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PubMed1976

Heat exchange in relation to blood flow between thorax and abdomen in bumblebees.

1. The narrow passage within the petiole between thorax and abdomen is anatomically constructed so that counter-current exchange should retain heat in the thorax despite blood flow to and from the cool abdomen. 2. However, the counter-current heat exchanger can be physiologically circumvented. Exogenously heated bumblebees prevented overheating of the thorax by shunting heat into the abdomen. They also regurgitated fluid, which helped to reduce head temperature but had little effect on thoracic temperature. 3. Temperature increases in the ventrum of the abdomen occurred in steps exactly coinciding with the beats of the ventral diaphragm, and with the abdominal 'ventilatory' pumping movements when these were present. The ability to prevent overheating of the thorax by transport of heat to the abdomen was abolished when the heart was made inoprative. 4. At low thoracic temperatures the ventral diaphragm beat at a wide range or rates and with varying interbeat intervals, while the heart beat at a high frequency relative to the ventral diaphragm, but at a very low amplitude. However, when thoracic temperature exceeded 43 degrees C the amplitudes of both were high, and the interbeat intervals as well as the beating frequencies of the two pulsatile organs became identical in any one bee. Furthermore, heated bees engaged in vigorous abdominal pumping at the same frequency as that of their heart and ventral diaphragm pulsations. 5. The results indicate that the anatomical counter-current heat exchanger is reduced or eliminated during heat stress by 'chopping' the blood flow into pulses, and the blood pulses are shunted through the petiole alternately by way of a switch mechanism.

Abdomen↗
PubMed1981

Relationship of rib cage and abdomen motion to diaphragm function during quiet breathing.

Although rib cage (RC) and abdomen (Ab) motion is believed to reflect intercostal and diaphragm contributions to breathing, systematic investigations have failed to confirm this. We measured inspiratory changes in RC and Ab anterior-posterior diameter (delta RC and delta Ab) both corrected for volume equivalence (isovolume) and not corrected (isodistance, observed), and correlated these with simultaneous changes in gastric (delta Pab) and esophageal (delta Ppl) pressure: delta Pab - delta Ppl = delta Pdi, the change in transdiaphragmatic pressure. The delta Pab/delta Pdi was used as an index of the relative contribution of diaphragm motion to the breathing process. Relative abdomen motion was expressed as delta Ab/(delta Ab + delta RC). Isodistance and isovolume delta Ab/(delta Ab + delta RC) correlated, R = 0.69; observed abdomen motion overestimated abdomen-diaphragm contribution to tidal volume. Isodistance delta Ab/(delta Ab + delta RC) was less for women than men; isovolume delta Ab/(delta Ab + delta RC) was similar for the two sexes. Among individuals, isodistance delta Ab/(delta Ab + delta RC) correlated with delta Pab/delta Pdi (R = 0.73, P less than 0.001). Within a given individual, the mean R for seven subjects for delta Pab/delta Pdi vs delta Ab/(delta Ab + delta RC) was 0.90. We conclude that observed rib cage and abdomen motion reflects intercostal and diaphragm contributions to breathing; the correlation is better within a given subject than among individuals.

Abdomen↗
PubMed1997

Subcutaneous fat distribution of the abdomen and buttocks in Japanese women aged 20 to 58 years.

Subcutaneous fat is an essential element in shaping the body of human beings. In this research, skinfold thickness was measured specifically in 33 regions of the human body, including the abdomen and buttocks. Based on our measurements, the subcutaneous fat distribution was assessed for several age groups. The subjects were healthy Japanese women aged 20 to 58 years. Skinfold thickness was measured using the B-mode ultrasound methods, together with anthropometric measurement. A comparison was made between the following five age groups: early 20's, late 20's, 30's, 40's and 50's. The measured values for the early 20's group were used as the standard and the relationship between increase ratio of subcutaneous fat and age was studied. Through our research, we obtained data on the subcutaneous fat distribution in each age group. The largest change was observed between the ages of the early 20's and late 20's. The skinfold thickness measurements of the abdomen and buttocks was consistently around 10 mm for the early 20's, and increased up to 23.8 mm on the rear side section for the late 20's. This result indicates that the increase ratio varied depending on the part of body. Furthermore, the changes in skinfold thickness were different in specific parts of the abdomen and buttocks among different age groups. The difference in skinfold thickness between upper and lower sections of the abdomen also becomes more pronounced with age. Skinfold thickness increased significantly between the early 20's and late 20's. Among the body regions, measurements at the rear side showed the largest change with age; averaging 11.3 mm for the early 20's compared to 33.6 mm for the 50's. The subcutaneous fat distribution on the buttock also showed the differences with age, indicating changes in body shape. Using careful measurements of the abdomen and buttocks, subcutaneous fat distribution among each age group was determined as well as the variation in changes with the aging process.

Abdomen↗
PubMed1989

Sampling bandwidth and fat suppression: effects on long TR/TE MR imaging of the abdomen and pelvis at 1.5 T.

In MR imaging, the sampling bandwidth is the rate at which the signal is digitized by the analog-to-digital converter. Reducing the sampling bandwidth can decrease noise in long TE images at the expense of increases in the artifacts of chemical-shift misregistration and motion. We compared 39 pairs of axial images with bandwidths of 32 kHz and 8-10 kHz. In 23 of these comparison studies (six female pelvis, seven male pelvis, 10 abdomen), all other variables were held constant, and in 16 comparisons (10 female pelvis, six male pelvis), signal from fat was suppressed in images with reduced bandwidth. Six patients with 11 liver lesions were included in those undergoing abdominal imaging. In three patients, fat was suppressed in images of the abdomen. The contrast-to-noise ratio was greater with reduced bandwidth for urine vs fat (24.5 vs 17.2; p less than .05) and central vs peripheral parts of the prostate gland (34.1 vs 22.7; p less than .02). In the abdomen, the contrast-to-noise ratio was increased between liver and right kidney (36.6 vs 25.2; p less than .01) and between liver and lesion (30.2 vs 18.2; p less than .005), but the motion-induced artifact was worse. An increase in chemical-shift misregistration did not affect the appearance of the internal structure of the uterus, prostate gland, or liver, but it made examination of the ovaries, seminal vesicles, and extrahepatic tissues difficult. The chemical-shift artifact in pelvic images could be eliminated by suppressing signal from fat with frequency-selective saturation pulses, but results were less satisfactory in the abdomen. When reduced bandwidth and fat suppression were combined, the contrast-to-noise ratio was improved for endometrium vs myometrium (22.9 vs 15.2; p less than .05) and central vs peripheral parts of the prostate gland (62.7 vs 28.5; p less than .02). Reduction of the sampling bandwidth is a promising technique for imaging the pelvis with small field of view and long TR/TE, but it currently appears less promising for images in the upper abdomen at 1.5 T. The increased chemical-shift artifact caused by reduced bandwidth can be eliminated by suppressing signal from fat.

Abdomen↗
PubMed1994

T2-weighted MR imaging of the upper part of the abdomen: should fat suppression be used routinely?

OBJECTIVE: Fat suppression has shown promise in improving the quality of T2-weighted spin-echo MR images of the upper part of the abdomen. The purpose of this study was to determine whether fat-suppressed images should be routinely used in lieu of conventional images. Accordingly, we prospectively compared the two techniques in a series of patients with both normal and abnormal findings in the upper part of the abdomen. MATERIALS AND METHODS: Conventional and fat-suppressed T2-weighted spin-echo images (3000/80,160 [TR/TE]) were obtained in 45 consecutive patients referred for MR imaging of the upper part of the abdomen. Thirty-three patients had abnormal findings, and 22 of those 33 patients had histologic or follow-up confirmation of the diagnosis (14 with metastasis, one with hepatoma, four with hemangiomas, and three with cysts). Signal intensities (hepatic lesions, liver, spleen) and noise were measured to calculate signal-to-noise ratios and contrast-to-noise ratios. Qualitative comparison (liver, hepatic lesions, porta hepatis, spleen, pancreas, bowel, kidneys, adrenal glands, noise), evaluation of the number of hepatic lesions, and characterization of hepatic lesions were done by independent observers. RESULTS: Compared with conventional images, fat-suppressed images had higher signal-to-noise ratios (lesions, liver, spleen) and contrast-to-noise ratios (lesion-liver and spleen-liver) (p < .005). In qualitative comparison, three of three radiologists preferred fat-suppressed over conventional images for depiction of hepatic lesions and all upper abdominal organs except the liver, for which no clear preference was shown for either technique. Detection rates for hepatic lesions were similar with both types of images (observer 1: 112 lesions on fat-suppressed vs 118 on conventional images, observer 2: 142 vs 135), as was the characterization of hepatic lesions (91% accuracy on fat-suppressed images and 84% accuracy on conventional images, for 22 proved lesions and two observers). CONCLUSION: Fat-suppressed T2-weighted spin-echo MR images were better than non-fat-suppressed images for evaluation of the upper part of the abdomen. These results suggest that fat suppression should be routinely used in T2-weighted MR imaging of the upper part of the abdomen.

Abdomen↗
PubMed1997

Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery.

OBJECTIVE: The purpose of this study was to evaluate the effect of CT on the diagnosis and management of acute abdominal pain in patients who did not undergo surgery and to determine what population of patients would profit most from CT examination. MATERIALS AND METHODS: Clinical data and CT reports of 91 patients with acute abdomen (41 men and 50 women, 22-96 years old) were analyzed retrospectively. The accuracies of clinical evaluation and CT in revealing the cause of acute abdomen were compared, and the effect of CT on patient management was assessed. Analysis included the entire population of patients and these subgroups: (1) patients who had symptoms for fewer than 24 hr versus patients who had symptoms for 24 hr or more and (2) patients who had a history of abdominal diseases versus patients who had no such history. RESULTS: Twenty-nine patients had signs or symptoms for fewer than 24 hr, and 62 patients had signs or symptoms for 24 hr or more. Fifty-nine patients had a history of abdominal disease, and 32 had no history of abdominal disease. In the entire population of patients, CT was superior to clinical evaluation for diagnosing the cause of acute abdomen (sensitivity was 90% for CT and 76% for clinical evaluation, p < .0005). Management was changed after CT in 25 patients (p < .0005). Similar differences were observed in the subgroups of patients with signs and symptoms for fewer than 24 hr, patients with signs and symptoms for 24 hr or more, and patients with no history of abdominal disease (p < .05). In the subgroup of patients with a history of abdominal disease, the differences between clinical evaluation and CT were not statistically significant. CONCLUSION: CT is an excellent examination technique for patients with acute abdomen, regardless of the duration of signs and symptoms. CT is particularly useful in defining the cause and therapeutic strategy in patients with acute abdomen who have no history of abdominal disease.

Abdomen, Acute↗
PubMedDate not supplied

Non-traumatic acute abdomen: videolaparoscopic approach.

BACKGROUND AND OBJECTIVE: Although videolaparoscopy has been considered a safe method for many elective procedures, its use in traumatic and non-traumatic acute abdomen needs to be evaluated. The aim of this article is to evaluate the role of videolaparoscopy in non-traumatic acute abdomen as a method of diagnosis and treatment. METHODS: Between January 1992 and December 1996, 462 patients' charts were reviewed, retrospectively. Patients were admitted to the emergency room of São Rafael Hospital with symptoms of non-traumatic acute abdomen. Routine investigation of abdominal pain was performed in all patients, followed by videolaparoscopy. The laparoscopic procedures were done with four main purposes: diagnosis (ie, enteritis); diagnosis and treatment (ie, appendicitis); treatment only, when the diagnosis was known (ie, acute cholecystitis); and in cases where the conversion to conventional laparotomy was necessary, indicating the best incision. RESULTS: The vast majority of patients had inflammatory causes of acute abdomen (82.03%); others causes were hemoperitoneum (11.03%), bowel obstruction (3.25%), perforation of a hollow viscera (1.74%), vascular occlusion (1.3%), and negative laparoscopy (0.65%). CONCLUSIONS: This study shows that laparotomy was necessary in only 7.14% of the patients. The videolaparoscopic approach was used for diagnosis (99.35%) and treatment (92.86%) of patients with acute abdomen.

Abdomen, Acute↗
PubMed1984

[Interference factors in sonography of the middle and lower abdomen].

Disturbing factors in diagnostic ultrasound of the mid-abdomen und lower abdomen are presented. Factors causing unsatisfactory sonographic studies were analysed in 304 sonographic studies of the middle abdomen and lower abdomen. The retroperitoneal space was not demonstrated in 31 of 304 cases (10.2%). Plain films of the abdomen and computed tomography demonstrated fat in subcutaneous tissue, the omentum and the mesenterium in 20 of 31 cases (66%) and intestinal gas in 11 of 31 cases (36%). If ultrasonic studies demonstrate diffuse accumulation of echos, then repetition of the study is not recommended, since computed tomography will provide more reliable results.

Abdomen↗
PubMed1995

Reclosure of the open abdomen.

BACKGROUND: The open abdomen technique for the treatment of diffuse peritonitis has gained acceptance. Our approach has been to use the zipper technique with daily irrigations. Once the abdominal problem has resolved, the mesh and zipper are removed. Surgeons are reluctant to reoperate on patients with such prior treatment because of the anticipation of a hostile abdomen. Our study is a retrospective review of 12 patients who were treated with the open abdomen technique. At a later date, they underwent elective reoperation. STUDY DESIGN: The charts of 12 patients were reviewed. After initial injury, the patients were in the surgical intensive care unit. Reoperations were performed nine months (mean) after discharge from this facility. The reasons for reoperation were closure of enteric fistula (five patients) and closure of an ostomy (seven patients). The abdominal wall was reconstructed in nine patients. In the other three patients, the abdomen was entered through a lateral incision and the bowel was reanastomosed. RESULTS: All of the patients survived. There were five complications. Two patients had ischemic skin grafts successfully treated by hyperbaric oxygen therapy (HBO). Two patients had ischemic skin flaps that were covering mesh. They responded to HBO with minimal slough of superficial tissue. One patient had a low output fistula that closed after two weeks of total parenteral nutrition. CONCLUSIONS: A history of an open abdomen is not a contraindication to later operation. Bowel continuity can be restored and abdominal wall reconstruction can be performed safely. This can be done as early as three to four months after recovery from the original injury.

Abdomen, Acute↗
PubMed1996

Laparoscopic surgical approach and anatomy of the abdomen in llamas.

OBJECTIVE: To describe 3 laparoscopic approaches for, and the normal laparoscopic anatomy of, the abdomen in adult llamas and to evaluate the effects of laparoscopy in those llamas. DESIGN: Prospective clinical trial. ANIMALS: Six adult castrated male llamas. PROCEDURE: After induction of general anesthesia, 3 surgical approaches to the abdomen were performed: left paralumbar, ventral midline, and right paralumbar. The abdomen was systematically examined, and anatomic features described. After recovery from anesthesia, all llamas were examined daily for 10 days and CBC was repeated 24, 72, and 120 hours after laparoscopy. RESULTS: Laparoscopy was successfully performed in all llamas by use of the ventral midline and right paralumbar approaches. The laparoscope was inadvertently placed into the left retroperitoneal space in 1 of the 6 llamas when the left paralumbar approach was used. Also, hemorrhage into the abdomen limited the view from the left side in another llama. Various approaches allowed viewing of the first and third forestomach compartments, liver, spleen, kidneys, small intestine, ileum, proximal loop of the ascending colon, spiral colon, and urinary bladder. Postoperative findings included subcutaneous emphysema and edema. Mean WBC count peaked 24 hours after surgery (mean, 23,500 cells/microliter). Generally, neutrophil count increased and lymphocyte count decreased during the 120 hours after surgery. CLINICAL IMPLICATIONS: Laparoscopy may be used for differentiation of medical and surgical lesions in the abdomen of llamas. The site for laparoscopy should be chosen on the basis of the most likely site of the suspected lesion.

Abdomen↗
PubMed1997

[Value of diagnostic laparoscopy and minimal invasive procedures in acute abdomen].

During the last three years 172 diagnostic laparoscopies (DL) were performed at our department in patients with an acute abdomen of unclear causes. This corresponds to 17% of all patients who underwent operation due to an acute abdomen in the same period. Always the indication for a diagnostic laparoscopy arose then, when the cause or the localization of the acute abdomen could not be found by conventional diagnostic methods. The advantages of DL were either the confirmation (93%) or the exclusion (7%) of the diagnosis "acute abdomen", the exact localization and simultaneously a definitive operative treatment of the cause by minimal invasive interventions (n = 109/65%). In these patients with acute abdomen the main causes were acute inflammations of gallbladder (n = 48) and appendix (n = 29), ulcus perforations (n = 9) and ileus (n = 9). The conversion rate amounted to 2.7%, the postoperative complication rate to 11% and the lethality rate to 1.8% in these patients. A new indication is the so-called "bedside laparoscopy" as means to control the postoperative course of mesenteric embolism (n = 9) and diffuse peritonitis (n = 3) in order to avoid the stress of a second-look operation for these seriously ill patients or to secure the indication for relaparotomy.

Abdomen, Acute↗
PubMed1986

Computed tomography of the abdomen and pelvis: documentation of tumor response and progression in disseminated prostate cancer.

Computed tomography of the abdomen and pelvis has been used to stage early prostatic cancer. We investigated its value in monitoring tumor response in more advanced disease. Serial computed tomography of the abdomen and pelvis was obtained along with multiple other staging tests prior to treatment and at 3- to 4-month intervals thereafter in 32 patients with stage D2 tumor treated initially with combination chemotherapy and with hormones at progression. Pretreatment lymphography with follow-up abdominal films was also performed. Initial computed tomography of the abdomen and pelvis showed evidence of node metastases in 35% of patients while lymphography was positive in 54%. Among 19 patients with tumor response and 25 with progression, the results of treatment were objectively documented by improvement or worsening, respectively, in a mean of 5.1 and 5.0 other staging tests, exclusive of computed tomography. Computed tomography of the abdomen and pelvis improved in 85% of responding patients examined. Progression was confirmed by worsening of computed tomography in 32%. Although lymphography was often abnormal prior to treatment, in our hands it was not useful in serial monitoring of tumor status. We conclude that serial computed tomography of the abdomen and pelvis, when initially positive, is a useful test to document objectively tumor response and progression in disseminated prostatic cancer.

Abdominal Neoplasms↗
PubMed1995

Reduced need for sedation in patients undergoing helical CT of the chest and abdomen.

Since 15 July 1993, we have used helical CT exclusively in chest and abdomen exams. The purpose of this study was to compare sedation rates in children undergoing conventional and helical CT of the chest and abdomen. Data for all CT examinations of the head (n = 1121), chest (n = 427), and abdomen (n = 315) performed between 1 April 1993 and 31 October 1993 were evaluated. Examinations were divided by anatomic site, patient age, date, whether motion was noted in the radiology report, and whether or not sedation was used. The oldest patient requiring sedation was 5 years old. All examinations in patients 5 years old or less (n = 1048) formed the study group. Because no head CT examinations were done helically, this constituted a control group. Comparisons of motion and sedation rates before and after 15 July 1993 were made with the chi 2 test. There was no statistically significant difference in the sedation rate in the control group (patients having conventional head CT examinations). In contrast, the use of helical technique for chest and abdomen CT coincided with a reduction of the sedation rate from 18% to 10% (P = 0.3). There was no statistically significant difference in reported motion for either head or chest/abdomen examinations over the study period. The implementation of helical CT coincided with a 45% reduction in the sedation rate of patients undergoing CT of the chest and abdomen. At the current volume of CT examinations at our institution, this decrease would result in an estimated 60 fewer sedations per year.

Child, Preschool↗
PubMed2001

Abdomen release in prone position does not improve oxygenation in an experimental model of acute lung injury.

OBJECTIVE: To analyze the effect of abdomen release in the prone position on oxygenation in an experimental model of acute lung injury. DESIGN: Experimental randomized controlled study. SETTING: Experimental laboratory of a tertiary university hospital. PARTICIPANTS: Mixed-breed adolescent pigs weighing between 25-31 kg. INTERVENTIONS: Thirty minutes after pulmonary edema was produced with oleic acid, the animals were turned prone and randomized into two groups: group I or control (n = 9), lying directly on the operating table; and group II (n = 11) with abdomen release, with positioning rolls under the upper part of the chest wall and the pelvis to allow free movement of the abdomen. MEASUREMENTS AND RESULTS: The gas exchange, respiratory mechanics, hemodynamics, intra-abdominal pressure (IAP) and the extravascular lung water (EVLW), determined by double indicator dilution method (DI), were recorded at baseline (time 0) and at 30, 60, 90, 120 and 150 min. The PaO2/FIO2 increased in both groups at 30 min after the pigs were placed in the prone position (time 60) and then decreased progressively until the end of the experimental period, with no statistical differences between the groups at any time (73.1 +/- 14.5 vs 79.5 +/- 14.9 at 150 min). Abdomen release was not associated with changes in the respiratory mechanics, EVLW or intra-abdominal pressure. CONCLUSIONS: Abdomen release in prone position does not improve oxygenation in an experimental model of acute lung injury.

Animals↗
PubMed2003

Breast cancer metastatic to abdomen and pelvis: role of surgical resection.

OBJECTIVE: The purpose of this study was to describe the characteristics and outcome of women with metastatic breast cancer to the abdomen and pelvis, and to assess the role of surgical resection of abdominal and pelvic metastasis in this disease. METHODS: We retrospectively reviewed the medical records of 59 women with documented metastatic breast cancer to the abdomen or pelvis who had exploratory surgery by the Gynecology Service between 1986 and 2001. RESULTS: Exploratory surgery was performed a median of 5 years (range, 0-25 years) after initial diagnosis of breast cancer. Median survival from diagnosis of abdominal disease was 23 months, and 5-year survival was 24%. Survival was 36 months for optimally debulked patients (<2 cm of residual disease) and 20 months for suboptimally debulked patients (P = 0.07). Patients diagnosed 5 or more years after initial breast cancer diagnosis had a median survival of 36 months versus 17 months if diagnosed earlier (P < 0.01). On multivariate analysis the time to recurrence of breast cancer in the abdomen and optimal debulking were both significant variables. Hazard ratio for dying of disease if recurring before 5 years was 2.7 (CI 1.45-5.03) [P < 0.01]. Hazard ratio for dying of disease if suboptimal debulking was achieved was 2.14 (CI 1.13-4.02) [P = 0.02]. CONCLUSIONS: The disease pattern of metastatic breast carcinoma to the abdomen and pelvis does not appear to effect survival. Survival in patients where optimal debulking is achieved and in those recurring late is improved. Surgical resection of metachronous metastatic breast cancer to the abdomen and pelvis may be an important component of the management of this disease and should be considered in candidate patients.

Abdominal Neoplasms↗
PubMed1999

Closure of burst abdomen after major gastrointestinal operations--comparison of different surgical techniques and later development of incisional hernia.

OBJECTIVE: To find out the incidence of incisional hernia in patients who had resuture of a burst abdomen and to compare different methods of wound closure and the development of incisional hernia. DESIGN: Retrospective study. SETTING: University hospital, Norway. SUBJECTS: 78 adults patients who had their burst abdomens resutured between January 1986 and December 1995. INTERVENTIONS: Five different methods were used to close the burst abdomen: interrupted or continuous sutures with or without retention sutures, or retention sutures alone. MAIN OUTCOME MEASURE: Incisional hernia after at least one year follow-up. RESULTS: Postoperative mortality was 14% (11/78), and 53 patients were followed up for at least a year. Incisional hernias developed in 43% (23/53) of the patients. When interrupted sutures were used (with or without retention sutures) 34% (13/38) of patients developed incisional hernias compared with 6/10 when the wound was closed with a continuous suture. Retention sutures did not reduce the incidence of incisional hernia. CONCLUSIONS: Incisional hernia is a common complication after resuture of a burst abdomen. We found no significant differences in the incidence of incisional hernias when continuous and interrupted techniques were compared. Retention sutures do not reduce the incidence of incisional hernias. There is still a need for refinements of the technique of closure of a burst abdomen.

Adult↗
PubMed2002

Late fascial closure in lieu of ventral hernia: the next step in open abdomen management.

BACKGROUND: The use of open abdomen techniques in damage control laparotomy and abdominal compartment syndrome has led to development of several methods of temporary abdominal closure. All of these methods require creation of a planned hernia with later reconstruction in patients unable to undergo fascial closure in the early postoperative period. We review a method of late primary fascial closure, thus eliminating the need for delayed reconstruction in some patients. METHODS: The records of all patients managed with open abdomens over a 5-year period at a Level I trauma center were reviewed for injury characteristics, operative treatment, final abdominal closure type and timing, and outcome. Patients requiring open abdomen who were unable to undergo fascial closure in the early postoperative period were managed with a vacuum-assisted fascial closure (VAFC) technique. This allows for constant tension on the wound edges and facilitates late fascial closure. Patients managed with planned hernia (HERNIA group) were compared with those undergoing fascial closure > or = 9 days after initial laparotomy (LATE group) for injury severity, fistula rate, and mortality. All patients in the LATE group underwent VAFC. RESULTS: From September 1996 to October 2001, 148 patients required management with an open abdomen. Fifty-nine underwent fascial closure, 37 of these before postoperative day 9 and 22 on or after day 9. Mean time to closure in the LATE group was 21 days (range, 9-49 days). Injury Severity Scores were similar in the HERNIA and LATE groups (26 vs. 30, p = 0.28), as were admission base deficit (-8.8 vs. -9.5, p = 0.71), number of fistulas (1 vs. 0, p = 0.99), and mortality (17% vs. 14%, p = 0.99). CONCLUSION: VAFC enables late fascial closure in open abdomen patients up to a month after initial laparotomy. Complication rates do not differ from patients with planned hernia, and the need for future abdominal wall reconstruction is avoided.

Abdominal Injuries↗
PubMed1991

[Acute abdomen as a postoperative complication].

The authors describe 11 cases of acute abdomen they observed during a two-year period mainly after abdominal operations. The male/female ratio was 6:5, the mean age 59 years with a range from 20 to 75 years. The mean period which had elapsed after the primary operation was 18.5 days. The authors describe four cases with ileus due to adhesions, three cases of volvulus of the small intestine, a stress ulcer, gangrenous appendicitis, acute cholecystitis and adnexitis. In general it is assumed that the most frequent acute abdomen during the post operative period is ileus due to adhesions, postoperative pancreatitis or stress ulcers are less frequent. Extremely rarely the cause of complaints is inflammatory acute abdomen of a different nature which is an unexpected finding during surgical revision. It is dangerous due to the atypical course and the fact that symptoms are masked by manifestations of the receding postoperative state. In the literature the aetiopathogenesis of such rare conditions is most frequently associated with impaired tissue perfusion due to an inadequate blood flow, general tissue hypoxia due to hypovolaemia, protracted postoperative shock, rigid vascular walls which are incapable of adequate reaction to acute deviations of circulatory demands. Despite this these conditions develop more rarely than corresponds to the coincidence of these general relatively frequent adverse factors. Severe immunosuppression is also observed much more frequently in surgical patients than these rare complications. The authors observed the incidence of these cases of acute abdomen at a ratio of 1:2000 which corresponds roughly to data in published work. Seeking the solution in immunity disorders does not explain this problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗