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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↗
PubMed2004

Abdominal dermolipectomy in an abdomen with pre-existing scars: a different concept.

Although abdominal dermolipectomy is a frequently performed procedure, few publications have reported on the safety of the procedure in the scarred abdomen. The aim of this study was to stress the possibility of performing a natural-looking abdominoplasty with no complication such as skin necrosis or liponecrosis in the presence of abdominal scars and to clarify that the scarred abdomen is not a great limitation for full abdominoplasty as reported in the literature. Seventy-six abdominoplasties were performed on scarred patients from July of 1997 to June of 2003. Twenty-five patients had oblique subcostal scars, six patients had median supraumbilical scars, three patients had median infraumbilical scars, 10 patients had appendectomy scars, nine patients had paramedian supraumbilical scars, eight patients had paramedian infraumbilical scars, seven patients had long transverse scars of repaired ventral hernias, and eight patients had multiple small scars after laparoscopy. In addition, there were concomitant transverse cesarean delivery scars in 40 patients. All patients underwent full abdominoplasties, plication of the musculoaponeurotic system, and liposuction assistance if required (45 patients). Of 76 subjects, three patients had very limited liponecrosis at the watershed area. Eleven patients (14.5 percent) were morbidly obese and heavy smokers. In comparisons of postabdominoplasty complications, such as liponecrosis, wound infection, and dehiscence with and without liposuction in scarred abdomen, no significant differences were found. Secondary revision was more common among abdominoplasties without liposuction [seven of 45 (15.6 percent) versus 12 of 31 (38.7 percent); p = 0.02]. In conclusion, there is no limitation or contraindication for abdominal dermolipectomy with or without liposuction assistance on the previously scarred abdomen as long as the vascular zones of the abdomen are respected. The abdominal wall dissection is limited to allow only the plication of the musculoaponeurotic system, and aggressive liposuction is avoided.

Abdominal Wall↗
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↗
PubMed1997

Evaluation of diagnostic peritoneal lavage in stable patients with gunshot wounds to the abdomen.

BACKGROUND: Diagnostic peritoneal lavage (DPL) is used to diagnose intra-abdominal injury in patients with stab wounds and blunt trauma. Because exploratory celiotomy is routinely performed on patients with gunshot wounds to the abdomen, DPL is rarely employed. However, several studies have questioned routine exploration and have drawn attention to the associated morbidity of negative celiotomy. Diagnostic peritoneal lavage is an easily performed and inexpensive test that may be useful in this situation. OBJECTIVE: To evaluate the performance of DPL in the diagnosis of intra-abdominal injury in hemodynamically stable patients with gunshot wounds to the abdomen. DESIGN: A prospective clinical trial. SETTING: Two urban trauma centers. PATIENTS: Patients with gunshot wounds to the abdomen and a systolic blood pressure of at least 90 mm Hg. INTERVENTIONS: Clinical predication of intra-abdominal injury in the emergency department and DPL performed in the operating room before the initiation of celiotomy. Injuries found during the celiotomy were recorded. MAIN OUTCOME MEASURES: The results of the clinical evaluation and DPL were compared with the findings of the celiotomy. RESULTS: Forty-four patients were enrolled into the study. Intra-abdominal injury was present in 32 (73%) of these patients. The senior surgery resident correctly predicted the presence of intra-abdominal injury in 36 (82%) of the patients (sensitivity = 90.0%, specificity = 58.3%, positive predictive value = 85.3%, negative predictive value = 63.6%, phi = 0.52, P < .01) in the emergency department before DPL and celiotomy were performed. Diagnostic peritoneal lavage correctly identified the presence or absence of intra-abdominal injury in 40 (91%) of the patients (positive predictive value = 96.7%, negative predictive value = 78.6%, phi = 0.79, P < .01). CONCLUSIONS: Clinical judgment is highly accurate in separating patients with tangential gunshot wounds to the abdomen from those with intra-abdominal injury but may miss patients with intra-abdominal hemorrhage. Diagnostic peritoneal lavage is highly predictive of the presence of intra-abdominal injury. The return of gross blood on aspiration or a lavage red blood cell count greater than 10 x 10(9)/L should prompt an urgent celiotomy. Missed injuries are rare and most likely to be bowel perforations. Diagnostic peritoneal lavage is an objective test that may augment clinical judgment in selecting hemodynamically stable patients with potential tangential gunshot wounds for observation and is especially useful in identifying intra-abdominal hemorrhage.

Abdomen↗
PubMed1975

Management of the acute abdomen in children with leukemia.

With the increase in remission and survival in children with acute leukemia, the complication of acute abdomen has become increasingly important in the total care of these children. A total of 286 children with acute leukemia was treated at Memorial Hospital between 1966 and 1971. Sixteen or 5.6% of these children developed an acute abdomen during the course of their disease. During the same period, many other children developed symptoms and signs mimicking an acute abdomen. Of the 9 children treated surgically, 5 were long-term survivors. Two children treated conservatively died, and 5 patients were diagnosed at autopsy. Prognosis was better in those patients in remission at the time of surgery, and where remission was maintained by immediately restarting antileukemic chemotherapy. A more aggressive surgical approach to the acute abdomen, combined with careful supportive measures, is further adding to the numbers of long-term survivors in childhood leukemia.

Abdomen, Acute↗
PubMed1988

Imaging the direct bidirectional spread of disease between the abdomen and the female pelvis via the subperitoneal space.

This report expands the concept of the subperitoneal space (SS) as the potential conduit for direct spread of disease in the abdomen to include the female pelvis. The normal anatomy of the SS in the lower abdomen, the female pelvis, and its uninterrupted continuation between the abdomen and pelvis are demonstrated by several imaging modalities. Surgically proven cases of bidirectional spread of disease between the abdomen and female pelvis are reported. The unifying concept of the interrelationship formed by the SS provides an understanding of the basic concepts of the pathways of direct spread of disease and the pathogenesis of the clinical presentation of disease distant from its site of origin.

Abdomen↗
PubMed2003

Imaging in acute abdomen.

OBJECTIVE: The present study aims at establishing the exact role and limitation of ultrasound in pediatric acute abdomen. METHODS: Fifty children less than 14 years of age presenting with acute abdomen were evaluated by US and other imaging modalities. The mean age of presentation was 3 1/2 years. Maximum number of cases were seen in less than two years of age. There were 17 cases of intussusception with US sensitivity and specificity of 88.2% and 100% respectively and positive and negative predictive values of 100% and 94.5% respectively. There were 13 cases of appendicitis. US was diagnostic in 11 with sensitivity and specificity of 91.6% and 97%; the positive and negative predictive values were 91.6% and 97% respectively. RESULTS: There were two cases each of congenital bands, adhesive intestinal obstruction, malrotation of bowel with volvulus, incarcerated inguinal hernia, hypertrophic pyloric stenosis, duplication cyst and pseudopancreatic cyst, one case each of trichobezoar, Meckel's diverticulum, ureteric calculus and worms as a cause of intestinal obstruction. The sensitivity of US for diagnosing specific cause of acute abdomen was found to be 77.5%. The main limitation of US was in the diagnosis of acute intestinal obstruction such as congenital bands and adhesions. CONCLUSION: US should now be considered as imaging modality of choice in pediatric acute abdomen. However, at times, plain radiography, conventional contrast studies and CT may be vital to reach the true diagnosis.

Abdomen, Acute↗
PubMed1995

A finite element analysis of the effects of the abdomen on regional lung expansion.

A finite element model of the dog lung, heart and abdomen, consisting of three solid linearly elastic bodies, was developed to study the effects of gravity on the vertical stress distribution and lung volume in different body positions at functional residual capacity (FRC). The geometry of the lung was obtained from an isolated dried dog lung after inflation to total lung capacity (TLC). The compliance of the rib cage, diaphragm and the abdomen was simulated by spring elements located on their surfaces. In the prone position, gravitational forces acting only on the lung contributed to the vertical gradient (0.19 cmH2O/cm) in transpulmonary pressure (Ptp). This result was independent of chest wall compliance. In the supine position, the addition of the heart and abdomen with a compliant diaphragm and abdominal walls increased the vertical Ptp gradient to 0.53 cmH2O/cm. In the head-up (upright) position, both heart and abdominal weight contributed to the vertical gradient (0.47 cmH2O/cm). Diaphragmatic compliance was of less importance to the vertical gradient in the head-up and head-down positions in the absence of the abdomen. The smallest vertical gradient (0.11 cmH2O/cm) was obtained in the head-down position with abdominal weight reducing the gradient caused by lung weight. Lung volume at FRC was virtually unaffected by gravity in the prone body position, was reduced by gravity in the supine and head-down positions but increased in the head-up position. The effects of a compliant diaphragm and abdominal weight are important contributors to the distribution of stress and volume in the intact lung.

Abdomen↗
PubMed2002

IMRT of large fields: whole-abdomen irradiation.

PURPOSE: To assess the feasibility of inverse planning for whole-abdomen intensity-modulated radiation therapy (IMRT) with bone marrow and kidney sparing and to develop approaches to circumventing field size restrictions in the application of whole-abdomen IMRT using dynamic multileaf collimators (DMLC). METHODS AND MATERIALS: The entire peritoneal cavity as derived from serial computerized tomography scans was defined as the gross target volume, whereas the planning target volume (PTV) was defined as the gross target volume plus a 5-mm margin extending 1 cm superiorly and inferiorly. In 10 randomly selected patients, the PTV ranged from 5629 to 12578 cc (median 7935 cc), and the superior-inferior, lateral, and anterior-posterior dimensions of the PTV ranged from 37 to 46 cm (median 42.5 cm), 27 to 33 cm (median 29 cm), and 18 to 23 cm (median 20 cm), respectively. A single isocenter was defined for patients with field length <40 cm. For patients with fields >40 cm, two isocenters were defined: one in the abdominal region, and the other in the pelvis. For IMRT planning, five 15-MV intensity-modulated beams at gantry angles of 180 degrees, 105 degrees, 35 degrees, 325 degrees, and 255 degrees were used. Optimization was designed to spare kidneys and bones. To fully account for the significant scattered dose contributions, an iterative process for dose calculations was implemented in the optimization. To overcome the 15-cm field width limit of our DMLC delivery system, fields with a width >15 cm were split into two or more subfields. To minimize field match errors, adjacent subfields overlapped by at least 2 cm, with intensity "feathering" in the overlap region. For patients with two isocenters, fields were overlapped and feathered in the cephalad-caudad direction by at least 3 cm. For comparison, conventional anterior-posterior/posterior-anterior 6-MV photon beams with posterior kidney blocks at extended distance were also generated for each patient. RESULTS: Treatment plan optimization calculations required 20-80 min on a 500-MHz DEC alpha workstation. Including beam splitting, an average of 16 DMLC beams was used per patient. Delivery of 150 cGy required, on average, 1442 monitor units. For the same dose constraints on the kidneys, whole-abdomen IMRT resulted in significant dose reduction to the bones and improved PTV coverage as compared to conventional treatment. For a prescription dose of 30 Gy, the volume of the pelvic bones receiving more than 21 Gy was reduced on average by almost 60% with IMRT, and the mean dose to all bones was reduced from 24.0 +/- 1.5 Gy to 18.5 +/- 1.0 Gy (p = 0.002). PTV coverage, as measured by V95 (the volume receiving 95% of the prescription dose), improved from 71.7 +/- 4.8% with conventional treatment to 83.5 +/- 3.9% with IMRT (p = 0.002), although small regions of underdose in areas near the kidneys could not be avoided completely. The high-dose regions within the PTV, as measured by D05 (the dose covering 5% of PTV volume), increased slightly from 31.2 +/- 0.6 Gy with conventional treatment to 32.8 +/- 0.2 Gy with IMRT. CONCLUSION: We have developed a process to plan and deliver whole-abdomen IMRT using standard linear accelerators and DMLC. IMRT can achieve better PTV coverage with the same level of kidney sparing and improved sparing of the bone marrow. These methods may be applicable also to other sites requiring large-field irradiation.

Abdomen↗
PubMed2003

Whole abdomen radiotherapy for patients with peritoneal dissemination of endometrial adenocarcinoma.

PURPOSE: No standard, universally accepted therapy exists for patients with adenocarcinoma of the endometrium with peritoneal dissemination. We report mature outcomes of selected patients with this uncommon pattern of spread treated with whole abdomen radiotherapy (RT). METHODS AND MATERIALS: A retrospective review was undertaken of all patients with a diagnosis of endometrial cancer referred to the Radiologic Associates of Sacramento Medical Group between January 1, 1988 and October 1, 1999. Eleven patients were identified who had surgically proven peritoneal dissemination (peritoneal seeding) treated with whole abdomen RT as the sole cytotoxic therapy after operative cytoreduction. Ten patients had International Federation of Obstetrics and Gynecology (1988) Stage IV disease at diagnosis, and one had peritoneal dissemination at the time of initial recurrence after hysterectomy for Stage I disease. RT was administered to the whole abdomen using 10-MV photons in fractions of 1.0 or 1.5 Gy. A cumulative dose of 30 Gy was given in all patients, with shielding used to reduce the dose to the liver and kidneys. Partial abdominal volumes (pelvis plus paraaortic nodes) received supplementary dose at 1.5-1.8 Gy/fraction to bring the cumulative dose within the limited volumes to 46.2-54 Gy. RESULTS: Four patients developed progressive cancer within 13 months of completion of whole abdomen RT. One additional patient died of hepatic venoocclusive disease (radiation hepatitis) 15 months after RT without evidence of cancer recurrence. Five patients were alive and clinically cancer free 55, 129, 131, 134, and 178 months after RT completion. One patient died of unrelated causes 79 months after treatment completion. CONCLUSION: Abdominal RT, in doses compatible with the acute and late tolerance of normal tissues, can eradicate small deposits of disseminated, intraperitoneal endometrial cancer. Currently, our patient selection criteria include limited peritoneal dissemination at diagnosis permitting complete surgical clearance (<1 mm residual) of visible and palpable disease, Grade 1 or 2 histologic features, lack of demonstrable extraabdominal metastasis, and absence of major medical contraindications.

Abdomen↗
PubMed2000

Open management of the abdomen and planned reoperations in severe bacterial peritonitis.

OBJECTIVE: To assess the results of open management of the abdomen and planned re-operations in severe bacterial peritonitis after perforation or anastomotic disruption of the digestive tract. DESIGN: Retrospective study. SETTING: University Hospital, The Netherlands. SUBJECTS: 67 consecutive patients. INTERVENTIONS: Open management of the abdomen and planned reoperations. MAIN OUTCOME MEASURES: Hospital morbidity and mortality, long-term follow-up. RESULTS: 38 patients developed multiple organ failure (MOF), but 29 needed only ventilatory and inotropic support. The mean number of re-operations was nine. 16 patients developed severe bleeding and 16 fistulas. In-hospital mortality was 42% (n = 28). Long-term morbidity, particularly the number of abdominal wall defects (n = 10), was considerable. CONCLUSION: Despite open management of the abdomen and planned re-operations, mortality of severe bacterial peritonitis still continues to be too high, and both short and long-term morbidity are appreciable. The value of open management of the abdomen and planned re-operations rests only on the clinical observation that other conventional surgical treatments of severe bacterial peritonitis often fail.

Abdomen↗
PubMed1980

Dynamic behaviour of the chest and of the abdomen in anaesthetized piglets during rapid insufflation.

Three piglets were ventilated with a TVM-ventilator, which releases predetermined volumes of compressed gas into the airways. The inspiratory flow depends on the pressure and volume of the compressed gas and compliance, resistance and inertia of the lungs, thorax and abdomen of the subject. The time for half filling of the chest was less than that of the abdomen and the difference increased with high driving pressure (with high acceleration). The difference was thus most probably a result of greater inertia of the abdomen. Inertia also seemed to influence the emptying of the lungs. This was so slow that increase of FRC--air trapping--was seen at a ventilatory frequency of 30 b.p.m. The practical consequences of these findings are that the abdomen (diaphragm) will take less and less part in ventilation and that a phase lag between chest and abdominal breathing should become larger with increasing ventilatory frequency. FRC will increase in regions with expiratory obstruction and lung rupture may follow.

Abdomen↗
PubMed1991

Mechanical coupling of the rib cage, abdomen, and diaphragm through their area of apposition.

Although volumetric displacements of the chest wall are often analyzed in terms of two independent parallel pathways (rib cage and abdomen), Loring and Mead have argued that these pathways are not mechanically independent (J. Appl. Physiol. 53: 756-760, 1982). Because of its apposition with the diaphragm, the rib cage is exposed to two distinct pressure differences, one of which depends on abdominal pressure. Using the analysis of Loring and Mead as a point of departure, we developed a complementary analysis in which mechanical coupling of the rib cage, abdomen, and diaphragm is modeled by a linear translational transformer. This model has the advantage that it possesses a precise electrical analogue. Pressure differences and compartmental displacements are related by the transformation ratio (n), which is the mechanical advantage of abdominal over pleural pressure changes in displacing the rib cage. In the limiting case of very high lung volume, n----0 and the pathways uncouple. In the limit of very small lung volume, n----infinity and the pathways remain coupled; both rib cage and abdomen are driven by abdominal pressure alone, in accord with the Goldman-Mead hypothesis. A good fit was obtained between the model and the previously reported data for the human chest wall from 0.5 to 4 Hz (J. Appl. Physiol. 66:350-359, 1989). The model was then used to estimate rib cage, diaphragm, and abdominal elastance, resistance, and inertance. The abdomen was a high-elastance high-inertance highly damped compartment, and the rib cage a low-elastance low-inertance more lightly damped compartment. Our estimate that n = 1.9 is consistent with the findings of Loring and Mead and suggests substantial pathway coupling.

Abdomen↗
PubMed2000

Acute abdomen and Clostridium difficile colitis: still a lethal combination.

BACKGROUND: With the steadily prevalent appropriate and inappropriate use of antimicrobial agents, Clostridium difficile colitis has continued to be noticed as a common problem in hospitalized patients. The aim of this communication is to highlight a subset of C. difficile colitis patients who presented with an acute abdomen. METHODS: This is a retrospective study of 10 patients who underwent laparotomy for an 'acute abdomen' with an intraoperative or postoperative diagnosis of C. difficile colitis. RESULTS: All patients received antibiotics (mean 9.5 days) for other illnesses. The mean APACHE II score was 18.8 (range 8-25) and the mortality rate was 80%. Two patients had colostomies created. One patient underwent a subtotal colectomy, and another underwent a Hartmann procedure; the rest had a nontherapeutic procedure. CONCLUSION: We conclude that C. difficile colitis presenting as an 'acute abdomen' still represents a lethal entity. Patients who present with an 'acute abdomen', with a history of recent or current antibiotic intake, and without findings which mandate an exploration should have C. difficile colitis urgently excluded. Timely diagnosis of C. difficile colitis through bedside sigmoidoscopy or a CT scan could spare the critically ill patient an unneccessary and risky operation. Furthermore, if laparotomy is subsequently needed then having a preoperative diagnosis of C. difficile colitis will allow appropriate surgical therapy to be implemented.

Abdomen, Acute↗
PubMed1999

hedgehog and engrailed: pattern formation and polarity in the Drosophila abdomen.

Like the Drosophila embryo, the abdomen of the adult consists of alternating anterior (A) and posterior (P) compartments. However the wing is made by only part of one A and part of one P compartment. The abdomen therefore offers an opportunity to compare two compartment borders (A/P is within the segment and P/A intervenes between two segments), and ask if they act differently in pattern formation. In the embryo, abdomen and wing P compartment cells express the selector gene engrailed and secrete Hedgehog protein whilst A compartment cells need the patched and smoothened genes in order to respond to Hedgehog. We made clones of cells with altered activities of the engrailed, patched and smoothened genes. Our results confirm (1) that the state of engrailed, whether 'off' or 'on', determines whether a cell is of A or P type and (2) that Hedgehog signalling, coming from the adjacent P compartments across both A/P and P/A boundaries, organises the pattern of all the A cells. We have uncovered four new aspects of compartments and engrailed in the abdomen. First, we show that engrailed acts in the A compartment: Hedgehog leaves the P cells and crosses the A/P boundary where it induces engrailed in a narrow band of A cells. engrailed causes these cells to form a special type of cuticle. No similar effect occurs when Hedgehog crosses the P/A border. Second, we look at the polarity changes induced by the clones, and build a working hypothesis that polarity is organised, in both compartments, by molecule(s) emanating from the A/P but not the P/A boundaries. Third, we show that both the A and P compartments are each divided into anterior and posterior subdomains. This additional stratification makes the A/P and the P/A boundaries fundamentally distinct from each other. Finally, we find that when engrailed is removed from P cells (of, say, segment A5) they transform not into A cells of the same segment, but into A cells of the same parasegment (segment A6).

Abdomen↗
PubMed1997

Sonographic appearance of hemorrhagic ovarian cyst with acute abdomen by transvaginal scan.

Hemorrhagic ovarian cyst (HOC) which is one of the functional cysts, is often involved in acute abdomen leading to laparatomy intervention. The reason for this mainly lies in the fact that it is easily misdiagnosed as an organic mass because of the presence of lower abdominal pain and the variable appearance of ultrasonographic images at presentation. We analyzed 15 cases of HOC associated with acute abdomen, of which in 2 cases the disease was confirmed by laparotomy. The remaining 13 cases were followed-up clinically and by daily transvaginal sonography (TVS) from the first detection of the cyst until complete resolution. The TVS images showed a variety of changes; however, when the images or their magnified views were observed precisely, important diagnostic characteristics were found which were classified into 3 categories: type 1 images showed mixed hypoechoic and hyperechoic areas, the demarcation line between which appeared as a thin or thick septum-like echo of smooth formation; type 2 images showed hypoechoic background and vertical, horizontal, or lamellar thin or thick thread-like echoes with an overall reticular-like or sponge-like pattern; and type 3 images showed an overall hyperechoic and solid pattern. Type 1 and 2 images occurred more frequent (93.3%), and only 1 case had a type 3 image. In all image types, septum-like or thread-like echoes were seen, TVS type 1 and 2 images showed a clear division into hyperechoic and other areas with the passing of time which was finally changed into a cystic pattern and disappeared. Severe lower abdominal pain was present for 1 to 3 hours in 12 cases (80%), 4 to 6 hours in 2 cases (13.3%), and 11 hours in 1 case (6.7%). Other characteristics of HOC may be its most frequent occurrence in the young age group (10 to 20 years old, 80.0%) and in the luteal phase (84.6%). With operative cases, histopathological diagnosis was HOC. The clinical and particularly TVS findings described in the present study are of significant value in differential diagnosis of HOC with acute abdomen from other disorders presenting with acute abdomen.

Abdomen, Acute↗
PubMed2002

Acute abdomen due to late retroperitoneal extravasation from a femoral venous catheter in a newborn.

CONTEXT: The use of parenteral nutrition via a central venous catheter is a common practice in the neonatal intensive care setting. Extravasation of the infusate leading to an acute abdomen is a complication that has only rarely been documented. This report describes the case of a premature infant with a femoral catheter placed in the inferior vena cava, who developed an acute abdomen as a result of late retroperitoneal extravasation of parenteral nutrition. CASE REPORT: A pre-term infant receiving total parenteral nutrition via a femoral venous catheter developed an acute abdomen five days after the catheter placement. Extravascular catheter migration to the retroperitoneal space and extravasation of the infusate was diagnosed by contrast injection. Withdrawal of the catheter was followed by prompt cessation of the signs and full recovery from the acute abdomen, without the need for surgery. A review of the literature is presented, emphasizing the clinical and therapeutic aspects of this unusual complication from femoral venous catheterization and parenteral nutrition.

Abdomen, Acute↗