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At least 631 records · Page 35Linked to original sources
PubMed1988

Treatment of severe intra-abdominal sepsis and/or necrotic foci by an 'open-abdomen' approach. Zipper and zipper-mesh techniques.

Undrained necrotic tissue or septic foci contribute to continued "activation" of host processes that in turn lead to multiple organ failure and death. We hypothesized that if wide-open drainage of the abdominal cavity is provided, thus not allowing intra-abdominal collections to form, mortality in these patients can be reduced. Since 1982 we have treated 49 patients with necrotic pancreatitis and related infections and 15 patients with severe intra-abdominal sepsis from intestinal perforations. The surgical treatment was based on the provision for daily laparotomies in the intensive care unit with the patient under epidural anesthesia by using an "open-abdomen" technique (zipper alone or a zipper-mesh combination). The APACHE II score and the functional classification were used to derive expected mortalities. The patients with intraabdominal sepsis had a mean APACHE II score of 25 and an expected mortality of 45%, vs the 26.5% mortality that we observed. The lowest mortality in the necrotic pancreatitis group was associated with noninfected pancreatic necrosis (6%) and single abscess (9%) vs 22% mortality rate in the patients with infected pancreatic necrosis. The mean expected mortality in this group was 47%, vs the observed 22%. We attributed this result to the daily abdominal explorations that achieved a complete excision of infected or necrotic tissue.

Abdomen↗
PubMed1991

Prediction of injury caused by penetrating wounds to the abdomen, flank, and back.

Controversy about the appropriate evaluation of penetrating abdominal, flank, and back injuries prompted this retrospective review of 311 patients at an urban level 1 trauma center over 5 years. Seventy-five (24%) patients sustained gunshot wounds to the abdomen. All patients with gunshot wounds underwent exploratory laparotomy; results of 67 laparotomies (89%) were positive. Of 236 patients sustaining stab wounds (140 abdominal wounds, 51 flank wounds, 26 back wounds, and 19 wounds to multiple sites), 147 were treated according to a selective protocol, based on results of physical examination, wound exploration, peritoneal lavage, and ancillary diagnostic studies. No injuries were found at celiotomy in three (2%) of these 147 patients. One false-negative result of evaluation of a flank wound occurred. Significant injuries were found in 13 patients (68%) with stab wounds to multiple sites, 61 patients (44%) with abdominal stab wounds, 15 patients (29%) with flank stab wounds, and four patients (15%) with back stab wounds. Mandatory exploration of gunshot wounds is justified. Physical findings of intra-abdominal injury or positive results of peritoneal lavage identify stab wound victims likely to benefit from surgical exploration. A policy of mandatory observation or routine celiotomy for treatment of stab wounds is not justified.

Abdomen↗
PubMed1997

Sonographic survey of the upper abdomen in 10 families of patients with immotile cilia syndrome.

Ten patients affected by the immotile cilia syndrome (ICS) and their families received an ultrasound examination of the upper abdomen to observe the possible familial occurrence of biliary, pancreatic, and splenic alterations. In 9 patients the liver was localized in the left hypochondrium, and in 1 patient there was an accessory spleen. In all the examined kin, the subdiaphragmatic organs were normally positioned. Two parents had an accessory spleen. We conclude that the supposed increased frequency of polysplenia, asplenia, and biliary atresia among ICS subjects and their kin is overestimated and based only upon anecdotal reports.

Abdomen↗
PubMed1996

Occlusion maneuver to detect the relative contribution of the rib cage and abdomen to tidal volume using respiratory inductive plethysmography in infants.

Respiratory inductive plethysmography (RIP) records movements of the rib cage (RC) and abdomen (AB). A calibration procedure is needed to determine their relative contribution to tidal volume. We evaluated the hypothesis that the relative contribution of the RC and AB could be defined from respiratory efforts made during a brief occlusion of the airways in 10 infants aged 6.5-19 months, who were studied in quiet sleep. Six occlusions were performed during tidal breathing, with and without a pneumotachograph (PNT) and face mask in place. We analyzed the periods of occluded respiratory effort when RC and AB were in opposite directions (paradoxical movements), plotting RC vs. AB and performing a least-squares linear regression to estimate the ratio of the coefficients of AB/RC. Multiple linear regression of AB and RC over tidal volume during about 100 seconds of tidal breathing provided a reference standard. A ratio of 1 means that AB and RC make equal contributions to tidal volume. The feasibility of the occlusion maneuver was poor; only 51% of occlusions with PNT and 54% without led to a paradoxical movement with a good fit (r > 0.9). The mean coefficient of variation (range) was 9.35% (3.9-15.3%) with PNT and 12.1% (2.5%-26.3%) without it. The accuracy was very poor, with the mean AB/RC value being 0.94 with occlusions and 2.39 with multiple linear regression. The mean difference was 1.45 (SD 0.80), yielding 95% confidence limits for the difference of 0.12-3.01. We concluded that, due to its very poor accuracy and feasibility, the occlusion technique is not a useful method to calibrate RIP in infancy.

Abdomen↗
PubMed1976

An acute abdomen: spontaneous rupture of liver during pregnancy.

Spontaneous rupture of liver during pregnancy is presented as an example of an acute abdomen admitted to a casualty department of a general hospital. The literature is reviewed and emphasis is placed on clinical awareness and earlier diagnosis as a means to reduce the high mortality.

Abdomen, Acute↗
PubMed1978

Disinfection of the skin of the abdomen.

The skin of the abdomen of 106 staff and 358 patients was sampled 5 min and 2 h after disinfection using contact plates. Control areas of skin were treated with water only or left untreated. A reduction of 99 per cent (log reduction factor = 2) or more in colony counts was obtained in 5 min with 70 per cent ethyl alcohol and alcoholic solutions of chlorhexidine, povidone-iodine and chloroxylenol/EDTA. Aqueous solutions of chlorhexidine (0.5 per cent) Savlon (5 per cent), povidone-iodine (10 per cent) and chloroxylenol/EDTA (X10 recommended concentration) also showed similar reductions. Weaker aqueous solutions of chlorhexidine (0.05 per cent), Savlon (1 per cent) and chloroxylenol/EDTA (recommended concentration) were significantly less effective than the alcoholic and the most effective aqueous solutions, although all were more effective than water. Total bacterial counts were lower from the skin of female than from male staff and lower from staff than from patients. Pathogens (Staphylococcus aureus or Gram-negative bacilli) were isolated from only one member of staff in small numbers and irregularly and rarely in large numbers from patients. Few pathogens were isolated after application of any of the disinfectants.

Abdomen↗
PubMed1979

Spinal epidural abscess presenting as acute abdomen in a child.

Spinal epidural abscess is seldom encountered in children and rarely occurs in the absence of spinal pain. A case is described in which a child with a thoracic epidural abscess presented with abdominal rather than spinal pain. Thoracolumbar radicular inflammation and visceroparietal reflexes initiated by a s'spinal ileus' probably produced the symptoms and signs of acute intra-abdominal disease. Consideration of intraspinal disease is advisable in all cases of acute abdomen which exhibit atypical features.

Abdomen, Acute↗
PubMed1982

The 'acute' abdomen in heroin addiction.

Twenty-two heroin addicts admitted with an acute abdomen to the surgical department in the years 1971-1981 were reviewed. Fifteen patients had symptoms suggesting intestinal obstruction, 7 proved to have pseudo-obstruction, 4 had withdrawal symptoms, 2 had faecal impaction and only 2 had adhesions which necessitated operation. A haematocrit level of more than 0.46 was found to be indicative of true obstruction. Frequently, elevation of the white blood cell count or erythrocyte sedimentation rate merely reflected a state of accompanying soft tissue infections which were very common in these patients. The remaining 7 patients were admitted with intra-abdominal inflammation, 2 patients had an appendix mass, 1 had gonococcal peritonitis, 3 had appendicitis and 1 had a normal appendix removed. In these 7 patients the history and physical findings were characteristic of the suspected pathology.

Abdomen, Acute↗
PubMed1991

Ultrasonography in the acute abdomen.

In a prospective study 152 consecutive patients presenting with acute abdominal pain were assessed clinically and an ultrasonographic examination was performed immediately. Of these, 16 (11 per cent) patients would normally have had an immediate ultrasonographic scan requested; routine (within 24 h of admission) ultrasonographic examination would have been requested in a further 66 (43 per cent) patients. In 70 (46 per cent) patients an ultrasonographic examination would not have been requested. Ultrasonography altered the diagnosis in one patient from probable appendicitis to cholecystitis. Ultrasonography missed one abdominal aortic aneurysm and one empyema of the gallbladder. Ultrasonography had a sensitivity of 96 per cent, a specificity of 94 per cent, a positive predictive value of 96 per cent, a negative predictive value of 94 per cent and an accuracy of 95 per cent in diagnosing appendicitis. Exactly the same values were found for the clinical diagnosis of appendicitis. The study shows that routine immediate ultrasonographic examination of the acute abdomen is rarely helpful, with the possible exception of appendicitis. Where an urgent ultrasonographic scan is necessary on clinical grounds the expertise of a radiologist is probably required, whereas in specific areas, for example in the diagnosis of right iliac fossa pain, there may be a place for training the surgical trainee.

Abdomen, Acute↗
PubMed1992

Laparoscopy in developing countries in the management of patients with an acute abdomen.

Surgeons in developing countries see a need to improve diagnosis and decision making in patients with an acute abdomen. Without the benefit of diagnostic aids such as computers and high-resolution ultrasonography, the rate of unnecessary laparotomy is often unacceptably high. The laparoscope is usually available in a developing country and its use easily acquired. Using laparoscopy in doubtful situations the unnecessary laparotomy rate was significantly reduced from 14.0 to 6 per cent (P < 0.05). Laparoscopy achieved a diagnostic accuracy of 86 per cent and prevented unnecessary laparotomy in 57 per cent of those in whom it was used.

Abdomen, Acute↗
PubMed1996

Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen.

Eighty-five consecutive patients were randomized to undergo mass closure of the abdomen with no. 1 polydioxanone mounted on either a blunt-tipped (n = 46) or cutting (n = 39) needle. Gloves were changed before closure and tested for perforation afterwards using standard air or water techniques. Fourteen pairs of gloves were punctured when using a cutting needle, and three pairs when a blunt-tipped needle was used. The majority of punctures were to the non-dominant glove. The surgeon was aware of the puncture in eight of the 14 instances involving a sharp needle and in one of the three involving a blunt-tipped needle. Blunt-tipped needles, while not eliminating the risk, significantly reduced the incidence of surgical glove puncture (P < 0.001, Fisher's exact test). The use of cutting needles for abdominal closure should be abandoned.

Abdomen↗
PubMed2001

Clinical anatomy and the physical examination part I: thorax, abdomen, perineum, and pelvis.

This paper by the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) is a sequel to one published earlier, "A Clinical Anatomy Curriculum for the Medical Student of the 21st Century: Gross Anatomy" (AACA. 1996, Clin Anat. 9:71-99). In that curricular document a number of clinical procedures that apply gross anatomy to current medical practice are cited, including procedures related to the physical examination. This paper describes numerous anatomically based procedures that are performed during a physical examination to demonstrate that (1) gross anatomy forms a fundamental basis for physical diagnosis and (2) such an anatomic basis is delineated in our previously published curricular document. The AACA Educational Affairs Committee also hopes that the examples presented here will serve as a starting point for incorporating elements of the physical examination within a clinical anatomy curriculum in gross anatomy at the medical school level. This paper focuses on the physical examination of the thorax, abdomen, perineum, and pelvis; a subsequent paper will treat the physical examination of the limbs, back, head, and neck.

Abdomen↗
PubMed1975

Gray scale compound scan echography of the normal upper abdomen.

Compound scanning shows the size, shape, position, and anatomical relationships between the various organs in the upper abdomen. Gray scale compound scanning gives additional information from the parenchyma of organs and allows description of the characteristic ultrasonic appearance of specific tissues such as liver, spleen, or kidney. The method is complementary to simple scanning and for diagnostic work a combination of the two methods is recommended.

Abdomen↗
PubMed1978

The liquid-filled stomach--an ultrasonic window to the upper abdomen.

An ultrasonic window to the upper abdomen is creasted by (a) filling the fasting stomach with methylcellulose suspension, (b) administering glucagon intravenously, and (c) examining the patient prone. Glucagon relaxes the gastric musculature and the prone position allows the stomach gas to rise to the fundus. This enables assessment of the relationships of the stomach to adjacent structures and permits display of structures forming the stomach bed. The equipment used was a commercially available water-delay system with wide-aperture focused transducers. The system gives good resolution and allows the gastric musculature to be distinguished from the mucosa and its overlying mucus.

Abdomen↗
PubMed1986

Differential diagnosis of anechoic/hypoechoic lesions in the abdomen detected by ultrasound.

Ultrasound is the method of choice in the detection and differentiation of solid or cystic masses in the abdomen. The differential diagnosis of anechoic and hypoechoic lesions comprises a large variety of benign and malignant diseases or abnormalities. This paper describes a number of such lesions and, in addition, discusses the possible differential diagnoses so far reported in the literature. An attempt is made to describe the different features of such lesions. Most of them are rare but have to be considered if a lesion of unknown origin or clinical relevance is detected by ultrasound.

Abdomen↗
PubMed1987

Fitting growth curves to head and abdomen measurements of the fetus: a multicentric study.

Three different mathematical models were fitted to ultrasonic measurements of the biparietal diameter, head circumference, and abdomen circumference obtained from 1,426 healthy fetuses. The linear cubic function gives coefficients comparable with most previous studies, but it does not thoroughly explain fetal growth throughout pregnancy. Both the exponential-power function and the logistic-logarithmic function fit the raw data well and theoretically reflect the biological phenomena of human fetal growth. The characteristics of each model are discussed.

Abdomen↗
PubMedDate not supplied

HASTE MR imaging: description of technique and preliminary results in the abdomen.

HASTE (Half fourier Single-shot Turbo spin-Echo) is a single-section T2-weighted sequence that acquires images in less than 1 second. Images are breathing independent and possess a variety of other features useful for imaging the abdomen. The design of this technique is described. Clinical studies of 38 consecutive patients were performed using this technique. HASTE images were considered good in 28 and fair in 10 patients, including five patients who could not suspend respiration. Definition of liver and bowel was particularly clear.

Abdomen↗
PubMedDate not supplied

Fast MR imaging techniques: impact in the abdomen.

The increased efficiency of MRI data acquisition has had a substantial impact on clinical MRI of the abdomen. Five particular applications that have thus been affected include breath-hold imaging of liver lesions (including detection, characterization, and biopsy), MR cholangiopan- creatography, practical chemical shift imaging (including liver and adrenal glands), dynamic imaging after contrast media injection, and MR angiography.

Abdomen↗