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PubMed1983

Computed tomography of the abdomen and pelvis in non-Hodgkin lymphoma.

The experience of one institution using abdominal computed tomography (CT) for staging and restaging of non-Hodgkin lymphoma (NHL) patients is reported. In 49% of abnormal examinations no significant difference in quantity of involved nodes between diffuse and nodular lymphomas appeared. High paraaortic, iliac, and mesenteric nodal sites were most commonly involved. At restaging examination, usually less extent of disease was found. Abdominal involvement could not be predicted from the presence of peripheral adenopathy. Computed tomography changed the staged during initial workup significantly in 14%. During restaging, CT detected unsuspected active disease in 43% and changed the clinical impression from limited to extensive involvement in 16%. Computed tomography proved to be useful in the management of NHL patients and is recommended as the primary imaging procedure in the abdomen in this disease.

Abdominal Neoplasms↗
PubMedDate not supplied

MR image contrast and relaxation times of solid tumors in the chest, abdomen, and pelvis.

A retrospective study of 121 patients with tumors in the chest, abdomen, and pelvis was made to assess the degree of contrast between solid tumors and adjacent tissue on magnetic resonance (MR) spin echo (SE) images. Tumors examined were hepatomas (five patients), liver metastases (17), hemangiomas (seven), biliary carcinomas (eight), pancreatic carcinomas (five), renal tumors (15), adrenal tumors (eight), uterine tumors (17), bladder carcinomas (five), prostatic carcinomas (13), bone tumors (six), and lung carcinomas (15). A long repetition time (TR) and a long echo time (TE) were found the most useful to delineate tumors from liver, renal tumors from kidney, lung carcinoma from lung, pelvic tumors from muscle, and uterine tumors from the myometrium. A short TR and short TE provided the best contrast between tumors and fat and bone marrow. Therefore, for detection and staging of tumors, both a sequence with short TR and short TE and one with long TR and long TE are necessary. Pancreatic carcinomas were difficult to differentiate from liver and pancreas on all SE sequences used in the study. Contrast of adrenal tumors was independent of the sequence used. Some adrenal tumors were hypointense and some similar in intensity to the kidney. Further MR characterization of the tumors was limited.

Abdominal Neoplasms↗
PubMedDate not supplied

Single breath-holding scans of the abdomen using FISP and FLASH at 1.5 T.

Single breath-holding gradient echo techniques fast imaging with steady-state free precession (FISP) and fast low angle shot (FLASH) images were evaluated in the study of the abdomen in 16 patients (13 liver, two kidney, and one pancreas examinations). Gradient echo images were compared retrospectively with conventional spin echo images for image quality (depiction of pathology and representation of anatomic detail), and contrast characteristics were evaluated. All lesions were shown on gradient echo images, and in three of 16 cases gradient echo images were more diagnostic than spin echo images. On both FISP and FLASH images, most hepatic metastases were hyperintense relative to normal liver. The predicted flip angles for maximal contrast for the liver were modeled from signal intensity equations for FISP and FLASH and yielded predicted flip angles of approximately 40-55 degrees for FISP and 15-25 degrees for FLASH. Peak signal-to-noise ratio in liver of normal volunteers occurred at approximately 30 degrees for both FISP and FLASH. Single breath-holding gradient echo images are useful in the evaluation of abdominal structures and this study provides a framework for future work.

Abdominal Neoplasms↗
PubMedDate not supplied

The infraconal compartment: a multidirectional pathway for spread of disease between the extraperitoneal abdomen and pelvis.

PURPOSE: The space below the kidneys where the anterior and posterior pararenal spaces converge has been defined only vaguley in the past. We describe observations on clinical CT cases and studies on cadavers that lead to a refinement in the terminology for this extraperitoneal compartment. METHOD: Abdominal/pelvic CT scans from 18 patients and the scans of 2 cadavers injected in the femoral region with iodinated contrast material were reviewed concerning the location and distribution of fluid or gas collections relative to the renal fascial enclosure. RESULTS: Pathologic processes involving the anterior or posterior pararenal spaces in addition to the pelvic extraperitoneal spaces were always accompanied by collections in the space below the cone of renal fascia. CONCLUSION: The term infraconal compartment is a suggested term for the caudal continuation of the anterior and posterior pararenal spaces. This compartment serves as an important multidirectional pathway for the spread of disease between the extraperitoneal abdomen and the pelvis. Fluid collections within this compartment have a characteristic CT appearance.

Body Fluids↗
PubMed1976

A time-management study of 25 patients with penetrating wounds of the chest and abdomen.

The present study prospectively reviewed the time management aspects of 25 patients with penetrating wounds of the chest or abdomen. Each diagnostic procedure or treatment carried out on each patient was recorded to the nearest minute after his arrival in the emergency department. This generated median elapsed times for procedures which could be compared (4+ minutes for starting an IV, 9 minutes for insertion of CVP, 31 minutes for insertion of a chest tube). Two of the 25 patients died; 20 were admitted of whom 8 required immediate surgery. Some preocedures carried out in the accident room were done indiscriminately and for questionable reasons. The tendency was to do as much as possible to "cover" the patient. Some redundancy in the acutely ill patient is desirable but the overtreatment in some cases may have reflected inexperience of some of the physicians. Delay in using radiography and defects in professional coverage appeared to be the most serious errors. Independent monitoring of the functioning of the accident room appears to be an affective means of self-evaluation.

Abdominal Injuries↗
PubMed1985

Prehospital advanced trauma life support for critical penetrating wounds to the thorax and abdomen.

The role of advanced trauma life support (ATLS) in the prehospital care of the critically injured is highly controversial. This study analyzes the efficacy of ATLS in the management of critical penetrating wounds of the thorax and abdomen. In the 2 1/2-year period ending July 1984, 203 consecutive patients underwent emergency laparotomy or thoracotomy for gunshot and stab wounds. All patients were treated in the field by advanced paramedics (EMT-P). For gunshot wounds the mean time (+/- S.E.M.) responding to the scene was 4.5 (+/- 0.29) minutes, on the scene 10.1 (+/- 0.41) minutes, and returning to the hospital 6.4 (+/- 0.32) minutes. For stab wounds the mean time responding to the scene was 4.8 (+/- 0.21) minutes, on the scene 9.5 (+/- 0.37) minutes, and returning to the hospital 5.7 (+ 0.30) minutes. The number of intravenous lines started averaged 1.8 per patient. Eighty-one patients had PASG applied and 28 patients underwent endotracheal intubation (21 orally, seven nasally). Thirty-three patients had no obtainable blood pressure, of whom six survived (18%). One hundred sixty (94%) of the remaining 170 patients who had any initial blood pressure survived. One hundred nine (55%) patients had an increase in BP greater than or equal to 10 mm Hg (average, 35.6 mm Hg), 64 (32%) had no significant change, and 25 (13%) had a fall greater than or equal to 10 mm Hg (average, 24.2 mm Hg) from the field to the emergency department. Twenty (80%) of the 25 patients with a fall in blood pressure survived.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1986

Bilateral transection of ureters secondary to gunshot wound to abdomen.

An unusual case in which a complete bilateral ureteral transection due to a single low velocity gunshot wound occurred. This case illustrates that in gunshot wounds to the abdomen involving the retroperitoneum, ureteral inspection is imperative especially in view of the fact that preliminary diagnostic workup during trauma resuscitation may be inadequate.

Abdominal Injuries↗
PubMed1997

Extending the horizons of "damage control" in unstable trauma patients beyond the abdomen and gastrointestinal tract.

"Damage control" has become an accepted technique for the treatment of patients with exsanguinating injuries to the abdomen. We describe a case where the damage control philosophy was applied outside the confines of the abdominal cavity, a gunshot wound to the groin, and in which a temporary intraluminal shunt was used to maintain distal perfusion while the acidosis and coagulopathy were corrected in the intensive care unit. Successful vascular reconstruction was later completed with polytetrafluoroethylene.

Adult↗
PubMed1997

A method of determining peritoneal penetration in gunshot wounds to the abdomen.

BACKGROUND: It has previously been shown that 98% of gunshot wounds that penetrate the peritoneal cavity cause injuries that require surgical repair. Many gunshot wounds in the vicinity of the abdomen (GSWA) may actually be tangential and not penetrate the peritoneal cavity at all. Patients with such wounds may not require laparotomy. It is important to determine which patients with a potential tangential GSWA actually have penetration of the peritoneal cavity to minimize negative laparotomies. This study was undertaken to determine the sensitivity, specificity, and accuracy of diagnostic peritoneal lavage (DPL) in the determination of peritoneal penetration for patients who sustain GSWA. METHODS: DPL was performed for all patients who had sustained a GSWA in whom peritoneal penetration was unclear, i.e., patients whose GSWA appeared to be tangential, thoracoabdominal, or transpelvic and for whom a clear indication for laparotomy (shock, peritonitis, etc.) did not exist. Our threshold for a positive DPL was 10,000 red blood cells (RBC)/mm3. A prospective data base was kept with information on the location of the wound, DPL result, findings at laparotomy, and outcome. RESULTS: During a 4-year period, 429 consecutive DPLs were performed for GSWA at our urban Level I trauma center. One hundred fifty DPLs were positive, with more than 10,000 RBC/mm3. Six of these patients were found to have no peritoneal penetration at laparotomy (false-positive). The remaining 144 patients with positive DPLs were found to have operative injuries (true-positive). Of the 279 patients with DPL counts less than 10,000 RBC/mm3, 2 developed indications for laparotomy and were found to have intraperitoneal injuries (false-negative). The remaining 277 patients had no peritoneal injuries (true-negative). This was demonstrated either by laparotomy done for another indication (n = 7) or by uneventful inpatient observation for 24 hours (n = 270). The sensitivity, specificity, and accuracy of DPL in determining peritoneal penetration in GSWA is therefore 99, 98, and 98%, respectively. CONCLUSION: For patients who sustain GSWA for whom peritoneal penetration is unclear, DPL is a sensitive, specific, and accurate test to determine the need for laparotomy. It remains our test of choice when confronted with these patients.

Abdominal Injuries↗
PubMed1998

The role of computed tomography in selective management of gunshot wounds to the abdomen and flank.

OBJECTIVE: To determine whether computed tomography (CT) is an accurate diagnostic modality for the triage of hemodynamically stable patients with gunshot wounds of the abdomen and flank. METHODS: A chart review of 83 trauma patients for whom abdominal CT was used as initial screening. RESULTS: In 53 patients, CT revealed no evidence of peritoneal penetration, and in 15 patients, there was evidence of either peritoneal penetration or liver injury. There were no false results in these patients. Among 15 patients with questionable peritoneal penetration, cavitary endoscopy was performed in 11 and exploratory laparotomy was performed in 3, and 1 patient was initially observed and subsequently underwent exploratory surgery for a missed colonic injury. CONCLUSION: In selected centers and in hemodynamically stable patients with abdominal and flank gunshot wounds, abdominal CT can be an effective and safe initial screening modality to document the presence or absence of peritoneal penetration and to manage nonoperatively stable patients with liver injuries. If there is any question of peritoneal penetration, cavitary endoscopy should be part of the protocol of nonoperative management.

Abdominal Injuries↗
PubMed2003

Detection of intra-abdominal injury using diagnostic peritoneal lavage after shotgun wound to the abdomen.

BACKGROUND: The utility of diagnostic peritoneal lavage (DPL) as a diagnostic tool specifically for shotgun wound to the abdomen (SGWA) is unknown. This prospective study was undertaken to determine the sensitivity, specificity, and accuracy of DPL for the detection of intra-abdominal injuries following SGWA. METHODS: DPL was performed on all patients sustaining SGWA who lacked a clear indication for laparotomy. Patients exceeding 10,000 red blood cells (RBC)/mm were taken for exploratory laparotomy. A prospective database was kept with information on wound location, DPL result, findings upon laparotomy and outcome. RESULTS: Thirty-two DPLs were performed at our urban Level I trauma center for SGWA. Of these, 8 patients had a positive DPL. Upon laparotomy, 7 patients were found to have intra-abdominal injuries, 6 of which required surgical intervention. One patient had no peritoneal penetration or intra-abdominal injury. Of the 24 patients that had a negative DPL, 1 subsequently developed indications for laparotomy and was found to have operative injuries. For predicting intra-abdominal injuries DPL has a sensitivity, specificity and accuracy of 87.5%, 95.8% and 93.8%, respectively. CONCLUSION: For patients presenting with SGWA who do not present with indications for immediate laparotomy, DPL is a reliable indicator of intra-abdominal injury and need for operative intervention.

Abdominal Injuries↗
PubMed1993

Acute lipodermatosclerosis in a pendulous abdomen.

A 54-year-old female developed tender, hot, erythematous skin at the apex of a large pendulous abdomen at the same time as she became symptomatic with congestive cardiac failure secondary to respiratory failure. Clinically and histologically the changes in the abdominal-wall skin resembled lipodermatosclerosis, a condition normally seen in the legs secondary to chronic venous insufficiency.

Abdominal Muscles↗
PubMed2005

Pustular calicivirus dermatitis on the abdomen of two cats following routine ovariectomy.

An unusual form of calicivirus dermatitis is described in two cats. Two fully vaccinated cats were re-admitted for anorexia and depression following routine ovariectomy. Signs of upper respiratory disease were not present. One cat subsequently showed painful necrosis of the incision wound, the other one developed dyspnoea with pleural effusion and discrete tongue ulcers. Intact pustular lesions confined to the surgically prepared abdomen appeared in both cats, respectively, on days 11 and 9. The histopathological diagnosis was panepidermal pustulosis and necrotizing dermatitis. Positive immunohistochemical staining consistent with feline calicivirus antigen was detected in epithelial cells within pustular lesions. The cats were treated with antibiotics and ketoprofen. The cat with progressive dyspnoea was euthanized. The clinical signs in the other cat rapidly and completely resolved following glucocorticoid therapy. It is hypothesized that the reported cases may represent a distinct calicivirus-induced pustular dermatitis following ovariectomy.

Animals↗
PubMed2006

Routine isotropic computed tomography scanning of the abdomen and pelvis.

For 30 years, abdominal CT has been imaged and reviewed in the axial plane. It is now possible to carry out isotropic imaging of the whole abdomen and pelvis using a 40-channel scanner. This allows creation of coronal and sagittal reformats with the same image quality as the axial images. In this study, we present our experience of reviewing routinely coronal and, occasionally, sagittal reformats. We discuss situations where these nonaxial reformats are most beneficial.

Adult↗
PubMed2006

Making a virtue of necessity: managing the open abdomen.

BACKGROUND: The open abdomen, or laparostomy, is becoming increasingly used in the management of critically ill surgical patients. METHODS: The published work on laparostomy is reviewed, in the light of personal experience, with particular attention to the history and pathophysiology associated with laparostomy. RESULTS AND CONCLUSION: The combination of an inert plastic sheet in contact with the viscera, and the application of subatmospheric pressure on the wound, is an effective combination to maximize the prospects of delayed primary wound closure while minimizing the chance of fistula and ventral hernia.

Abdominal Wall↗
PubMed1975

Reflex inhibition of the slowly adapting stretch receptors in the intact abdomen of the crayfish.

The reflex inhibition of abdominal stretch receptors in crayfish was studied by controlled passive flexion of individual abdominal joints. The results are very similar to those obtained by electrical or mechanical stimulation of individual stretch receptors in immobilized abdomens. Reflex effects from posterior to anterior abdominal segments are somewhat stronger than in the opposite direction. Flexion of one abdominal joint excites the stretch receptors of that joint and inhibits the stretch receptors in neighbouring abdominal segments. Without reflex inhibition flexion of one abdominal joint excites the stretch receptors in several abdominal segments.

Action Potentials↗
PubMed1978

Computed tomography of abdomen in staging and clinical management of lymphoma.

During July 1976 to Demember 1977, 150 patients with Hodgkin's disease and 138 with non-Hodgkin's lymphoma were examined by computed tomography (CT). In 45 cases 50 repeat examinations were conducted. Concurrent laparotomy and lymphography were performed on 68 and 56 patients respectively. The overall incidence of false-positive CT examinations as confirmed by laparotomy was 7.4%. In 18 patients with non-Hodgkin's lymphoma in the abdomen there was good correlation between the two techniques. Of the 50 patients with Hodgkin's disease who underwent laparotomy, 17 had splenic disease and 14 minimally enlarged lymph nodes in 20 areas; CT, however, detected only four diseased spleens and five minimally enlarged lymph nodes. Nevertheless, CT often detected enlarged lymph nodes missed by lymphography and was 23% more efficient than lymphography in detecting unsuspected disease. CT also detected unsuspected disease in patients with relapse of lymphoma. CT may replace other non-invasive investigations of abdominal disease in patients with lymphoma and give a reliable guide to prognosis. It does not, however, eliminate the need for laparotomy in staging Hodgkin's disease.

Abdominal Neoplasms↗