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At least 595 records · Page 33Linked to original sources
PubMed2003

[Clinicopathological, immunohistochemical and molecular genetic study of intra-abdomen extra-gastrointestinal stromal tumors].

OBJECTIVE: To explore the clinicopathological, immunohistochemical and molecular genetic features of intra-abdomen extra-gastrointestinal stromal tumors (EGISTs) and their differential diagnosis. METHODS: Nine cases of EGISTs from the abdominal cavity or retroperitoneum which were previously diagnosed as leiomyoma, leiomyoblastoma, or leiomyosarcoma etc. by a panel of antibodies such as CD117, CD34, alpha-SMA, MSA, desmin, S-100, and PGP9.5 from which five cases were detected for c-kit gene mutation. RESULTS: The tumors occurred in 5 men and 4 women, the age ranged from 38 to 72 years (mean 61.7 years). Four cases arose from the mesentery, two from omentum, two from retroperitoneum and one located at the hilus of the spleen. The size of tumors ranged from 5 cm to 23 cm (mean 12.9 cm) in diameter and the tumor cell components varied: mainly spindle cells (seven cases), epithelioid cells (one case), mixed cells (one case). Tumors expressed CD117 (8/9), CD34 (5/9), alpha-SMA (3/9), MSA (4/9), desmin (0), S-100 protein (1/9) and PGP9.5 (1/9). Of the five cases examined for heterozygous deletion mutation of 11 exon of the c-kit gene two were found positive. Two borderline cases showed long-term survival of 8 years and 11 years, respectively. In seven malignant cases, two showed adverse outcome, one survived 4 years without recurrence, two were lost in follow up and two new cases were still being in followed. CONCLUSIONS: GIST-type stromal tumors can also occur in the abdomen, most cases were borderline or malignant, tumor coagulative necrosis, mitoses >or= 5 per 50 high-power fields and obvious nuclear atypia indicating malignancy. Differential diagnosis of EGIST including benign or malignant smooth muscle tumors, benign or malignant nerve sheath tumors etc.

Adult↗
PubMed2004

Managing the open abdomen.

Control of intra-abdominal fluid secretion, facilitation of abdominal exploration, and preservation of the fascia for abdominal wall closure is a major challenge in the management of patients with an open abdomen. Studies comparing different protocols of care have not been conducted and frequency of exploration, surgical procedures, and indications for definitive closure are generally based on clinical judgment. Morbidity and mortality rates are high. Vacuum-assisted therapy has been reported to help meet the challenges of managing the open abdomen and is particularly useful in patients with abdominal compartment syndromes, traumatic injuries, and severe intra-abdominal sepsis. Over the years, clinicians have developed various approaches to achieve vacuum-assisted closure using wall suction. Some disadvantages of the wall-suction methods are eliminated when using more recently developed vacuum therapy devices. These devices apply subatmospheric pressure, reducing bowel edema, bacterial counts, and inflammatory substances found in open abdominal wounds while eliminating the need for frequent dressing changes, maintaining intact skin, and improving fluid management. The results of six case studies presented are encouraging, suggesting that this treatment approach is safe and effective. Controlled clinical studies to establish the safety and effectiveness of this treatment approach and to facilitate the development of treatment guidelines are needed to help manage an increasingly common group of patients who might benefit from this treatment approach.

Abdominal Injuries↗
PubMed2005

Mitochondrial DNA levels of peripheral blood mononuclear cells and subcutaneous adipose tissue from thigh, fat and abdomen of HIV-1 seropositive and negative individuals.

Mitochondrial dysfunction has been demonstrated in subcutaneous adipose tissue from lipoatrophic HIV-1-infected patients treated with nucleoside reverse transcriptase inhibitors (NRTIs). To further assess mitochondrial toxicity, mitochondrial DNA (mtDNA) copies/cell were measured in subcutaneous fat from various sites. Peripheral adipose tissues were obtained from the abdominal wall near the umbilicus, anterior lateral thigh, and dorsal cervical region of the neck of individuals from four cohorts: 1) seven lipoatrophic HIV-1-infected patients receiving a regimen with nucleoside reverse transcriptase inhibitors (NRTIs) as part of highly active antiretroviral therapy (HAART) for > 6 months; 2) seven non-lipoatrophic HIV-1-infected patients receiving NRTIs-containing HAART; 3) five HIV-1-infected patients on antiretroviral therapy < 2 weeks (naive); 4) and five HIV-1-negative participants. Along with the adipose tissue samples, peripheral blood mononuclear cells (PBMC) were also obtained from each patient for mtDNA depletion examination. Total DNA was isolated and mtDNA copies/cell quantitated by competitive and real-time PCR. MtDNA copies/cell in abdomen, thigh, and neck fat were depleted in lipoatrophic HIV-1 seropositive compared to the seropositive naive and seronegative cohorts. MtDNA copies/cell in thigh and neck fat were also decreased in non-lipoatrophic subjects exposed to NRTIs compared with NRTI-naive and HIV seronegative controls. PBMC values did not differ among the cohorts and there was no correlation with lipoatrophy state or HIV-1 serostatus. Additionally, differences in mtDNA copies/cell were observed in the fat depots from seronegative subjects. Thigh fat mtDNA levels were 45-55% lower than abdomen and neck. These studies help demonstrate that mtDNA levels can vary in different subcutaneous adipose depots suggesting possible metabolic differences.

Adipose Tissue↗
PubMed2005

The quality of surgical resident interpretation of after-hour CT scans of the head and abdomen in trauma.

Computed tomography (CT) is an important diagnostic tool in the evaluation of trauma patients. Accurate interpretation of CT scans remains critical in decision-making and the resultant quality of care. In our study, the records of a consecutive cohort of trauma patients who underwent after-hour CT scans of the head and abdomen between January 23 and June 30, 2004, at Kern Medical Center were reviewed. Three hundred thirty-five CT studies were collected in 211 patients. The accuracy of resident interpretation was 92.8 per cent for abdominal and 97.5 per cent for head CT. Resident readings were 93.2 per cent sensitive and 95.4 per cent specific with a positive predictive value of 85.2 per cent and a negative predictive value of 98.0 per cent. There were 16 (4.8%) instances of interpretation discrepancy between the surgical resident and attending radiologist. Most differences occurred in the evaluation of abdominal CT. In no instance was management or outcome for these patients affected. This data demonstrates a low error rate in resident interpretation of after-hour CT scans of the head and abdomen in trauma, but there remains a need for the continued review of the quality of surgical resident radiologic interpretation in situations when an attending radiologist is not immediately available.

Abdominal Injuries↗
PubMed2006

[Incidental cystic structures in the upper abdomen: to remove or not to remove?].

An abdominal cystic structure was diagnosed incidentally in two women aged 44 and 52 years, respectively. The first patient had a mesenteric cyst that was removed because of its malignant potential. The second had a duodenal duplication cyst which was not removed due to the minor risk of complications. Two other patients, a man aged 19 years and a woman aged 40 years, were referred with mechanical complaints due to a splenic cyst and a hepatic cyst, respectively. The splenic cyst was removed surgically and the hepatic cyst was treated by sclerotherapy. Cysts are fluid-filled cavities that can develop throughout the abdomen. They are often discovered by coincidence. These four patients show that cysts in the upper abdomen may be due to various disorders and that the decision to treat is based on the risk of complications, such as bleeding, rupture or malignant potential, as well as the symptoms related to the size ofthe cyst.

Adult↗
PubMed2004

Diagnostic imaging of carcinoid metastases to the abdomen and pelvis.

BACKGROUND: Functional and anatomical imaging methods are currently the standard approach to the evaluation of carcinoid tumor extent. Due to the nature of carcinoid tumors ,there is not a single imaging procedure that is sufficient to detect the malignancy. The aim of the study was to compare the value of CT, MR and functional imaging study with(111) In-Octreotide (SRS) in carcinoid detection and evaluation of its extent as well as to work out the imaging studies diagnostic algorithm that could enhance diagnostic efficacy. MATERIAL/METHODS: A total of 34 patients with carcinoid tumor confirmed clinically,biochemically and/or histopathologically were enrolled into the study. Computed tomography (CT) examinations of the abdomen and pelvis were performed before and after administration of a contrast medium, the triple-phase liver scanning included. Magnetic Resonance Imaging (MRI)of the liver was performed according to the standardized protocol before and after administration of a contrast medium .Planar scintigraphy with(111) In Octreotide and SPECT were performed. In each case liver as well as lymph node metastases in the abdomen and pelvis were searched for. All results were reviewed independently. Clinical picture at follow-up and further imaging and/or histological studies confirmed or excluded the diagnosis of the disease. RESULTS: Twenty nine patients were diagnosed with carcinoid tumor. Liver metastases were found in 26 patients and lymph node metastases were detected in 18 of them. Complete diagnostic conformity as far as the diagnosis and extent of the disease are concerned was obtained only in 7 cases. Incorrect assessment of the disease extent was the source of discrepancy between the imaging studies results in most of the remaining 22 patients. The SRS and MR results of liver metastases detection were mostly consistent with one another. Both imaging modalities evaluated the extent of hepatic metastases incorrectly in 22%of the patients,as compared to 43% of the patients for CT. The highest proportion percentages of incorrect results of lymphatic involvement detection were 41%, 29%and 43%for MR, SRS and CT, respectively. CONCLUSIONS: The results of our study have indicated that application of a complex imaging algorithm enables higher accuracy of hepatic and lymph nodes metastases detection in carcinoid tumor patients. Combining the results of MR and SRS in evaluating the extent of the carcinoid disease seems to represent higher diagnostic value than relying on one of this method in combination with CT images.

Adolescent↗
PubMed2006

[Magnetic resonance imaging--diagnosis and differential diagnosis of tumor formations (cyst) in the abdomen cavity during pregnancy].

The existence of tumor formations with unidentified origin in the abdomen cavity of the pregnant can cause serious problems during the operative intervention. It is critical to find the organ origin of the existing formation and it's relations with the neighboring organs. In the following article we present some of the capabilities of the magnetic resonance tomography as a complementally to the existing in the clinical practice classical and special methods for diagnosis and differential diagnosis of tumor formations in the abdomen cavity during pregnancy. MRI locates precisely the organ origin, the type and the size of the cyst formation, furthermore it helps to determine in detail the access point, the type and size of the operative intervention. The technique is harmless concerning the pregnancy and the development of a normal, healthy fetus.

Abdominal Cavity↗
PubMed2006

Laparoscopic debridement of recurrent pancreatic abscesses in the hostile abdomen.

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.

Abscess↗
PubMedDate not supplied

[Colon lesion for blunt trauma in the abdomen].

Colon lesions resulting from blunt trauma in the abdomen can be defined as infrequent. Actually, they represent 3-5% of all hollow organ trauma. They present, however, serious social burden because of its prevalence in males with medium age ranging from 40 to 70 years. Study was conducted from 1971 to present at the University of Rome "La Sapienza" Institute of Clinical Emergency Surgery. 42 cases were observed in which 72% had motor vehicle accidents (with less than 1/4 of these resulting from seat belt). Numerous lesions were associated, especially in the abdomen (31), and the skull (20), both with Medium OIS 4.2. Most part of the cases was within the OIS-Class III category. The clinical parameters recorded upon admission revealed particular serious situations with average values of SAP-92 mm Hg, HR-114, RR-28, GCS-12, RTS-10.8. 17% had shock upon arrival with unsuccessful resuscitation. Ultrasound results at emergency indicated 62% with effusion/major parenchymal lesion, and 22% with severe peritonitis. 41% were treated with direct suture, 26% with resection-anastomosis, 19% with primary Hartman resection, and 14% with simple colostomy. 24% had abdominal complications including 14% sepsis, 5% hemorrhage, and 2 cases of post-surgical caval thrombus. The overall mortality was 26%. In general these lesions were frightening because of their uncertain manifestations. In most instances clinical signs related to associate lesions are overlooked, and these often present late symptoms from 24 to 48 hours. Delayed treatment for untimely diagnosis is one of the yet prevailing complications. The methods of surgical repair depend on the timing, the nature of associated lesions and, above all, eventual peritoneal contamination. The primary treatment involves surgical option actually recommended according to the EAST guideline with specific preference of reconstruction using the primary principle, and resorting to earlier interventions only in the presence of associated critical factors.

Adult↗
PubMed1991

[Clinical application of helical scanning CT of upper abdomen].

The helical scanning CT unit, in which an X-ray tube continuously rotates at the rate of one revolution per second with constant movement of the table on which the patient is placed, was clinically tested in scanning of upper abdomen. Quality of the images obtained was equal to that of conventional CT. The images were particularly good at an X-ray beam width of 5 mm and table movement of 5 mm/sec with scan parameters of 120 kvp, 200 mA. Because of limitation of the X-ray tube capacity. X-ray beam width of 5 mm and table movement of 10 mm/sec with scan parameters of 120 kvp, 150 m, would be the most appropriate clinically. Application of the helical scanning CT will result in examination times shorter than in the case of conventional high-resolution CT and be obtained images at early vascular enhancement phase through the whole scanning area, so that it can be expected to be extremely useful in clinical diagnosis involving upper abdomen.

Adult↗
PubMed1991

[Injuries of the small and large intestine in the traumatized abdomen].

Between 1973 and 1989 a total of 388 patients underwent laparotomy because of abdominal trauma. In 98 cases, injuries of the small bowel, the colon or the mesentery were found. The injuries were caused by motor vehicle accidents in 55 patients; 12 had gunshot or stab wounds and 12 committed suicide. There were 78 patients who had sustained a blunt abdominal trauma and 20 patients with a penetrating trauma. Only 21 patients had suffered a solitary injury of the gastrointestinal tract. In 41 patients there were also lesions to other intraabdominal organs, in 11 patients, thoracic injuries and in 24 patients, a craniocerebral trauma. Combined injuries of skull, thorax and abdomen were present in 24 patients. Neither ultrasound nor peritoneal lavage allows reliable prediction of injuries of the gastrointestinal tract. In 51 cases a defect of the mesentery or serosa was repaired. In 54 patients there was a rupture of the small or large intestine: in 20 of these cases primary repair without resection was performed and in 34, resection and anastomosis. Ileostomy or colostomy was done in only 8 patients. An anastomotic leak developed in 2 patients. Lethality is correlated to the extent of concomitant injuries. Solitary injury of the small bowel or colon was followed by lethality of only 4.1%, increasing to 50% in patients with combined injuries of skull, thorax and abdomen.

Abdominal Injuries↗
PubMed1989

[Blood reinfusion in injuries of the chest and abdomen].

Reinfusion of blood used in 78 patients with injuries of the chest and abdomen has shown the method to be clinically effective and expedient including treatment of injuries of hollow organs of the abdominal cavity. The technique of blood reinfusion for different injuries is described. Data are presented which allow to suspect that the reinfused blood has curative properties in treatment of injuries of the chest and abdomen.

Abdominal Injuries↗
PubMed1985

Infection about the spine associated with low-velocity-missile injury to the abdomen.

We reviewed the cases of twenty patients who had a fracture or disruption of the disc space of a lower thoracic or lumbar vertebra that was associated with a low-velocity-missile wound to the abdomen. All of the patients underwent an exploratory laparotomy at the time of admission and all received broad-spectrum antibiotics for a minimum of two days. None of the patients had an immediate laminectomy or an immediate debridement of the paraspinal area. In eight patients the gastrointestinal tract was not perforated, and none of them had evidence of infection. In four patients the stomach and small bowel were perforated by the bullet before it struck the vertebral column, and none of them had meningitis, paraspinal infection, or osteomyelitis. In contrast, meningitis, paraspinal infection, or osteomyelitis did develop in seven of eight patients in whom the bullet perforated the colon before it hit the vertebra. Perforation of the colon by a low-velocity missile before the missile fractured the thoracic or lumbar vertebra was associated with a high incidence of infection. The appropriate management may require early operative intervention. This is in contrast to the non-operative approach that has been advocated for low-velocity gunshot wounds to the spine. We agree that a non-operative approach is indicated for gunshot wounds of the abdomen that do not involve the colon.

Abdominal Injuries↗
PubMed1986

The septic abdomen: open management with Marlex mesh with a zipper.

The "open" abdomen has gained popularity in the management of severe intraabdominal sepsis. Drawbacks include evisceration, need for ventilator support, and recurrent abdominal sepsis. We have applied a more aggressive and effective technique consisting of abdominal "closure" with a Marlex mesh sheet containing a zipper. Manual exploration and lavage is performed daily through the zipper in the surgical intensive care unit. Ten patients with severe abdominal sepsis were treated for the following: fecal peritonitis (three patients), radiation enteritis with fistula (one patient), diverticular abscess and dehiscence (one patient), diffuse postoperative abdominal sepsis (two patients), and necrotizing pancreatitis (three patients). Thirteen meshes were inserted, four at first operation and nine at the second to sixth operations. Eight patients survived (80%). Only three patients required respirators; two died. Two patients underwent drainage of three defined abscesses in the surgical intensive care unit. Three patients underwent five major operations through the zipper. Intestinal stomas were present adjacent to the mesh in six patients and were not a management problem. No fistulas resulted from this technique. The Marlex/zipper was removed when all septic signs abated and adhesions were allowed to form (average of 10 to 12 days). Daily aggressive manual lavage of the abdomen through a Marlex mesh/zipper is rapid, simple, and well tolerated. It has permitted effective management of severe septic peritonitis and easier wound care. This technique merits further controlled trials to ascertain its ultimate benefit in survival.

Abscess↗
PubMedDate not supplied

[Abnormal gas collections in the abdomen in infants].

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.

Diagnosis, Differential↗
PubMed1981

Abdominal sepsis managed by leaving abdomen open.

Intra-abdominal sepsis and necrotizing infection of the abdominal wall are usually fatal unless adequate drainage and wide debridement are possible. To follow these principles, we managed 18 seriously ill patients with abdominal sepsis by leaving the abdomen completely open. All except two of the patients had severe intra-abdominal sepsis. Eight patients had full-thickness wound infections and intra-abdominal infections refractory to the usual surgical drainage techniques. Two had necrotizing wound infections only. In 12 an upper abdominal incision was managed open, and in six the open incision was lower. As part of the initiating illness, there were eight small bowel and six colon fistulas. They were managed by colostomy in five patients and ileostomy in two. More than one organism was cultured in all patients and 12 of 18 had a positive blood culture. Respiratory failure made mechanical ventilation necessary in 13 patients for an average of 44 days. Previous adhesions, usually present, or an intact greater omentum, were necessary to prevent bowel evisceration, but three patients required paralysis and mechanical ventilation until adhesions became strong enough to prevent evisceration. There were seven deaths (39%), six caused by continuing sepsis and one from hemorrhage. In those surviving, granulation tissue grew over omentum or bowel loops to eventually seal the abdominal cavity. The late management was split-skin grafting in five and secondary closure in two. Four healed by second intention. We conclude that leaving the abdomen completely open facilitates the widest possible drainage, uncompromising debridement of the abdominal wall, and is compatible with good recovery. The ultimate result in survivors is acceptable. This technique is preferable to closing an abdominal wall of questionable viability in the face of intraperitoneal sepsis.

Abdominal Muscles↗
PubMed1983

[The "left-open abdomen". Technic, indication and results].

Critical evaluation of 22 cases with serious diffuse purulent or fecal peritonitis treated by open abdomen following surgical intervention. Seven (32%) patients died, three because of continuing sepsis and one because of acute haemorrhagic necrotizing pancreatitis. The three other died of general complications (1 coma hepaticum, 2 massive embolisms; at autopsy their abdominal cavity was entirely cleaned. The therapeutic principle of "open abdomen" in cases of severe purulent and fecal peritonitis will be recommendable.

Bacterial Infections↗
PubMed1981

[Behavior of an intra-uterine device in the abdomen of animals (author's transl)].

The authors have carried out an experimental study on the reaction of an animal's organism to the presence of an open copper intra-uterine device when placed in the abdomen. The study was carried out on two groups each of 10 rabbits and two bitches. The intra-uterine device was placed in the pouch of Douglas by laparotomy, directly in one group and after contamination with genital secretions in the other. The state of the animals was checked six weeks after the initial laparotomy. Trauma caused by the operation was minimal because there were no adhesions found on the parietal peritoneum. On the other hand in experimental conditions that are very similar to those found when an intra-uterine device goes through the uterus in a human subject and involves contamination with genital secretions, in 50 per cent of cases the intra-uterine device migrated within the abdominal cavity. It was picked up by the omentum and this underwent such a strong fibrous reaction that it brought about multiple intestinal adhesions. Though the authors admit that experimental results in animals cannot be extrapolated to women, they believe that these results should be taken into consideration and that it would be imprudent to leave an intra-uterine device in the abdomen in a woman when there is proof that it has migrated, because there would then be a major risk of intestinal obstruction due to an adhesion that as formed a band.

Animals↗