording of dc-like signals without moving the subject; these are direct measurements. The total observed magnetic drifts are limited by 1/f-noise and external disturbances to a value below 6 pT/h. The measurement is continuous in time, therefore provides frequency resolution from dc to several kHz. This allows us to also observe the changing pattern between two different static magnetic states. As an example, the measurement of the cold reflex of the abdomen is shown and discussed. Not only the expected cold reflex, but other periodic and spontaneous signals from the human body can be seen with this method.

  12. Consolidation whole abdomen irradiation following adjuvant carboplatin-paclitaxel based chemotherapy for advanced uterine epithelial cancer: feasibility, toxicity and outcomes

    PubMed Central

    2013-01-01

    Background To evaluate feasibility and preliminary outcomes associated with sequential whole abdomen irradiation (WAI) as consolidative treatment following comprehensive surgery and systemic chemotherapy for advanced endometrial cancer. Methods We conducted a retrospective analysis of patients treated at our institution from 2000 to 2011. Inclusion criteria were stage III-IV endometrial cancer patients with histological proof of one or more sites of extra-uterine abdomen-confined disease, treated with WAI as part of multimodal therapy. Endpoints were feasibility, acute toxicity, late effects, recurrence-free survival (RFS) and overall survival (OS). Twenty patients were identified. Chemotherapy consisted of 3 to 6 cycles of a platinum-paclitaxel regimen in 18 patients. WAI was delivered using conventional technique to a median total dose of 27.5 Gy. Results No grade 4 toxicities occurred during chemotherapy or radiotherapy. No radiation dose reduction was necessary. Three patients developed small bowel obstruction, all in the context of recurrent intraperitoneal disease. Kaplan-Meier estimates and 95% confidence intervals for RFS and OS at one year were 63% (38–80%) and 83% (56-94%) and at 3 years 57% (33-76%) and 62% (34-81%), respectively. On univariate Cox analysis, stage IVB and serous papillary (SP) histology were found to be statistically significantly (at the p = 0.05 level) associated with worse RFS and OS. The peritoneal cavity was the most frequent site of initial failure. Conclusions Consolidative WAI following chemotherapy is feasible and can be performed without interruption with manageable acute and late toxicity. Patients with endometrioid adenocarcinoma, especially stage FIGO III, had favorable outcomes possibly meriting prospective evaluation of the addition of WAI following chemotherapy in selected patients. Patients with SP do poorly and do not routinely benefit from this approach. PMID:24125168

  13. Influence of image registration on ADC images computed from free-breathing diffusion MRIs of the abdomen

    NASA Astrophysics Data System (ADS)

    Guyader, Jean-Marie; Bernardin, Livia; Douglas, Naomi H. M.; Poot, Dirk H. J.; Niessen, Wiro J.; Klein, Stefan

    2014-03-01

    The apparent diffusion coefficient (ADC) is an imaging biomarker providing quantitative information on the diffusion of water in biological tissues. This measurement could be of relevance in oncology drug development, but it suffers from a lack of reliability. ADC images are computed by applying a voxelwise exponential fitting to multiple diffusion-weighted MR images (DW-MRIs) acquired with different diffusion gradients. In the abdomen, respiratory motion induces misalignments in the datasets, creating visible artefacts and inducing errors in the ADC maps. We propose a multistep post-acquisition motion compensation pipeline based on 3D non-rigid registrations. It corrects for motion within each image and brings all DW-MRIs to a common image space. The method is evaluated on 10 datasets of free-breathing abdominal DW-MRIs acquired from healthy volunteers. Regions of interest (ROIs) are segmented in the right part of the abdomen and measurements are compared in the three following cases: no image processing, Gaussian blurring of the raw DW-MRIs and registration. Results show that both blurring and registration improve the visual quality of ADC images, but compared to blurring, registration yields visually sharper images. Measurement uncertainty is reduced both by registration and blurring. For homogeneous ROIs, blurring and registration result in similar median ADCs, which are lower than without processing. In a ROI at the interface between liver and kidney, registration and blurring yield different median ADCs, suggesting that uncorrected motion introduces a bias. Our work indicates that averaging procedures on the scanner should be avoided, as they remove the opportunity to perform motion correction.

  14. A novel technique for managing open abdomen with the combined use of mesh-mediated traction and the bilateral anterior rectus abdominis sheath turnover flap method: how to do it.

    PubMed

    Arai, Masatoku; Kushimoto, Shigeki; Kim, Shiei; Masuno, Tomohiko; Hagiwara, Jun; Ishii, Hiromoto; Yokota, Hiroyuki

    2015-10-01

    Proper management of abdominal compartment syndrome and open abdomen is important for improving the survival of critically ill patients. However, in cases requiring a prolonged period of open abdomen, it is frequently difficult to perform definitive fascial closure due to lateralization of the abdominal musculature. We herein present a novel combined technique for managing open abdomen. A 74-year-old male with diffuse peritonitis was transferred to our department, after which a long period of open abdomen made it difficult to achieve fascial closure. Polypropylene mesh was sutured to the fascial edges to reduce the gap, which was then serially tightened under negative pressure wound therapy. However, since it was not possible to accomplish definitive fascial closure, abdominal closure was performed using the bilateral anterior rectus abdominis sheath turnover flap method after removing the mesh, without any complications. This combined technique may be an effective alternative in patients requiring open abdomen with subsequent difficulty in achieving definitive fascial closure.

  15. Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney Disease

    PubMed Central

    Neuville, Marie; Hustinx, Roland; Jacques, Jessica; Krzesinski, Jean-Marie

    2016-01-01

    Background Acute febrile abdomen represents a diagnostic challenge in patients with autosomal dominant polycystic kidney disease (ADPKD). Although criteria have been proposed for cyst infection (CyI) and hemorrhage (CyH), there is a lack of comparative assessments. Furthermore, distinguishing cystic from non-cystic complications remains problematic. Design ADPKD patients presenting with abdominal pain and/or fever between 01/2005 and 06/2015 were retrospectively identified in a systematic computerized billing database. CyH was defined as spontaneous intracystic density above 50 Hounsfield units on computed tomography (CT). CyI was definite if confirmed by cyst puncture, and probable if 4 criteria were met: 3-day fever, loin/liver tenderness, C-reactive protein (CRP) plasma levels >50mg/L and no CT evidence for CyH. Other episodes were grouped as inflammation of unknown origin (IUO). Results Among a cohort of 173 ADPKD patients, 101 presented with 205 episodes of abdominal pain (n = 172) and/or fever (n = 33). 20 patients experienced 30 CyH, whereas 16 presented 23 episodes of definite (n = 11) or probable (n = 12) CyI. 35 IUO were observed in 31 patients. Clinically, fever was observed in 7% vs. 100% vs. 66% of CyH, CyI and IUO, respectively. Biologically, CRP cut-off at 70 mg/dl showed 92% sensitivity and 81% specificity in CyI diagnosis. Urine or blood cultures remained sterile in >90% of CyH, but were contributive in 53.4% of CyI and IUO, with a 74.2% prevalence for E. coli. Radiologically, ultrasounds, CT and magnetic resonance diagnosed CyI in 2.6%, 20% and 16.7% of cases, respectively. 18F-FDG positron-emission tomography (PET)/CT was done within a median period of 7 days post antibiotics, and significantly changed patient management in 71.4%. Conclusions This retrospective single-center series underscores the usefulness of clinical–fever–and biological–CRP–parameters, but emphasizes the limitations of bacteriological and radiological investigations

  16. Whole abdomen radiation therapy in ovarian cancers: a comparison between fixed beam and volumetric arc based intensity modulation

    PubMed Central

    2010-01-01

    Purpose A study was performed to assess dosimetric characteristics of volumetric modulated arcs (RapidArc, RA) and fixed field intensity modulated therapy (IMRT) for Whole Abdomen Radiotherapy (WAR) after ovarian cancer. Methods and Materials Plans for IMRT and RA were optimised for 5 patients prescribing 25 Gy to the whole abdomen (PTV_WAR) and 45 Gy to the pelvis and pelvic nodes (PTV_Pelvis) with Simultaneous Integrated Boost (SIB) technique. Plans were investigated for 6 MV (RA6, IMRT6) and 15 MV (RA15, IMRT15) photons. Objectives were: for both PTVs V90% > 95%, for PTV_Pelvis: Dmax < 105%; for organs at risk, maximal sparing was required. The MU and delivery time measured treatment efficiency. Pre-treatment Quality assurance was scored with Gamma Agreement Index (GAI) with 3% and 3 mm thresholds. Results IMRT and RapidArc resulted comparable for target coverage. For PTV_WAR, V90% was 99.8 ± 0.2% and 93.4 ± 7.3% for IMRT6 and IMRT15, and 98.4 ± 1.7 and 98.6 ± 0.9% for RA6 and RA15. Target coverage resulted improved for PTV_Pelvis. Dose homogeneity resulted slightly improved by RA (Uniformity was defined as U5-95% = D5%-D95%/Dmean). U5-95% for PTV_WAR was 0.34 ± 0.05 and 0.32 ± 0.06 (IMRT6 and IMRT15), 0.30 ± 0.03 and 0.26 ± 0.04 (RA6 and RA15); for PTV_Pelvis, it resulted equal to 0.1 for all techniques. For organs at risk, small differences were observed between the techniques. MU resulted 3130 ± 221 (IMRT6), 2841 ± 318 (IMRT15), 538 ± 29 (RA6), 635 ± 139 (RA15); the average measured treatment time was 18.0 ± 0.8 and 17.4 ± 2.2 minutes (IMRT6 and IMRT15) and 4.8 ± 0.2 (RA6 and RA15). GAIIMRT6 = 97.3 ± 2.6%, GAIIMRT15 = 94.4 ± 2.1%, GAIRA6 = 98.7 ± 1.0% and GAIRA15 = 95.7 ± 3.7%. Conclusion RapidArc showed to be a solution to WAR treatments offering good dosimetric features with significant logistic improvements compared to IMRT. PMID:21078145

  17. Whole abdomen radiation therapy in ovarian cancers: a comparison between fixed beam and volumetric arc based intensity modulation.

    PubMed

    Mahantshetty, Umesh; Jamema, Swamidas; Engineer, Reena; Deshpande, Deepak; Sarin, Rajiv; Fogliata, Antonella; Nicolini, Giorgia; Clivio, Alessandro; Vanetti, Eugenio; Shrivastava, Shyamkishore; Cozzi, Luca

    2010-11-15

    A study was performed to assess dosimetric characteristics of volumetric modulated arcs (RapidArc, RA) and fixed field intensity modulated therapy (IMRT) for Whole Abdomen Radiotherapy (WAR) after ovarian cancer. Plans for IMRT and RA were optimised for 5 patients prescribing 25 Gy to the whole abdomen (PTV_WAR) and 45 Gy to the pelvis and pelvic nodes (PTV_Pelvis) with Simultaneous Integrated Boost (SIB) technique. Plans were investigated for 6 MV (RA6, IMRT6) and 15 MV (RA15, IMRT15) photons. Objectives were: for both PTVs V90% > 95%, for PTV_Pelvis: Dmax < 105%; for organs at risk, maximal sparing was required. The MU and delivery time measured treatment efficiency. Pre-treatment Quality assurance was scored with Gamma Agreement Index (GAI) with 3% and 3 mm thresholds. IMRT and RapidArc resulted comparable for target coverage. For PTV_WAR, V90% was 99.8 ± 0.2% and 93.4 ± 7.3% for IMRT6 and IMRT15, and 98.4 ± 1.7 and 98.6 ± 0.9% for RA6 and RA15. Target coverage resulted improved for PTV_Pelvis. Dose homogeneity resulted slightly improved by RA (Uniformity was defined as U5-95% = D5%-D95%/Dmean). U5-95% for PTV_WAR was 0.34 ± 0.05 and 0.32 ± 0.06 (IMRT6 and IMRT15), 0.30 ± 0.03 and 0.26 ± 0.04 (RA6 and RA15); for PTV_Pelvis, it resulted equal to 0.1 for all techniques. For organs at risk, small differences were observed between the techniques. MU resulted 3130 ± 221 (IMRT6), 2841 ± 318 (IMRT15), 538 ± 29 (RA6), 635 ± 139 (RA15); the average measured treatment time was 18.0 ± 0.8 and 17.4 ± 2.2 minutes (IMRT6 and IMRT15) and 4.8 ± 0.2 (RA6 and RA15). GAIIMRT6 = 97.3 ± 2.6%, GAIIMRT15 = 94.4 ± 2.1%, GAIRA6 = 98.7 ± 1.0% and GAIRA15 = 95.7 ± 3.7%. RapidArc showed to be a solution to WAR treatments offering good dosimetric features with significant logistic improvements compared to IMRT.

  18. Comparison of muscular activities in the abdomen and lower limbs while performing sit-up and leg-raise.

    PubMed

    Kim, Kanghoon; Lee, Taesik

    2016-01-01

    [Purpose] This study compared the muscle activities of sit-up and leg-raise. [Subjects and Methods] The subjects of this study were healthy students in their 20s. For electromyography of sit-ups and leg-raises in the supine position, 5 muscle groups of the abdomen were selected for the attachment of sensors: the upper and lower rectus abdominis, external oblique, rectus femoris, and the iliopsoas. SPSS 20.0 was used for the statistical analysis. One-way ANOVA with repeated measures of all factors was performed to verify the statistical significance of the measurements taken for the muscle activities and follow-up verification was made with the Bonferroni post hoc test. [Results] Sit-up and leg raise showed a significant difference. The eccentric sit-up exercise elicited a significant increase in the activation of the abdominal muscle. The leg raise and eccentric sit-up exercises elicited significant increases in the activation of hip flexor muscle. [Conclusion] The eccentric sit-up had the most outstanding effect on the abdominal muscles involved in stability of the trunk.

  19. Comparison of muscular activities in the abdomen and lower limbs while performing sit-up and leg-raise

    PubMed Central

    Kim, Kanghoon; Lee, Taesik

    2016-01-01

    [Purpose] This study compared the muscle activities of sit-up and leg-raise. [Subjects and Methods] The subjects of this study were healthy students in their 20s. For electromyography of sit-ups and leg-raises in the supine position, 5 muscle groups of the abdomen were selected for the attachment of sensors: the upper and lower rectus abdominis, external oblique, rectus femoris, and the iliopsoas. SPSS 20.0 was used for the statistical analysis. One-way ANOVA with repeated measures of all factors was performed to verify the statistical significance of the measurements taken for the muscle activities and follow-up verification was made with the Bonferroni post hoc test. [Results] Sit-up and leg raise showed a significant difference. The eccentric sit-up exercise elicited a significant increase in the activation of the abdominal muscle. The leg raise and eccentric sit-up exercises elicited significant increases in the activation of hip flexor muscle. [Conclusion] The eccentric sit-up had the most outstanding effect on the abdominal muscles involved in stability of the trunk. PMID:27065536

  20. Acute abdomen due to ovarian congestion: a fallopian tube accompanied by a paratubal cyst, coiling tightly round the ovary.

    PubMed

    Kaido, Yoshitaka; Kikuchi, Akihiko; Kanasugi, Tomonobu; Fukushima, Akimune; Sugiyama, Toru

    2013-01-01

    We experienced an unreported rare case with an adnexal mass causing severe acute abdomen during pregnancy. A 30-year-old Japanese pregnant woman was transported to our hospital for her right lower abdominal pain at 30 weeks of gestation. Magnetic resonance imaging and ultrasound demonstrated a cyst measuring 3-4 cm in diameter adjacent to the right ovary, and a parovarian cyst was considered to be the most probable diagnosis. We strongly suspected torsion of the ovarian pedicle or fallopian tube in conjunction with her clinical symptoms. Laparotomy revealed that the elongated right fallopian tube accompanied by a paratubal cyst was coiling tightly 2.5 times round the right ovary, causing apparent congestion and enlargement of the right ovary. Soon after we released the congested right ovary from the coiling of the fallopian tube, the congestion subsided. The postoperative course was favorable, and pregnancy and delivery were uneventful. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  1. Relative Kinematics of the Rib Cage and Abdomen during Speech and Nonspeech Behaviors of 15-Month-Old Children

    PubMed Central

    Moore, Christopher A.; Caulfield, Tammy J.; Green, Jordan R.

    2010-01-01

    Speech motor control emerges in the neurophysiologic context of widely distributed, powerful coordinative mechanisms, including those mediating respiratory function. It is unknown, however, whether developing children are able to exploit the capabilities of neural circuits controlling homeostasis for the production of speech and voice. Speech and rest breathing were investigated in eleven 15-month-old children using inductance plethysmography (Respitrace). Rib cage and abdominal kinematics were studied using a time-varying correlational index of thoracoabdominal coupling (i.e., reflecting the synchrony of movement of the rib cage and abdomen) as well as simple classification of the moment-to-moment kinematic relationship of these two functional components (i.e., concurrent expansion or compression, or oppositional movement). Results revealed markedly different patterns of movement for rest breathing and speech breathing, although within types of vocalization (nonspeech vocalization, babbling, true word production) no differences were apparent. Whereas rest breathing was characterized by tight coupling of rib cage and abdominal movement (average correlation coefficients usually exceeded .90), speech breathing exhibited weak coupling (the correlation coefficient ranged widely, but averaged about .60). Furthermore, speech production by these toddlers included the occurrence of both rib cage and abdominal paradoxing, which are observed infrequently in adult speakers. These results fail to support the suggestion that speech emerges from the extant coordinative organization of rest breathing. Rather, even in its earliest stages breathing for speech and voice exhibits kinematic properties distinct from those of other observed behaviors. PMID:11218112

  2. Mechanosensilla in the adult abdomen of Drosophila: engrailed and slit help to corral the peripheral sensory axons into segmental bundles.

    PubMed

    Fabre, Caroline C G; Casal, José; Lawrence, Peter A

    2010-09-01

    The abdomen of adult Drosophila bears mechanosensory bristles with axons that connect directly to the CNS, each hemisegment contributing a separate nerve bundle. Here, we alter the amount of Engrailed protein and manipulate the Hedgehog signalling pathway in clones of cells to study their effects on nerve pathfinding within the peripheral nervous system. We find that high levels of Engrailed make the epidermal cells inhospitable to bristle neurons; sensory axons that are too near these cells are either deflected or fail to extend properly or at all. We then searched for the engrailed-dependent agent responsible for these repellent properties. We found slit to be expressed in the P compartment and, using genetic mosaics, present evidence that Slit is the responsible molecule. Blocking the activity of the three Robo genes (putative receptors for Slit) with RNAi supported this hypothesis. We conclude that, during normal development, gradients of Slit protein repel axons away from compartment boundaries - in consequence, the bristles from each segment send their nerves to the CNS in separated sets.

  3. Cell rearrangements, cell divisions and cell death in a migrating epithelial sheet in the abdomen of Drosophila.

    PubMed

    Bischoff, Marcus; Cseresnyés, Zoltán

    2009-07-01

    During morphogenesis, cell movements, cell divisions and cell death work together to form complex patterns and to shape organs. These events are the outcome of decisions made by many individual cells, but how these decisions are controlled and coordinated is elusive. The adult abdominal epidermis of Drosophila is formed during metamorphosis by divisions and extensive cell migrations of the diploid histoblasts, which replace the polyploid larval cells. Using in vivo 4D microscopy, we have studied the behaviour of the histoblasts and analysed in detail how they reach their final position and to what extent they rearrange during their spreading. Tracking individual cells, we show that the cells migrate in two phases that differ in speed, direction and amount of cellular rearrangement. Cells of the anterior (A) and posterior (P) compartments differ in their behaviour. Cells near the A/P border are more likely to change their neighbours during migration. The mitoses do not show any preferential orientation. After mitosis, the sisters become preferentially aligned with the direction of movement. Thus, in the abdomen, it is the extensive cell migrations that appear to contribute most to morphogenesis. This contrasts with other developing epithelia, such as the wing imaginal disc and the embryonic germband in Drosophila, where oriented mitoses and local cell rearrangements appear to direct morphogenesis. Furthermore, our results suggest that an active force created by the histoblasts contributes to the formation of the adult epidermis. Finally, we show that histoblasts occasionally undergo apoptosis.

  4. The pregenital abdomen of Enicocephalomorpha and morphological evidence for different modes of communication at the dawn of heteropteran evolution.

    PubMed

    Davranoglou, Leonidas-Romanos; Baňař, Petr; Schlepütz, Christian M; Mortimer, Beth; Taylor, Graham K

    2017-09-20

    The internal and external anatomy of the posterior metathoracic region, pregenital abdomen, and associated nervous system of the heteropteran infraorder Enicocephalomorpha are thoroughly described, using an array of state-of-the art techniques. Based on morphology, it is hypothesised which modes of communication these insects use. This study is based primarily on an undescribed species of Cocles Bergroth, 1905 (Enicocephalidae) and another undescribed species of Lomagostus Villiers, 1958 (Aenictopecheidae), but additional representatives of the infraorder are also examined. Our results are compared with the literature on other Heteroptera. The metathoracic scent gland system of Enicocephalomorpha uses the same muscles as that of more derived Heteroptera, although the efferent system is different. The presence of a tergal plate and well-developed longitudinal musculature in the families Enicocephalidae and Aenictopecheidae, as well as a sexually dimorphic set of sclerites and membranes that allow an as yet undetermined type of motion, may indicate the presence of vibrational signaling in the infraorder, although experimental confirmation is required. Our findings raise new research questions regarding heteropteran functional morphology and communication. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Stab wounds of the anterior abdomen. Analysis of a management plan using local wound exploration and quantitative peritoneal lavage.

    PubMed Central

    Oreskovich, M R; Carrico, C J

    1983-01-01

    A management plan for stab wounds to the anterior abdomen incorporating local wound exploration and quantitative peritoneal lavage was applied to 572 patients. One hundred eighty-five of these patients presented with shock, peritonitis, or evisceration and underwent immediate exploratory laparotomy with the finding of an intraperitoneal organ injury in 183 (99%). The remaining 387 patients with a negative physical examination underwent exploration of the stab wound to determine fascial penetration. Wound exploration was negative in 151 of these patients and they were discharged from the emergency room. Two hundred thirty-six additional patients had penetration of the fascia and underwent peritoneal lavage. Ninety-two per cent of patients with lavage counts greater than 50,000 had an intraperitoneal organ injury. No patients with lavage counts less than 1,000 red cells had an organ injury. Forty-three per cent of patients in the intermediate group (1,000-50,000 RBCs/mm3) had an organ injury and 59% included penetration of a hollow viscus. An approach incorporating local wound exploration and quantitative peritoneal lavage followed by exploratory laparotomy for red blood cell counts greater than 1,000 should result in less than 10% negative laparotomies and no missed injuries. PMID:6625712

  6. Castleman disease of the abdomen--single-center experience of 13 surgically treated patients over 11 years.

    PubMed

    Kim, Myung-Hwa; Hwang, Shin; Choi, Youn-Baik; Oh, Sung-Tae; Kim, Song-Cheol; Choi, Gun-Moo; Ahn, Chul-Soo; Kim, Ki-Hun; Moon, Deok-Bog; Ha, Tae-Yong; Song, Gi-Won; Jung, Dong-Hwan; Yu, Eun-Sil; Lee, Sung-Gyu

    2010-01-01

    Castleman disease (CD) is a lymphocytic hyperplastic disease, also known as angiofollicular lymphoid hyperplasia and giant lymph node hyperplasia, which rarely occurs in the abdomen. We analyzed the clinical manifestations in 13 patients treated surgically at our center for abdominal CD lesions. We retrospectively reviewed the medical records of 13 patients with abdominal CD who underwent surgery at our institution in the 11-year period from January 1998 to May 2009. Of the 13 patients, 8 were women; their mean +/- SD age was 47.1 +/- 12.0 years. CD was incidentally found in seven patients with no symptoms. Only 3 patients were preoperatively suspected of CD, with 10 suspected of other diseases. Twelve of the 13 patients (92.3%) underwent excisional surgery, with 11, 1 and 1 undergoing R0, R1, and R2 resections, respectively. Eleven tumors were hyaline vascular type and two were plasma cell type. After a mean follow-up of 63.3 months, only one patient showed recurrence, but this patient remains progression-free 7 years after repeat resection. Abdominal CD is a rare disease that is often misdiagnosed due to the absence of specific clinical manifestations. Definitive diagnosis requires histologic examination of the surgical specimen. Excisional surgery is the method of choice for unicentric abdominal CD, and is associated with a low incidence of recurrence.

  7. Acute abdomen caused by bladder rupture attributable to neurogenic bladder dysfunction following a stroke: a case report

    PubMed Central

    2011-01-01

    Introduction Spontaneous bladder rupture is a rare and serious event with high mortality. It is not often considered in the patient presenting with peritonitis. This often leads to delays in diagnosis. There are very few case reports of true spontaneous rupture in the literature. This is the first such reported case in which bladder rupture was attributable to neurogenic bladder dysfunction following a stroke. Case presentation We report the case of a 67-year-old Caucasian man who presented with lower abdominal pain and a peritonitic abdomen. He had a long-term urethral catheter because of urinary retention following a previous stroke. He was treated conservatively with antibiotics before a surgical opinion was sought. Exploratory laparotomy confirmed the diagnosis of spontaneous bladder rupture. After repair of the defect, he eventually made a full recovery. Conclusion In this unusual case report, we describe an example of a serious event in which delays in diagnosis may lead to increased morbidity and mortality. To date, no unifying theory explaining why rupture occurs has been postulated. We conducted a thorough literature search to examine the etiological factors in other published cases. These etiological factors either increase intra-vesical pressure or decrease the strength of the bladder wall. We hope that by increasing awareness of these etiological factors, spontaneous bladder rupture may be diagnosed earlier and appropriate therapy started. PMID:21714888

  8. Location of Radicular Spinal Arteries in the Lumbar Spine from Analysis of CT Angiograms of the Abdomen and Pelvis.

    PubMed

    Simon, Jeremy I; McAuliffe, Matthew; Smoger, David

    2016-01-01

    Reports of catastrophic neurologic injuries following lumbar transforaminal epidural steroid injections are rare but serious potential complications. The traditional method of performing lumbar transforaminal epidural steroid injections is in the "safe triangle" to avoid contact to the spinal nerve. Some authors advocate an alternative approach by placing the needle inferiorly in a region referred to as "Kambin's triangle" to avoid incurring arteries. This study aimed to determine the location of arteries within the L1-L4 intervertebral foramen in vivo, specifically if they lie within or in close proximity to the "safe triangle" or Kambin's triangle using CT angiograms of the abdomen and pelvis. The authors retrospectively evaluated the location in vivo of arterial vessels in the intervertebral foramen from L1 to L4 in patients who underwent abdominopelvic CT angiograms for aortic vascular disease. The data were reanalyzed to confirm inter-rater reliability. Arteries were found in both the safe triangle and Kambin's triangle at a statistically significant rate (P < 0.05). In this group of patients, an artery was found in either the safe triangle or in Kambin's triangle frequently, suggesting the location of these arteries can be quite variable. Physicians performing these procedures should use universal precautions to avoid inadvertent injection into the lumbar spinal arteries and minimize potential complications regardless of the approach. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.

  9. [Removal of weremit from the abdomen. Interpretation and efficacy of an ancient Egyptian prescription by the newest scientific results].

    PubMed

    Katona, Júlia; Győry, Hedvig; Blázovics, Anna

    2015-12-13

    Significant percentage of today's knowledge of ancient Egyptian medicine has been acquired from papyri left behind from various periods of Egyptian history. The longest and the most comprehensive is the Ebers papyrus, kept at the University Museum of Leipzig, which was written more than one thousand years before Hippocrates (c. 460-377 BC). One of the riddles among the prescriptions of the Ebers papyrus Eb20 has been used in order to remove the so called "wemyt" weremit from the abdomen with the help of a drink, which consists of "jnnk", Conyza dioscoridis in milk or sweet beer. The authors assume that the disease could be an infection of Schistosoma haematobium and/or Schistosoma mansoni. Nowadays the tea of Conyza dioscoridis is widely used as an important part of traditional medicine against rheumatism, intestinal distention and cramps, as well as an antiperspirant, and with external use for wound healing. The authors' intent is to interpret the efficacy of the above-mentioned ancient prescription with the help of modern medical and pharmaceutical knowledge.

  10. Surgical treatment of severe necrotizing pancreatitis by the method of "open abdomen"--early and long-term results.

    PubMed

    Piotrowski, Z; Tołwiński, W

    2000-01-01

    The aim of our study was the evaluation of "open abdomen" method (OAM) in treatment of severe acute pancreatitis. Fifty patients were treated by this technique in our Department from 1983 to 1999 year. Patients were retrospectively classified into 3 groups: with sterile pancreatic necrosis (SPN), pancreatic abscess(PA) and infected pancreatic necrosis(IPN). Early results embraced: number of local and general complications and a lot of parameters, which let to recognise objectively efficiency of management(time of hospital and intensive care unit stay, time of total parenteral nutrition, number of reoperations and others). These results were compared with analogical groups, in which used other management. Long-term results embraced the pancreatic efficiency tests in 24 patients in period 2-16 years after surgical treatment of OAM. Based on these results three groups of patients were separated: 12 persons (50%) recognised healthy, 4 (17%) with exocrine insufficiency of pancreas and 8 (33%) with exocrine and endocrine insufficiency of pancreas. Our results prove that OAM is the efficient treatment of IPN, but it shouldn't be used in cases of PA or SPN. Patients after OAM need prospective monitoring of exocrine and endocrine pancreatic function due to serious risk of this organ dysfunction.

  11. The experience and training of British general surgeons in trauma surgery for the abdomen, thorax and major vessels.

    PubMed

    Brooks, A; Butcher, W; Walsh, M; Lambert, A; Browne, J; Ryan, J

    2002-11-01

    The report Better Carefor the Severely Injured [London: The Royal College of Surgeons of England and the British Orthopaedic Association; 2000] states that an experienced general surgeon trained in the techniques required to perform life-saving emergency surgery is vital in the management of major trauma. The experience and training of general surgeons in the UK in the management of trauma to the abdomen, thorax and major vessels has never been assessed. Postal questionnaire sent to UK general surgical consultants and Higher Surgical Trainees (HSTs). A total of 854 (48%) questionnaires were completed. Of respondents, 85% believe that major trauma should be directed to hospitals that provide a dedicated trauma service. Of non-vascular specialists, 43% felt their training was adequate to manage vascular trauma and only one-third of general surgical consultants felt adequately prepared to manage acute cardiothoracic injuries. The median number of trauma laparotomies undertaken annually was 2 for blunt injury and 1 for penetrating injury. Of HSTs, 21% had not performed a splenectomy for trauma and 44% had no experience of packing for liver injuries. There is limited experience and training in the surgical management of torso trauma in the UK. Implementation of the recommendations from Better Care for the Severely Injured will be hampered unless steps are taken to maximise experience and improve training.

  12. Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

    PubMed Central

    Lepore, Anna; D’Antini, Davide; Raimondo, Pasquale; Mirabella, Lucia; Pennisi, Leonardo; Carrillo, Giuseppe; Cotoia, Antonella; Dambrosio, Michele; Cinnella, Gilda

    2016-01-01

    Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy. PMID:27853393

  13. The prevalence of incidental findings on computed tomography of the abdomen/pelvis in pediatric trauma patients.

    PubMed

    Onwubiko, C; Mooney, D P

    2017-06-08

    Computed tomography scans of the abdomen/pelvis (CTAP) in the adult population may reveal findings unrelated to the injury, such as a mass; the occurrence of incidental findings in pediatric patients remains unknown. This study aims to determine the percentage of pediatric trauma patients with incidental findings. Data regarding consecutive 250 patients who underwent CTAP during their evaluation were retrieved from our level 1 pediatric trauma center trauma registry. Interpretations were reviewed for mention of incidental findings. Records for patients with incidental findings were examined to determine what further evaluation occurred. Nine patients were excluded due to incomplete records. Of the remaining 241 patients, 114 incidental findings were identified among 86 (35.7%) patients. There were 47 clinically significant incidental findings, occurring in 41 (17%) patients. Seven patients (8.1%) had further workup of their findings; Three (3.5%) went on to have an operation (two patients with ureteropelvic junction obstruction and one with high-riding testicle). No potential tumors were found in this population. Incidental findings were mentioned in 25.5% of discharge summaries. Pediatric trauma CTAP reveals incidental findings at a lower rate than in their adult counterparts. Documentation of findings should be improved for optimal care of the injured child.

  14. Aromatherapy massage on the abdomen for alleviating menstrual pain in high school girls: a preliminary controlled clinical study.

    PubMed

    Hur, Myung-Haeng; Lee, Myeong Soo; Seong, Ka-Yeon; Lee, Mi-Kyoung

    2012-01-01

    This study investigated the alleviating effects of aromatherapy massage and acetaminophen on menstrual pain in Korean high school girls. Subjects were divided into two groups: the aromatherapy massage (treatment) group (n = 32) and the acetaminophen (control) group (n = 23). Aromatherapy massage was performed on subjects in the treatment group. The abdomen was massaged once using clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil. The level of menstrual pain was assessed using a visual analogue scale at baseline and twenty-four hours afterward. The reduction of menstrual pain was significantly higher in the aromatherapy group than in the acetaminophen group. Using multiple regression, aromatherapy massage was found to be more highly associated with reduction in the level of menstrual pain than acetaminophen. These finding suggest that aromatherapy massage may be an effective treatment for menstrual pain in high school girls. However, it could not be verified whether the positive effects derived from the aromatherapy, the massage, or both. Further rigorous studies should be conducted using more objective measures.

  15. Aromatherapy Massage on the Abdomen for Alleviating Menstrual Pain in High School Girls: A Preliminary Controlled Clinical Study

    PubMed Central

    Hur, Myung-Haeng; Lee, Myeong Soo; Seong, Ka-Yeon; Lee, Mi-Kyoung

    2012-01-01

    This study investigated the alleviating effects of aromatherapy massage and acetaminophen on menstrual pain in Korean high school girls. Subjects were divided into two groups: the aromatherapy massage (treatment) group (n = 32) and the acetaminophen (control) group (n = 23). Aromatherapy massage was performed on subjects in the treatment group. The abdomen was massaged once using clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil. The level of menstrual pain was assessed using a visual analogue scale at baseline and twenty-four hours afterward. The reduction of menstrual pain was significantly higher in the aromatherapy group than in the acetaminophen group. Using multiple regression, aromatherapy massage was found to be more highly associated with reduction in the level of menstrual pain than acetaminophen. These finding suggest that aromatherapy massage may be an effective treatment for menstrual pain in high school girls. However, it could not be verified whether the positive effects derived from the aromatherapy, the massage, or both. Further rigorous studies should be conducted using more objective measures. PMID:21949670

  16. Variability of motoneuron activation and the modulation of force production in a postural reflex of the hermit crab abdomen.

    PubMed

    Krans, Jacob L; Chapple, William D

    2005-08-01

    The tri-phasic reflex in hermit crab (Pagurus pollicarus) abdomen is triggered by local mechanoreceptors and is essential for postural control. The reflex consists of three stereotypical phases: a brief, high-frequency burst, a transient cessation of firing, and a late-discharge that is much lower in frequency than the initial burst. To better understand the reflex generation of force, variability of motoneuron discharge in each of five parameters of reflex activation was assessed. An intracellular current injection routine was used to correlate each of these parameters with force production. Phase 3 motoneuron firing frequency showed the greatest correlation with force production. Phase 3 spike rate increased as a function of phase 2 duration, but the relationship between phase 2 duration and force produced by the reflex was weak. Junction potential amplitude decreased as phase 2 duration increased, and we hypothesize that this trend counteracts the increased phase 3 frequency, explaining the weak relationship of phase 2 duration and force production. Surprisingly, when phase 3 frequency was held constant and phase 2 was increased in duration, the concurrent decrease in junction potential amplitude did not reduce force production.

  17. Deflection corridors of abdomen and thorax in oblique side impacts using equal stress equal velocity approach: comparison with other normalization methods.

    PubMed

    Yoganandan, Narayan; Arun, Mike W J; Humm, John; Pintar, Frank A

    2014-10-01

    The first objective of the study was to determine the thorax and abdomen deflection time corridors using the equal stress equal velocity approach from oblique side impact sled tests with postmortem human surrogates fitted with chestbands. The second purpose of the study was to generate deflection time corridors using impulse momentum methods and determine which of these methods best suits the data. An anthropometry-specific load wall was used. Individual surrogate responses were normalized to standard midsize male anthropometry. Corridors from the equal stress equal velocity approach were very similar to those from impulse momentum methods, thus either method can be used for this data. Present mean and plus/minus one standard deviation abdomen and thorax deflection time corridors can be used to evaluate dummies and validate complex human body finite element models.

  18. Estimates of the image quality and the radiation dose for head and abdomen phantom image acquisition by using dual-energy CT

    NASA Astrophysics Data System (ADS)

    Kim, Dae-Hong; Kim, Hee-Joung; Lee, Chang-Lae; Jeon, Pil-Hyun; Lee, Won-Hyung; Jeon, Sung-Soo

    2012-04-01

    Using dual-energy computed tomography (CT) scans, we obtained images from a raw data set by using low- and high-energy scans (usually 80 and 140 kV, respectively). Generally, the head and the abdomen examinations were performed using single-energy (120 kV) scanning with a routine exposure protocol, and the images were used for diagnostic interpretation. The dual-energy CT scans can also be used for diagnosis by using the linearly-mixed method with low- and high-energy images. In the current study, we evaluated mixed images in dual-energy and single-energy scans for image quality and radiation dose. The CT scan protocol for single energy was adopted from IEC protocols, and the recommended dose from the EC. The dual-energy scan protocol was based on the Siemens dual-energy CT scan protocol. The CT scan protocols were extended further in the mA range for both scans to estimate the image quality corresponding to these dose alternations. The results demonstrate that the Contrast-to-noise ratio (CNR) value of a dual-energy mixed image is higher than that of a single-energy image in similar dose regions for both the head and the abdomen phantoms. We observed that the dual-energy images could reduce the dose compared to single-energy images. In the abdomen phantom study, the CNR of dual-energy images was even higher than that of single-energy images with half the radiation dose of the single-energy scan. Therefore, the dual-energy CT scan can accomplish a remarkable dose reduction while preserving image quality for head and abdomen imaging.

  19. Staged repair of severe open abdomens due to high-energy gunshot injuries with early vacuum pack and delayed tissue expansion and dual-sided meshes.

    PubMed

    Alhan, Doğan; Şahin, İsmail; Güzey, Serbülent; Aykan, Andaç; Zor, Fatih; Öztürk, Serdar; Nışancı, Mustafa; Özerhan, İsmail Hakkı

    2015-12-01

    Open abdomen is a salvage procedure that prevents catastrophes after severe intraabdominal traumas. However, following this life saving attempt, it is mostly not feasible to close the abdomen immediately after the recovery of intraabdominal injuries. Consequently, a staged reconstruction is required, and the first stage is usually a temporary closing approach. At the end of this stage, resulting giant "ventral hernia" is a burden for both the patient and the surgeon. Therefore a permanent repair is subsequently needed. Although there are many treatment modalities described for this goal, etiologies like high-energy gunshots may cause an exactly nuisance scene which can limit treatment options and reduce final success. Herein, it was the objective of this study to present our staged protocol to restore the abdominal wall defect and strategy for optimizing the results in such conundrum cases. Treatment was performed on nine male patients suffering from severe open abdomen due to high-energy gunshot injury. In all patients, temporary closure was provided by negative pressure wound treatment applied directly to the viscera and followed by skin grafting. Late permanent closure was performed with the lamination of expanded abdominal skin and dual-sided meshes. The follow-up period ranged between 24 months to 4.5 years (mean, 3 years). During this period, no recurrence of ventral hernia, enteric fistula formation, abdominal infection and seroma formation was observed in any patient. In this study, NPWT, tissue expansion and dual-sided mesh were used together as a staged procedure for optimizing the results in the clinical scenario of an open abdomen due to high-energy gunshot wound. Results were highly satisfactory for patients and acceptable aesthetically.

  20. Desmoplastic small round cell tumor in the abdomen and pelvis: report of CT findings in 11 affected children and young adults.

    PubMed

    Bellah, Richard; Suzuki-Bordalo, Lisa; Brecher, Eric; Ginsberg, Jill P; Maris, John; Pawel, Bruce R

    2005-06-01

    Our objective was to evaluate the CT features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis in pediatric and young adult patients. Characteristic CT features of DSRCT include bulky intraabdominal soft-tissue masses that involve omental and serosal surfaces, without a distinct organ of origin; solid, dominant, heterogeneous pelvic masses in the retrovesical or rectouterine spaces; and concurrent metastases, common at the time of diagnosis, particularly those involving lymph nodes and liver.

  1. Adaptive iterative dose reduction (AIDR) 3D in low dose CT abdomen-pelvis: Effects on image quality and radiation exposure

    NASA Astrophysics Data System (ADS)

    Ang, W. C.; Hashim, S.; Karim, M. K. A.; Bahruddin, N. A.; Salehhon, N.; Musa, Y.

    2017-05-01

    The widespread use of computed tomography (CT) has increased the medical radiation exposure and cancer risk. We aimed to evaluate the impact of AIDR 3D in CT abdomen-pelvic examinations based on image quality and radiation dose in low dose (LD) setting compared to standard dose (STD) with filtered back projection (FBP) reconstruction. We retrospectively reviewed the images of 40 patients who underwent CT abdomen-pelvic using a 80 slice CT scanner. Group 1 patients (n=20, mean age 41 ± 17 years) were performed at LD with AIDR 3D reconstruction and Group 2 patients (n=20, mean age 52 ± 21 years) were scanned with STD using FBP reconstruction. Objective image noise was assessed by region of interest (ROI) measurements in the liver and aorta as standard deviation (SD) of the attenuation value (Hounsfield Unit, HU) while subjective image quality was evaluated by two radiologists. Statistical analysis was used to compare the scan length, CT dose index volume (CTDIvol) and image quality of both patient groups. Although both groups have similar mean scan length, the CTDIvol significantly decreased by 38% in LD CT compared to STD CT (p<0.05). Objective and subjective image quality were statistically improved with AIDR 3D (p<0.05). In conclusion, AIDR 3D enables significant dose reduction of 38% with superior image quality in LD CT abdomen-pelvis.

  2. CT-soft tissue window of the cranial abdomen in clinically normal dogs: an anatomical description using macroscopic cross-sections with vascular injection.

    PubMed

    Rivero, M A; Vázquez, J M; Gil, F; Ramírez, J A; Vilar, J M; De Miguel, A; Arencibia, A

    2009-02-01

    The aim of this study was to provide a detailed anatomic atlas of the cranial abdomen by means of computed tomography (CT). Three mature dogs, all mixed breed males, were used. The dogs were sedated, anaesthetized and positioned in sternal recumbency. CT scans from the eighth thoracic vertebra to the fourth lumbar vertebra were performed using a third-generation equipment (TOSHIBA 600HQ scanner) with 1 cm slice thickness. CT-images of the cranial abdomen were taken with soft-tissue window (WL: -14, WW: 658) settings. Dogs were killed and vascular-injection technique was performed: red and blue latex filled the vascular system. Injected dogs were frozen in the same position as used for CT examination and sectioned with an electric bandsaw at 1-cm-thick intervals. The cuts matched as closely as possible to the CT-images. The anatomic sections were compared and studied with the corresponding CT-images, and clinically relevant abdominal anatomic structures were identified and labelled on the corresponding CT-images. The results of our study could be used as a reference for evaluating CT-images of the canine cranial abdomen with abdominal diseases.

  3. Comparison of SAR in realistic fetus models of two fetal positions exposed to electromagnetic wave from business portable radio close to maternal abdomen.

    PubMed

    Akimoto, Shimpei; Nagaoka, Tomoaki; Saito, Kazuyuki; Watanabe, Soichi; Takahashi, Masaharu; Ito, Koichi

    2010-01-01

    Since the diversification of the electromagnetic (EM) environment is spreading, it is essential to estimate the EM energy absorption rate [specific absorption rate (SAR)] of a pregnant woman's body and her fetus under various exposure situations. For example, if pregnant women work in jobs where they might wear business portable radios around their abdomens, they should also be concerned about this issue, because the fetuses are in their abdomens. In this paper, in order to evaluate the SAR in the pregnant woman and her fetus when wearing the wireless radio terminal on her abdomen, the SAR distribution in the fetus is calculated using the numerical model of the pregnant woman by exposed to near-field of a normal mode helical antenna (NHA) with a metallic case at 150 MHz. In addition, the SAR in the fetus will be evaluated under two fetal positions. It was found that the fetal SARs are greatly affected by the distance and penetration path from the antenna to the fetal surface. In addition, the fetal SARs are lower than the RF safety guidelines for occupational exposure.

  4. Effect on the tensile strength of human acellular dermis (Epiflex®) of in-vitro incubation simulating an open abdomen setting

    PubMed Central

    2014-01-01

    Background The use of human acellular dermis (hAD) to close open abdomen in the treatment process of severe peritonitis might be an alternative to standard care. This paper describes an investigation of the effects of fluids simulating an open abdomen environment on the biomechanical properties of Epiflex® a cell-free human dermis transplant. Methods hAD was incubated in Ringers solution, blood, urine, upper gastrointestinal (upper GI) secretion and a peritonitis-like bacterial solution in-vitro for 3 weeks. At day 0, 7, 14 and 21 breaking strength was measured, tensile strength was calculated and standard fluorescence microscopy was performed. Results hAD incubated in all five of the five fluids showed a decrease in mean breaking strength at day 21 when compared to day 0. However, upper GI secretion was the only incubation fluid that significantly reduced the mechanical strength of Epiflex after 21days of incubation when compared to incubation in Ringer’s solution. Conclusion hAD may be a suitable material for closure of the open abdomen in the absence of upper GI leakage and pancreatic fistulae. PMID:24468201

  5. The muscle pattern of the Drosophila abdomen depends on a subdivision of the anterior compartment of each segment.

    PubMed

    Krzemien, Joanna; Fabre, Caroline C G; Casal, José; Lawrence, Peter A

    2012-01-01

    In the past, segments were defined by landmarks such as muscle attachments, notably by Snodgrass, the king of insect anatomists. Here, we show how an objective definition of a segment, based on developmental compartments, can help explain the dorsal abdomen of adult Drosophila. The anterior (A) compartment of each segment is subdivided into two domains of cells, each responding differently to Hedgehog. The anterior of these domains is non-neurogenic and clones lacking Notch develop normally; this domain can express stripe and form muscle attachments. The posterior domain is neurogenic and clones lacking Notch do not form cuticle; this domain is unable to express stripe or form muscle attachments. The posterior (P) compartment does not form muscle attachments. Our in vivo films indicate that early in the pupa the anterior domain of the A compartment expresses stripe in a narrowing zone that attracts the extending myotubes and resolves into the attachment sites for the dorsal abdominal muscles. We map the tendon cells precisely and show that all are confined to the anterior domain of A. It follows that the dorsal abdominal muscles are intersegmental, spanning from one anterior domain to the next. This view is tested and supported by clones that change cell identity or express stripe ectopically. It seems that growing myotubes originate in posterior A and extend forwards and backwards until they encounter and attach to anterior A cells. The dorsal adult muscles are polarised in the anteroposterior axis: we disprove the hypothesis that muscle orientation depends on genes that define planar cell polarity in the epidermis.

  6. [Noninvasive detection of dynamics of various elements in the upper abdomen of selenium-deficient rat using multitracer analysis technique].

    PubMed

    Matsumoto, Ken-ichiro; Kawahigashi, Hisako; Hirunuma, Rieko; Enomoto, Shuichi; Endo, Kazutoyo

    2002-04-01

    The advantages of a technique as a diagnostic tool for examining the distribution of bio-trace elements in the living body are discussed. Time courses of the distribution of Be, V, Mn, Fe, Co, Zn, As, Se, Rb, Sr, and Y in the upper abdomen of living selenium-deficient rats were examined using the in vivo multitracer analysis technique. The dynamics of the elements were estimated by comparison with the distribution of As. Almost all As was taken up by red blood cells. The present findings of a decrease in Se and increase in Co in the liver of Se-deficient rats are in good agreement with the previous data that showed a decrease in Se and increase in Co uptake into the liver cell fraction of Se-deficient rats. Although the normalized uptake rate and the relative distribution of Co 48 h after administration increased in Se-deficient rats, the early level of the relative distribution of Co was not lower compared with that in the normal group. This suggests that the high level of the normalized uptake rate and the relative distribution of Co in Se-deficient rats were affected by the decreasing excretion rate rather than by the increasing uptake rate of Co. The plateau level of relative distribution of Se in the Se-deficient rats is lower than that in normal rats, suggesting that the lower levels of the normalized uptake rate and relative distribution of Se in Se-deficient rats were due to the decreased uptake rate of the element.

  7. Are contrast media required for (68)Ga-DOTATOC PET/CT in patients with neuroendocrine tumours of the abdomen?

    PubMed

    Mayerhoefer, Marius E; Schuetz, Matthias; Magnaldi, Silvia; Weber, Michael; Trattnig, Siegfried; Karanikas, Georgios

    2012-04-01

    To determine the value of intravenous contrast medium in (68)Ga-DOTA-Phe(1)-Tyr(3)-octreotide - (68)Ga-DOTATOC - PET/CT for the detection of abdominal neuroendocrine tumours (NET). In fifty-five patients with known or suspected NETs of the abdomen PET/CT was performed on a 64-row multi-detector hybrid system. For PET, 150 MBq of (68)Ga-DOTATOC were injected intravenously. Full-dose unenhanced, and arterial- and venous-phase contrast-enhanced CT images were obtained. Unenhanced and contrast-enhanced PET/CT images were evaluated separately for the presence of NETs on a per-region basis, by two separate teams with different experience levels. On unenhanced PET/CT, sensitivity and specificity ranged from 89.3% (junior team) to 92% (senior team), and 99.1% (junior team) to 99.2% (senior team), respectively. On contrast-enhanced PET/CT, sensitivity and specificity ranged from 92.3% (junior team) to 98.5% (senior team), and 99.4% (junior team) to 99.5% (senior team), respectively. These increases in sensitivity and specificity, due to the use of contrast-enhanced images, were statistically significant (P < 0.05). Intravenous contrast medium only moderately, aleit significantly, improves the sensitivity of (68)Ga-DOTATOC PET/CT for the detection of abdominal NETs, and hardly affects specificity. Thus, while contrast enhancement is justified to achieve maximum sensitivity, unenhanced images may be sufficient for routine PET/CT in NET patients. Contrast media moderately improve the sensitivity of (68)Ga-DOTATOC PET/CT for neuroendocrine tumours. Contrast media hardly affect the specificity of (68)Ga-DOTATOC PET/CT for neuroendocrine tumours. Unenhanced PET/CT is sufficient for routine imaging of patients with neuroendocrine tumours.

  8. The muscle pattern of the Drosophila abdomen depends on a subdivision of the anterior compartment of each segment

    PubMed Central

    Krzemień, Joanna; Fabre, Caroline C. G.; Casal, José; Lawrence, Peter A.

    2012-01-01

    In the past, segments were defined by landmarks such as muscle attachments, notably by Snodgrass, the king of insect anatomists. Here, we show how an objective definition of a segment, based on developmental compartments, can help explain the dorsal abdomen of adult Drosophila. The anterior (A) compartment of each segment is subdivided into two domains of cells, each responding differently to Hedgehog. The anterior of these domains is non-neurogenic and clones lacking Notch develop normally; this domain can express stripe and form muscle attachments. The posterior domain is neurogenic and clones lacking Notch do not form cuticle; this domain is unable to express stripe or form muscle attachments. The posterior (P) compartment does not form muscle attachments. Our in vivo films indicate that early in the pupa the anterior domain of the A compartment expresses stripe in a narrowing zone that attracts the extending myotubes and resolves into the attachment sites for the dorsal abdominal muscles. We map the tendon cells precisely and show that all are confined to the anterior domain of A. It follows that the dorsal abdominal muscles are intersegmental, spanning from one anterior domain to the next. This view is tested and supported by clones that change cell identity or express stripe ectopically. It seems that growing myotubes originate in posterior A and extend forwards and backwards until they encounter and attach to anterior A cells. The dorsal adult muscles are polarised in the anteroposterior axis: we disprove the hypothesis that muscle orientation depends on genes that define planar cell polarity in the epidermis. PMID:22147953

  9. Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen.

    PubMed

    Zielinski, M D; Goussous, N; Schiller, H J; Jenkins, D

    2013-02-01

    Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the "chemical components separation," which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral abdominal wall musculature. This is a retrospective review of all OA patients (age ≥18) from December 2009-June 2010 who underwent BTX injection. Under ultrasound guidance, a total of 300 units of BTX were injected into the external oblique, internal oblique and transversus abdominus. A total of 18 patients were injected with a median age of 66 years (56 % male). Indications for OA treatment included questionable bowel viability (39 %), shock (33 %), loss of abdominal domain (6 %) and feculent contamination (17 %). Median ASA score was 3 with an APACHE 3 score of 85. Patients underwent a median of 4 serial abdominal explorations. The primary fascial closure rate was 83 % with a partial fascial closure rate of 6 % and planned ventral hernia rate of 11 %. Of the 9 patients injected within 24 h of their initial OA procedure, 89 % achieved primary fascial closure. Mortality was 11 %; death was unrelated to BTX injection. The overall complication rate was 67 %; specific complications rates included fascial dehiscence (11 %), enterocutaneous fistula development (0 %), intra-abdominal abscess (44 %) and deep surgical site infection (33 %). The "chemical components separation" technique described is safe and avoids the extensive dissection necessary for mechanical components separation in critically ill patients with infected/contaminated abdominal domains. While further evaluation is required, the described technique provides potential to improve delayed primary fascial closure rates in the OA setting.

  10. Ultrasound: Abdomen (For Parents)

    MedlinePlus

    ... abdominal area and images are recorded on a computer. The black-and-white images show the internal ... the images can be seen clearly on the computer screen. A technician (sonographer) trained in ultrasound imaging ...

  11. [Imaging of the abdomen.

    PubMed

    Dietrich, C F; Ignee, A; Gebel, M; Braden, B; Schuessler, G

    2002-12-01

    In the last decade, innovative ultrasound technology has become the primary imaging method in Gastroenterology. Compared to other imaging techniques (e. g., computed tomography and magnetic resonance imaging), conventional ultrasound images have the disadvantage of a restricted field-of-view (width), thus producing images that are not always easy to read. During the examination, the many mosaic-like single images obtained in real-time sonography must be mentally pieced together by the user, in order to obtain a complex 3-dimensional picture of the anatomical structure and its surrounding tissue. The extended field-of-view of the Panoramic Imaging technique is a useful addition to conventional diagnostic ultrasound since it provides the enhanced overview required for exact topography of surrounding structures. This is especially true for the Power Mode Panoramic Imaging technique that allows the trading of vessels over greater distances, e.g., in the extremities. Thus, accuracy and reproducibility of measurements in the examination of larger structures and organs has improved. A clearer representation of these anatomical structures increases understanding and acceptance by referring clinicians. An exact diagnosis based on ultrasound imaging will certainly result in cost savings in health-care, since the use of further imaging methods (and therefore the total examination time) may be reduced.

  12. [Auscultation of the abdomen].

    PubMed

    Moll van Charante, Eric P; de Jongh, Tjeerd O H

    2011-01-01

    Normal bowel sounds vary considerably in intensity, pitch and frequency. Due to the wide range of physiological variation, the clinical significance of abdominal bowel sounds is limited. There is no clear evidence that very high-pitched bowel sounds have clinical pertinence. Small bowel obstruction is more commonly associated with hyperactive bowel sounds than with substantially diminished or absent bowel sounds. In 4-20% of young adults, systolic bruits are heard in the epigastric region that are not associated with abnormalities. There is no evidence that abdominal aortic aneurysms are associated with abdominal bruits. An abdominal bruit is indicative of renal artery stenosis when blood pressure control remains unsatisfactory, in particular when the bruit is also heard during diastole.

  13. Lump in the abdomen

    MedlinePlus

    ... In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 19th ed. ... In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 19th ed. ...

  14. Clinical evaluation of digital radiography based on a large-area cesium iodide-amorphous silicon flat-panel detector compared with screen-film radiography for skeletal system and abdomen.

    PubMed

    Okamura, Terue; Tanaka, Saori; Koyama, Koichi; Norihumi, Nishida; Daikokuya, Hideo; Matsuoka, Toshiyuki; Kishimoto, Kenji; Hatagawa, Masakatsu; Kudoh, Hiroaki; Yamada, Ryusaku

    2002-07-01

    The aim of this clinical study was to compare the image quality of digital radiography using the new digital Bucky system based on a flat-panel detector with that of a conventional screen-film system for the skeletal structure and the abdomen. Fifty patients were examined using digital radiography with a flat-panel detector and screen-film systems, 25 for the skeletal structures and 25 for the abdomen. Six radiologists judged each paired image acquired under the same exposure parameters concerning three observation items for the bone and six items for the abdomen. Digital radiographic images for the bone were evaluated to be similar to screen-film images at the mean of 42.2%, to be superior at 50.2%, and to be inferior at 7.6%. Digital radiographic images for the abdomen were judged to be similar to screen-film images at the mean of 43.4%, superior at 52.4%, and inferior at 4.2%; thus, digital radiographic images were estimated to be either similar as or superior to screen-film images at over 92% for the bone and abdomen. On the statistical analysis, digital radiographic images were also judged to be preferred significantly in the most items for the bone and abdomen. In conclusion, the image quality of digital radiography with a flat-panel detector was superior to that of a screen-film system under the same exposure parameters, suggesting that dose reduction is possible with digital radiography.

  15. High-resolution 3D-GRE imaging of the abdomen using controlled aliasing acceleration technique - a feasibility study.

    PubMed

    AlObaidy, Mamdoh; Ramalho, Miguel; Busireddy, Kiran K R; Liu, Baodong; Burke, Lauren M; Altun, Ersan; Dale, Brian M; Semelka, Richard C

    2015-12-01

    To assess the feasibility of high-resolution 3D-gradient-recalled echo (GRE) fat-suppressed T1-weighted images using controlled aliasing acceleration technique (CAIPIRINHA-VIBE), and compare image quality and lesion detection to standard-resolution 3D-GRE images using conventional acceleration technique (GRAPPA-VIBE). Eighty-four patients (41 males, 43 females; age range: 14-90 years, 58.8 ± 15.6 years) underwent abdominal MRI at 1.5 T with CAIPIRINHA-VIBE [spatial resolution, 0.76 ± 0.04 mm] and GRAPPA-VIBE [spatial resolution, 1.17 ± 0.14 mm]. Two readers independently reviewed image quality, presence of artefacts, lesion conspicuity, and lesion detection. Kappa statistic was used to assess interobserver agreement. Wilcoxon signed-rank test was used for image qualitative pairwise comparisons. Logistic regression with post-hoc testing was used to evaluate statistical significance of lesions evaluation. Interobserver agreement ranged between 0.45-0.93. Pre-contrast CAIPIRINHA-VIBE showed significantly (p < 0.001) sharper images and lesion conspicuity with decreased residual aliasing, but more noise enhancement and inferior image quality. Post-contrast CAIPIRINHA-VIBE showed significantly (p < 0.001) sharper images and higher lesion conspicuity, with less respiratory motion and residual aliasing artefacts. Inferior fat-suppression was noticeable on CAIPIRINHA-VIBE sequences (p < 0.001). High in-plane resolution abdominal 3D-GRE fat-suppressed T1-weighted imaging using controlled-aliasing acceleration technique is feasible and yields sharper images compared to standard-resolution images using standard acceleration, with higher post-contrast image quality and trend for improved hepatic lesions detection. • High-resolution imaging of the upper abdomen is clinically feasible using 2D-controlled aliasing acceleration technique. • High-resolution imaging yields significantly sharper images and increased hepatic lesions conspicuity. • High

  16. Multidendritic sensory neurons in the adult Drosophila abdomen: origins, dendritic morphology, and segment- and age-dependent programmed cell death

    PubMed Central

    Shimono, Kohei; Fujimoto, Azusa; Tsuyama, Taiichi; Yamamoto-Kochi, Misato; Sato, Motohiko; Hattori, Yukako; Sugimura, Kaoru; Usui, Tadao; Kimura, Ken-ichi; Uemura, Tadashi

    2009-01-01

    Background For the establishment of functional neural circuits that support a wide range of animal behaviors, initial circuits formed in early development have to be reorganized. One way to achieve this is local remodeling of the circuitry hardwiring. To genetically investigate the underlying mechanisms of this remodeling, one model system employs a major group of Drosophila multidendritic sensory neurons - the dendritic arborization (da) neurons - which exhibit dramatic dendritic pruning and subsequent growth during metamorphosis. The 15 da neurons are identified in each larval abdominal hemisegment and are classified into four categories - classes I to IV - in order of increasing size of their receptive fields and/or arbor complexity at the mature larval stage. Our knowledge regarding the anatomy and developmental basis of adult da neurons is still fragmentary. Results We identified multidendritic neurons in the adult Drosophila abdomen, visualized the dendritic arbors of the individual neurons, and traced the origins of those cells back to the larval stage. There were six da neurons in abdominal hemisegment 3 or 4 (A3/4) of the pharate adult and the adult just after eclosion, five of which were persistent larval da neurons. We quantitatively analyzed dendritic arbors of three of the six adult neurons and examined expression in the pharate adult of key transcription factors that result in the larval class-selective dendritic morphologies. The 'baseline design' of A3/4 in the adult was further modified in a segment-dependent and age-dependent manner. One of our notable findings is that a larval class I neuron, ddaE, completed dendritic remodeling in A2 to A4 and then underwent caspase-dependent cell death within 1 week after eclosion, while homologous neurons in A5 and in more posterior segments degenerated at pupal stages. Another finding is that the dendritic arbor of a class IV neuron, v'ada, was immediately reshaped during post-eclosion growth. It exhibited

  17. Physiological aspects of the determination of comprehensive arterial inflows in the lower abdomen assessed by Doppler ultrasound

    PubMed Central

    2012-01-01

    Non-invasive measurement of splanchnic hemodynamics has been utilized in the clinical setting for diagnosis of gastro-intestinal disease, and for determining reserve blood flow (BF) distribution. However, previous studies that measured BF in a "single vessel with small size volume", such as the superior mesenteric and coeliac arteries, were concerned solely with the target organ in the gastrointestinal area, and therefore evaluation of alterations in these single arterial BFs under various states was sometimes limited to "small blood volumes", even though there was a relatively large change in flow. BF in the lower abdomen (BFAb) is potentially a useful indicator of the influence of comprehensive BF redistribution in cardiovascular and hepato-gastrointestinal disease, in the postprandial period, and in relation to physical exercise. BFAb can be determined theoretically using Doppler ultrasound by subtracting BF in the bilateral proximal femoral arteries (FAs) from BF in the upper abdominal aorta (Ao) above the coeliac trunk. Prior to acceptance of this method of determining a true BFAb value, it is necessary to obtain validated normal physiological data that represent the hemodynamic relationship between the three arteries. In determining BFAb, relative reliability was acceptably high (range in intra-class correlation coefficient: 0.85-0.97) for three arterial hemodynamic parameters (blood velocity, vessel diameter, and BF) in three repeated measurements obtained over three different days. Bland-Altman analysis of the three repeated measurements revealed that day-to-day physiological variation (potentially including measurement error) was within the acceptable minimum range (95% of confidence interval), calculated as the difference in hemodynamics between two measurements. Mean BF (ml/min) was 2951 ± 767 in Ao, 316 ± 97 in left FA, 313 ± 83 in right FA, and 2323 ± 703 in BFAb, which is in agreement with a previous study that measured the sum of BF in the major

  18. Multidendritic sensory neurons in the adult Drosophila abdomen: origins, dendritic morphology, and segment- and age-dependent programmed cell death.

    PubMed

    Shimono, Kohei; Fujimoto, Azusa; Tsuyama, Taiichi; Yamamoto-Kochi, Misato; Sato, Motohiko; Hattori, Yukako; Sugimura, Kaoru; Usui, Tadao; Kimura, Ken-ichi; Uemura, Tadashi

    2009-10-02

    For the establishment of functional neural circuits that support a wide range of animal behaviors, initial circuits formed in early development have to be reorganized. One way to achieve this is local remodeling of the circuitry hardwiring. To genetically investigate the underlying mechanisms of this remodeling, one model system employs a major group of Drosophila multidendritic sensory neurons - the dendritic arborization (da) neurons - which exhibit dramatic dendritic pruning and subsequent growth during metamorphosis. The 15 da neurons are identified in each larval abdominal hemisegment and are classified into four categories - classes I to IV - in order of increasing size of their receptive fields and/or arbor complexity at the mature larval stage. Our knowledge regarding the anatomy and developmental basis of adult da neurons is still fragmentary. We identified multidendritic neurons in the adult Drosophila abdomen, visualized the dendritic arbors of the individual neurons, and traced the origins of those cells back to the larval stage. There were six da neurons in abdominal hemisegment 3 or 4 (A3/4) of the pharate adult and the adult just after eclosion, five of which were persistent larval da neurons. We quantitatively analyzed dendritic arbors of three of the six adult neurons and examined expression in the pharate adult of key transcription factors that result in the larval class-selective dendritic morphologies. The 'baseline design' of A3/4 in the adult was further modified in a segment-dependent and age-dependent manner. One of our notable findings is that a larval class I neuron, ddaE, completed dendritic remodeling in A2 to A4 and then underwent caspase-dependent cell death within 1 week after eclosion, while homologous neurons in A5 and in more posterior segments degenerated at pupal stages. Another finding is that the dendritic arbor of a class IV neuron, v'ada, was immediately reshaped during post-eclosion growth. It exhibited prominent radial

  19. Validation of biomechanical deformable image registration in the abdomen, thorax, and pelvis in a commercial radiotherapy treatment planning system.

    PubMed

    Velec, Michael; Moseley, Joanne L; Svensson, Stina; Hårdemark, Björn; Jaffray, David A; Brock, Kristy K

    2017-07-01

    implementations were ≤ 0.5 mm for mean DTA and ≤ 0.7 mm for mean TRE. Accuracy of biomechanical deformable registration evaluated on a large cohort of images in the thorax, abdomen and prostate was similar to the image voxel resolution on average across multiple modalities. Validation of this treatment planning system implementation supports biomechanical deformable registration as a versatile clinical tool to enable accurate target delineation at planning and treatment adaptation. © 2017 American Association of Physicists in Medicine.

  20. An approach to correlate the CTDIvol to organ dose for thorax and abdomen CT taking tube current modulation and patient size into account

    NASA Astrophysics Data System (ADS)

    Lopez-Rendon, X.; Zanca, F.; Oyen, R.; Bosmans, H.

    2013-03-01

    Purpose: To estimate conversion factors for calculating effective dose (E) and organ dose taking tube current modulation (TCM) and patient size into account in adult thorax and abdomen CT examinations. Method: 99 consecutive adult patients were included in this study. All examinations were performed with TCM (CareDose 4D. Siemens Definition Flash) at 120 kVp and 110 (thorax) and 200 (abdomen) reference mAs. E and organ dose were estimated with PCXMC 2.0 (STUK. Helsinki. Finland). using an extension of the software from a planar geometry to spiral acquisitions of aCT scanner. This software accounts for patient size by rescaling the anthropomorphic phantom to actual patient weights and heights. E and organ doses were normalized to the CTDivol as reported in the patient's report. These conversion factors (dE and dorgan were studied as a function of different patient metrics: lateral and anterior-posterior (AP) diameter. sum of the lateral and AP diameter, area of a cross section image and effective diameter. Results:. No trend was found for any of the metrics neither forE nor for the organs investigated (lungs. breasts. stomach and liver). Average value +/- 2 standard deviation were calculated. For a thorax examination, the average dE was 0.57 +/- 0.14 mSv/mGy. dlungs was 1.26 +/- 0.28 mGy/mGy and dbreasts was 1.29 +/- 0.40 mGy/mGy. For an abdomen scan dE was 0.82 +/- 0.18. mSv/mGy. d,tomooh was 1.42 +/- 0.26 mGy/mGy. dliver was 1.42 +/- 0.30 mGy/mGy. Conclusion:. For the scanner studied, average conversion factors, which account for TCM and patient size, were proposed. This is a first step towards patient-specific dosimetry.

  1. High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis-a retrospective analysis.

    PubMed

    Mintziras, Ioannis; Miligkos, Michael; Bartsch, Detlef Klaus

    2016-08-01

    The aim of this study was to evaluate the efficacy of vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis and to identify possible risk factors of fistula formation. The hospital OPS-database (time period 2005-2014) was searched to identify patients treated with an open abdomen due to secondary peritonitis, who underwent vacuum-assisted closure therapy. Medical records were retrospectively analyzed for patients' characteristics, cause of peritonitis, duration of vacuum therapy, number of relaparotomies, fascial closure rates, and risk factors of fistula formation. Forty-three patients (19 male, 24 female) with a median age of 65 years (range 24-90 years) were identified. The major cause of secondary peritonitis was anastomotic leakage after intestinal anastomosis or bowel perforation, the median APACHE II score was 11. Median duration of VAC treatment was 12 days (range 3-88 days). Twenty of 43 (47 %) patients died from septic complications. Delayed fascial closure was obtained by suturing in 20 of 43 patients (47 %). Overall 16 of 43 (37 %) patients developed enteroatmospheric fistulas. Re-explorations after starting VAC treatment and duration of VAC therapy were significantly associated with the occurrence of enteroatmospheric fistulas (p < 0.001). ROC curve analysis determined the optimal duration of VAC therapy to reduce the risk of fistula formation at 13 days. Long-term VAC treatment of patients with an open abdomen due to secondary peritonitis results in a relatively low fascial closure rate and a high risk of fistula formation.

  2. Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management.

    PubMed

    Ibarra-Hurtado, T R; Nuño-Guzmán, C M; Miranda-Díaz, A G; Troyo-Sanromán, R; Navarro-Ibarra, R; Bravo-Cuéllar, L

    2014-10-01

    Abdominal wall hernia secondary to open abdomen management represents a surgical challenge. The hernia worsens due to lateral muscle retraction. Our objective was to evaluate if Botulinum Toxin Type A (BTA) application in lateral abdominal wall muscles modifies its thickness and length. A clinical trial of male trauma patients with hernia secondary to open abdomen management was performed from January 2009 to July 2011. Thickness and length of lateral abdominal muscles were measured by a basal Computed Tomography and 1 month after BTA application. A dosage of 250 units of BTA was applied at five points at each side between the external and internal oblique muscles under ultrasonographic guidance. Statistical analysis for differences between basal and after BTA application measures was performed by a paired Student's t test (significance: p < 0.05). Seventeen male patients with a mean age of 35 years were included. There were muscle measure modifications in all the patients. Left muscle thickness: mean reduction of 1 ± 0.55 cm (p < 0.001). Right muscle thickness: mean reduction of 1.00 ± 0.49 cm (p < 0.001). Left muscle length: mean increase of 2.44 ± 1.22 cm (p < 0.001). Right muscle length: mean increase of 2.59 ± 1.38 cm (p < 0.001). No complications secondary to BTA or recurrences at mean follow-up of 49 months were observed. BTA application in lateral abdominal muscles decreases its thickness and increases its length in abdominal wall hernia patients secondary to open abdomen management.

  3. An investigation of human body model morphing for the assessment of abdomen responses to impact against a population of test subjects.

    PubMed

    Beillas, Philippe; Berthet, Fabien

    2017-05-29

    Human body models have the potential to better describe the human anatomy and variability than dummies. However, data sets available to verify the human response to impact are typically limited in numbers, and they are not size or gender specific. The objective of this study was to investigate the use of model morphing methodologies within that context. In this study, a simple human model scaling methodology was developed to morph two detailed human models (Global Human Body Model Consortium models 50th male, M50, and 5th female, F05) to the dimensions of post mortem human surrogates (PMHS) used in published literature. The methodology was then successfully applied to 52 PMHS tested in 14 impact conditions loading the abdomen. The corresponding 104 simulations were compared to the responses of the PMHS and to the responses of the baseline models without scaling (28 simulations). The responses were analysed using the CORA method and peak values. The results suggest that model scaling leads to an improvement of the predicted force and deflection but has more marginal effects on the predicted abdominal compressions. M50 and F05 models scaled to the same PMHS were also found to have similar external responses, but large differences were found between the two sets of models for the strain energy densities in the liver and the spleen for mid-abdomen impact simulations. These differences, which were attributed to the anatomical differences in the abdomen of the baseline models, highlight the importance of the selection of the impact condition for simulation studies, especially if the organ location is not known in the test. While the methodology could be further improved, it shows the feasibility of using model scaling methodologies to compare human models of different sizes and to evaluate scaling approaches within the context of human model validation.

  4. Impact of injection speed and volume on perceived pain during subcutaneous injections into the abdomen and thigh: a single-centre, randomized controlled trial.

    PubMed

    Heise, T; Nosek, L; Dellweg, S; Zijlstra, E; Præstmark, K A; Kildegaard, J; Nielsen, G; Sparre, T

    2014-10-01

    The aim of this study was to assess pain associated with subcutaneous injection into the abdomen and thigh of different combinations of injection speeds and volumes. The study was a single-centre, one-visit, double-blinded, randomized controlled trial in 82 adults with type 1 or type 2 diabetes receiving daily injections of insulin or glucagon-like peptide-1 (GLP-1) agonists. Participants received 17 subcutaneous injections (12 in abdomen, 5 in thigh) of saline at different injection speeds (150, 300 and 450 µl/s), with different volumes (400, 800, 1200 and 1600 µl), and two needle insertions without any injection. Pain was evaluated on a 100-mm visual analogue scale (VAS) (0 mm no pain, 100 mm worst pain) and on a yes/no scale for pain acceptability. Injection speed had no impact on injection pain (p = 0.833). Injection of larger volumes caused significantly more pain [VAS least square mean differences 1600 vs. 400 µl, 7 · 2 mm (95% confidence interval - CI; 4.6-9.7; p < 0.0001); 1600 vs. 800 µl, 7.2 mm (4.4-10.0; p < 0.0001); 1200 vs. 400 µl, 3.5 mm (0.4-6.6; p = 0.025) and 1200 vs. 800 µl, 3.6 mm (0.4-6.7; p = 0.027)]. Significantly more pain occurred in the thigh versus the abdomen [9.0 mm (6.7-11.3; p < 0.0001)]. Injection speed had no effect on injection pain, whereas higher injection volumes caused more pain. The results of this study may be of value for guiding patients to use the appropriate injection site and technique to reduce their injection pain. Furthermore, these findings may have important implications for the development of new injection devices and drug formulations for clinical practice. © 2014 John Wiley & Sons Ltd.

  5. Nonlinear image blending for dual-energy MDCT of the abdomen: can image quality be preserved if the contrast medium dose is reduced?

    PubMed

    Mileto, Achille; Ramirez-Giraldo, Juan Carlos; Marin, Daniele; Alfaro-Cordoba, Marcela; Eusemann, Christian D; Scribano, Emanuele; Blandino, Alfredo; Mazziotti, Silvio; Ascenti, Giorgio

    2014-10-01

    The objective of this study was to compare the image quality of a dual-energy nonlinear image blending technique at reduced load of contrast medium with a simulated 120-kVp linear blending technique at a full dose during portal venous phase MDCT of the abdomen. Forty-five patients (25 men, 20 women; mean age, 65.6 ± 9.7 [SD] years; mean body weight, 74.9 ± 12.4 kg) underwent contrast-enhanced single-phase dual-energy CT of the abdomen by a random assignment to one of three different contrast medium (iomeprol 400) dose injection protocols: 1.3, 1.0, or 0.65 mL/kg of body weight. The contrast-to-noise ratio (CNR) and noise at the portal vein, liver, aorta, and kidney were compared among the different datasets using the ANOVA. Three readers qualitatively assessed all datasets in a blinded and independent fashion. Nonlinear blended images at a 25% reduced dose allowed a significant improvement in CNR (p < 0.05 for all comparisons), compared with simulated 120-kVp linear blended images at a full dose. No statistically significant difference existed in CNR and noise between the nonlinear blended images at a 50% reduced dose and the simulated 120-kVp linear blended images at a full dose. Nonlinear blended images at a 50% reduced dose were considered in all cases to have acceptable image quality. The dual-energy nonlinear image blending technique allows reducing the dose of contrast medium up to 50% during portal venous phase imaging of the abdomen while preserving image quality.

  6. SU-E-P-08: Establishment of Local Diagnostic Reference Levels of Routine Abdomen Exam in Computed Tomography According to Body Weight

    SciTech Connect

    Wang, H; Wang, Y; Weng, H

    2015-06-15

    Purpose: The national diagnostic reference levels (NDRLs) is an efficient, concise and powerful standard for optimizing radiation protection of a patient. However, for each hospital the dose-reducing potential of focusing on establishment of local DRLs (LDRLs). A lot of study reported that Computed tomography exam contributed majority radiation dose in different medical modalities, therefore, routine abdomen CT exam was choose in initial pilot study in our study. Besides the mAs of routine abdomen CT exam was decided automatic exposure control by linear attenuation is relate to body shape of patient. In this study we would like to establish the local diagnostic reference levels of routine abdomen exam in computed tomography according to body weight of patient. Methods and Materials: There are two clinical CT scanners (a Toshiba Aquilion and a Siemens Sensation) were performed in this study. For CT examinations the basic recommended dosimetric quantity is the Computed Tomography Dose Index (CTDI). The patient sample involved 82 adult patients of both sexes and divided into three groups by their body weight (50–60 kg, 60–70 kg, 70–80 kg).Carried out the routine abdomen examinations, and all exposure parameters have been collected and the corresponding CTDIv and DLP values have been determined. The average values were compared with the European DRLs. Results: The majority of patients (75%) were between 50–70 Kg of body weight, the numbers of patient in each group of weight were 40–50:7; 50–60:29; 60–70:33; 70–80:13. The LDRLs in each group were 10.81mGy, 14.46mGy, 20.27mGy and 21.04mGy, respectively. The DLP were 477mGy, 630mGy, 887mGy and 959mGy, respectively. No matter which group the LDRLs were lower than European DRLs. Conclusions: We would like to state that this was a pioneer work in local hospital in Chiayi. We hope that this may lead the way to further developments in Taiwan.

  7. A rare case of perforated "sub-hepatic appendicitis" - a challenging differential diagnosis of acute abdomen based on the combination of appendicitis and maldescent of the caecum.

    PubMed

    Chiapponi, Costanza; Jannasch, Olof; Petersen, Manuela; Lessel, Wiebke; Bruns, Christiane; Meyer, Frank

    2017-01-01

    Unusual locations of the appendix vermiformis can result in delay in appropriate diagnosis and treatment of appendicitis. So an inflamed appendix in a sub-hepatic caecum caused by caecal maldescent for example can mimic cholecystitis, the pain being localized in the right upper quadrant. Here, we present a case of perforated sub-hepatic appendicitis with peritonitis, requiring open ileocaecal resection. Review of the existing literature has demonstrated that this pathology is uncommon, yet not so rare as one might presume. In conclusion, surgeons should be aware of this possibility in the diagnostic and therapeutic management of acute abdomen. Copyright © 2016. Published by Elsevier GmbH.

  8. A Six-week Low-level Laser Therapy Protocol is Effective for Reducing Waist, Hip, Thigh, and Upper Abdomen Circumference

    PubMed Central

    Thaxton, Paul M.; Hornfeldt, Carl S.

    2016-01-01

    Objective: The efficacy of low-level laser therapy for noninvasive body contouring has been previously demonstrated in clinical trials leading to its market clearance. Subjects achieved these beneficial effects following three weekly low-level laser therapy treatments for two weeks. The objective of this study was to determine if the same aesthetic benefit can be achieved following one weekly low-level laser therapy treatment for six weeks. Setting: Two private dermatology practices. Participants: Healthy adults with a body mass index of 25 to 40kg/m2 (N=54). Measurements: Subjects underwent one weekly low-level laser therapy procedure for six consecutive weeks using a device consisting of six 17mW, 635nm red diodes. Waist, hip, thigh, and upper abdomen circumference were measured weekly. Study success criteria was a 4.5-inch mean decrease in combined body circumference. Results: The mean decrease in combined circumference reduction at six weeks was 5.4 inches (p<0.001), and most subjects (72.2%) achieved a ≥4.5-inch decrease. Most subjects (81.0%) were Satisfied (27%) or Very Satisfied (54%) with the aesthetic results they achieved. There were no adverse events. Conclusion: One weekly low-level laser therapy treatment for six weeks is clinically effective for reducing waist, hip, thigh, and upper abdomen circumference and may be more effective than the previous two-week treatment protocol. ClinicalTrials.gov Identifier: NCT02109107. PMID:27386049

  9. Management of a Septic Open Abdomen Patient with Spontaneous Jejunal Perforation after Emergent C/S with Confounding Factor of Mild Acute Pancreatitis

    PubMed Central

    Yetisir, Fahri; Sarer, Akgün Ebru; Acar, Hasan Zafer; Osmanoglu, Gokhan; Özer, Mehmet; Yaylak, Faik

    2016-01-01

    Introduction. We report the management of a septic Open Abdomen (OA) patient by the help of negative pressure therapy (NPT) and abdominal reapproximation anchor (ABRA) system in pregnant woman with spontaneous jejunal perforation after emergent cesarean section (C/S) with confounding factor of mild acute pancreatitis (AP). Presentation of Case. A 29-year-old and 34-week pregnant woman with AP underwent C/S. She was arrested after anesthesia induction and responded to cardiopulmonary resuscitation (CPR). There were only ash-colored serosanguinous fluid within abdomen during C/S. After C/S, she was transferred to intensive care unit (ICU) with vasopressor support. On postoperative 1st day, she underwent reoperation due to fecal fluid coming near the drainage. Leakage point could not be identified exactly and operation had to be deliberately abbreviated due to hemodynamic instability. NPT was applied. Two days later source control was provided by conversion of enteroatmospheric fistula (EAF) to jejunostomy. ABRA was added and OA was closed. No hernia developed at 10-month follow-up period. Conclusion. NPT application in septic OA patient may gain time to patient until adequate source control could be achieved. Using ABRA in conjunction with NPT increases the fascial closure rate in infected OA patient. PMID:27006853

  10. Management of Septic Open Abdomen in a Morbid Obese Patient with Enteroatmospheric Fistula by Using Standard Abdominal Negative Pressure Therapy in Conjunction with Intrarectal One

    PubMed Central

    Yetisir, Fahri; Salman, A. Ebru; Acar, Hasan Zafer; Özer, Mehmet; Aygar, Muhittin; Osmanoglu, Gokhan

    2015-01-01

    Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging. We would like to report the management of septic OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. We would also like to emphasize, in this case, the conversion of EAF to ileostomy by the help of second Negative Pressure Therapy (NPT) on ostomy side, and the chance of new EAF occurrence was reduced with intrarectal NPT. Case Presentation. 62-year-old morbid obese woman became an OA patient with EAF after strangulated recurrent giant hernia. EAF was converted to ostomy with pezzer drain by the help of second NPT on ostomy. Colonic distention was reduced with the third NPT application via rectum. Abdominal reapproximation anchor (ABRA) system was used for delayed abdominal closure. Conclusions. Using the 2nd NPT on ostomy side may help in the maturation of the ostomy created in a difficult condition in an open abdomen. Using the 3rd NPT through rectum may decrease the chance of EAF formation by reducing the pressure difference between intraluminal pressure and extraluminal pressure in hollow viscera. PMID:26779360

  11. The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature

    PubMed Central

    Aziret, Mehmet; Erdem, Hasan; Ülgen, Yiğit; Kahramanca, Şahin; Çetinkünar, Süleyman; Bozkurt, Hilmi; Bali, İlhan; İrkörücü, Oktay

    2014-01-01

    INTRODUCTION Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression. PRESENTATION OF CASE Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest. DISCUSSION PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery. CONCLUSION In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection. PMID:25460434

  12. The twisted Gene Encodes Drosophila Protein O-Mannosyltransferase 2 and Genetically Interacts With the rotated abdomen Gene Encoding Drosophila Protein O-Mannosyltransferase 1

    PubMed Central

    Lyalin, Dmitry; Koles, Kate; Roosendaal, Sigrid D.; Repnikova, Elena; Van Wechel, Laura; Panin, Vladislav M.

    2006-01-01

    The family of mammalian O-mannosyltransferases includes two enzymes, POMT1 and POMT2, which are thought to be essential for muscle and neural development. Similar to mammalian organisms, Drosophila has two O-mannosyltransferase genes, rotated abdomen (rt) and DmPOMT2, encoding proteins with high homology to their mammalian counterparts. The previously reported mutant phenotype of the rt gene includes a clockwise rotation of the abdomen and defects in embryonic muscle development. No mutants have been described so far for the DmPOMT2 locus. In this study, we determined that the mutation in the twisted (tw) locus, tw1, corresponds to a DmPOMT2 mutant. The twisted alleles represent a complementation group of recessive mutations that, similar to the rt mutants, exhibit a clockwise abdomen rotation phenotype. Several tw alleles were isolated in the past; however, none of them was molecularly characterized. We used an expression rescue approach to confirm that tw locus represents DmPOMT2 gene. We found that the tw1 allele represents an amino acid substitution within the conserved PMT domain of DmPOMT2 (TW) protein. Immunostaining experiments revealed that the protein products of both rt and tw genes colocalize within Drosophila cells where they reside in the ER subcellular compartment. In situ hybridization analysis showed that both genes have essentially overlapping patterns of expression throughout most of embryogenesis (stages 8–17), while only the rt transcript is present at early embryonic stages (5 and 6), suggesting its maternal origin. Finally, we analyzed the genetic interactions between rt and tw using several mutant alleles, RNAi, and ectopic expression approaches. Our data suggest that the two Drosophila O-mannosyltransferase genes, rt and tw, have nonredundant functions within the same developmental cascade and that their activities are required simultaneously for possibly the same biochemical process. Our results establish the possibility of using

  13. SU-E-I-29: Care KV: Dose It Influence Radiation Dose in Non-Contrast Examination of CT Abdomen/pelvis?

    SciTech Connect

    Zhang, J; Ganesh, H; Weir, V

    2015-06-15

    Purpose: CARE kV is a tool that automatically recommends optimal kV setting for individual patient for specific CT examination. The use of CARE kV depends on topogram and the user-selected contrast behavior. CARE kV is expected to reduce radiation dose while improving image quality. However, this may work only for certain groups of patients and/or certain CT examinations. This study is to investigate the effects of CARE kV on radiation dose of non-contrast examination of CT abdomen/pelvis. Methods: Radiation dose (CTDIvol and DLP) from patients who underwent abdomen/pelvis non-contrast examination with and without CARE kV were retrospectively reviewed. All patients were scanned in the same scanner (Siemens Somatom AS64). To mitigate any possible influences due to technologists’ unfamiliarity with the CARE kV, the data with CARE kV were retrieved 1.5 years after the start of CARE kV usage. T-test was used for significant difference in radiation dose. Results: Volume CTDIs and DLPs from 18 patients before and 24 patients after the use of CARE kV were obtained in a duration of one month. There is a slight increase in both average CTDIvol and average DLP with CARE kV compared to those without CARE kV (25.52 mGy vs. 22.65 mGy for CTDIvol; 1265.81 mGy-cm vs. 1199.19 mGy-cm). Statistically there was no significant difference. Without CARE kV, 140 kV was used in 9 of 18 patients, while with CARE KV, 140 kV was used in 15 of 24 patients. 80kV was not used in either group. Conclusion: The use of CARE kV may save time for protocol optimization and minimize variability among technologists. Radiation dose reduction was not observed in non-contrast examinations of CT abdomen/pelvis. This was partially because our CT protocols were tailored according to patient size before CARE kV and partially because of large size patients.

  14. Primitive Spindle Cell Neoplasm of Ileum with Extensive Heterotopic Cartilage, Presenting as Acute Abdomen in a 6-Day-Old Neonate.

    PubMed

    Nael, Ali; Wu, William W; Shane, Lisa; Rao, Nagesh; Zwerdling, Theodore

    2016-01-01

    Neonatal intestinal masses with spindle cell morphology have broad differential diagnoses and require a multidisciplinary approach to make the final diagnosis. Spindle cell masses with heterotopic cartilage in the gastrointestinal tract are very rare, and, to our knowledge, have not previously been reported in the neonate. Here we present a case of intestinal primitive spindle cell neoplasm with extensive heterotopic cartilage that manifested initially as acute abdomen in a 6-day-old term infant. Plain radiography demonstrated pneumoperitoneum, prompting diagnostic laparotomy that identified a perforated mass involving the midileum. Histologic and immunohistochemical examination demonstrated an infiltrative spindle cell tumor most compatible with infantile fibrosarcoma (IFS) by a process of exclusion, with nodules of mature heterotopic cartilage. Additional staging studies did not reveal any evidence of residual or metastatic disease. Recognition of this rare variant of IFS will aid in differentiation from other neonatal intestinal mesenchymal tumors.

  15. A cross-platform survey of CT image quality and dose from routine abdomen protocols and a method to systematically standardize image quality

    NASA Astrophysics Data System (ADS)

    Favazza, Christopher P.; Duan, Xinhui; Zhang, Yi; Yu, Lifeng; Leng, Shuai; Kofler, James M.; Bruesewitz, Michael R.; McCollough, Cynthia H.

    2015-11-01

    Through this investigation we developed a methodology to evaluate and standardize CT image quality from routine abdomen protocols across different manufacturers and models. The influence of manufacturer-specific automated exposure control systems on image quality was directly assessed to standardize performance across a range of patient sizes. We evaluated 16 CT scanners across our health system, including Siemens, GE, and Toshiba models. Using each practice’s routine abdomen protocol, we measured spatial resolution, image noise, and scanner radiation output (CTDIvol). Axial and in-plane spatial resolutions were assessed through slice sensitivity profile (SSP) and modulation transfer function (MTF) measurements, respectively. Image noise and CTDIvol values were obtained for three different phantom sizes. SSP measurements demonstrated a bimodal distribution in slice widths: an average of 6.2  ±  0.2 mm using GE’s ‘Plus’ mode reconstruction setting and 5.0  ±  0.1 mm for all other scanners. MTF curves were similar for all scanners. Average spatial frequencies at 50%, 10%, and 2% MTF values were 3.24  ±  0.37, 6.20  ±  0.34, and 7.84  ±  0.70 lp cm-1, respectively. For all phantom sizes, image noise and CTDIvol varied considerably: 6.5-13.3 HU (noise) and 4.8-13.3 mGy (CTDIvol) for the smallest phantom; 9.1-18.4 HU and 9.3-28.8 mGy for the medium phantom; and 7.8-23.4 HU and 16.0-48.1 mGy for the largest phantom. Using these measurements and benchmark SSP, MTF, and image noise targets, CT image quality can be standardized across a range of patient sizes.

  16. Noise-Optimized Virtual Monoenergetic Dual-Energy CT Improves Diagnostic Accuracy for the Detection of Active Arterial Bleeding of the Abdomen.

    PubMed

    Martin, Simon S; Wichmann, Julian L; Scholtz, Jan-Erik; Leithner, Doris; D'Angelo, Tommaso; Weyer, Hendrik; Booz, Christian; Lenga, Lukas; Vogl, Thomas J; Albrecht, Moritz H

    2017-09-01

    To evaluate diagnostic accuracy of a noise-optimized virtual monoenergetic imaging (VMI+) reconstruction technique for detection of active arterial abdominal bleeding on dual-energy (DE) CT angiography compared with standard image reconstruction. DE CT angiography data sets of 71 patients (46 men; age 63.6 y ± 13.3) with suspected arterial bleeding of the abdomen or pelvis were reconstructed with standard linearly blended (F_0.5), VMI+, and traditional virtual monoenergetic imaging (VMI) algorithms in 10-keV increments from 40 to 100 keV. Attenuation measurements were performed in the descending aorta, area of hemorrhage, and feeding artery to calculate contrast-to-noise ratios (CNRs) in patients with active arterial bleeding. Based on quantitative image quality results, the best series for each reconstruction technique were chosen to analyze the diagnostic performance of 3 blinded radiologists. DE CT angiography showed acute arterial bleeding in 36 patients. Mean CNR was superior in 40-keV VMI+ compared with VMI series (all P < .001), which showed highest CNRs in 70-keV VMI and F_0.5 (21.6 ± 7.9, 12.9 ± 4.7, and 10.4 ± 3.6) images. Area under the curve analysis for detection of arterial bleeding showed significantly superior (P < .001) results for 40-keV VMI+ (0.963) compared with 70-keV VMI (0.775) and F_0.5 (0.817) series. Diagnostic accuracy in patients with active arterial bleeding of the abdomen can be significantly improved using VMI+ reconstructions at 40 keV compared with standard linearly blended and traditional VMI series in DE CT angiography. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  17. 64-Slice multidetector row CT angiography of the abdomen: comparison of low versus high concentration iodinated contrast media in a porcine model

    PubMed Central

    Holalkere, N-S; Matthes, K; Kalva, S P; Brugge, W R; Sahani, D V

    2011-01-01

    Objective In this study we aimed to assess the image quality and degree of vascular enhancement using low-concentration contrast media (LCCM) (300 mg I ml–1) and high-concentration contrast media (HCCM) (370 mg I ml–1) on 64-slice multidetector row CT (MDCT) abdominal CT angiography (CTA). In addition, we aimed to study the feasibility of using HCCM with a reduced total iodine dose. Methods CTA of the abdomen on a 64-slice MDCT was performed on 15 anaesthetised pigs. Study pigs were divided into three groups of five each based on the iodine concentration and dose received: Group A (LCCM; 300 mg I ml–1), Group B (HCCM; 370 mg I ml–1) and Group C HCCM with 20% less iodine dose. The total iodine injected was kept constant (600 mg kg–1) in Groups A and B. Qualitative and quantitative analyses were performed to study and compare each group for image quality, visibility of the branch order of the superior mesenteric artery (SMA), artefacts, degree of enhancement in the aorta and main stem arteries and uniformity of enhancement in the aorta. Groups were compared using the analysis of variance test. Results The image quality of 64-slice MDCT angiography was excellent with a mean score of 4.63 and confident visualisation of the third to fifth order branches of the SMA in all groups. Group B demonstrated superior vascular enhancement, as compared with Groups A and C (p≤0.05). Uniform aortic enhancement was achieved with the use of LCCM and HCCM with 20% less iodine dose. Conclusion 64-slice MDCT angiography of the abdomen was of excellent quality. HCCM improves contrast enhancement and overall CTA image quality and allows the iodine dose to be reduced. PMID:21081582

  18. 64-Slice multidetector row CT angiography of the abdomen: comparison of low versus high concentration iodinated contrast media in a porcine model.

    PubMed

    Holalkere, N-S; Matthes, K; Kalva, S P; Brugge, W R; Sahani, D V

    2011-03-01

    In this study we aimed to assess the image quality and degree of vascular enhancement using low-concentration contrast media (LCCM) (300 mg I ml(-1)) and high-concentration contrast media (HCCM) (370 mg I ml(-1)) on 64-slice multidetector row CT (MDCT) abdominal CT angiography (CTA). In addition, we aimed to study the feasibility of using HCCM with a reduced total iodine dose. CTA of the abdomen on a 64-slice MDCT was performed on 15 anaesthetised pigs. Study pigs were divided into three groups of five each based on the iodine concentration and dose received: Group A (LCCM; 300 mg I ml(-1)), Group B (HCCM; 370 mg I ml(-1)) and Group C HCCM with 20% less iodine dose. The total iodine injected was kept constant (600 mg kg(-1)) in Groups A and B. Qualitative and quantitative analyses were performed to study and compare each group for image quality, visibility of the branch order of the superior mesenteric artery (SMA), artefacts, degree of enhancement in the aorta and main stem arteries and uniformity of enhancement in the aorta. Groups were compared using the analysis of variance test. The image quality of 64-slice MDCT angiography was excellent with a mean score of 4.63 and confident visualisation of the third to fifth order branches of the SMA in all groups. Group B demonstrated superior vascular enhancement, as compared with Groups A and C (p≤0.05). Uniform aortic enhancement was achieved with the use of LCCM and HCCM with 20% less iodine dose. 64-slice MDCT angiography of the abdomen was of excellent quality. HCCM improves contrast enhancement and overall CTA image quality and allows the iodine dose to be reduced.

  19. A cross-platform survey of CT image quality and dose from routine abdomen protocols and a method to systematically standardize image quality

    PubMed Central

    Favazza, Christopher P.; Duan, Xinhui; Zhang, Yi; Yu, Lifeng; Leng, Shuai; Kofler, James M.; Bruesewitz, Michael R.; McCollough, Cynthia H.

    2015-01-01

    Through this investigation we developed a methodology to evaluate and standardize CT image quality from routine abdomen protocols across different manufacturers and models. The influence of manufacturer-specific automated exposure control systems on image quality was directly assessed to standardize performance across a range of patient sizes. We evaluated 16 CT scanners across our health system, including Siemens, GE, and Toshiba models. Using each practice’s routine abdomen protocol, we measured spatial resolution, image noise, and scanner radiation output (CTDIvol). Axial and in-plane spatial resolutions were assessed through slice sensitivity profile (SSP) and modulation transfer function (MTF) measurements, respectively. Image noise and CTDIvol values were obtained for three different phantom sizes. SSP measurements demonstrated a bimodal distribution in slice widths: an average of 6.2 ± 0.2 mm using GE’s “Plus” mode reconstruction setting and 5.0 ± 0.1 mm for all other scanners. MTF curves were similar for all scanners. Average spatial frequencies at 50%, 10%, and 2% MTF values were 3.24 ± 0.37, 6.20 ± 0.34, and 7.84 ± 0.70 lp/cm, respectively. For all phantom sizes, image noise and CTDIvol varied considerably: 6.5–13.3 HU (noise) and 4.8–13.3 mGy (CTDIvol) for the smallest phantom; 9.1–18.4 HU and 9.3–28.8 mGy for the medium phantom; and 7.8–23.4 HU and 16.0–48.1 mGy for the largest phantom. Using these measurements and benchmark SSP, MTF, and image noise targets, CT image quality can be standardized across a range of patient sizes. PMID:26459751

  20. Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single-center 8-year experience.

    PubMed

    Tolonen, Matti; Mentula, Panu; Sallinen, Ville; Rasilainen, Suvi; Bäcklund, Minna; Leppäniemi, Ari

    2017-06-01

    Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates. This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed. Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups. The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later. Therapeutic/care management study, level IV.

  1. Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 1-Common Sarcomas: From the Radiologic Pathology Archives.

    PubMed

    Levy, Angela D; Manning, Maria A; Al-Refaie, Waddah B; Miettinen, Markku M

    2017-01-01

    Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most common in the extremities, trunk wall, retroperitoneum, and head and neck. In the adult population, soft-tissue sarcomas arising in the abdomen and pelvis are often large masses at the time of diagnosis because they are usually clinically silent or cause vague or mild symptoms until they invade or compress vital organs. In contrast, soft-tissue sarcomas arising from the abdominal wall come to clinical attention earlier in the course of disease because they cause a palpable mass, abdominal wall deformity, or pain that is more clinically apparent. The imaging features of abdominal and pelvic sarcomas and abdominal wall sarcomas can be nonspecific and overlap with more common pathologic conditions, making diagnosis difficult or, in some cases, delaying diagnosis. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor (GIST) are the most common intra-abdominal primary sarcomas. Any soft-tissue sarcoma can arise in the abdominal wall. Knowledge of the classification and pathologic features of soft-tissue sarcomas, the anatomic locations where they occur, and their cross-sectional imaging features helps the radiologist establish the diagnosis or differential diagnosis so that patients with soft-tissue sarcomas can receive optimal treatment and management. In part 1 of this article, the most common soft-tissue sarcomas (liposarcoma, leiomyosarcoma, and GIST) are reviewed, with a discussion on anatomic locations, classification, clinical considerations, and differential diagnosis. Part 2 will focus on the remainder of the soft-tissue sarcomas occurring in the abdomen and pelvis.

  2. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 10. Injuries of the Eye, Ear, Nose, Abdomen, Central Nervous System and Genitalia. Burns and Environmental Injuries. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers injuries of the eyes, ears, nose, abdomen, central nervous system (CNS), and genitalia; burns; and environmental injuries. Objectives stated for the two chapters are for the student to be able to describe procedures…

  3. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 10. Injuries of the Eye, Ear, Nose, Abdomen, Central Nervous System and Genitalia. Burns and Environmental Injuries. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers injuries of the eyes, ears, nose, abdomen, central nervous system (CNS), and genitalia; burns; and environmental injuries. Objectives stated for the two chapters are for the student to be able to describe procedures…

  4. Abdominal intra-compartment syndrome - a non-hydraulic model of abdominal compartment syndrome due to post-hepatectomy hemorrhage in a man with a localized frozen abdomen due to extensive adhesions: a case report.

    PubMed

    Bressan, Alexsander K; Kirkpatrick, Andrew W; Ball, Chad G

    2016-09-15

    Postoperative hemorrhage is a significant cause of morbidity and mortality following liver resection. It typically presents early within the postoperative period, and conservative management is possible in the majority of cases. We present a case of late post-hepatectomy hemorrhage associated with overt abdominal compartment syndrome resulting from a localized functional compartment within the abdomen. A 68-year-old white man was readmitted with sudden onset of upper abdominal pain, vomiting, and hemodynamic instability 8 days after an uneventful hepatic resection for metachronous colon cancer metastasis. A frozen abdomen with adhesions due to complicated previous abdominal surgeries was encountered at the first intervention, but the surgery itself and initial recovery were otherwise unremarkable. Prompt response to fluid resuscitation at admission was followed by a computed tomography of his abdomen that revealed active arterial hemorrhage in the liver resection site and hemoperitoneum (estimated volume <2 L). Selective arteriography successfully identified and embolized a small bleeding branch of his right hepatic artery. He remained hemodynamically stable, but eventually developed overt abdominal compartment syndrome. Surgical exploration confirmed a small volume of ascites and blood clots (1.2 L) under significant pressure in his supramesocolic region, restricted by his frozen lower abdomen, which we evacuated. Dramatic improvement in his ventilatory pressure was immediate. His abdomen was left open and a negative pressure device was placed for temporary abdominal closure. The fascia was formally closed after 48 hours. He was discharged home at postoperative day 6. Intra-abdominal pressure and radiologic findings of intra-abdominal hemorrhage should be carefully interpreted in patients with extensive intra-abdominal adhesions. A high index of suspicion and detailed understanding of abdominal compartment mechanics are paramount for the timely diagnosis of

  5. The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes

    PubMed Central

    Sim, Kang Hee; Kim, Sun Young; Lee, Hye Mi; Chang, Ji Yeun; Lee, Moon Kyu

    2014-01-01

    Background Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well. Methods First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression. Results The mean skin thickness was 2.29±0.37 mm in the abdomen and 2.00±0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15±6.54 mm in the abdomen and 5.50±2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI. Conclusion It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes. PMID:24851206

  6. Feature-based respiratory motion tracking in native fluoroscopic sequences for dynamic roadmaps during minimally invasive procedures in the thorax and abdomen

    NASA Astrophysics Data System (ADS)

    Wagner, Martin G.; Laeseke, Paul F.; Schubert, Tilman; Slagowski, Jordan M.; Speidel, Michael A.; Mistretta, Charles A.

    2017-03-01

    Fluoroscopic image guidance for minimally invasive procedures in the thorax and abdomen suffers from respiratory and cardiac motion, which can cause severe subtraction artifacts and inaccurate image guidance. This work proposes novel techniques for respiratory motion tracking in native fluoroscopic images as well as a model based estimation of vessel deformation. This would allow compensation for respiratory motion during the procedure and therefore simplify the workflow for minimally invasive procedures such as liver embolization. The method first establishes dynamic motion models for both the contrast-enhanced vasculature and curvilinear background features based on a native (non-contrast) and a contrast-enhanced image sequence acquired prior to device manipulation, under free breathing conditions. The model of vascular motion is generated by applying the diffeomorphic demons algorithm to an automatic segmentation of the subtraction sequence. The model of curvilinear background features is based on feature tracking in the native sequence. The two models establish the relationship between the respiratory state, which is inferred from curvilinear background features, and the vascular morphology during that same respiratory state. During subsequent fluoroscopy, curvilinear feature detection is applied to determine the appropriate vessel mask to display. The result is a dynamic motioncompensated vessel mask superimposed on the fluoroscopic image. Quantitative evaluation of the proposed methods was performed using a digital 4D CT-phantom (XCAT), which provides realistic human anatomy including sophisticated respiratory and cardiac motion models. Four groups of datasets were generated, where different parameters (cycle length, maximum diaphragm motion and maximum chest expansion) were modified within each image sequence. Each group contains 4 datasets consisting of the initial native and contrast enhanced sequences as well as a sequence, where the respiratory motion is

  7. Comprehensive Comparison of Virtual Monoenergetic and Linearly Blended Reconstruction Techniques in Third-Generation Dual-Source Dual-Energy Computed Tomography Angiography of the Thorax and Abdomen.

    PubMed

    Albrecht, Moritz H; Trommer, Jesko; Wichmann, Julian L; Scholtz, Jan-Erik; Martin, Simon S; Lehnert, Thomas; Vogl, Thomas J; Bodelle, Boris

    2016-09-01

    The aim of this study was to perform an objective and subjective image analysis of traditional and advanced noise-optimized virtual monoenergetic imaging (VMI) algorithms and standard linearly blended images in third-generation dual-source dual-energy computed tomography angiography (DE-CTA) of the thorax and abdomen. Thoracoabdominal DE-CTA examinations of 55 patients (36 male; mean age, 64.2 ± 12.7 years) were included in this retrospective institutional review board-approved study. Dual-energy computed tomography angiography data were reconstructed using standard linearly blended M_0.6 (merging 60% low kiloelectron volt [90 kV] with 40% high kiloelectron volt [150 kV] spectrum), traditional (VMI), and advanced VMI (VMI+) algorithms. Monoenergetic series were calculated ranging from 40 to 120 keV with 10 keV increments. Attenuation and standard deviation of 8 arteries and various anatomical landmarks of the thorax and abdomen were measured to calculate contrast-to-noise ratio values. Two radiologists subjectively assessed image quality, contrast conditions, noise, and visualization of small arterial branches using 5-point Likert scales. Vascular attenuation of VMI and VMI+ series showed a gradual increase from high to low kiloelectron volt levels without significant differences between both algorithms (P < 0.894). VMI+ 40-keV series showed the highest contrast-to-noise ratio for both thoracic and abdominal DE-CTA (P < 0.001), albeit revealing higher noise than M_0.6 images (objectively and subjectively, P < 0.001) and were rated best for visualization of small arterial branches in the subjective analysis (P < 0.109). Substantially increased noise was found for VMI 40 and 50 keV series compared with all other reconstructions (objectively and subjectively, P < 0.001). VMI+ images at 100 keV+ were rated best regarding image noise (P < 0.843), whereas VMI+ reconstructions at 70 keV were found to have superior subjective image quality (P < 0.031) compared with other

  8. A Case of Acute Budd-Chiari Syndrome Complicating Primary Antiphospholipid Syndrome Presenting as Acute Abdomen and Responding to Tight Anticoagulant Therapy

    PubMed Central

    Koyama, Yasushi; Suzuki, Yasuo

    2016-01-01

    A 34-year-old woman with primary antiphospholipid syndrome was admitted to the Gastroenterology Department of our hospital with fever, acute abdomen, watery diarrhea, and extremely high levels of inflammatory parameters. She had a history of left lower limb deep vein thrombosis and pulmonary embolism and was taking warfarin potassium. Acute gastroenteritis was suspected and an antibiotic was administered, but symptoms progressed. Abdominal ultrasonography showed occlusion of the left hepatic vein and the middle hepatic vein and her D-dimer level was high. Accordingly, Budd-Chiari syndrome was diagnosed and high-dose intravenous infusion of heparin was initiated. Her abdominal symptoms improved and the levels of inflammatory parameters and D-dimer decreased rapidly. It is known that antiphospholipid syndrome can be complicated by Budd-Chiari syndrome that usually occurs as subacute or chronic onset, but acute onset is rare. It is difficult to diagnose acute Budd-Chiari syndrome complicating antiphospholipid syndrome and this complication generally has a poor outcome. However, the present case can get early diagnosis and successful treatment with tight anticoagulant therapy. PMID:27672472

  9. Computed tomography of the abdomen of calves during the first 105 days of life: II. Liver, spleen, and small and large intestines.

    PubMed

    Braun, U; Schnetzler, C; Augsburger, H; Müller, U; Dicht, S; Ohlerth, S

    2014-05-01

    Computed tomography (CT) findings of the liver, spleen and intestines of five healthy calves during six examinations in the first 105 days of life were compared with corresponding cadaver slices. The liver was located in the right hemiabdomen adjacent to the diaphragm and right abdominal wall. The caudal vena cava was seen dorsomedially and the portal vein further ventrally. The umbilical vein was seen running from the navel to the liver in all calves in the first scan and in four calves in the second scan. The spleen ran dorsoventrally adjacent to the costal part of the left abdominal wall and appeared sickle-shaped on transverse images. Differentiation of small and large intestines was only possible when the former contained fluid content and the latter gaseous content. The small intestine was in the left hemiabdomen dorsal to the abomasum and caudodorsal to the rumen at the first two examinations. Growth of the forestomachs caused displacement of the small intestine to the right and toward the ventral abdomen caudal to the liver and adjacent to the right abdominal wall. The large intestine was located caudodorsally, and the typical features of the spiral colon were apparent in the dorsal plane. The location of the caecum varied from dorsal to the spiral colon to adjacent to the right abdominal wall with the apex always pointing caudally. The rectum was easily identified in the pelvic region. The size, volume and density of the described organs throughout the study are shown in several tables.

  10. Initial evaluation of virtual un-enhanced imaging derived from fast kVp-switching dual energy contrast enhanced CT for the abdomen

    NASA Astrophysics Data System (ADS)

    Joshi, M.; Mendonca, P.; Okerlund, D.; Lamb, P.; Kulkarni, N.; Pinho, D.; Sahani, D.; Bhotika, R.

    2011-03-01

    The feasibility and utility of creating virtual un-enhanced images from contrast enhanced data acquired using a fast switching dual energy CT acquisition, is explored. Utilizing projection based material decomposition data, monochromatic images are generated and a Multi-material decomposition technique is applied. Quantitative and qualitative evaluation is performed to assess the equivalence of Virtual Un-Enhanced (VUE) and True Un-enhanced (TUE) for multiple tissue types and different organs in the abdomen. Ten patient cases were analyzed where a TUE and a subsequent Contrast Enhanced (CE) acquisition were obtained using fast kVp-switching dual energy CT utilizing Gemstone Spectral Imaging. Quantitative measurements were made by placing multiple Regions of Interest on the different tissues and organs in both the TUE and the VUE images. The absolute Hounsfield Unit (HU) differences in the mean values between TUE & VUE were calculated as well as the differences of the standard deviations. Qualitative analysis was done by two radiologists for overall image quality, presence of residual contrast, appearance of pathology, appearance and contrast of normal tissues and organs in comparison to the TUE. There is a very strong correlation between the TUE and VUE images.

  11. The action of spike frequency adaptation in the postural motoneurons of hermit crab abdomen during the first phase of reflex activation.

    PubMed

    Krans, Jacob L; Chapple, William D

    2005-02-01

    Cuticular strain associated with support of the shell of the hermit crab, Pagurus pollicarus, by its abdomen activates mechanoreceptors that evoke a stereotyped reflex in postural motoneurons. This reflex consists of three phases: a brief high-frequency burst of motoneuron spikes, a pause, and a much longer duration but lower frequency period of spiking. These phases are correlated with a rapid increase in muscle force followed by a slight decline to a level of tone that is greater than that at rest but less than maximal. The present experiments address the mechanisms underlying the transition from the first to second phase of the reflex and their role in force generation. Although centrally generated inhibitory post-synaptic potentials (IPSPS) are present during the pause period of the reflex, intracellular current injection of motoneurons reveals a spike frequency adaptation that rapidly and substantially reduces motoneuron firing frequency and is unchanged in saline that reduces synaptic transmission. The adaptation is voltage sensitive and persists for several hundred milliseconds upon repolarization. Hyperpolarization partially restores the initial response of the motoneuron to depolarizing current. Spike frequency adaptation and synaptic inhibition are important mechanisms in the generation of force that maintains abdominal stiffness at a constant, submaximal level.

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

    PubMed

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

    2017-09-21

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

  13. Realtime or Delayed Tele-Echography Using (A) a Robotic Arm, ISDN or Satellite Lines, (B) a Volumic Echographic Capture Mode and Internet (Application to Abdomen and Fetus)

    NASA Astrophysics Data System (ADS)

    Arbeille, Ph.; Cloppet, F.; Boucher, A.; Capri, A.; Vincent, N.

    2008-06-01

    Objective: to test (a) the tele-echography in realtime based on the use of a robotic arm, (b) the delayed tele echography using a volumic echographic capture and delayed processing. Method: A dedicated robotic arm (ESTELE) holding a real ultrasound probe is remotely controlled from the expert site with a fictive probe, and reproduces on the real probe all the movements of the expert hand. A dedicated motorized probe holder (TILTER) was used for tilting a 2D probe from -45 to +45°. Results: During fetal robotized Tele-echography (n=50) the expert was able to visualize and measure the fetal structures in 95% of the cases, while during abdomen echography (n=87) the expert visualized the main organs and lesions in 87% of the cases. The mean duration of the robotized tele echography session for one patient was 20+/-10 min. The delayed echography using the TILTER was tested on 40 patients. The organs were adequately visualized in 85% of the cases after 3 capture per organ. The average time from the first capture until the diagnostic was delivered was 40+/-10 minutes. Conclusion: Realtime or delayed Tele-echography provide similar information as direct examination in at least 85% of the cases. No false diagnostic was reported.

  14. Attenuation-based estimation of patient size for the purpose of size specific dose estimation in CT. Part II. Implementation on abdomen and thorax phantoms using cross sectional CT images and scanned projection radiograph images

    SciTech Connect

    Wang Jia; Christner, Jodie A.; Duan Xinhui; Leng Shuai; Yu Lifeng; McCollough, Cynthia H.

    2012-11-15

    Purpose: To estimate attenuation using cross sectional CT images and scanned projection radiograph (SPR) images in a series of thorax and abdomen phantoms. Methods: Attenuation was quantified in terms of a water cylinder with cross sectional area of A{sub w} from both the CT and SPR images of abdomen and thorax phantoms, where A{sub w} is the area of a water cylinder that would absorb the same dose as the specified phantom. SPR and axial CT images were acquired using a dual-source CT scanner operated at 120 kV in single-source mode. To use the SPR image for estimating A{sub w}, the pixel values of a SPR image were calibrated to physical water attenuation using a series of water phantoms. A{sub w} and the corresponding diameter D{sub w} were calculated using the derived attenuation-based methods (from either CT or SPR image). A{sub w} was also calculated using only geometrical dimensions of the phantoms (anterior-posterior and lateral dimensions or cross sectional area). Results: For abdomen phantoms, the geometry-based and attenuation-based methods gave similar results for D{sub w}. Using only geometric parameters, an overestimation of D{sub w} ranging from 4.3% to 21.5% was found for thorax phantoms. Results for D{sub w} using the CT image and SPR based methods agreed with each other within 4% on average in both thorax and abdomen phantoms. Conclusions: Either the cross sectional CT or SPR images can be used to estimate patient attenuation in CT. Both are more accurate than use of only geometrical information for the task of quantifying patient attenuation. The SPR based method requires calibration of SPR pixel values to physical water attenuation and this calibration would be best performed by the scanner manufacturer.

  15. Application of Optical Measurement Techniques During Stages of Pregnancy: Use of Phantom High Speed Cameras for Digital Image Correlation (D.I.C.) During Baby Kicking and Abdomen Movements

    NASA Technical Reports Server (NTRS)

    Gradl, Paul

    2016-01-01

    Paired images were collected using a projected pattern instead of standard painting of the speckle pattern on her abdomen. High Speed cameras were post triggered after movements felt. Data was collected at 120 fps -limited due to 60hz frequency of projector. To ensure that kicks and movement data was real a background test was conducted with no baby movement (to correct for breathing and body motion).

  16. The role of negative CT of the abdomen and pelvis in the decision to admit adults from the emergency department after blunt trauma.

    PubMed

    Heilbrun, Marta E; Chew, Felix S; Tansavatdi, Katharine R; Tooze, Janet A

    2005-11-01

    Computed tomography (CT) is widely used in the initial evaluation of blunt trauma patients and is associated with a high rate of negative imaging. A described benefit of negative imaging is prompt discharge. This study examined a single level 1 trauma center to determine whether adult blunt trauma patients are discharged from the emergency department (ED) after negative CT of the abdomen and pelvis (CT AP). The authors retrospectively created a data set of adult blunt trauma patients who received CT AP in the ED from August to November 2003. Statistical analysis of admission rates on the basis of positivity or negativity on CT AP was performed to determine if the test influenced admission rates. Additional subgroup analysis was made between the patients admitted with negative CT AP and those who were discharged from the ED. Two thirds (316/469) had negative CT AP. Whereas 80.4% of the patients (254/316) with negative CT AP were admitted, 98.0% (148/151) with positive CT AP were admitted, a statistically significant difference in admission rate (P < .0001). The vast majority (208/254, 81.9%) of patients with negative CT AP were admitted for extra-abdominal injuries. There was no statistical difference in the characteristics of a subgroup of 45 patients who were admitted without any documented injuries from the group discharged from the ED in terms of age, gender, comorbidity, Glasgow Coma Scale score, or intoxication. Under current practice, negative CT AP after blunt trauma results in a statistically significant decrease in admissions.

  17. Analysis of Clinical and Dosimetric Factors Associated With Change in Renal Function in Patients With Gastrointestinal Malignancies After Chemoradiation to the Abdomen

    SciTech Connect

    May, Kilian Salerno; Khushalani, Nikhil I.; Chandrasekhar, Rameela; Wilding, Gregory E.; Iyer, Renuka V.; Ma, Wen W.; Flaherty, Leayn; Russo, Richard C. C.; Fakih, Marwan; Kuvshinoff, Boris W.; Gibbs, John F.; Javle, Milind M.; Yang, Gary Y.

    2010-03-15

    Purpose: To analyze clinical and dosimetric factors associated with change in renal function in patients with gastrointestinal malignancies after chemoradiation to the abdomen. Methods and Materials: A retrospective review of 164 patients with gastrointestinal malignancies treated between 2002 and 2007 was conducted to evaluate change in renal function after concurrent chemotherapy and three-dimensional conformal abdominal radiotherapy (RT). Laboratory and biochemical endpoints were determined before RT and after RT at 6-month intervals. Factors assessed included smoking, diabetes, hypertension, blood urea nitrogen, creatinine, creatinine clearance (CrCl), chemotherapy, and dose-volume parameters. Renal toxicity was assessed by decrease in CrCl and scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring schema. Results: Of 164 patients, 63 had clinical and dosimetric data available. Median follow-up was 17.5 months. Creatinine clearance declined from 98.46 mL/min before RT to 74.20 mL/min one year after chemoradiation (p < 0.0001). Mean decrease in CrCl was 21.37%. Pre-RT CrCl, percentage of bilateral renal volume receiving at least 10 Gy (V{sub 10}), and mean kidney dose were significantly associated with development of Grade >=2 renal complications at 1 year after chemoradiation (p = 0.0025, 0.0170, and 0.0095, respectively). Conclusions: We observed correlation between pre-RT CrCl, V{sub 10}, and mean kidney dose and decline in CrCl 1 year after chemoradiation. These observations can assist in treatment planning and renal dose constraints in patients receiving chemotherapy and abdominal RT and may help identify patients at increased risk for renal complications.

  18. TU-F-CAMPUS-I-03: Preliminary Study of Size-Specific Dose Estimates in Adult Abdomenal CT Examinations in Taiwan

    SciTech Connect

    Tsai, H; Hu, Y; Hwang, Y

    2015-06-15

    Purpose: This study was to investigate size-specific dose estimates (SSDE) for routine adult abdominal CT examinations in Taiwan. Methods: A national survey was conducted in Taiwan in 2014 to investigate SSDEs for routine adult abdominal CT examinations. The hospitals involved in this study provided CT images of their typical patients. The CT image in the level of the middle liver was selected to record the corresponding tube current, slice mAs or effective mAs. The image was also used to estimate the dimensions of patient as measuring the lengths in the anterior to posterior (AP) and lateral (LAT) directions. The effective diameter was then calculated from AP and LAT, and used to look up conversion factors in the AAPM 204 report. The volume CTDI (CTDIvol) for each CT unit was measured on sites using a 32-cm cylindrical standard dose phantom and a calibrated pencil-type ionization chamber. Individual patient’s SSDEs were then calculated from the corresponding SSDE conversion factor and the CTDIvol. Results: The study cohort included 111 CT units. The ratio of turning on automatic tube current modulation (ATCM) or not is 88:23. Effective diameters are 258.7±25.1 mm (167–366 mm). 99.3% of typical patients selected by each hospital have smaller effective diameter than the 32-cm dosimetry phantom. Adult abdomenal SSDE is 17.5 ± 8.8 mGy (1.9-58 mGy). The SSDE seems to decrease as the effective diameter increases as the ATCM turns off, and independent with the effective diameter as the ATCM turns on. Conclusion: The SSDE for typical patients in Taiwan was investigated. We continue to complete this investigation in 2015 to include more valid data to establish SSDE reference level in Taiwan. This study was financially supported by the Atomic Energy Council in Taiwan.

  19. Comparison of visual biofeedback system with a guiding waveform and abdomen-chest motion self-control system for respiratory motion management.

    PubMed

    Nakajima, Yujiro; Kadoya, Noriyuki; Kanai, Takayuki; Ito, Kengo; Sato, Kiyokazu; Dobashi, Suguru; Yamamoto, Takaya; Ishikawa, Yojiro; Matsushita, Haruo; Takeda, Ken; Jingu, Keiichi

    2016-07-01

    Irregular breathing can influence the outcome of 4D computed tomography imaging and cause artifacts. Visual biofeedback systems associated with a patient-specific guiding waveform are known to reduce respiratory irregularities. In Japan, abdomen and chest motion self-control devices (Abches) (representing simpler visual coaching techniques without a guiding waveform) are used instead; however, no studies have compared these two systems to date. Here, we evaluate the effectiveness of respiratory coaching in reducing respiratory irregularities by comparing two respiratory management systems. We collected data from 11 healthy volunteers. Bar and wave models were used as visual biofeedback systems. Abches consisted of a respiratory indicator indicating the end of each expiration and inspiration motion. Respiratory variations were quantified as root mean squared error (RMSE) of displacement and period of breathing cycles. All coaching techniques improved respiratory variation, compared with free-breathing. Displacement RMSEs were 1.43 ± 0.84, 1.22 ± 1.13, 1.21 ± 0.86 and 0.98 ± 0.47 mm for free-breathing, Abches, bar model and wave model, respectively. Period RMSEs were 0.48 ± 0.42, 0.33 ± 0.31, 0.23 ± 0.18 and 0.17 ± 0.05 s for free-breathing, Abches, bar model and wave model, respectively. The average reduction in displacement and period RMSE compared with the wave model were 27% and 47%, respectively. For variation in both displacement and period, wave model was superior to the other techniques. Our results showed that visual biofeedback combined with a wave model could potentially provide clinical benefits in respiratory management, although all techniques were able to reduce respiratory irregularities.

  20. The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience.

    PubMed

    Orgiano, L; Pani, F; Astara, G; Madeddu, C; Marini, S; Manca, A; Mantovani, Giovanni

    2016-10-01

    The purpose of this study was to review the results of a single-center experience in the management of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) using a sophisticated technical device (EXIPER®) in the palliative setting of neoplastic ascites from peritoneal carcinomatosis in patients with advanced cancer of different primary sites. The study was an open, prospective, single-center, non-randomized study conducted at the Department of Medical Oncology 1, University of Cagliari, Italy, from May 2006 to October 2012. Fifteen patients with peritoneal carcinomatosis were treated with HIPEC: 5 males and 10 females (age range 51-82, median 62 years), for a total of 30 procedures (5 patients were treated more than once). Malignant ascites were from ovarian, uterine cervical, colorectal, gastric, malignant pleural mesothelioma, and unknown primary cancer. Main endpoints were increase of free interval between two consecutive procedures, progressive reduction of ascites volumes and improvement of quality of life assessed with ECOG performance status and EORTC QLQ-C30 questionnaire, and improvement of immunologic function. Twelve patients were completely evaluable while three patients were "lost" to follow-up. The treatment was well tolerated. The mean free interval between two consecutive drainages increased from 11.2 to 39.5 days. The mean ascites volume drained decreased from 7.8 to 1.8 l. ECOG PS improved in the majority of patients and EORTC QLQ-C30 scores in all patients as well as immunologic function. In September 2015, only one patient was still alive. Our study shows that good results may be achieved in terms of symptom palliation and improvement of quality of life in very advanced cancer patients with MA from PC. The treatment was generally well tolerated considering the limited treatment options available for these patients.

  1. The molecular through ecological genetics of abnormal abdomen in Drosophila mercatorum. V. Female phenotypic expression on natural genetic backgrounds and in natural environments.

    PubMed

    Templeton, A R; Hollocher, H; Johnston, J S

    1993-06-01

    The abnormal abdomen (aa) syndrome in Drosophila mercatorum depends on the presence of R1 inserts in a third or more of the X-linked 28S rDNA genes and the absence of selective underreplication of inserted repeats in polytene tissues that is controlled by an X-linked locus (ur) half a map unit from the rDNA complex. This syndrome affects both life history and morphology in the laboratory. Because abnormal morphologies are rarely encountered in nature, the purpose of this study is to see if the female life history traits are still affected under more natural genetic backgrounds and environmental conditions. Two outbred stocks were extracted from the natural population living near Kamuela, Hawaii: KaaX that has only X chromosomes with uraa alleles, and K+X that has only ur+ alleles. These two stocks have nonoverlapping distributions of insert proportions, indicating strong disequilibrium between the ur locus and the rDNA complex. The KaaX stock had almost no morphological penetrance of uraa, indicating that genetic background is important. KaaX expressed longer female egg-to-adult developmental times, increased early adult female fecundity, and decreased female adult longevity compared with K+X. By bagging natural rots of the cactus Opuntia megacantha near Kamuela, Hawaii, it was shown that egg-to-adult developmental time is slowed down by 0.92 days in females bearing uraa alleles in nature, with no detectable slowdown in uraa males. The bagged rot data also indicate that females bearing uraa alleles have a strong fecundity advantage in nature under some ecological conditions but not others.

  2. 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.

  3. Quality of life and hernia development 5 years after open abdomen treatment with vacuum-assisted wound closure and mesh-mediated fascial traction.

    PubMed

    Petersson, U; Bjarnason, T; Björck, M; Montgomery, A; Rogmark, P; Svensson, M; Sörelius, K; Acosta, S

    2016-10-01

    To report incisional hernia (IH) incidence, abdominal wall (AW) discomfort and quality of life (QoL) 5 years after open abdomen treatment with vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). Five-year follow-up of patients included in a prospective study 2006-2009. The protocol included physical examination, patient interview, chart review, questionnaires on abdominal wall and stoma complaints and the SF-36 questionnaire. Fifty-five (12 women, 43 men; median age 70 years) of 111 included patients were alive. Follow-up rate was 91 %. Cumulative IH incidence during the whole study was 62 %. One-third of the IHs was repaired. At 5-year follow-up 59 % of IHs were clinically detectable. AW symptoms were equivalent in patients with (15/23) and without (11/21) IH (p = 0.541). SF-36 scores were lower than population mean for component scores and all subscales except bodily pain. Patients with major co-morbidity had lower physical component score [31.6 (95 %, CI 25.6-37.4)] compared to those without [48.9 (95 %, CI 46.2-51.4)]. Major co-morbidity was not associated with IH (p = 0.56), AW symptoms (p = 0.54) or stoma (p = 0.10). Patients with IH or other AW symptoms had similar SF-36 results compared to those without, whereas patients with a stoma had >5 point lower mean scores for general health, social function and physical component score compared to those without. VAWCM treatment results in high incidence of IH. However, at five years, there was no detectable difference in abdominal wall complaints and QoL in patients with IH compared to those without. Lower QoL appeared mainly to be associated with the presence of major co-morbidity.

  4. Outcome of negative-pressure wound therapy for open abdomen treatment after nontraumatic lower gastrointestinal surgery: analysis of factors affecting delayed fascial closure in 101 patients.

    PubMed

    Bertelsen, Claus Anders; Fabricius, Rasmus; Kleif, Jakob; Kristensen, Bent; Gögenur, Ismail

    2014-04-01

    Few studies have focused on the risk factors for failure to achieve fascial closure after use of negative-pressure wound therapy (NPWT) in an open abdomen (OA). We aimed at analyzing possible risk factors for failure of fascial closure and the risk of fistulas after nontrauma lower gastrointestinal (GI) tract surgery treated with OA. This retrospective study included 101 nontrauma patients treated with OA from 2007 to 2011. Multivariate analyses of risk factors were performed. Indications for OA were diffuse peritonitis (n = 47), need for second look (n = 26), failure to achieve fascial closure (e.g., bowel edema) at primary laparotomy (n = 24), and fascial necrosis (n = 4). Of the 101 patients, 61 (60 %) were alive at discharge, with one death possibly related to OA (fistula from an iatrogenic perforation). Delayed fascial closure was obtained in 40 (66 %) of the surviving patients, with 80 % when the indications for OA was need for second look and 72 % in cases of diffuse peritonitis. Compared with need for second look [hazard ratio (HR = 1), 95 % CI], proportional HR for failure of delayed fascial closure were peritonitis 1.96 (1.10-3.49) and failure to achieve fascial closure at primary laparotomy 4.70 (2.17-10.2). In the presence of a stoma the HR was 2.02 (1.13-3.63). OA using NPWT seems to be a safe procedure, with few procedure-related complications. Failure of fascial closure is related to the indication of OA and the presence of a stoma. Prospective multicenter studies are needed to establish which patients with lower GI surgery benefit from OA.

  5. Prenatal prediction of neonatal survival in cases diagnosed with congenital diaphragmatic hernia using abdomen-to-thorax ratio determined by ultrasonography.

    PubMed

    Lee, Ji Yeon; Jun, Jong Kwan; Lee, JoonHo

    2014-09-01

    The aim of this study was to evaluate the usefulness of abdomen-to-thorax ratio (ATR) measured by antenatal ultrasonography for predicting neonatal survival of fetuses with congenital diaphragmatic hernia (CDH). We identified 75 fetuses who were prenatally diagnosed with CDH and delivered in Seoul National University Hospital from 1998 to 2012, retrospectively. Of these, 40 cases who met the following criteria were included: (i) singleton pregnancy; (ii) a case that had available ultrasonographic images; and (iii) a neonate in whom follow-up until discharge from the hospital was available. ATR was measured as follows: each anteroposterior distance (APD) in the abdominal and thoracic cavity was measured in the same midsagittal plane with the fetal neutral position. A thoracic APD was measured from the back to the distal end of the sternum and an abdominal APD from the back to the most protruding abdominal surface. ATR is the ratio of the abdominal APD versus the thoracic APD. Survival rates were 57.5%. There were significant differences in ATR, lung-head ratio (LHR), observed/expected-LHR, quantitative lung index and intrathoracic liver between survivors and non-survivors. Regression analysis demonstrated that only ATR and intrathoracic position of the liver were independent predictors of survival. ATR by multivariate analysis had the most influence on survival rate (P = 0.002). The area under the receiver-operator curve for prediction of survival from ATR was 0.770 (P = 0.004). The diagnostic cut-off value for ATR was 0.96. Because ATR is effective to predict neonatal survival in CDH fetuses and is easy to measure, it can be used as another powerful parameter for managing CDH fetuses. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  6. Unusual Cancers of the Abdomen

    MedlinePlus

    ... cancer ) cells form in the tissues of the larynx . The larynx is also called the voice box . It's the ... following: Laryngoscopy : A procedure to look at the larynx (voice box) for abnormal areas. A mirror or ...

  7. Abdomen X-Ray (Radiography)

    MedlinePlus

    ... have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure. top ...

  8. MO-E-17A-06: Organ Dose in Abdomen-Pelvis CT: Does TG 111 Equilibrium Dose Concept Better Accounts for KVp Dependence Than Conventional CTDI?

    SciTech Connect

    Li, X; Morgan, A; Davros, W; Dong, F; Primak, A; Segars, W

    2014-06-15

    Purpose: In CT imaging, a desirable quality assurance (QA) dose quantity should account for the dose variability across scan parameters and scanner models. Recently, AAPM TG 111 proposed to use equilibrium dose-pitch product, in place of CT dose index (CTDI100), for scan modes involving table translation. The purpose of this work is to investigate whether this new concept better accounts for the kVp dependence of organ dose than the conventional CTDI concept. Methods: The adult reference female extended cardiac-torso (XCAT) phantom was used for this study. A Monte Carlo program developed and validated for a 128-slice CT system (Definition Flash, Siemens Healthcare) was used to simulate organ dose for abdomenpelvis scans at five tube voltages (70, 80, 100, 120, 140 kVp) with a pitch of 0.8 and a detector configuration of 2x64x0.6 mm. The same Monte Carlo program was used to simulate CTDI100 and equilibrium dose-pitch product. For both metrics, the central and peripheral values were used together with helical pitch to calculate a volume-weighted average, i.e., CTDIvol and (Deq)vol, respectively. Results: While other scan parameters were kept constant, organ dose depended strongly on kVp; the coefficient of variation (COV) across the five kVp values ranged between 70–75% for liver, spleen, stomach, pancreas, kidneys, colon, small intestine, bladder, and ovaries, all of which were inside the primary radiation beam. One-way analysis of variance (ANOVA) for the effect of kVp was highly significant (p=3e−30). When organ dose was normalized by CTDIvol, the COV across the five kVp values reduced to 7–16%. The effect of kVp was still highly significant (p=4e−4). When organ dose was normalized by (Deq)vol, the COV further reduced to 4−12%. The effect of kVp was borderline significant (p=0.04). Conclusion: In abdomen-pelvis CT, TG 111 equilibrium dose concept better accounts for kVp dependence than the conventional CTDI. This work is supported by a faculty startup

  9. Single-source chest-abdomen-pelvis cancer staging on a third generation dual-source CT system: comparison of automated tube potential selection to second generation dual-source CT.

    PubMed

    Park, Clara; Gruber-Rouh, Tatjana; Leithner, Doris; Zierden, Amelie; Albrecht, Mortiz H; Wichmann, Julian L; Bodelle, Boris; Elsabaie, Mohamed; Scholtz, Jan-Erik; Kaup, Moritz; Vogl, Thomas J; Beeres, Martin

    2016-10-10

    Evaluation of latest generation automated attenuation-based tube potential selection (ATPS) impact on image quality and radiation dose in contrast-enhanced chest-abdomen-pelvis computed tomography examinations for gynaecologic cancer staging. This IRB approved single-centre, observer-blinded retrospective study with a waiver for informed consent included a total of 100 patients with contrast-enhanced chest-abdomen-pelvis CT for gynaecologic cancer staging. All patients were examined with activated ATPS for adaption of tube voltage to body habitus. 50 patients were scanned on a third-generation dual-source CT (DSCT), and another 50 patients on a second-generation DSCT. Predefined image quality setting remained stable between both groups at 120 kV and a current of 210 Reference mAs. Subjective image quality assessment was performed by two blinded readers independently. Attenuation and image noise were measured in several anatomic structures. Signal-to-noise ratio (SNR) was calculated. For the evaluation of radiation exposure, CT dose index (CTDIvol) values were compared. Diagnostic image quality was obtained in all patients. The median CTDIvol (6.1 mGy, range 3.9-22 mGy) was 40 % lower when using the algorithm compared with the previous ATCM protocol (median 10.2 mGy · cm, range 5.8-22.8 mGy). A reduction in potential to 90 kV occurred in 19 cases, a reduction to 100 kV in 23 patients and a reduction to 110 kV in 3 patients of our experimental cohort. These patients received significantly lower radiation exposure compared to the former used protocol. Latest generation automated ATPS on third-generation DSCT provides good diagnostic image quality in chest-abdomen-pelvis CT while average radiation dose is reduced by 40 % compared to former ATPS protocol on second-generation DSCT.

  10. Intraperitoneal chemotherapy hyperthermia (HIPEC) for peritoneal carcinomatosis of ovarian cancer origin by fluid and CO2 recirculation using the closed abdomen technique (PRS-1.0 Combat): A clinical pilot study.

    PubMed

    Sánchez-García, Susana; Villarejo-Campos, Pedro; Padilla-Valverde, David; Amo-Salas, Mariano; Martín-Fernández, Jesús

    2016-08-01

    Background This paper reports a study of 21 patients with peritoneal carcinomatosis from ovarian cancer who underwent cytoreductive surgery and HIPEC by means of PRS-1.0 Combat®, a new model for closed abdomen HIPEC aimed at improving fluid distribution with assistance from a CO2 recirculation system. This new technology has been previously shown to be successful in an experimental study (pig model) performed by our group, and has been approved for use in our hospital. Methods Twenty-one patients with peritoneal carcinomatosis of ovarian cancer origin were included in the study. Cytoreductive surgery and HIPEC were performed by a closed abdomen fluid and CO2 recirculation technique using the PRS-1.0 Combat(®) model. We analysed the intraoperative safety tolerance and post-operative morbidity and mortality during the first 30 days. Results Between November 2011 and March 2014 21 patients with epithelial ovarian cancer, International Federation of Gynecology and Obstetrics stage II-IV, were included in the study. During the procedure there were no significant haemodynamic or analytical disturbances. Complication rates were 38.1% and 57.14% for grade III/IV and minor (grade I/II) complications, respectively. Post-operative mortality was 4.76% (one patient). Complete cytoreductive surgery and intraperitoneal chemotherapy improved overall survival and disease-free survival in women with advanced ovarian cancer. The association of intra-abdominal hyperthermia with chemotherapy (HIPEC) increased the therapeutic benefit. Conclusions This study has shown that closed abdomen intraperitoneal chemohyperthermia by a fluid and CO2 recirculation system (PRS-1.0 Combat(®)) can be a safe and feasible model for the treatment of peritoneal carcinomatosis of ovarian cancer origin.

  11. Eviscération transanale de l'intestin grêle chez l'enfant secondaire à une contusion de l'abdomen: à propos d'un cas

    PubMed Central

    Bâ, Papa Abdoulaye; Soumah, Sékou Amadou; Diop, Balla; Traoré, Mamadou Mour; Mahdi, Charfi; Mbaye, Elhadji Malick; Fall, Babacar

    2011-01-01

    L’éviscération transanale de l'intestin grêle au cours d'un traumatisme fermé de l'abdomen est une situation exceptionnelle. Nous rapportons le cas d'une fille de 7 ans, reçue pour un état de choc hémorragique avec une éviscération transanale de l'intestin grêle suite à une contusion de l'abdomen. Ce tableau clinique est survenu au décours d'un accident de la circulation. La laparotomie exploratrice permettait de découvrir une plaie longitudinale de la face antérieure du rectum, située au dessus de la réflexion péritonéale, à travers laquelle passaient les anses grêles. Une suture de la plaie rectale associée à une iléostomie double après résection du grêle éviscéré et un à drainage du cul-de-sac de Douglas ont été réalisés. L'enfant est décédé en postopératoire précoce. A travers cette observation, les auteurs se proposent de revoir les cas précédemment décrits et de discuter les options thérapeutiques. PMID:22384296

  12. Neues Fleckenmaximum beim aktiven Doppelstern V505 Ser

    NASA Astrophysics Data System (ADS)

    Bernhard, Klaus; Frank, Peter; Huemmerich, Stefan

    2016-02-01

    V505 Ser is a short-period, eclipsing RS CVn system which was discovered by Bernhard (2005). New photometry gives further evidence to the existence of a 5-6 year spot cycle and of a starspot maximum in 2015.

  13. Accuracy of the new radiographic sign of fecal loading in the cecum for differential diagnosis of acute appendicitis in comparison with other inflammatory diseases of right abdomen: a prospective study

    PubMed Central

    Petroianu, A; Alberti, LR

    2012-01-01

    Rationale: To assess the importance of the new radiographic sign of faecal loading in the cecum for the diagnosis of acute appendicitis, in comparison with other inflammatory diseases, and to verify the maintenance of this radiographic sign after surgical treatment of appendicitis. Methods: 470 consecutive patients admitted to the hospital due to acute abdomen were prospectively studied: Group 1 [n=170] – diagnosed with acute appendicitis, subdivided into: Subgroup 1A – [n=100] – submitted to an abdominal radiographic study before surgical treatment, Subgroup 1B – [n=70] – patients who had plain abdominal X-rays done before the surgical procedure and also the following day; Group 2 [n=100] – right nephrolithiasis; Group 3 [n=100] – right acute inflammatory pelvic disease; Group 4 [n=100] – acute cholecystitis. The patients of Groups 2,3 and 4 were submitted to abdominal radiography during the pain episode. Results: The sign of faecal loading in the cecum, characterized by hypo transparency interspersed with multiple small foci of hyper transparent images, was present in 97 patients of Subgroup 1A, in 68 patients of Subgroup 1B, in 19 patients of Group 2, in 12 patients of Group 3 and in 13 patients of Group 4. During the postoperative period the radiographic sign disappeared in 66 of the 68 cases that had presented with the sign. The sensitivity of the radiographic sign for acute appendicitis was 97.05% and its specificity was 85.33%. The positive predictive value for acute appendicitis was 78.94% and its negative predictive value was 98. 08%. Discussion: The radiographic image of faecal loading in the cecum is associated with acute appendicitis and disappears after appendectomy. This sign is uncommon in other acute inflammatory diseases of the right side of the abdomen. PMID:22574093

  14. Comparative study of the microvascular blood flow in the intestinal wall, wound contraction and fluid evacuation during negative pressure wound therapy in laparostomy using the V.A.C. abdominal dressing and the ABThera open abdomen negative pressure therapy system.

    PubMed

    Lindstedt, Sandra; Malmsjö, Malin; Hlebowicz, Joanna; Ingemansson, Richard

    2015-02-01

    This study aimed to compare the changes in microvascular blood flow in the small intestinal wall, wound contraction and fluid evacuation, using the established V.A.C. abdominal dressing (VAC dressing) and a new abdominal dressing, the ABThera open abdomen negative pressure therapy system (ABThera dressing), in negative pressure wound therapy (NPWT). Midline incisions were made in 12 pigs that were subjected to treatment with NPWT using the VAC or ABThera dressing. The microvascular blood flow in the intestinal wall was measured before and after the application of topical negative pressures of −50, −75 and −125mmHg using laser Doppler velocimetry. Wound contraction and fluid evacuation were also measured. Baseline blood flow was defined as 100% in all settings. The blood flow was significantly reduced to 64·6±6·7% (P <0·05) after the application of −50mmHg using the VAC dressing, and to 65·3±9·6% (P <0·05) after the application of −50mmHg using the ABThera dressing. The blood flow was significantly reduced to 39·6±6·7% (P <0·05) after the application of −125mmHg using VAC and to 40·5±6·2% (P <0·05) after the application of −125mmHg using ABThera. No significant difference in reduction in blood flow could be observed between the two groups. The ABThera system afforded significantly better fluid evacuation from the wound, better drainage of the abdomen and better wound contraction than the VAC dressing.

  15. Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years.

    PubMed

    Agresta, Ferdinando; Campanile, Fabio Cesare; Podda, Mauro; Cillara, Nicola; Pernazza, Graziano; Giaccaglia, Valentina; Ciccoritti, Luigi; Ioia, Giovanna; Mandalà, Stefano; La Barbera, Camillo; Birindelli, Arianna; Sartelli, Massimo; Di Saverio, Salomone

    2017-04-01

    Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity. Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher's exact test, and data were considered significant when p < 0.05. Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically, p = 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %; p = 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26-75 % of cases (14.0 vs. 29.7 %; p = 0.009), those with >25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %; p = 0.0009), the units with >50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice. The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen.

  16. CAIPIRINHA-Dixon-TWIST (CDT)-volume-interpolated breath-hold examination (VIBE): a new technique for fast time-resolved dynamic 3-dimensional imaging of the abdomen with high spatial resolution.

    PubMed

    Michaely, Henrik J; Morelli, John N; Budjan, Johannes; Riffel, Philipp; Nickel, Dominik; Kroeker, Randall; Schoenberg, Stefan O; Attenberger, Ulrike I

    2013-08-01

    The purpose of this study was to assess the feasibility and image quality of a novel, highly accelerated T1-weighted sequence for time-resolved imaging of the abdomen during the first pass of contrast media transit using controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) under sampling, view-sharing techniques, and Dixon water-fat separation (CAIPRINHA-Dixon-time-resolved imaging with interleaved stochastic trajectories-volumetric interpolated breath-hold examination [CDT-VIBE]). In this retrospective, institutional review board-approved study, 47 patients (median age, 62 years; 25 men, 22 women) scanned on a 3.0-T magnetic resonance system (Skyra; Siemens) were included. The CDT-VIBE (repetition time/echo time1/echo time2, 4.1/1.33/2.56 milliseconds; acquisition time, 29 seconds) was used in place of the standard arterial phase acquisition and started 15 seconds after the injection of 0.1 mmol/kg Gd-DOTA (Dotarem, Guerbet). Within 29 seconds, 14 high spatial resolution (1.2 × 1.2 × 3 mm) 3-dimensional data sets were acquired and reconstructed using view sharing (temporal resolution, 2.1 seconds). The CDT-VIBE images were evaluated independently by 2 blinded, experienced radiologists with regard to image quality and the number of hepatic arterial-dominant phases present on an ordinal 5-point scale (5, excellent; 1, nondiagnostic). Added diagnostic information with CDT-VIBE relative to portal venous phase VIBE was assessed. In all patients, CDT-VIBE measurements were successfully acquired. The image quality was diagnostic in 46 of the 47 patients. Both readers assessed the highest image quality present in the data sets with a median score of 4 (range, 3-5 for both readers; κ, 0.789) and the worst image quality with a median score of 3 (range, 1-4 for both readers; κ, 0.689). With a range between 1 and 8 (median, 5), hepatic arterial-dominant data sets (of the 14 acquired) were obtained in each case. There was an added diagnostic

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

    PubMed

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

    2014-06-01

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

  18. Third version of vendor-specific model-based iterativereconstruction (Veo 3.0): evaluation of CT image quality in the abdomen using new noise reduction presets and varied slice optimization.

    PubMed

    Telesmanich, Morgan E; Jensen, Corey T; Enriquez, Jose L; Wagner-Bartak, Nicolaus A; Liu, Xinming; Le, Ott; Wei, Wei; Chandler, Adam G; Tamm, Eric P

    2017-08-01

    To qualitatively and quantitatively compare abdominal CT images reconstructed with a newversion of model-based iterative reconstruction (Veo 3.0; GE Healthcare Waukesha, WI) utilizing varied presetsof resolution preference, noise reduction and slice optimization. This retrospective study was approved by our Institutional Review Board and was Health Insurance Portability and Accountability Act compliant. The raw datafrom 30 consecutive patients who had undergone CT abdomen scanning were used to reconstructfour clinical presets of 3.75mm axial images using Veo 3.0: 5% resolution preference (RP05n), 5%noise reduction (NR05) and 40% noise reduction (NR40) with new 3.75mm "sliceoptimization," as well as one set using RP05 with conventional 0.625mm "slice optimization" (RP05c). The images were reviewed by two independent readers in a blinded, randomized manner using a 5-point Likert scale as well as a 5-point comparative scale. Multiple two-dimensional circular regions of interest were defined for noise and contrast-to-noise ratio measurements. Line profiles were drawn across the 7 lp cm(-1) bar pattern of the Catphan 600 phantom for evaluation of spatial resolution. The NR05 image set was ranked as the best series in overall image quality (mean difference inrank 0.48, 95% CI [0.081-0.88], p = 0.01) and with specific reference to liver evaluation (meandifference 0.46, 95% CI [0.030-0.89], p = 0.03), when compared with the secondbest series ineach category. RP05n was ranked as the best for bone evaluation. NR40 was ranked assignificantly inferior across all assessed categories. Although the NR05 and RP05c image setshad nearly the same contrast-to-noise ratio and spatial resolution, NR05 was generally preferred. Image noise and spatial resolution increased along a spectrum with RP05n the highest and NR40the lowest. Compared to RP05n, the average noise was 21.01% lower for NR05, 26.88%lower for RP05c and 50.86% lower for NR40. Veo 3.0 clinical presets allow for

  19. 49 CFR 572.197 - Abdomen.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... side of the seated dummy tangent to a vertical plane located within 10 mm of the side edge of the bench as shown in Figure V7-A in Appendix A to this subpart, while the midsagittal plane of the dummy is in...); (6) Adjust orientation of the legs such that they are symmetrical about the mid-sagittal plane,...

  20. 49 CFR 572.197 - Abdomen.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... side of the seated dummy tangent to a vertical plane located within 10 mm of the side edge of the bench as shown in Figure V7-A in Appendix A to this subpart, while the midsagittal plane of the dummy is in...); (6) Adjust orientation of the legs such that they are symmetrical about the mid-sagittal plane,...

  1. 49 CFR 572.197 - Abdomen.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... side of the seated dummy tangent to a vertical plane located within 10 mm of the side edge of the bench as shown in Figure V7-A in Appendix A to this subpart, while the midsagittal plane of the dummy is in... subpart); (6) Adjust orientation of the legs such that they are symmetrical about the mid-sagittal...

  2. 49 CFR 572.197 - Abdomen.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... side of the seated dummy tangent to a vertical plane located within 10 mm of the side edge of the bench as shown in Figure V7-A in Appendix A to this subpart, while the midsagittal plane of the dummy is in... subpart); (6) Adjust orientation of the legs such that they are symmetrical about the mid-sagittal...

  3. 49 CFR 572.197 - Abdomen.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... side of the seated dummy tangent to a vertical plane located within 10 mm of the side edge of the bench as shown in Figure V7-A in Appendix A to this subpart, while the midsagittal plane of the dummy is in...); (6) Adjust orientation of the legs such that they are symmetrical about the mid-sagittal plane,...

  4. MRI of the Body (Chest, Abdomen, Pelvis)

    MedlinePlus

    ... magnetic field of the MRI unit, metal and electronic items are not allowed in the exam room. ... tell the technologist if you have medical or electronic devices in your body. These objects may interfere ...

  5. Parasitic diseases in the abdomen: imaging findings.

    PubMed

    Lim, Jae Hoon

    2008-01-01

    Parasitic diseases of the liver and biliary tract include echinococcosis, schistosomiasis, toxocariasis, clonorchiasis, and opisthorchiasis, affecting millions people in some endemic areas. Amebiasis and ascariasis are believed to be the most common bowel lumen indwelling parasitic diseases, affecting billions people worldwide, but sometimes these parasites migrate inadvertently to the liver and biliary tract, resulting in liver abscess or obstructive jaundice. Imaging findings of these parasitic diseases are fairly characteristic and easy to recognize if radiologists are aware of the findings, especially in endemic areas. Because of increased immigration and frequent travelling, some patients with "exotic" parasitic diseases may be encountered in non-endemic areas, and the diagnosis may be delayed or difficult, and it is often made only after operation. This feature section was designed to provide the detailed imaging features of common parasitic diseases affecting the abdominal organs and peritoneal cavity, based on pathology-image correlation.

  6. MRI of the Body (Chest, Abdomen, Pelvis)

    MedlinePlus

    ... of any kind, such as an allergy to iodine or x-ray contrast material, drugs, food, or ... gadolinium . Gadolinium can be used in patients with iodine contrast allergy, but may require pre-medication. It ...

  7. Computed tomographic studies of the painful abdomen

    SciTech Connect

    Benson, M.; Bree, R.L.; Schwab, R.E.; Ouimette, M.

    1985-05-01

    Abdominal CT scans were reviewed in a series of 53 patients who had abdominal pain without objective physical, radiographic, or laboratory abnormalities. Forty patients presented with abdominal pain alone, while the remaining patients had abdominal pain associated with nausea, vomiting or mild weight loss. Abdominal CT scans in all patients were interpreted as normal. One patient had a pancreatic carcinoma discovered at surgery one month after the CT scan was obtained. The patients were followed up for 6 to 12 months to confirm absence of significant disease. Our analysis suggests a very low yield from abdominal CT in patients with abdominal pain and no other objective findings.

  8. MR imaging of the pediatric abdomen.

    PubMed

    Siegel, M J

    1995-02-01

    MR imaging has had a major impact on pediatric abdominal imaging. It is particularly important in evaluating abdominal masses because it can provide information about resectability and extent of lesions. MR imaging is recommended over other imaging techniques for detection of vasculature encasement and intraspinal extension of tumor. The use of this imaging technique should continue to increase with the development of faster scanning sequences and contrast agents for bowel opacification.

  9. Radiotherapy of abdomen with precise renal assessment with SPECT/CT imaging (RAPRASI): design and methodology of a prospective trial to improve the understanding of kidney radiation dose response

    PubMed Central

    2013-01-01

    Background The kidneys are a principal dose-limiting organ in radiotherapy for upper abdominal cancers. The current understanding of kidney radiation dose response is rudimentary. More precise dose-volume response models that allow direct correlation of delivered radiation dose with spatio-temporal changes in kidney function may improve radiotherapy treatment planning for upper-abdominal tumours. Our current understanding of kidney dose response and tolerance is limited and this is hindering efforts to introduce advanced radiotherapy techniques for upper-abdominal cancers, such as intensity-modulated radiotherapy (IMRT). The aim of this study is to utilise radiotherapy and combined anatomical/functional imaging data to allow direct correlation of radiation dose with spatio-temporal changes in kidney function. The data can then be used to develop a more precise dose-volume response model which has the potential to optimise and individualise upper abdominal radiotherapy plans. Methods/design The Radiotherapy of Abdomen with Precise Renal Assessment with SPECT/CT Imaging (RAPRASI) is an observational clinical research study with participating sites at Sir Charles Gairdner Hospital (SCGH) in Perth, Australia and the Peter MacCallum Cancer Centre (PMCC) in Melbourne, Australia. Eligible patients are those with upper gastrointestinal cancer, without metastatic disease, undergoing conformal radiotherapy that will involve incidental radiation to one or both kidneys. For each patient, total kidney function is being assessed before commencement of radiotherapy treatment and then at 4, 12, 26, 52 and 78 weeks after the first radiotherapy fraction, using two procedures: a Glomerular Filtration Rate (GFR) measurement using the 51Cr-ethylenediamine tetra-acetic acid (EDTA) clearance; and a regional kidney perfusion measurement assessing renal uptake of 99mTc-dimercaptosuccinic acid (DMSA), imaged with a Single Photon Emission Computed Tomography / Computed Tomography (SPECT

  10. Traumatismes fermés et pénétrants de l'abdomen: analyse rétrospective sur 175 cas et revue de la littérature

    PubMed Central

    Fanomezantsoa, Raherinantenaina; Davidà, Rakotomena Solonirina; Tianarivelo, Rajaonarivony; Fabienne, Rabetsiahiny Lalao; Aina, Rajaonanahary Toky Mamin'Ny; Auberlin, Rakototiana Felantsoa; Allen, Hunald Francis; Nirina, Rakoto Ratsimba Hery

    2015-01-01

    Les traumatismes abdominaux sont relativement fréquents mais graves dans les pays en développement. Le but de cette étude était de décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs des contusions et plaies pénétrantes de l'abdomen prises en charge dans un pays à faibles ressources. Patients et méthodes: Il s'agissait d'une étude rétrospective et descriptive de 2 ans (2011-2012) ayant colligé 175 cas de traumatisés abdominaux au CHU-JRA Tananarive Madagascar. Parmi ces blessés (144 hommes et 31 femmes), il existait 122 vivants (69,7%) et 53 décès (30,3%) avant tout geste thérapeutique hospitalier. Les étiologies étaient dominées par les accidents à responsabilité civile (52,5%) et de la voie publique (38,5%). Les contusions et plaies pénétrantes représentaient respectivement 41,8% et 58,2%. Parmi les blessés vivants, 112 ont été opérés (91,8%). L’évolution hospitalière était favorable dans 94,3%. Quatre patients avaient des suites opératoires compliquées (3,6%). Sept patients étaient décédés (5,7%). Parmi les décès préhospitaliers, nous avons observé 73,6% de polytraumatisme (n = 39) et 26,4% de traumatismes abdominaux isolés (n = 14). A l'autopsie, les lésions abdominales étaient hémorragiques dans 94,3% incluant des plaies vasculaires rétropéritonéales, des ruptures hépatospléniques et des traumatismes graves du bassin. En situation précaire, les traumatismes abdominaux ont une mortalité préhospitalière assez importante. A l'hôpital, l’évolution était généralement favorable au prix d'un acte opératoire invasif. PMID:26097633

  11. Comparison of radial 4D Flow-MRI with perivascular ultrasound to quantify blood flow in the abdomen and introduction of a porcine model of pre-hepatic portal hypertension.

    PubMed

    Frydrychowicz, A; Roldan-Alzate, A; Winslow, E; Consigny, D; Campo, C A; Motosugi, U; Johnson, K M; Wieben, O; Reeder, S B

    2017-06-27

    Objectives of this study were to compare radial time-resolved phase contrast magnetic resonance imaging (4D Flow-MRI) with perivascular ultrasound (pvUS) and to explore a porcine model of acute pre-hepatic portal hypertension (PHTN). Abdominal 4D Flow-MRI and pvUS in portal and splenic vein, hepatic and both renal arteries were performed in 13 pigs of approximately 60 kg. In six pigs, measurements were repeated after partial portal vein (PV) ligature. Inter- and intra-reader comparisons and statistical analysis including Bland-Altman (BA) comparison, paired Student's t tests and linear regression were performed. PvUS and 4D Flow-MRI measurements agreed well; flow before partial PV ligature was 322 ± 30 ml/min in pvUS and 297 ± 27 ml/min in MRI (p = 0.294), and average BA difference was 25 ml/min [-322; 372]. Inter- and intra-reader results differed very little, revealed excellent correlation (R (2) = 0.98 and 0.99, respectively) and resulted in BA differences of -5 ml/min [-161; 150] and -2 ml/min [-28; 25], respectively. After PV ligature, PV flow decreased from 356 ± 50 to 298 ± 61 ml/min (p = 0.02), and hepatic arterial flow increased from 277 ± 36 to 331 ± 65 ml/min (p = n.s.). The successful in vivo comparison of radial 4D Flow-MRI to perivascular ultrasound revealed good agreement of abdominal blood flow although with considerable spread of results. A model of pre-hepatic PHTN was successfully introduced and acute responses monitored. • Radial 4D Flow-MRI in the abdomen was successfully compared to perivascular ultrasound. • Inter- and intra-reader testing demonstrated excellent reproducibility of upper abdominal 4D Flow-MRI. • A porcine model of acute pre-hepatic portal hypertension was successfully introduced. • 4D Flow-MRI successfully monitored acute changes in a model of portal hypertension.

  12. Werkzeugverschleißdetektion beim Fräsen mittels Infrarotmesstechnik

    NASA Astrophysics Data System (ADS)

    Pittner, Walter

    Heute ist es praxisüblich, bei der spanenden Bearbeitung mittels definierter Schneide die Werkzeuge aus Gründen der Qualitätssicherung vorzeitig, im Allgemeinen nach Ermessen des Maschinenbedieners, zu wechseln. Dadurch entstehen zwangsläufig höhere Werkzeugkosten als notwendig, die dann an den Verbraucher weitergegeben werden. Wird jedoch ein rechtzeitiger Werkzeugwechsel verpasst, so entstehen insbesondere bei Hochleistungsbearbeitungsprozessen hohe Ausschussraten. Daher sollte die Entscheidung zum Werkzeugwechsel nicht mehr dem Maschinenbediener allein überlassen werden [1, 2].

  13. Infektion mit Epstein-Barr-Virus und Tumor-Entstehung beim Menschen

    NASA Astrophysics Data System (ADS)

    Kirchner, H.

    1981-08-01

    The Epstein-Barr Virus (EBV) is the only infectious agent for which a close association with human malignant tumors has been clearly demonstrated. These tumors are one type of nasopharyngeal carcinoma which is frequent in parts of East Asia and the Burkitt lymphoma which predominantly occurs in parts of Africa and New Guinea. Nonetheless, the EBV is the causative agent of infectious mononucleosis (IM), a benign, self-limiting lymphoproliferative disease of adolescents. The major difference between the countries in which the EBV-induced tumors occur and those in which IM occurs is the late primary EBV infection in the latter, whereas primary infection with EBV occurs in the first year of life in the former. All theories of viral carcinogenesis have to explain the long latency period between primary infection and tumor growth and how an ubiquitous virus may be oncogenic. Thus, invariably, one has to assume a role of cofactors, which may be of cytogenetic nature or may be represented by additional infections or by chemical agents. Since most modern theories of carcinogenesis consider a multi-step development of tumors, the theory that infection with an ubiquitous virus at the right time of life represents one step to carcinogenesis seems to be tenable.

  14. Physik gestern und heute: Fragwürdiges beim Millikan-Versuch

    NASA Astrophysics Data System (ADS)

    Heering, Peter

    2006-09-01

    Robert A. Millikan erhielt 1923 als erster amerikanischer Physiker den Nobelpreis für Physik. Geehrt wurde er für seine Präzisionsmessungen zum Photoeffekt und zur experimentellen Bestimmung der elektrischen Elementarladung. Millikans Experimente zur Elementarladung sind auch heute noch ein Standardthema im schulischen Physikunterricht, gleichzeitig werfen sie aber eine Reihe von wissenschaftstheoretischen und ethisch relevanten Fragen auf.

  15. Acute abdomen caused by both acute appendicitis and epididymitis.

    PubMed

    Nakatani, Hajime; Hamada, Shinichi; Okanoue, Toyotake; Kawamura, Akihiro; Inoue, Yuichiro; Yamamoto, Shinya; Chikai, Takashi; Hiroi, Makoto; Hanazaki, Kazuhiro

    2011-08-01

    Acute appendicitis often presents as right lower quadrant (RLQ) pain, severe tenderness at the point of McBurny or Lanz, and Blumberg's sign. Scrotal events with appendicitis are very rare. In our case, a 63-year-old Japanese man presented with severe RLQ pain and high fever. Physical examination revealed severe tenderness (including both points of McBurny and Lanz) and Blumberg's sign. The scrotum was slightly swollen and showed local heat with severe testicular pain. Abdominal computed tomography revealed ascites in a pelvic space and the right side of the spermatic cord was swollen. Emergency operation was performed and the final diagnosis was catarrhal appendicitis and acute epididymitis. This is the first report of acute appendicitis concomitant with acute epididymitis.

  16. [Acute abdomen as initial manifestation of metastatic melanoma].

    PubMed

    Barros, Marcos Aurélio Pessoa; de Castro, Nathalia Siqueira Robert; Mourão, Thiago Camelo

    2013-01-01

    The malignant melanoma is a relatively common neoplasia, with origin generally in the melanocytics cells in the skin, but with presentation of other possible primary lesions, being presented in this, a case witnessed of liver and mesentery metastases with unknown primary sites.

  17. Injuries to the Abdomen and Thorax: Diagnostic and Therapeutic Considerations.

    ERIC Educational Resources Information Center

    Maull, Kimball

    It is the responsibility of the athletic trainer to diagnose the nature and extent of an injury to an athlete, administer prompt first aid treatment, prevent any exacerbation of the injury, and hospitalize the patient quickly if it is necessary. The importance of these responsibilities is emphasized when an athlete suffers an injury to the abdomen…

  18. A Clinical Skills Instruction Program: The Acute Abdomen.

    ERIC Educational Resources Information Center

    Laube, Douglas W.; And Others

    1982-01-01

    An effective evaluation of the acutely ill female implies a thorough examination that integrates skills representing three learning domains. This process should include: a thorough medical history, a physical examination, good patient-physician rapport, and development of an efficacious management plan. A University of Iowa simulation approach is…

  19. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

    PubMed Central

    Geranpayeh, Loabat; Fadaei-Araghi, Mohsen; Shakiba, Behnam

    2006-01-01

    Spontaneous perforation of the uterus is rare, its incidence being about 0.01% − 0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain. PMID:17485806

  20. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

    PubMed Central

    Okuno, Kentaro; Ugaki, Hiromi; Komoto, Yoshiko; Fujimi, Satoshi; Takemura, Masahiko

    2014-01-01

    Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts. PMID:25057420

  1. Spontaneous uterine perforation of pyometra presenting as acute abdomen.

    PubMed

    Kitai, Toshihiro; Okuno, Kentaro; Ugaki, Hiromi; Komoto, Yoshiko; Fujimi, Satoshi; Takemura, Masahiko

    2014-01-01

    Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.

  2. CT angiography in the abdomen: a pictorial review and update.

    PubMed

    Liu, Peter S; Platt, Joel F

    2014-02-01

    The development of multidetector CT technology and helical scanning techniques has revolutionized the use of CT for primary diagnostic evaluation of the abdominal vasculature, particularly the arterial system. CT angiography has numerous benefits relative to conventional catheter angiography, and has largely replaced catheter-based techniques in many clinical algorithms. This pictorial review and update will cover important technical principles related to modern CT angiography (including contrast delivery and dose considerations), discuss relevant anatomy and variants, and illustrate numerous arterial conditions related to the abdominal aorta and branch vessels.

  3. Silent navigator-triggered silent MRI of the abdomen.

    PubMed

    Iwadate, Yuji; Nozaki, Atsushi; Nunokawa, Yoshinobu; Okuda, Shigeo; Jinzaki, Masahiro; Kabasawa, Hiroyuki

    2017-08-07

    To develop and demonstrate the feasibility of a silent respiratory navigator technique for prospective triggering, which was incorporated into a three-dimensional radial zero-echo-time sequence for respiratory navigated silent abdominal imaging. A nonselective hard excitation radiofrequency pulse was used for the navigator sequence with a derated readout gradient, to avoid generation of high levels of acoustic noise. The acquired navigator signals were processed in real time and used for prospective triggering of the zero-echo-time sequence. Ten healthy volunteers were scanned using the proposed and conventional techniques at 1.5 T. An acoustic noise measurement with A-weighted continuous equivalent sound pressure level was also performed. The sound pressure-level values of the background noise, zero-echo-time imaging, conventional, and silent navigators were 68.3, 68.4, 102.5, and 69.4 dBA, respectively. Excellent correlation with correlation coefficients greater than 0.9 was observed between the bellows signals and displacement values calculated from the navigators. Sharpness of the portal vein of both conventional and silent navigator-triggered images was significantly higher than those of nontriggered images. The silent navigator-triggered zero-echo-time technique is feasible and might improve image quality and workflow of abdominal MRI of patients who are prone to acoustic noise. Magn Reson Med, 2017. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  4. Percutaneous Removal of Retained Calculi from the Abdomen

    SciTech Connect

    O'Shea, S.J.; Martin, D.F.

    2003-02-15

    With rising pressure placed on health service resources minimally invasive techniques requiring only short hospital admissions are increasing in importance. We describe the techniques used to remove calculi from the peritoneal cavity which had been retained after surgery and continued to cause clinical problems. In both cases described the calculi lay within abscess cavities associated with fistulous tracks to the skin. The fistulae were dilated to allow passage of therapeutic radiologic and endoscopic equipment enabling manipulation and subsequent extraction of the stones. In both cases removal of the calculi allowed complete resolution of the fistulae and the patients made a full clinical recovery. Removal of gallstones which have escaped into the peritoneum at laparoscopic cholecystectomy leading to sepsis has been described; we describe the novel management of a patient in whom extraction had already been attempted, at another hospital, without success. Removal of an appendicolith, described herein another patient, does not appear to have been reported previously.

  5. Restless abdomen: a phenotypic variant of restless legs syndrome.

    PubMed

    Pérez-Díaz, Hernando; Iranzo, Alex; Rye, David B; Santamaría, Joan

    2011-09-27

    A diagnosis of restless legs syndrome (RLS) requires an urge to move the legs in combination with sensory leg discomfort. Localization of the symptoms to other body areas in the absence of leg involvement is not recognized as part of the phenotypic spectrum of RLS. We describe 3 patients who presented with sensorimotor symptoms confined to the abdominal wall and, with the exception of not involving the legs, satisfied the primary and secondary diagnostic criteria for RLS. Patients underwent detailed clinical history, video-polysomnography, abdominal imaging, and serologic and genotyping assessment. Unpleasant abdominal symptoms emerged at night during periods of rest and were accompanied by an urge to move and temporized by movement. Patients reported sleep onset and sleep maintenance insomnia due to their abdominal symptomatology. Abdominal imaging was normal. Secondary features included periodic leg movements of sleep (PLMS), and dramatic symptom amelioration with the D(2)-D(3) dopaminergic agonist pramipexole. Two subjects were anemic. Conventional RLS emerged in one subject and resolved after dose escalation. Each subject was homozygous for the most common RLS/PLMS-associated risk allele in the BTBD9 gene. Our observations indicate that the restricted abdominal symptomatology manifest in our subjects represents a phenotypic variant of RLS. Physicians should be vigilant to the existence of this unique phenotype when encountering subjects who present with insomnia and abnormal abdominal sensations. Our experience emphasizes the importance of supportive clinical features in rendering a correct diagnosis such that the most cost-effective workups and treatment can be realized.

  6. Experimental Injury Biomechanics of the Pediatric Thorax and Abdomen

    NASA Astrophysics Data System (ADS)

    Kent, Richard; Ivarsson, Johan; Maltese, Matthew R.

    Motor vehicle crashes are the leading cause of death and injury for children in the United States. Pediatric anthropomorphic test devices (ATD) and computational models are important tools for the evaluation and optimization of automotive restraint systems for child occupants. The thorax interacts with the restraints within the vehicle, and any thoracic model must mimic this interaction in a biofidelic manner to ensure that restraint designs protect humans as intended. To define thoracic biofidelity for adults, Kroell et al. (1974) conducted blunt impacts to the thoraces of adult postmortem human subjects (PMHS), which have formed the basis for biofidelity standards for modern adult ATD thoraces (Mertz et al. 1989). The paucity of pediatric PMHS for impact research led to the development of pediatric model biofidelity requirements through scaling. Geometric scale factors and elastic moduli of skull and long bone have been used to scale the adult thoracic biofidelity responses to the 3-, 6-, and 10-year-old child (Irwin and Mertz 1997; Mertz et al. 2001; van Ratingen et al. 1997). There is currently a need for data that apply to the child without scaling, both for validation of scaling methods used in the past and to confirm the validity of the specifications currently used to develop models of the child.

  7. [Intestinal tuberculosis--cause of acute surgical abdomen].

    PubMed

    Ciurea, M; Ion, D; Ionescu, S; Tica, M R

    2001-01-01

    Tuberculosis, in its various forms, remains an important cause of morbidity and mortality in developing countries in immunodeficitary patients. The indicatives of epidemiology of tuberculosis show that Romania presents a fresh outbreak of the disease in the last few years. The purpose of this paper is to present from the various forms of extrapulmonary tuberculosis, the intestinal tipe which have a high incidence. The authors describe theirs preliminary experience of intraoperative small and large bowel emergencies resections in a short period (1 year) of three young patients (between 30 and 40 years old) with history of pulmonary tuberculosis. The pathology was complex (bowel obstructions, peritonitis) and so were the surgical operations (resections, devirations). The patients showed short and long term good results.

  8. Injuries to the Abdomen and Thorax: Diagnostic and Therapeutic Considerations.

    ERIC Educational Resources Information Center

    Maull, Kimball

    It is the responsibility of the athletic trainer to diagnose the nature and extent of an injury to an athlete, administer prompt first aid treatment, prevent any exacerbation of the injury, and hospitalize the patient quickly if it is necessary. The importance of these responsibilities is emphasized when an athlete suffers an injury to the abdomen…

  9. A Clinical Skills Instruction Program: The Acute Abdomen.

    ERIC Educational Resources Information Center

    Laube, Douglas W.; And Others

    1982-01-01

    An effective evaluation of the acutely ill female implies a thorough examination that integrates skills representing three learning domains. This process should include: a thorough medical history, a physical examination, good patient-physician rapport, and development of an efficacious management plan. A University of Iowa simulation approach is…

  10. Second trimester placenta percreta presenting as acute abdomen

    PubMed Central

    Dew, Lauren; Yost, Nicole; Magee, Kevin; dePrisco, Gregory

    2015-01-01

    Diagnosing placenta percreta can be difficult. We describe a 41-year-old woman presenting at 21 weeks' gestation with intraabdominal bleeding and no signs of placental abnormality on ultrasound. The disagreement between results of the ultrasound and magnetic resonance imaging made definitive diagnosis difficult. The bleeding resolved spontaneously after a blood transfusion, and the patient was hospitalized for the remainder of the pregnancy. Delivery was by scheduled repeat cesarean at 34 weeks' gestation. Spontaneous rupture of the entire fundus occurred at the time of delivery. Placenta percreta was confirmed by histologic examination of the operatively excised uterus. PMID:25552794

  11. Perforasomes of the upper abdomen: an anatomical study.

    PubMed

    Schmidt, Manfred; Tinhofer, Ines; Duscher, Dominik; Huemer, Georg M

    2014-01-01

    Pedicled perforator flaps in the trunk such as the DIEAP or the IMAP-flap have increasingly been used for reconstructive purposes. However, perforator flaps of the upper abdominal wall derived from the SEA and DIEA have not been widely reported in literature. The aim of this study was to investigate the vascular basis of perforator flaps of the upper abdominal wall based on the epigastric vascular axis and to describe the location and size of the individual flaps. The superior and deep inferior epigastric artery perforators (SEAPs and DIEAPs) of the supraumbilical abdominal wall of ten fresh anatomical specimens were selectively injected with Methylene blue solution or India ink. The location and size of the labeled skin area was observed. Finally, the arterial perforators were dissected and the length, diameter and the distance of the perforation point to the midline, xiphoid process and umbilicus were recorded. The SEAPs and DIEAPs supplied the ventromedial skin of the lower thoracic and supraumbilical abdominal wall in a sequential order. The mean size of all injected skin areas was 65 ± 31.4 cm(2) (10.2 × 8.8 cm). A mean number of 9.7 ± 4.2 perforators per specimen was identified. The mean external diameter of the dissected perforators was 0.82 ± 0.32 mm. The perforator length until arborization averaged 3.44 ± 1.07 cm. Most perforators were located in an area 2-6 cm from the midline and 0-10 cm below the xiphoid process. Through selective injection of perforators, a reliable anatomy of SEAP- and DIEAP-flaps of the upper abdominal wall could be demonstrated. From a clinical point of view, subcostal SEAP-flaps are of special interest. These flaps may be rotated cranially for lower chest wall or breast reconstruction or deflected caudally for abdominal wall reconstructive purposes. The harvest site can be closed directly or via a reverse abdominoplasty procedure. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Elephantiasis nostrum verrucosa of the abdomen: clinical results with tazarotene.

    PubMed

    Boyd, Jason; Sloan, Steven; Meffert, Jeffrey

    2004-01-01

    Elephantiasis nostras verrucosa represents an uncommon yet distinct clinical entity resulting from chronic lymphedema of an extremity or body region. Characterized by profound non-pitting edema with cobblestone-like papules, plaques, and nodules, it typically occurs secondary to infections, surgeries, tumor obstruction, radiation, congestive heart failure, and obesity. This progressively deformative disorder has been treated with various medical and surgical measures. In the following case report, the history, clinical, and pathologic appearance of elephantiasis nostras verrucosa are discussed, as well as newer treatment options.

  13. Laparoscopic surgery in pregnant patients with acute abdomen.

    PubMed

    Kocael, Pinar Cigdem; Simsek, Osman; Saribeyoglu, Kaya; Pekmezci, Salih; Goksoy, Ertugrul

    2015-01-01

    Nonostante i significativi vantaggi della chirurgia laparoscopica rispetto a quella laparotomica, essa era considerata controindicata per le donne gestanti. Attualmente si confrontano opinioni contrastanti riguardo alla sicurezza durante la gestazione della chirurgia laparoscopica, specie se nell’ultimo trimestre. Lo scopo di questo studio è quello di valutare la fattibilità della chirurgia laparoscopica in donne gestanti in caso di addome acuto analizzando retrospettivamente la casistica della pazienti ricoverate tra il gennaio 1995 ed il gennaio 2013 presso l’Emergency Department della Cerrahpasa Medical Faculty. Sono stati pertanto analizzati tutti i dati clinici riguardanti le gestanti sottoposte a chirurgia laparoscopica, comprese le cartelle cliniche, gli interventi eseguiti, i reperti anatomopatologici, e le informazioni riguardanti il parto. Nella casistica sono rientrate 14 donne gravide (in media alla 19,2° settimana di gestazione, distribuite tra 9 e 33 settimane), di cui 11 sottoposte ad appendicectomia laparoscopica, 2 a colecistectomia laparoscopica ed 1 per scopi diagnostici. In media il parto si è espletato alla 37,4° settimana di gestazione (tra la 35° e la 40° settimana). Due pazienti hanno avuto un parto prematuro, ma in nessune dei casi si sono verificate complicazioni durante le manovre laparoscopiche, e cioè danni all’utero, morti fetali o mortalità materna. Si conclude che la chirurgia laparoscopica può essere effettuata nel corso di tutti i trimestri della gravidanza, con il possibile vantaggio di una utile diagnosi differenziale in caso di dolori addominali acuti durante la gravidanza, e diminuzioni delle morti fetali dovute a ritardi diagnostici, e che tempi chirurgici più brevi riducono gli effetti negativi sulla madre e sul feto.

  14. Ultrasonographic Examination of the Equine Neonate: Thorax and Abdomen.

    PubMed

    Sprayberry, Kim A

    2015-12-01

    Diagnostic imaging can substantially augment physical examination findings in neonatal foals. Used in combination with radiography or as a stand-alone imaging modality, ultrasound evaluation of the thoracic and abdominal body cavities can be a high-yield diagnostic undertaking. Many of the conditions that afflict neonatal foals are highly amenable to sonographic interrogation, including pneumonia and other changes in the lungs associated with sepsis, systemic inflammatory response syndrome, multiple organ dysfunction, and prematurity; colic arising from medical and surgical causes; and urinary tract disorders. Sonographic imaging is not affected by intracavitary fluid accumulation and reveals abnormalities of soft tissue and bony origin. Published by Elsevier Inc.

  15. The acute abdomen: the role of computer-assisted diagnosis.

    PubMed

    Gunn, A A

    1991-09-01

    CAD has been used in over 20,000 patients in an Accident and Emergency Department. Structured documentation has replaced normal case notes and a patient record is created which includes investigations and management. A copy of the documentation acts as an immediate communication to the general practitioner. The information is held on a computer and is readily accessed to produce feedback and to allow audit of any number of parameters. The results show that an improvement in diagnostic accuracy and a reduction in admissions and unnecessary laparotomies continues over 15 years. Problems have occurred; some are inherent to the system and some have been minimized as a result of a series of studies. The savings in terms of finance and facilities are considerable and the cost is small in comparison as the programs are available and the cost of hardware has diminished. It is concluded that documentation is essential. This allows the more accurate collection of information, permits analysis, acts as a method of communication and creates a detailed patient record. The use of this part of the CADA system produces a considerable improvement in the parameters used to assess satisfactory patient management. The computer diagnostic program produces a higher level of diagnostic accuracy than that obtained by doctors who are not using the system. It does not normally exceed the accuracy of the doctors who are using the structured documentation and entering the information into the computer. Other mathematical models might lead to an improvement, particularly if they were based on the diagnostic process used by a senior clinician. The method of entry of information could be facilitated by modern technology, including light pens or word sensitive computers. This would reduce the time required for completion of the documents. A number of possible improvements in the CADA system are reported and some have been studied in detail with little evidence of significant change. The computer part of the system has an educational value and presents a stimulating challenge to the junior hospital staff seeing the patient for the first time in the Accident and Emergency Department. Rapid feedback is possible and advantageous. Possibly the greatest value of the computer is in the analysis of the value of clinical features in diagnosis, which has not been easy in the past. It has also allowed precise assessment of the value of investigations in the diagnosis of patients with a suspected disease, which leads to more appropriate management and the saving of facilities.(ABSTRACT TRUNCATED AT 400 WORDS)

  16. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...″ cap screw holes and attach the front mounting at the femur axial rotation joint. Tighten the mountings so that the pelvic-lumbar adapter is horizontal and adjust the femur friction plungers at each hip socket joint to 240 inch-pounds torque. (3) Flex the thorax forward 50° and then rearward as necessary...

  17. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...″ cap screw holes and attach the front mounting at the femur axial rotation joint. Tighten the mountings so that the pelvic-lumbar adapter is horizontal and adjust the femur friction plungers at each hip socket joint to 240 inch-pounds torque. (3) Flex the thorax forward 50° and then rearward as necessary...

  18. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining surface is horizontal and adjust the femur ball-flange screws at each hip socket joint to 50...

  19. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...″ cap screw holes and attach the front mounting at the femur axial rotation joint. Tighten the mountings so that the pelvic-lumbar adapter is horizontal and adjust the femur friction plungers at each hip socket joint to 240 inch-pounds torque. (3) Flex the thorax forward 50° and then rearward as necessary...

  20. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining surface is horizontal and adjust the femur ball-flange screws at each hip socket joint to 50...

  1. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining surface is horizontal and adjust the femur ball-flange screws at each hip socket joint to 50...

  2. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining surface is horizontal and adjust the femur ball-flange screws at each hip socket joint to 50...

  3. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...″ cap screw holes and attach the front mounting at the femur axial rotation joint. Tighten the mountings so that the pelvic-lumbar adapter is horizontal and adjust the femur friction plungers at each hip socket joint to 240 inch-pounds torque. (3) Flex the thorax forward 50° and then rearward as necessary...

  4. 49 CFR 572.19 - Lumbar spine, abdomen and pelvis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... rotation joints by the attachments shown in Figure 18. Tighten the mountings so that the pelvis-lumbar joining surface is horizontal and adjust the femur ball-flange screws at each hip socket joint to 50...

  5. 49 CFR 572.9 - Lumbar spine, abdomen, and pelvis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...″ cap screw holes and attach the front mounting at the femur axial rotation joint. Tighten the mountings so that the pelvic-lumbar adapter is horizontal and adjust the femur friction plungers at each hip socket joint to 240 inch-pounds torque. (3) Flex the thorax forward 50° and then rearward as necessary...

  6. Gastric Duplication Cyst Presenting as Acute Abdomen: A Case Report

    PubMed Central

    Sheikh, Afzal

    2010-01-01

    Gastric duplication cysts are rare variety of gastrointestinal duplications. Sometimes they may present with complications like hemorrhage, infection, perforation, volvulus, intussusception and rarely neoplastic changes in the gastric duplication cyst. We present one and half year old male child who developed sudden abdominal distension with pain and fever for two days. Ultrasound revealed a cystic mass in the hypochondrium and epigastric regions. On exploration an infected and perforated gastric duplication cyst was found. Surgical excision of most part of cyst wall with mucosal stripping of the rest was performed. Histopathology confirmed the diagnosis of gastric duplication cyst. Early surgical intervention can result in good outcome. PMID:22953249

  7. An Experience in the Management of the Open Abdomen in Severely Injured Burn Patients

    DTIC Science & Technology

    2012-07-01

    Mace, MD, John D. Ritchie, MD, Kevin K. Chung, MD, Katharine W. Markell, MD, Evan M. Renz, MD, Steven E. Wolf, MD, Lorne H. Blackbourne, MD...345–8. 14. Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia. Staged management for acute abdominal wall de- fects. Ann Surg 1994;219

  8. Redefining Fetal Evoked Fields with Biomagnetic Recordings Over the Whole Maternal Abdomen

    DTIC Science & Technology

    2007-11-02

    about the fetus in a common reference frame of MEG and ultrasound. Our initial tests with the localization coils showed that the coregistration error...the coregistration of 3D ultrasound and MEG. In addition we hope that more elaborated protocols are used in this field, which show the competence of

  9. Prevention and treatment of pulmonary complications in patients after surgery of the upper abdomen.

    PubMed

    Breslin, E H

    1981-01-01

    Pulmonary complications are the leading cause of morbidity and death during the postoperative period in patients who have undergone upper abdominal surgery. Significant pulmonary mechanical alterations, such as reductions in VC, TV, and FRC and an increase in CV, are noted postoperatively in this patient population. Preexisting patient conditions, postoperative treatments, and certain respiratory maneuvers may increase the patient's risk in the development of postoperative pulmonary complications. Current research unanimously advocates sustained maximal inspiration, the normal physiologic sigh maneuver, as the best method of prevention and treatment of this problem. Commonly utilized maneuvers, such as blowing into a rubber glove or bag, blow bottles, and the like, should be avoided in all situations. A guide for preoperative and postoperative pulmonary assessment and care based on current research is included. After consideration of the data in addition to personal clinical experience, I conclude that to prevent pulmonary complications in patients after upper abdominal surgery, as well as in all hospitalized patients, sustained maximal inspiration, preferably with an incentive spirometer, and conscientious nurse supervision and coaching is the method of choice.

  10. Thermographic mapping of the abdomen in healthy subjects and patients after enterostoma.

    PubMed

    Siah, C J R; Childs, C

    2015-03-01

    Heat is a sign and symptom of surgical wound infection in wound assessment criteria but there is currently no diagnostic tool being used in clinical practice to assess the skin temperature of surgical wounds. Using thermal imaging, the objective of this study was to map the temperature of the healing surgical wound and to provide confirmatory data of: a) optimum IR imaging distance from skin temperature target field of view (FOV) b) body composition effects on abdominal skin surface temperature readings c) thermal mapping characteristics of infected versus non-infected wounds post stoma-closure. The abdominal skin surface temperature of healthy, afebrile subjects was measured under controlled, ambient conditions in a small (240cm x 320cm) clinical room. Subject standing positions were 30cm, 60cm and 100cm from the IR camera. Abdominal skin surface temperature and thermal imaging maps were acquired in a population of surgical patients before and after closure of enterostoma. Subjects (30) aged 19-52 (median=29) years were recruited. At a distance of 100cm, each of nine anatomical regions showed a decrease in mean temperature as BMI increased. Subjects with BMI >25 had lower mean abdominal temperatures. Statistically significant differences were observed for right hypochondrium (p=0.022), left lumbar region (p=0.009), right lumbar region (p=0.010) and the umbilical region (p=0.021). Half of patients (5/10) developed surgical wound infection. Within the operating distances investigated, no significant effect on abdominal temperature readings was observed. With increasing BMI, lower abdominal temperatures were noted. The thermal pattern of abdominal surgical wounds reveals some differences between the healing and infected wound. Healing wounds showed changes in the thermal 'map'; an increase in temperature on the first post-operative day, and 'warming' over the subsequent five days. 'Cold spots' emerged on the thermogram of the surgical wounds which subsequently were shown to be infected. Within the setting of a clinical environment, distances up to 100cm did not significantly alter skin temperature readings within the FOV. There is a suggestion that body composition influences skin temperature. Infected surgical wounds appear 'colder' than healing wounds. The authors have no conflict or interest. The work was supported by a grant from the SingHealth Foundation.

  11. Peritoneal Lavage in the Diagnosis of Acute Surgical Abdomen Following Thermal Injury.

    DTIC Science & Technology

    1995-01-01

    disease, others6𔄂-15 have confirmed his Sepsis syndrome 13 findings. Hoffman16 reviewed the literature on the use of Abdominal distension 11 Ileus 7 DPL...developed sepsis, ileus , and abdominal distention 98 Fourteen of the 17 patients died, a mortality rate of 82%. days following injury. Lavage fluid...the greater omentum. The difficulty in diag- whelming pulmonary sepsis or multisystem organ failure, nosing biliary disease with DPL has been

  12. Inferior vena cava pseudoaneurysm after penetrating injury of the abdomen: a case report.

    PubMed

    Delgado-Beltran, Alvaro; Cubillos, Diego

    2009-09-01

    Reports of inferior vena cava (IVC) pseudoaneurysms are always associated with arteriovenous fistulae and arterial injuries. This seems to be the first case report of an isolated IVC pseudoaneurysm in a 40-year-old man who suffered a penetrating abdominal injury 4 weeks before being referred to our hospital. Jaundice was the finding that leads to the identification of this aneurysm and its later successful surgical treatment. This is a nonreported lesion in the published literature about IVC injuries, in which the endovascular therapy is recently included.

  13. Imaging effects of radiation therapy in the abdomen and pelvis: evaluating "innocent bystander" tissues.

    PubMed

    Maturen, Katherine E; Feng, Mary U; Wasnik, Ashish P; Azar, Shadi F; Appelman, Henry D; Francis, Isaac R; Platt, Joel F

    2013-01-01

    Accurate interpretation of posttherapeutic images obtained in radiation oncology patients requires familiarity with modern radiation therapy techniques and their expected effects on normal tissues. Three-dimensional conformal external-beam radiation therapy techniques (eg, intensity-modulated radiation therapy, stereotactic body radiation therapy), although they are designed to reduce the amount of normal tissue exposed to high-dose radiation, inevitably increase the amount of normal tissue that is exposed to low-dose radiation, with the potential for resultant changes that may evolve over time. Currently available internal radiation therapy techniques (eg, arterial radioembolization for hepatic malignancies, brachytherapy for prostate cancer and gynecologic cancers) also carry risks of possible injury to adjacent nontargeted tissues. The sensitivity of tissues to radiation exposure varies according to the tissue type but is generally proportional to the rate of cellular division, with rapidly regenerating tissues such as intestinal mucosa being the most radiosensitive. The characteristic response to radiation-induced injury likewise varies according to tissue type, with atrophy predominating in epithelial tissue whereas fibrosis predominates in stromal tissue. Moreover, changes in irradiated tissues evolve over time: In the liver, decreased attenuation at computed tomography and increased signal intensity at T2-weighted magnetic resonance imaging reflect hyperemia and edema in the early posttherapeutic period; later, veno-occlusive changes alter the hepatic enhancement pattern; and finally, fibrosis develops in some patients. In the small bowel, wall thickening and mucosal hyperenhancement predominate initially, whereas luminal narrowing is the most prominent feature of chronic enteropathy. Correlation of posttherapeutic images with images used for treatment planning may be helpful when interpreting complex cases.

  14. Torsion of wandering spleen as a rare reason for acute abdomen: A presentation of two cases.

    PubMed

    Yılmaz, Özkan; Bayrak, Vedat; Daştan, Ertuğrul; Kotan, Çetin

    2013-01-01

    Wandering spleen is a rare disease that is clinically characterized by torsion of the pedicle. The congenital absence of ligaments anchoring the spleen to the left sub-phrenic area or an acquired looseness is the major reason behind its mobilization. Unless splenic torsion occurs and acute abdominal clinical symptomatology develops, clinical diagnosis is highly challenging due to lack of symptoms. This study aims to share the information acquired from two encountered cases accompanied by the relevant literature.

  15. Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen.

    PubMed

    O'Leary, Michael P; Ashman, Zane W; Plurad, David S; Kim, Dennis Y

    2016-01-01

    Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

  16. Organ detection in thorax abdomen CT using multi-label convolutional neural networks

    NASA Astrophysics Data System (ADS)

    Humpire Mamani, Gabriel Efrain; Setio, Arnaud Arindra Adiyoso; van Ginneken, Bram; Jacobs, Colin

    2017-03-01

    A convolutional network architecture is presented to determine bounding boxes around six organs in thoraxabdomen CT scans. A single network for each orthogonal view determines the presence of lungs, kidneys, spleen and liver. We show that an architecture that takes additional slices before and after the slice of interest as an additional input outperforms an architecture that processes single slices. From the slice-based analysis, a bounding box around the structures of interest can be computed. The system uses 6 convolutional, 4 pooling and one fully connected layer and uses 333 scans for training and 110 for validation. The test set contains 110 scans. The average Dice score of the proposed method was 0.95 and 0.95 for the lungs, 0.59 and 0.58 for the kidneys, 0.83 for the liver and 0.63 for the spleen. This paper shows that automatic localization of organs using multi-label convolution neural networks is possible. This architecture can likely be used to identify other organs of interest as well.

  17. Open abdomen in gastrointestinal surgery: Which technique is the best for temporary closure during damage control?

    PubMed Central

    Ribeiro Junior, Marcelo A F; Barros, Emily Alves; de Carvalho, Sabrina Marques; Nascimento, Vinicius Pereira; Cruvinel Neto, José; Fonseca, Alexandre Zanchenko

    2016-01-01

    AIM To compare the 3 main techniques of temporary closure of the abdominal cavity, vacuum assisted closure (vacuum-assisted closure therapy - VAC), Bogota bag and Barker technique, in damage control surgery. METHODS After systematic review of the literature, 33 articles were selected to compare the efficiency of the three procedures. Criteria such as cost, infections, capacity of reconstruction of the abdominal wall, diseases associated with the technique, among others were analyzed. RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost, what is not observed in the VAC procedure. The VAC technique is the most efficient, not only because it reduces the tension on the boarders of the lesion, but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division. Bogota bag presents the higher rates of skin laceration and evisceration, greater need for a stent for draining fluids and wash-ups, higher rates of intestinal adhesion to the abdominal wall. The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing. The VAC dressing can generate irritation and dermatitis when the drape is applied, in addition to pain, infection and bleeding, as well as toxic shock syndrome, anaerobic sepsis and thrombosis. CONCLUSION The VAC technique, showed to be superior allowing a better control of liquid on the third space, avoiding complications such as fistula with small mortality, low infection rate, and easier capability on primary closure of the abdominal cavity. PMID:27648164

  18. Contraction of the Ventral Abdomen Potentiates Extracardiac Retrograde Hemolymph Propulsion in the Mosquito Hemocoel

    PubMed Central

    Andereck, Jonathan W.; King, Jonas G.; Hillyer, Julián F.

    2010-01-01

    Background Hemolymph circulation in mosquitoes is primarily controlled by the contractile action of a dorsal vessel that runs underneath the dorsal midline and is subdivided into a thoracic aorta and an abdominal heart. Wave-like peristaltic contractions of the heart alternate in propelling hemolymph in anterograde and retrograde directions, where it empties into the hemocoel at the terminal ends of the insect. During our analyses of hemolymph propulsion in Anopheles gambiae, we observed periodic ventral abdominal contractions and hypothesized that they promote extracardiac hemolymph circulation in the abdominal hemocoel. Methodology/Principal Findings We devised methods to simultaneously analyze both heart and abdominal contractions, as well as to measure hemolymph flow in the abdominal hemocoel. Qualitative and quantitative analyses revealed that ventral abdominal contractions occur as series of bursts that propagate in the retrograde direction. Periods of ventral abdominal contraction begin only during periods of anterograde heart contraction and end immediately following a heartbeat directional reversal, suggesting that ventral abdominal contractions function to propel extracardiac hemolymph in the retrograde direction. To test this functional role, fluorescent microspheres were intrathoracically injected and their trajectory tracked throughout the hemocoel. Quantitative measurements of microsphere movement in extracardiac regions of the abdominal cavity showed that during periods of abdominal contractions hemolymph flows in dorsal and retrograde directions at a higher velocity and with greater acceleration than during periods of abdominal rest. Histochemical staining of the abdominal musculature then revealed that ventral abdominal contractions result from the contraction of intrasegmental lateral muscle fibers, intersegmental ventral muscle bands, and the ventral transverse muscles that form the ventral diaphragm. Conclusions/Significance These data show that abdominal contractions potentiate extracardiac retrograde hemolymph propulsion in the abdominal hemocoel during periods of anterograde heart flow. PMID:20886066

  19. Improved patient size estimates for accurate dose calculations in abdomen computed tomography

    NASA Astrophysics Data System (ADS)

    Lee, Chang-Lae

    2017-07-01

    The radiation dose of CT (computed tomography) is generally represented by the CTDI (CT dose index). CTDI, however, does not accurately predict the actual patient doses for different human body sizes because it relies on a cylinder-shaped head (diameter : 16 cm) and body (diameter : 32 cm) phantom. The purpose of this study was to eliminate the drawbacks of the conventional CTDI and to provide more accurate radiation dose information. Projection radiographs were obtained from water cylinder phantoms of various sizes, and the sizes of the water cylinder phantoms were calculated and verified using attenuation profiles. The effective diameter was also calculated using the attenuation of the abdominal projection radiographs of 10 patients. When the results of the attenuation-based method and the geometry-based method shown were compared with the results of the reconstructed-axial-CT-image-based method, the effective diameter of the attenuation-based method was found to be similar to the effective diameter of the reconstructed-axial-CT-image-based method, with a difference of less than 3.8%, but the geometry-based method showed a difference of less than 11.4%. This paper proposes a new method of accurately computing the radiation dose of CT based on the patient sizes. This method computes and provides the exact patient dose before the CT scan, and can therefore be effectively used for imaging and dose control.

  20. Segmentation of organs at risk in CT volumes of head, thorax, abdomen, and pelvis

    NASA Astrophysics Data System (ADS)

    Han, Miaofei; Ma, Jinfeng; Li, Yan; Li, Meiling; Song, Yanli; Li, Qiang

    2015-03-01

    Accurate segmentation of organs at risk (OARs) is a key step in treatment planning system (TPS) of image guided radiation therapy. We are developing three classes of methods to segment 17 organs at risk throughout the whole body, including brain, brain stem, eyes, mandible, temporomandibular joints, parotid glands, spinal cord, lungs, trachea, heart, livers, kidneys, spleen, prostate, rectum, femoral heads, and skin. The three classes of segmentation methods include (1) threshold-based methods for organs of large contrast with adjacent structures such as lungs, trachea, and skin; (2) context-driven Generalized Hough Transform-based methods combined with graph cut algorithm for robust localization and segmentation of liver, kidneys and spleen; and (3) atlas and registration-based methods for segmentation of heart and all organs in CT volumes of head and pelvis. The segmentation accuracy for the seventeen organs was subjectively evaluated by two medical experts in three levels of score: 0, poor (unusable in clinical practice); 1, acceptable (minor revision needed); and 2, good (nearly no revision needed). A database was collected from Ruijin Hospital, Huashan Hospital, and Xuhui Central Hospital in Shanghai, China, including 127 head scans, 203 thoracic scans, 154 abdominal scans, and 73 pelvic scans. The percentages of "good" segmentation results were 97.6%, 92.9%, 81.1%, 87.4%, 85.0%, 78.7%, 94.1%, 91.1%, 81.3%, 86.7%, 82.5%, 86.4%, 79.9%, 72.6%, 68.5%, 93.2%, 96.9% for brain, brain stem, eyes, mandible, temporomandibular joints, parotid glands, spinal cord, lungs, trachea, heart, livers, kidneys, spleen, prostate, rectum, femoral heads, and skin, respectively. Various organs at risk can be reliably segmented from CT scans by use of the three classes of segmentation methods.