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At least 127 records · Page 7Linked to original sources

[Intraperitoneal chemo-hyperthermia with "overflow" open abdomen].

The authors report an original procedure of open-abdomen intraperitoneal chemo-hyperthermia. The skin edges are watertightly stapled with a soft "abdominal cavity expander", supported by a Thompson self-retaining retractor positioned over the abdomen. So, the level of the liquid can be widely raised above the level of the skin edges. The anterior wall peritoneum, the wall edges are constantly exposed to the liquid. Large amplitude movements become possible: introduction into the abdomen of two forearms, even two arms, does not induce loss of any liquid. The small bowel, the stomach can be partially exteriorized. It becomes very easy to expose all the peritoneal spaces, to maintain an homogeneous hyperthermia within the abdomen, while using only one inflow drain, and one outflow drain.

Abdominal Neoplasms↗

Novel approach to the treatment of intestinal fistula in the inaccessible abdomen: transbursal end-to-side duodenogastrostomy.

BACKGROUND: Treatment of enterocutaneous fistula in patients with intra-abdominal sepsis and a surgically inaccessible abdomen is frequently unsuccessful. METHODS: A new approach has been devised: total disconnection of the proximal digestive tract, which can be performed through the bursa omentalis without entering the scarred abdomen. RESULTS: The procedure was carried out in four patients with high-output small bowel fistula and an inaccessible abdomen. Output of fistulas stopped promptly, recovery from intra-abdominal sepsis was achieved, the abdomens became accessible again and continuity of the digestive tract could be restored in all patients after intervals of 2-5.5 months. CONCLUSION: Transbursal end-to-side duodenogastrostomy is a useful procedure when traditional surgical interventions have failed or cannot be applied.

Adult↗

["Abdominal dressing" - a new method of treatment for open abdomen following secondary peritonitis].

INTRODUCTION: Treatment of open abdomen following secondary peritonitis is a challenge for surgery and intensive care units (ICU). The aim of this study was to compare three different concurrent treatment strategies. METHODS: Patients suffering an open abdomen following surgery for secondary peritonitis at the Department of General Surgery from 01/01 to 12/03 were investigated. Factor studied: duration of open abdomen, incidence of multi-organ failure, need for surgical revisions, length of stay (LOS) in ICU, nursing requirements (change of dressing/day), survival and integrity of abdominal wall after discharge. Treatment strategies included: open packing (OP), classic vacuum assisted (V.A.C.(R))-therapy with silicone net protection for the intestine (CV) and V.A.C.(R)-therapy with "abdominal dressing" a newly developed meshed polyvinyl wrap (AD). RESULTS: 21 patients were studied: 5 patients were treated with OP, 8 patients with CV and 8 patients with AD. Mean LOS was 65 (OP) vs. 53 (CV) vs. 42 (AD) days (NS), peritonitis related death was 3 (OP) vs. 1 (CV) vs. 0 (AD) (p < 0.05 Chisquare test). Median nursing effort was 4 dressings/day (OP), 0.5 (CV) and 0.5 (AD) (p < 0.005 OP vs CV, AD Kruskal-Wallis test). CONCLUSION: The "abdominal dressing"-therapy seems to be a more efficient treatment option in patients suffering from open abdomen following secondary peritonitis. A trend towards shorter ICU-LOS, lower mortality rates and reduced nursing requirements support our hypothesis.

Critical Care↗

Quality of life after severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdomen and planned re-operations.

OBJECTIVE: To determine quality of life after severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdomen and planned re-operations. DESIGN: Retrospective chart review. SETTING: University hospital intensive care unit, general wards, and outpatient department. PATIENTS: Forty-one patients who survived severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdomen and planned re-operations. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Over a period of 7 yrs, 95 patients underwent open management of the abdomen and planned re-operations for severe bacterial peritonitis and infected necrotizing pancreatitis. Thirty-nine patients died during the initial intensive care unit stay and 12 as a result of nonperitonitis-related systemic diseases after discharge. Four patients were lost or excluded from final analysis. Long-term morbidity and quality of life using Karnofsky and Rankin scores at discharge and at follow-up at least 1 yr after discharge (mean: 4 yrs) and the Sickness Impact Profile (SIP) were determined. The remaining 41 patients reviewed showed significant long-term morbidity, including dysfunction of the abdominal wall resulting from herniation, persistent polyneuropathy, and mental disorders needing psychiatric support. Patients having persistent polyneuropathy and, to a lesser extent, mental disorders, showed significantly lower Karnofsky, higher Rankin, and higher SIP scores. After discharge, performance status of patients improved significantly, as shown by higher Karnofsky and lower Rankin scores, and, because Karnofsky and Rankin scores are closely related to SIP scores, higher SIP scores. Especially in measuring quality of life in terms of social and role management, assessment of the SIP proved to have additional value. CONCLUSIONS: About three-quarters of patients who survive open management of the abdomen and planned re-operations for severe bacterial peritonitis and infected necrotizing pancreatitis regain a good quality of life. Some patients, especially those who suffer from persistent polyneuropathy and mental disorders, show restrictions in daily life.

Adult↗

CT in searching for abscess after abdominal or pelvic surgery in patients with neoplasia: do abdomen and pelvis both need to be scanned?

PURPOSE: This prospective study was undertaken to determine the incremental yield of combined abdominal and pelvic CT in searching for clinically suspected postoperative abscess in oncologic patients. METHOD: One hundred seventeen oncologic patients underwent CT to exclude a clinically suspected abscess within 30 days of abdominal or pelvic surgery during an 8 month period. Scans were evaluated for the presence of ascites, loculated fluid collections, or other possible sources of fever. The clinical course and any intervention in the abdomen or pelvis within 30 days after CT were recorded. RESULTS: After abdominal surgery, 44 of 69 [64%; confidence interval (CI) 51-75%] patients had loculated fluid collections in the abdomen; no patient (0%; CI 0-5%) had a loculated fluid collection present only in the pelvis. After pelvic surgery, 22 of 48 (46%; CI 31-61%) patients had loculated fluid collections in the pelvis; no patient (0%; CI 0-7%) had a loculated collection present only in the abdomen. Loculated collections were present in both the abdomen and the pelvis in 4 of 69 (6%; CI 1.6-14%) patients after abdominal surgery and 3 of 48 (6%; CI 1.3-17%) after pelvic surgery. CONCLUSION: Isolated pelvic abscesses after abdominal surgery and isolated abdominal abscesses after pelvic surgery appear to be very uncommon in oncologic patients. CT initially need be directed only to the region of surgery in this particular patient population.

Abdominal Abscess↗

The biomechanical response of the lower abdomen to belt restraint loading.

The biomechanical response of the lower abdomen was investigated by simulated belt-restraint loading to the lower abdomen in a supine, rigidly supported, anesthetized swine. Impacts were delivered through a belt interface to the external ventrodorsad dimension of the lower abdomen at L4. A combination of a velocity and compression varying from 1.6-6.6 m/s and 6-67%, respectively, constituted one impact. Logist analysis indicated that maximum Compression (Cmax), maximum Viscous response (VCmax), and particularly peak Force-maximum Compression (FmaxCmax), were effective correlates to injury severity at AIS greater than or equal to 3 and 4. Statistical fit to AIS greater than or equal to 4 injury probability was strongest with a multi-parametric Logist analysis of Cmax and VCmax which indicated that abdominal injury may be related to both a velocity and compression mechanism. Force-deformation curves, characterized by a gradual, almost linear rise followed by rapid unloading, provided information on the stiffness of the lower abdomen in response to belt loading. Force-deflection curves based on total load indicated a reasonable correlation (R2 = 0.61) between estimated lower abdominal stiffness and velocity.

Abdominal Injuries↗

Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma.

BACKGROUND: This study reviews the efficacy of vacuum-assisted wound closure (VAWC) to obtain primary fascial closure of open abdomens after severe trauma. METHODS: The study population included shock resuscitation patients who had open abdomens treated with VAWC. The VAWC dressing was changed at 2- to 3-day intervals and downsized as fascial closure was completed with interrupted suture. The Trauma Research Database and the medical records were reviewed for pertinent data. RESULTS: Over 26 months, 35 patients with open abdomens were managed by VAWC. Six died early, leaving 29 patients who were discharged. Of these, 25 (86%) were successfully closed using VAWC at a mean of 7 +/- 1 days (range, 3-18 days). Of the four patients that failed VAWC, two developed fistulas. No patients developed evisceration, intra-abdominal abscess, or wound infection. CONCLUSION: VAWC achieved early fascial closure in a high percentage of open abdomens, with an acceptable rate of complications.

Abdominal Injuries↗

A patient-equivalent attenuation phantom for estimating patient exposures from automatic exposure controlled x-ray examinations of the abdomen and lumbo-sacral spine.

The Joint Commission on Accreditation of Healthcare Organizations requires diagnostic radiology facilities to known the approximate amount of radiation received by an average patient during radiographic examinations at the facility. Automatic exposure controlled (AEC) techniques are used for many of these exams, and a standard patient-equivalent phantom is necessary when estimating patient exposure on such systems. This is of particular importance if exposures are to be compared among AEC systems with different entrance x-ray spectra. We have developed a phantom, LucA1 Abdomen, to facilitate determining the average patient exposure from AEC anteroposterior (AP) abdomen and lumbo-sacral (LS) spine radiography. The phantom is relatively lightweight, transportable, sturdy, and made of readily available inexpensive materials (Lucite and aluminum). It accurately simulates the primary and scatter transmission through the soft tissue and L-4 spinal regions of a patient-equivalent anthropomorphic phantom for x-ray spectra typically used in abdomen/LS spine radiography. A clinical evaluation to verify the patient-equivalence of three commercial anthropomorphic phantoms (Humanoid, Rando, 3-M) and two acrylic/aluminum phantoms (ANSI and LucA1 Abdomen) has been conducted. The design and development of the LucA1 Abdomen phantom and the evaluation of all phantoms is described.

Humans↗

Rectal examination in patients with pain in the right lower quadrant of the abdomen.

OBJECTIVE: To determine whether rectal examination provides any diagnostic information in patients admitted to hospital with pain in the right lower quadrant of the abdomen. DESIGN: Casualty officer or surgical registrar recorded symptoms and signs on admission on detailed forms. Final diagnosis was noted on discharge from hospital. SETTING: District general hospital. PATIENTS: 1204 Consecutive patients admitted to hospital with pain in the right lower quadrant of the abdomen as their major complaint; 1028 had a rectal examination on admission. MAIN OUTCOME MEASURES: Odds ratio for each symptom and sign related to final diagnosis. Results of multiple logistic regression analysis for acute appendicitis. RESULTS: Right sided rectal tenderness, present in 309 of those examined, was more common in patients with acute appendicitis (odds ratio 1.34, p less than 0.05). This odds ratio was considerably less than that for other clinical signs--namely, tenderness in the right lower quadrant (odds ratio 5.09), rebound tenderness (3.34), guarding (3.07), and muscular rigidity in the abdomen (5.03). In the logistic regression analysis of patients with acute appendicitis, when allowance was made for the presence or absence of rebound tenderness, rectal tenderness on the right lost its significance. Six patients had masses palpable rectally, of which three were palpable on abdominal examination; the other three patients had acute appendicitis. No other unexpected diagnoses were established, and no useful additional diagnostic information was obtained by routine rectal examination. CONCLUSION: If patients presenting with pain in the right lower quadrant of the abdomen are tested for rebound tenderness then rectal examination does not give any further diagnostic information.

Abdominal Pain↗

[Multislice CT of the abdomen].

With the advent of multislice CT, temporal and spatial resolution has been dramatically improved, enabling multi-phase dynamic CT of the abdomen with very thin slices. The image quality of multiplanar reconstruction (MPR) and CT angiography (CTA) has been markedly improved. These high-quality dynamic CT, MPR, and CTA images are an advantage of multislice CT of the abdomen. The CT protocol is very important in obtaining such high-quality images, and knowledge of the relation between the contrast medium and enhancement of each organ is essential. In this article, we present our multislice CT protocol for the abdomen as well as the results of our investigation using time-density-curve analysis. The clinical usefulness of MPR images and CTA of the abdomen are also discussed.

Contrast Media↗

[The laparoscopic procedures on abdomen with adhesions].

The scar abdomen is more and more seldom a contraindication of the laparoscopic approach. According to Rohr it is classified in scar abdomen after Mac Burney, suprapubic or supraumbilical approach and of the polyoperated patients. Our trial consists in 452 patients with laparoscopic operations consecutive open abdominal surgery (out of the 3900 patients undergoing celioscopic procedures between 1995-2001). The laparoscopic procedure was performed distant to the previous operation in 95.1%, on a neighboring organ to that initially conventionally operated in 4.1% or on the same organ in 3 patients (0.8%). We lead no preoperative fatalities, but the conversational rate was 12% (54 patients), due to the high-risk dissection or to the unsolvable bleedings by laparoscopic means (2 cases). The operative accidents consisted in visceral injuries soloed by laparotomy. Postoperatively we registered 5 port site seronas, 1 deep vein thrombosis and 1 pneumonia. The evolution and the mean hospitalization was the same for the scar abdomen patients with the operative procedure accomplished laparoscopically as for non previously operated patients. The data support the feasibility of the laparoscopic procedures on scar abdomen, using the "open laparoscopy" with a reasonably increased conversational rate.

Abdominal Muscles↗

The usefulness of technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan to differentiate periappendiceal abscess from acute appendicitis--a preliminary report.

BACKGROUND/AIMS: The purpose of this study is to assess the usefulness of Tc-HMPAO (technetium-99m hexamethylpropyleneamineoxide) labeled white blood cells abdomen scan to differentiate acute appendicitis from periappendiceal abscess. METHODOLOGY: Forty-five patients with atypical symptoms and signs of appendicitis were included in this preliminary study. At 4 hours after an intravenous injection of Tc-HMPAO labeled white blood cells, static images over the anterior abdomen were obtained using a gamma camera. Two regions of interest were selected, one was over the lumbar spine and the other was over the appendiceal area. The mean count ratio of the appendiceal area over the mean pixel count of the lumbar spine was calculated. Sixteen patients were diagnosed with acute appendicitis and 19 patients with periappendiceal abscess by final operative findings. Meanwhile, the other 10 patients with acute abdomen but with no appendicitis served as controls. RESULTS: The mean count ratio of controls, acute appendicitis and periappendiceal abscess was 0.65 +/- 0.05, 0.82 +/- 0.07, and 1.25 +/- 0.11, respectively. If the mean count ratio > or = 1.00 was defined as the cutoff value to diagnose periappendiceal abscess, the specificity and the positive predictive value was 100%. CONCLUSIONS: We concluded that Tc-HMPAO white blood cells abdomen scan should be a potential tool to differentiate periappendiceal abscess from acute appendicitis.

Abdominal Abscess↗

[Analysis of the causes of postoperative chest or/and abdomen colic in benign prostatic hyperplasia].

OBJECTIVE: To analyze the causes of chest or/and abdomen colic with in 1 week after prostatectomy and transurethral resection of the prostate (TURP). METHODS: Retrospective studies were made on 120 cases of benign prostatic hyperplasia (BPH) with postoperative colic in the chest or/and abdomen from October 2001 to October 2002, 35 (Group A) treated by prostatectomy and the other 85 (Group B) by TURP. RESULTS: In sequence of frequency, the causes of the postoperative chest or/and abdomen colic were bladder spasm, catheter block, acute gastroenteritis, angina and acute myocardial infarction. CONCLUSION: The causes of chest or/and abdomen colic after prostatectomy are multiple. If the causes are timely established and corresponding measures immediately taken, its complications can be minimized.

Aged↗

The abdomen in the patient with multiple injuries.

The body may be divided into three main areas for consideration of serious injuries: head and neck, trunk, extremities. Injuries to he head and neck give limited opportunity for effective medical treatment and early recognition is important. The trunk (chest and abdomen) is the site of of the most serious, life-threatening trauma. In abdominal injury there are three clinically and radiologically silent areas-the thoracic abdomen, the pelvis and the retroperitoneal space. In the thoracic abdomen there are injuries to three major organs: hepatic and splenic injuries, easily diagnosed by abdominal lavage, and diaphragmatic rupture, not easily diagnosed; only 25% of diaphragmatic ruptures present in a characteristic fashion. The others may show subtle abnormalities on the chest roentgenogram, such as slight blunting of the costophrenic angle and abnormal position of the nasogastric tube and stomach. In the pelvis there are also three organ systems that can be injured: the urinary tract, the rectum and the urinary bladder. In each case, the presence of blood - hematuria, gross or microscopic, and blood on the examining finger after rectal examination - signals the possibility of severe injury. The retroperitoneal space may also be the site of three important injuries - of kidney, usually flagged by developing hematuria; of pancreas and of retroperitoneal duodenum, each difficult to diagnose. Five signs may be present in a scout film of the abdomen: (a) slight scoliosis, (b) air in the duodenum, (c) no psoas shadow, (d) fracture of a lumbar vertebra or transverse process and (e) retroperitoneal air. Diagnosis and treatment must not be delayed.

Abdominal Injuries↗

Placement of a multiorificed catheter in the inferior portion of the right atrium; percentage of gas retrieved and success rate of resuscitation after venous air embolism in prone dogs positioned with the abdomen hanging freely.

Based on reports of fatal venous air embolism (VAE) occurring during lumbar laminectomy and spinal fusion in prone patients positioned with the abdomen hanging freely, it has been recommended that monitoring for VAE should be used for such cases, and that a multiorificed central venous catheter should be inserted for aspiration of VAE. A previous study from this laboratory reported that, in prone dogs positioned with the abdomen hanging freely, a multiorificed catheter located in the superior portion of the right atrium did not increase the success rate of resuscitation after VAE given via the femoral vein. The present study was designed to examine aspiration of VAE when prone dogs positioned with the abdomen hanging freely were given a fatal VAE via a femoral vein and a multiorificed catheter was located in the inferior portion of the right atrium. Fourteen dogs were anesthetized with isoflurane and nitrous oxide in oxygen and positioned with the abdomen ventral and hanging freely, the head fixed in a stereotaxic frame, the upper extremities resting on a surface approximately 10 cm below the level of the stereotaxic frame and the lower extremities on a surface below the level of the upper extremities (to assure that VAE entering the inferior vena cava would ascend toward the heart). In the control group (n = 7) a catheter was placed in the inferior portion of the right atrium but was not used to aspirate VAE. In a second group (n = 7) a modified Arrow prototype multiorificed catheter was inserted in the inferior portion of the right atrium.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The acute abdomen. An overview and algorithms.

The diagnosis and management of the patient with an acute abdomen remains one of the most difficult challenges for the surgeon. A thorough understanding of the anatomy and physiology of the abdomen are essential to properly generate a differential diagnosis and to formulate a treatment plan. While recent advances in technology can be extremely helpful in certain situations, they cannot replace a physician's clinical judgment based upon a good history and physical examination. This article provides a general overview of the evaluation of the patient with an acute abdomen. It will also suggest algorithms to consider in the diagnosis and treatment of these patients.

Abdomen↗

Postsplenectomy Capnocytophaga canimorsus sepsis presenting as an acute abdomen.

Patients with intra-abdominal processes that require prompt surgical intervention, including appendicitis, perforated viscus, ischemic bowel, volvulus, and bowel obstruction, often present with signs and symptoms of an acute abdomen. Several medical problems can mimic an acute abdomen. Overwhelming postsplenectomy infection is a life-threatening condition that can present with acute abdominal symptoms. The incidence of overwhelming postsplenectomy infection ranges from 1% to 25%, and is caused by Streptococcus pneumoniae in 50% of cases. Capnocytophaga canimorsus, a bacteria commonly found in dog saliva, accounts for less than 1% of cases. Overwhelming postsplenectomy infection has a rapidly deteriorating course that progresses to respiratory and renal failure, cardiovascular collapse, and death. The mortality associated with overwhelming postsplenectomy infection is 60% to 80%. Early diagnosis and institution of appropriate antibiotic therapy and supportive care is essential to improve patient outcome. A previously healthy woman who had undergone splenectomy secondary to trauma 11 years earlier presented with symptoms of an acute abdomen. A diagnosis of overwhelming postsplenectomy infection due to C canimorsus was made based on her peripheral blood smear and blood culture findings. Early aggressive care and antibiotic treatment resulted in a successful outcome for this patient with no long-term morbidity. This patient's clinical course demonstrates the importance of early diagnosis and treatment of overwhelming postsplenectomy infection.

Abdomen, Acute↗

A multisite phase III study of the safety and efficacy of a new manganese chloride-based gastrointestinal contrast agent for MRI of the abdomen and pelvis.

The purpose of this study was to evaluate the safety and efficacy of a manganese chloride-based oral magnetic resonance (MR) contrast agent during a Phase III multisite clinical trial. Two hundred seventeen patients were enrolled who were already scheduled for MRI of the abdomen and/or pelvis. In this group of patients, it was postulated that the use of an oral agent would better allow discrimination of pathology from bowel. Patients with known gastrointestinal pathology including peptic ulcer disease, inflammatory bowel disease, obstruction, or perforation were excluded to minimize confounding variables that could affect the safety assessment. Of these 217 patients, 18 received up to 900 mL of placebo, and 199 patients were given up to 900 mL of a manganese chloride-based oral contrast agent, LumenHance (Bracco Diagnostics, Inc.). Safety was determined by comparing pre- and post-dose physical examinations, vital signs, and laboratory examinations and by documenting adverse events. Efficacy was assessed by unblinded site investigators and two blinded reviewers who compared pre- and post-dose T1- and T2-weighted MRI scans of the abdomen and/or pelvis. In 111 (57%) of the 195 cases evaluated for efficacy by site investigators (unblinded readers), MRI after LumenHance provided additional diagnostic information. Increased information was found by two blinded readers in 52% and 51% of patients, respectively. In 44/195 cases (23%) unblinded readers felt the additional information would have changed patient diagnosis and in 50 patients (26%), it would have changed management and/or therapy. Potential changes in patient diagnosis or management/therapy were seen by the two blinded readers in 8-20% of patients. No clinically significant post-dose laboratory changes were seen. Forty-eight patients (24%) receiving LumenHance and four patients (22%) receiving placebo experienced one or more adverse events. Gastrointestinal tract side effects were most common, seen in 29 (15%) of LumenHance patients and in 3 (17%) of the placebo patients. LumenHance is a safe and efficacious oral gastrointestinal contrast agent for MRI of the abdomen and pelvis.

Abdomen↗