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At least 343 records · Page 19Linked to original sources
PubMed2006

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

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 < or =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.

Abdomen↗
PubMed2005

Acute diarrhea during pelvic irradiation: is small-bowel volume effect different in gynecologic patients with prior abdomen operation or not?

OBJECTIVE: To evaluate volume effect of small bowel for diarrhea during pelvic irradiation in gynecologic patients with or without prior abdomen operation. METHODS: From January 1996 through December 2003, 759 patients undergoing 4-field pelvic irradiation for cervical or uterine cancer were analyzed. Whole pelvic (WP), modified whole pelvic (MWP), or lower pelvic (LP) irradiation were delivered initially. According to contrast medium within small bowel in simulation films, we categorized the small-bowel volume of full dose related to WP fields as small-volume and large-volume groups. We recorded the severity of diarrhea until 39.6 Gy/22 fractions of pelvic irradiation. The actuarial rates of overall and moderate to severe diarrhea were compared among different groups. RESULTS: Significantly more large-volume distribution (85%) was noted in patients >60 years without prior operation (P < 0.001). Large-volume distribution was 53%, 65%, and 82% in post-operative patients with no diarrhea, mild diarrhea, and moderate to severe diarrhea (P = 0.002), respectively. The corresponding rate was 79%, 77%, and 80% in patients without prior abdomen operation (P = 0.869). In multivariate analysis, prior operation with LP fields (P = 0.005) and prior operation with small volume (P = 0.031) were significantly protective factors for overall diarrhea. The latter was also a protective factor for moderate to severe diarrhea (P = 0.026). Prior operation could diminish overall diarrhea in patients without simultaneous large-field (WP or MWP) and large-volume. Large volume was a significant factor of overall (P = 0.014) and moderate to severe (P = 0.004) diarrhea in large-field patients with operation. The volume effect did not exist in those patients without operation. CONCLUSION: Age and operation can change small-bowel distribution. Prior operation may attenuate diarrhea if irradiated volume of small bowel is small. There is a volume effect in post-operative rather than non-operative patients receiving large-field irradiation. More practical dose-volume evaluation of small bowel may be applied for volume effect in gynecologic patients without prior operation.

Abdomen↗
PubMed2001

Skin only or silo closure in the critically ill patient with an open abdomen.

BACKGROUND: The morbidity and mortality of various open abdominal techniques remains unclear. METHODS: A retrospective review was made of all trauma or general surgery patients who underwent an open abdominal closure from January 1997 to December 2000, at a large urban acute care hospital. Data are mean +/- SD. RESULTS: From 1997 to 2000, 181 patients (aged 39.8 +/- 16.5 years) had an open abdomen for abdominal infection, planned reexploration, abdominal compartment syndrome, inability to reapproximate fascia, or as part of a "damage control" procedure. Twenty-three patients went on to develop an abdominal compartment syndrome. Gastrointestinal fistulas occurred in 26 patients, and 9 patients had a dehiscence. The overall mortality was 44.7%. Of the survivors, 52% went on to fascial closure, requiring 1 to 7 additional abdominal operations. CONCLUSIONS: The morbidity of the open abdomen varies with the particular indication. Gastrointestinal fistulas are the most common acute complication and an abdominal wall hernia, the most common chronic complication.

Abdomen↗
PubMed2002

Reoperation on the abdomen encased in adhesions.

PURPOSE: To determine outcome after lysis of intestinal adhesions, relief of obstruction, closure of fistulas and drainage of abscesses in patients with an abdominal cavity obliterated by chronic postoperative adhesions. METHODS: Among 40 patients with an abdomen encased in dense adhesions after a mean of 5 previous operations, 31 patients also had intestinal obstruction, 25 enteric fistulas and 20 abdominal abscesses. Reoperation was done and outcome assessed from the medical records and by a mailed questionnaire. RESULTS: Only 1 postoperative death occurred, but 24 early complications appeared. At hospital discharge, obstruction, fistula and abscess were completely resolved in all but 3 patients (P <0.001). Only 2 of 16 patients on parenteral nutrition before operation (TPN) still required it (P = 0.004). At late follow-up (mean, 4.6 years) the patients' quality of life (mean score +/- SD, 8.6 +/- 2.1) was similar to that of a healthy control population (9.2 +/- 1.2, P = 0.17). CONCLUSIONS: Reoperation on the abdomen encased in adhesions restores most patients to good health and an excellent long-term quality of life.

Abdomen↗
PubMed1979

Ultrasonic detection of pericardial effusions adjacent to the right atrium during routine examination of the upper abdomen.

Pericardial effusions are usually detected on ultrasound by examining the heart with time--motion (T/M) or real-time equipment through a left chest intercostal space. Since fluid within the pericardium also accumulated around the right atrium, effusions can also be diagnosed by observing fluid separating the right atrium from hemidiaphragm on parasagittal scans of the right upper abdomen. In order to be certain that this space represents pericardial rather than pleural fluid, the inferior vena cava must be identified along the lower margin of the fluid space as a tubular structure traversing from the diaphragm into the right atrium. Our procedure is proposed as an ancillary approach for detecting clinica-ly unsuspected effusions during the routine examination of the upper abdomen rather than as a replacement for the usual method of visualising pericardial effusions.

Abdomen↗
PubMed2003

Pain as a presenting feature of acute abdomen in spinal injuries.

The diagnosis of acute abdomen can be difficult in patients with spinal injuries. We reviewed all the 1039 case records of patients admitted with spinal injuries to the Queen Elizabeth National Spinal Injuries Unit, Glasgow over a 7-year-period and found 5 (0.48%) cases of acute abdomen that required surgical intervention and were not caused by original injury. Their presenting signs and symptoms were analysed. Pain was found to be an unreliable symptom in these patients.

Abdomen, Acute↗
PubMed1997

Advances in imaging of the acute abdomen.

Over the last 10 years, the most significant advancement in imaging of the acute abdomen has been the development of helical CT imaging. Rapid breath-hold imaging and improved intravascular opacification have enabled radiologists to obtain volumetric data that can be viewed in smaller slice increments. Helical data can also be analyzed utilizing multiplanar and three-dimensional techniques. With its proven ability to diagnose a wide variety of conditions, CT remains the diagnostic modality of choice for imaging the surgical abdomen. There have been considerable improvements in image resolution in US with improvements in transducer technology. Ultrasonography often serves as the first study in evaluating the pediatric or female patient with right lower quadrant or pelvic pain. Computed tomography may be necessary if US is not diagnostic. Despite these technical advances, plain film radiography should be the first imaging study for suspected cases of bowel perforation or obstruction. Magnetic resonance imaging continues to evolve, with improvements in hardware and software design that allow for faster imaging, but current levels of availability in the acute setting preclude its wider use. Whereas further imaging is not necessary for patients presenting with classic signs and symptoms of various acute abdominal diseases, the atypical patient often requires careful diagnostic imaging. Close consultation between the radiologist and surgeon leads to studies appropriately tailored to meet the diagnostic challenge at hand.

Abdomen, Acute↗
PubMed1988

The acute abdomen in the immunocompromised host.

Immunocompromised hosts are a heterogeneous group, including patients receiving transplants, those receiving chemotherapy for malignant disease, and those receiving steroids for autoimmune disease, as well as patients with AIDS. Each group has specific abdominal conditions, and the clinician must be familiar with the specific causes of the acute abdomen within each subset. The causes of the acute abdomen in immunocompromised patients may be divided into two broad categories: (1) those disorders that are closely associated with the immunocompromised state and (2) those processes that can occur in any patient regardless of the immune status. Physicians at every level of specialization must become familiar with the unusual complications that occur in this population and with the ways in which the underlying disease and its therapy can modify the clinical presentation and management of common abdominal conditions. This article outlines broad principles of common clinical findings and surgical therapy in these patients.

Abdomen, Acute↗
PubMed1994

The acute abdomen.

Acute abdomen patients present a diagnostic and therapeutic challenge to emergency clinicians. The decision to perform surgery or to treat medically is often difficult to make and requires assimilating patient information, laboratory findings, radiological studies, and DPL. The importance of careful and repetitive PE cannot be overemphasized when managing these patients. If all diagnostics performed are not definitive and the patient continues to exhibit signs of abdominal pain, it is advisable to explore the abdominal cavity while administering supportive measures. Abdominal ultrasonography is emerging as a valuable diagnostic tool for the acute abdomen patient. Laparoscopy, CT, and CAD may also prove useful in certain cases.

Abdomen, Acute↗
PubMed2000

Analgesic administration to patients with an acute abdomen: a survey of emergency medicine physicians.

The objective of this study was to examine current practice patterns of analgesia administration among emergency physicians (EPs) when caring for a patient with an acute abdomen. Cross sectional data were acquired by a survey mailed in October 1997 to 1,000 American College of Emergency Physicians (ACEP) members from a purchased ACEP mailing list which contained 1,000 randomized ACEP members. A repeat survey was sent to nonresponders 2 months later and a random subset of recurrent nonresponders were telephoned. The questionnaire focused on physician demographics, practice patterns, and factors which influenced physician decision of when and whether to administer pain medication, specifically opiates, to patients with an acute abdomen. Forty-four percent of surveys were returned. Seventy-seven percent of respondents were men with an average of 10 years of experience. Fifty-seven percent were residency trained in emergency medicine. Although eighty-five percent felt that the conservative administration of pain medication did not change important physical findings on the physical examination, 76% choose not to give an opiate analgesic until after the examination by a surgeon. Twenty-five percent of patients did not receive any pain medication in the department. In conclusion, although EPs report that the judicious administration of pain medication does not mask important examination findings, the majority wait until after the surgeon has evaluated the patient to deliver analgesics.

Abdomen, Acute↗
PubMed2002

The insect abdomen--a heartbeat manager in insects?

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.

Abdomen↗
PubMed2006

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

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.

Abdomen, Acute↗
PubMed2002

[Solitary duodenal diverticulum with enterolith as a rare cause of acute abdomen].

Diverticula of the duodenum are not rare and in the most cases without any symptoms. The incidence of duodenal diverticula in autopsies is known to be 20-22%. Only in a very small number of cases, they are complicated and therefore clinically presented by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. The most uncommon complication is the enterolith formed within the diverticulum. In all reported cases, the enterolith--formation was associated with small bowel obstruction or perforation. Complications of duodenal diverticula have a high mortality rate (33-48%) that could be due to difficulties in diagnostics and the adequate surgical procedure. In our case report, a patient presented at our institution with symptoms of an acute abdomen caused by an enterolith inside a solitary duodenal diverticulum "ante perforationem". The ultrasound and the CT scan of the abdomen showed free intraabdominal fluid beside the duodenum, the exact diagnosis however was not made. The indication for laparotomy was given by the clinical signs. The dicerticula was resected and ligated.

Abdomen, Acute↗
PubMed1983

Inhibition of artificial and spontaneous lung metastases by preirradiation of abdomen--II. Target organ and mechanism.

We have previously reported that irradiation of the abdomen of mice before i.v. injection of both immunogenic and nonimmunogenic tumour cells is capable of suppressing their ability to form metastatic lung nodules in a time and dose-dependent fashion. Experiments with segmental exposure indicated the target organ to be located in the ventral half of the abdomen. The effect has now been shown positively to depend upon irradiation of the caecum, and can be abolished either by shielding the caecum from irradiation or by surgically removing it prior to irradiation. Further experiments have shown that the effect cannot be elicited in germ-free mice and that its magnitude is markedly reduced in animals given gut-sterilizing antibiotics. Split-dose irradiation only slightly reduced the magnitude of suppression, provided both doses were given within the time window of effectiveness of single doses. Tumour-growth retardation was observed and spontaneous lung metastases were also suppressed when tumour-bearing mice received abdominal irradiation 7 days after tumour cell transplantation into the leg. However, abdominal irradiation did not significantly reduce subsequent tumour transplantability by the s.c. or i.p. routes. The experimental data are consistent with a mechanism by which transmigration of enteric bacteria across the radiation-damaged mucous membrane of the caecum effectively results in an endogenous infusion of endotoxin.

Abdomen↗
PubMed1995

The acute abdomen in spinal cord injury individuals.

A review of 1300 patients with spinal cord injury (SCI), over a period of 14 years, revealed 12 patients with an 'acute abdomen'. Seven events occurred during the initial admission, ranging from 10 days to 9 months from injury, and five during readmission of 'chronic' SCI patients. Four were in the acute stage 10-30 days from injury, all with peptic ulcer perforations. The remainder had either an intestinal obstruction, appendicitis or peritonitis. All of the neurological levels were above T6 except for one patient who had a low level paraplegia. The classical signs of an 'acute abdomen' may be missing in such patients thus delaying diagnosis by 1-4 days. The most important signs were autonomic dysreflexia, referred shoulder tip pain, abdominal pain, abdominal distension, increased spasticity and abdominal pain with nausea and vomiting. Less importance was given to the classical signs of abdominal tenderness, abdominal muscle rigidity, rebound, fever and of leukocytosis. Prompt diagnosis and treatment will minimise morbidity and mortality.

Abdomen, Acute↗
PubMed2001

Placing the newborn on the maternal abdomen increases the volume of umbilical cord blood collected.

Haematopoietic stem cell transplantation is an important therapy for certain haematological and malignant disorders. Umbilical cord blood contains a high proportion of potentially transplantable haematopoietic progenitor cells. However, the use of cord blood stem cell transplantation is limited by the low number of stem cells obtainable from a single cord blood donor. The aim of our study was to investigate the possibility that procedures during delivery might influence the number of umbilical cord blood haematopoietic progenitor cells available for transplantation. We assessed the effects of upper and lower positions of the newborn infant on the yield of cord blood stem cells in 51 vaginal deliveries. Neonates in the upper position group were placed by the midwife on the maternal abdomen immediately after birth, while those in the lower position group were placed on the delivery table, below the maternal introitus. The total volume of cord blood and the total number of CD34+ cells collected from babies in the upper position group were significantly higher than those from babies in the lower position group. There were no significant differences in cord blood haemoglobin levels and white blood cell counts between the two groups, nor were there any adverse effects in the newborn infants. The simple manoeuvre of placing the newborn on the maternal abdomen after delivery may thus increase the yield of transplantable haematopoietic progenitor cells in cord blood.

Abdomen↗
PubMed2003

Intestinal localization of anisakiasis manifested as acute abdomen.

Anisakis pathology is due mainly to two mechanisms: allergic reactions (from isolated urticaria and angioedema to life-threatening anaphylactic shock associated with gastrointestinal symptoms or 'gastroallergic anisakiasis'), and direct tissue damage, due to invasion of the gut wall, development of eosinophilic granuloma, or perforation (gastric or intestinal anisakiasis). Anisakiasis is a misdiagnosed and underestimated cause of acute abdomen: most patients undergo laparotomy, and virtually no cases are diagnosed before surgery. In some cases, diagnosis is obtained accidentally during other pathologic investigations. We report a case of acute abdomen due to terminal ileum involvement. Microscopic examination of the resected segment showed the presence of helminthic sections consistent with larvae of Anisakis spp. A history of raw fish ingestion was recorded. Histopathologic features are illustrated. A short but up-to-date review of the literature on diagnostic devices (particularly imaging and serology), clinical aspects and therapy is presented.

Abdomen, Acute↗
PubMed2000

The acute abdomen and the obstetrician.

An acute abdomen in pregnancy can be caused by pregnancy itself, be predisposed to by pregnancy or be the result of a purely incidental cause. These various conditions are discussed. The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. The clinical evaluation is generally confounded by the various anatomical and physiological changes occurring in pregnancy itself. Clinical examination is further hampered by the gravid uterus. The general reluctance to use conventional X-rays because of the pregnancy should be set aside when faced with the seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both mother and fetus. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems regardless of the pregnancy.

Abdomen, Acute↗