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At least 883 records · Page 49Linked to original sources
PubMed1990

Fat-saturation MR imaging of the upper abdomen.

The fat-saturation (fatsat) MR technique decreases the signal intensity of fat, thereby enhancing the definition of upper abdominal organs and reducing artifacts while maintaining the T1 and T2 information available on spin-echo sequences. To evaluate the potential of fatsat in examining the abdomen, we conducted a prospective study involving 30 subjects, including four normal volunteers, 18 patients investigated for liver disease, and eight patients studied for miscellaneous abdominal disease. Short TR, 300-600/15-20 (TR/TE), and long TR, 2000-2500/20-30, 70-80, spin-echo images with and without fatsat were compared. The images were evaluated both qualitatively and quantitatively. Qualitative assessment was made with receiver-operating-characteristic (ROC) curve analysis of the confidence level of observers to detect the presence of disease, comparing fatsat with standard spin-echo sequences. ROC analysis showed greater interpreter confidence and accuracy for fatsat sequences than for standard spin-echo sequences. The measured signal-difference-to-noise (SD/N) ratio comparing upper abdominal organs with surrounding tissue revealed the highest values for short TR/TE regular spin echo, followed by short TR/TE fatsat. The highest SD/N ratio for hepatic masses was with long TR/TE fatsat followed by short TR/TE fatsat. The results of this study suggest that the fatsat technique may improve abdominal MR imaging.

Abdomen↗
PubMed1994

Cost-effectiveness of unenhanced MR imaging vs contrast-enhanced CT of the abdomen or pelvis.

OBJECTIVE: The purpose of this study was to compare the cost of unenhanced MR imaging with that of CT with high- or low-osmolality contrast agents for abdominal or pelvic imaging in patients at risk for nephrotoxic effects induced by contrast material. MATERIALS AND METHODS: Using decision analysis, we evaluated direct medical care costs associated with the use of CT with high- or low-osmolality contrast agents vs MR imaging. We used data from a variety of sources and assumed that the three imaging techniques provide nearly equivalent diagnostic information. The base-case analysis assumed that patients were at low risk (i.e., 2%) for development of nephrotoxic effects. Nephrotoxic effects were defined as increases in the serum level of creatinine of 50% or more above baseline. Our analysis took the perspective of the hospital and used estimated hospital costs, not charges. Sensitivity analyses were performed on risk estimates for development of nephrotoxic effects and for the estimates of medical care costs. RESULTS: For the base case, CT with a high-osmolality contrast agent is the least costly imaging strategy. When the risk of nephrotoxic effects exceeds 5% for high-osmolality contrast agents or 2.6% for low-osmolality contrast agents, then MR imaging is the preferred strategy. The model is relatively insensitive to treatment costs. CONCLUSION: From a hospital's perspective, MR imaging of the abdomen or pelvis is cost minimizing in patients at high risk for nephrotoxic effects induced by contrast agents. Use of low-osmolality contrast agents must reduce the frequency of nephrotoxic effects in high-risk patients by at least 50% to be less costly than MR imaging.

Abdomen↗
PubMed2001

Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography.

OBJECTIVE: The purpose of this investigation is to determine the sensitivity, specificity, and accuracy of unenhanced limited CT of the abdomen in children with suspected appendicitis and compare these results with graded compression sonography. MATERIALS AND METHODS: Seventy-six children underwent unenhanced limited CT over a 11-month period for evaluation of suspected appendicitis. A historical cohort of 86 consecutive children who had undergone graded compression sonography was identified. Results were correlated with surgical, pathologic, chart, and clinical follow-up data. The sensitivity, specificity, accuracy, rate of alternate diagnosis, time to perform examinations, and charge at our institution were determined for unenhanced limited CT and sonography. RESULTS: Sensitivity, specificity, and accuracy for unenhanced limited CT were 97%, 100%, 99%, respectively, and were 100%, 88%, 91%, respectively, for sonography. Alternate diagnoses were suggested in 35% and 28% children without appendicitis who had unenhanced limited CT and sonography, respectively. Unenhanced limited CT required 5 min and sonography required 20-30 min to perform. The charge at our institution was $408 for unenhanced limited CT and $295 for sonography. CONCLUSIONS: CT can be performed rapidly in children without IV, oral, or rectal contrast medium. Unenhanced limited CT and sonography are highly sensitive, specific, and accurate in the evaluation of children with suspected appendicitis.

Abdomen↗
PubMed2004

Clinical significance of unexplained abnormal focal FDG uptake in the abdomen during whole-body PET.

OBJECTIVE: FDG PET is frequently used as part of the diagnostic workup in cancer patients. Visualization of radiotracer-avid foci suggests the presence of malignant disease. Unexplained focal FDG accumulation in the abdomen is sometimes noted, but the clinical significance of this finding is unknown. Therefore, we followed cases with unexplained focal abdominal FDG uptake found incidentally on whole-body scans to define the cause and clinical significance of this finding. CONCLUSION: Unexplained focal abdominal FDG uptake is an unusual finding with causes that include malignant and benign processes. Among the 14 cases with definitive diagnoses, seven were adenomas, which is a premalignant condition, and five (35.7%) were malignant. Therefore, although rare, unexplained focal abdominal FDG uptake should not be ignored and further diagnostic workup is warranted.

Abdomen↗
PubMed2005

Gadolinium-enhanced MDCT angiography of the abdomen: feasibility and limitations.

OBJECTIVE: The purpose of this study was to evaluate a protocol for gadolinium-enhanced MDCT angiography of the abdomen and to identify technical parameters that optimize image quality. CONCLUSION: The degree of enhancement and image quality achieved using this gadolinium-enhanced MDCT angiography appear adequate for angiographic evaluation of the abdominal aorta and its major branches.

Abdomen↗
PubMedDate not supplied

The acute abdomen in the geriatric patient.

Evaluating an elderly patient with an acute abdomen is a challenging clinical problem. THe diagnosis is more difficult to secure in this age group, because it is difficult to obtain an accurate history, and physical findings are more subtle. The major factors that increase mortality include associated medical diseases, emergent operations, and delay in recognition and treatment of the problem. Patients with widespread malignancy and generalized peritonitis fare poorly, but operative mortality in the geriatric group has improved significantly because of more prompt diagnosis, aggressive resuscitation, precise monitoring, and expedient but definitive procedures. As the proportion of elderly patients in the population continues to rise, it becomes increasingly important to evaluate and manage this problem expediently.

Abdomen, Acute↗
PubMed1998

Neotropical echinococcosis in Suriname: Echinococcus oligarthrus in the orbit and Echinococcus vogeli in the abdomen.

This paper reports two cases of neotropical echinococcosis caused by Echinococcus oligarthrus and E. vogeli, neither of which has been reported from Suriname. Case 1, a six-year-old boy, presented a 15 x 25 mm retro-ocular cystic tumor (observed by ultrasound, computed tomography scan, and magnetic resonance imaging) causing exophthalmia, chemosis, palpebral ptosis, and blindness of the left eye. Of two tentative diagnoses, Echinococcus cyst or dermoid tumor, the former was shown to be correct at surgery when a clear liquid and detached protoscoleces were aspirated. Rostellar hooks of the protoscolex were characteristic of E. oligarthrus. Case 2, a 41-year-old man, had polycystic masses excised from the liver and abdomen. A presurgery diagnosis of E. vogeli infection was made due to calcifications seen in the lesions, positive serology, residence of the patient in the tropical forest, and later by the size and shape of rostellar hooks. The presence of these two parasites in one of the former Guianas is not surprising; both species are endemic in tropical forest in Central and South America wherever people have not exterminated wild canids, especially the bush dog, (Speothos venaticus), and felids (wild cats of several species), along with pacas, agoutis, and other rodents that serve as intermediate host of these two cestodes. Eighty-six cases of polycystic echinococcosis are known in people from 11 countries from Nicaragua to Argentina: 32 due to E. vogeli, three to E. oligarthrus, and 51 for which determination of the species was not possible because the hooks of the protoscolex were not found or described. Research to elucidate aspects of transmission of E. vogeli and E. oligarthrus is of practical importance for defining measures for preventing the severe and frequently fatal illnesses caused by these two cestodes.

Abdomen↗
PubMed1996

[CA19-9 producing mixed gonadal germ-cell tumor in undescended testis located in abdomen. A case report].

A rare case of CA19-9 producing tumor in undescended testis was presented. A forty-three year old man visited to our hospital with a chief complaint of left flank pain. Serum tumor markers (AFP, beta-HCG, and CA19-9) were elevated. Abdominal CT scan demonstrated large solid mass with multilocular cysts were capsulated. The tumor resection was performed after 3 courses of CEB (Carboplatin, Etoposide, and Bieomycin) chemotherapy. Macroscopically, the tumor was consisted of necrotic mass and multilocular cysts. The tumor size was 25 x 8 x 5 cm and weight was 1000 g. Microscopically, the large part of tumor was necrotic due to chemotherapy, and the teratoma component which was consist of neural, muscular, and digestive tissue was seen in some area. In conclusion, this is a rare case of mixed germ-cell tumor in undescended testis located in abdomen.

Abdomen↗
PubMed1993

Increased echogenicity in the fetal abdomen: use of DNA analysis to establish a diagnosis of cystic fibrosis.

The sonographic finding of increased echogenicity within the fetal abdomen presents a diagnostic dilemma, with a differential diagnosis ranging from normal variation to CF. We report the diagnostic evaluation of four cases, two of which were found to be the result of CF. On the basis of this experience, we believe that persistence of an echogenic bowel pattern, especially with bowel dilation, after 20 weeks' gestation should prompt an evaluation for CF. Using DNA analysis, approximately 75% of the cases involving CF can be detected with noninvasive studies of the parents, and confirmation by amniocentesis is performed only in those cases in which both parents are carriers of known mutations.

Abdomen↗
PubMed1998

[Acute disorders of intestinal perfusion; a nonrigid abdomen may still be acute].

Three patients, a man aged 50 years and two women aged 46 and 45 years, with abdominal pains and an undistended abdomen, were found to have acute mesenteric ischaemia. The causes were: unknown, a thrombus in the descending aorta and severe atherosclerosis, respectively. In the male patient, only 30 cm of vital small intestine ultimately remained; in one woman embolectomy sufficed, in the other, resection of a limited portion of the jejunal tract. All three patients fully recovered. Acute mesenteric ischaemia is a potentially lethal disease. Diagnosis in the first reversible phase makes full recovery of the intestine possible. This may be difficult since the clinical signs and symptoms are not specific in this phase and invasive diagnostic procedures (angiography) are required for accurate diagnosis. By making an angiogram of the mesenteric vessels in each patient with severe abdominal pain, no signs of peritonitis and leukocytosis, without another diagnosis, reversible mesenteric ischaemia can be diagnosed and a vascular surgical reconstruction can be planned.

Abdomen, Acute↗
PubMed1999

['Acute abdomen' in children].

A child is said to have an 'acute abdomen' in case of severe abdominal pain of sudden onset. Further investigations are necessary if the pain is very bad, persists for longer than 3-4 hours or is accompanied by vomiting. Failure to make the correct diagnosis may result in severe complications. The principal cause in an older child is acute appendicitis. This diagnosis is to be based on the anamnesis, physical examination and laboratory tests. If one of these is typical, active observation is indicated; if two or three are typical, appendectomy is indicated. Differential diagnoses can only be made during laparotomy. Intussusception occurs more frequently in toddlers. In a child with possible intussusception, observation is not justified: the diagnosis should be excluded by a contrast colonic X-ray, or operation should be performed either immediately or, if the symptoms persist, after the X-ray. Rest and patience, careful and child-adapted approach, and correct evaluation of aberrant symptoms may minimize unnecessary intervention.

Abdomen, Acute↗
PubMed1999

[Laparoscopy in acute abdomen as diagnostic and surgical aid].

In cases of acute abdomen, the preoperative diagnostic options are limited. Diagnostic laparoscopy offers a superior overview of the abdominal cavity with minimal trauma to the patient. If further surgery is needed, it may take the form of either laparoscopic procedures or conversion to open surgery, the incision being guided by laparoscopy findings. Complications associated to laparoscopy are few and can be minimized further by using minilaparotomy techniques. Intensive educational programmes for all categories of staff are required to make a 24-hours-a-day laparoscopy service available.

Abdomen, Acute↗
PubMedDate not supplied

Disseminated cystic lymphangiomatosis presenting with acute abdomen: report of a case and review of the literature.

Lymphangioma is an uncommon tumor. Lymphangiomatosis, a benign tumor consisting of a cluster of dilated lymphatic channels, is very unusual. Most lymphangiomatoses are found in the neck and head area. Less than 5% are diagnosed intraabdominally and they are very infrequently encountered in the retroperitoneal area. Herein, we report a rare case of a 32 year-old woman who had disseminated intra-abdominal and retroperitoneal cystic lymphangiomatosis, which presented as acute abdomen. She received exploratory laparotomy due to the suspicion of malignancy, which was finally confirmed as cystic lymphangiomatosis. The clinical manifestations, imaging features, and management of this patient are discussed and compared with previous literature.

Abdomen, Acute↗
PubMed1999

[Pica in psychotic patients: an unusual cause of acute abdomen].

Pica is a pathologic craving for substances not commonly regarded as foods. In this study the authors report their experience about five cases presented with an acute abdomen following foreign bodies ingestion by patients mentally handicapped. Therapeutic treatment was emergency laparatomy with postoperative morbidity of 40% and mortality of 40%. It is hoped that specific drug therapy with more aggressive surgical treatment will reduce the mortality significantly.

Abdomen, Acute↗
PubMed1999

[Hypersensitivity vasculitis causing an acute abdomen].

The members of a family of four persons suffered acute gastroenteritis after eating a meal consisting of chicken. While three of them recovered rapidly, the 18-year old son developed an acute abdomen which had to be treated surgically and led to a complicated stay at the intensive care unit. Intraoperatively, a mild insignificantly inflamed appendix and an obscure segmental inflammatory process of the small bowel with local peritonitis were seen; this required an appendectomy and a peritoneal lavage. The development of bacterial peritonitis with multiple organ dysfunction required several surgical revisions with an open abdominal toilet treatment. Histological examination of the resected appendix specimen showed a severe primary fibrinoid necrotizing vasculitis with epitheloid-granulomatous reaction. Diseases such as Panenteritis nodosa, Wegener's disease and Churg-Strauss's syndrome were excluded by negative serology. By a process of exclusion, a hypersensitivity vasculitis was diagnosed and treated successfully with a high-dose cortisone regime.

Abdomen, Acute↗
PubMed2000

[Diabetic ketoacidosis presenting as acute abdomen].

Three patients, two women aged 21 and 67 and a man aged 43 years, presented at the emergency department with diabetic ketoacidosis and abdominal symptoms mimicking an acute abdominal condition. In two of them laparotomy was performed which proved to be negative. Abdominal symptoms resolved after correction of metabolic, fluid and electrolyte disturbances. Symptoms indicating a possible diagnosis of acute abdomen have to be regarded as being compatible with diabetic ketoacidosis per se. However, a potential acute abdominal problem prompting surgical intervention should not be overlooked; it may have been the precipitating factor for diabetic ketoacidosis.

Abdomen, Acute↗
PubMed2000

Acute abdomen with colonic necrosis induced by Kayexalate-sorbitol.

Colonic necrosis is an unusual complication after treatment of hyperkalemia with sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol. To increase awareness of this complication, we report a case of necrosis of the transverse colon in a patient given oral and rectal SPS-sorbitol for hyperkalemia. Colonic necrosis was manifested as an acute abdomen within 24 hours of initial administration. Prompt surgical resection of the necrotic transverse colon permitted rapid recovery of bowel function. Although SPS crystals are seen microscopically in the necrotic bowel, experimental evidence implicates the sorbitol component of the SPS-sorbitol in the pathogenesis of colonic necrosis. A high index of suspicion for the unusual complication of colonic necrosis after oral or rectal administration of SPS-sorbitol may allow prompt recognition and surgical cure.

Abdomen, Acute↗