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PubMed1994

[Perspectives in the advancement of abdominal wall repair using e synthetic prosthesis].

Alloplasty with synthetic prosthesis has its advantages and shortcomings. The great number of wound complications limits the wide use of alloplastics in repair of defects in the abdominal wall in patients with large postoperative hernias. For reducing the incidence of wound complications, it is important to solve some problems: organization of herniological centers and specialized departments, industrial production of synthetic prostheses of various size in sterile packings, perfection of the alloplasty techniques, and observance of measures for the prevention of infection.

Abdominal Muscles↗
PubMed1991

Leukotriene B4, interleukin 1 and leucocyte accumulation in titanium and PTFE chambers after implantation in the rat abdominal wall.

The inflammatory reaction elicited after implantation of non-biologic materials was studied by analysis of the exudate in pure titanium or polytetrafluorethylene chambers 1-9 d after insertion in the abdominal wall of the rat. In chambers made of pure titanium, the number of leucocytes increased about twofold from 1.8 x 10(6)/ml to 4.1 x 10(6)/ml between 24 h and 6 d, whereas a larger increase from 2.1 x 10(6)/ml to 8.3 x 10(6)/ml was observed in the polytetrafluorethylene chambers. Irrespective of implant material, polymorphonuclear granulocytes constituted the vast majority of leucocytes (greater than 81%). After 24 h the leukotriene B4 content was slightly higher in polytetrafluorethylene chambers than in titanium chambers. In contrast to the titanium chambers, a marked increase in leukotriene B4 levels was detected in polytetrafluorethylene chambers 6 d after insertion, whereas the greatest amount of leukotriene B4 in titanium chambers was measured at 9 d. Interleukin 1 was only detected in both types of chambers after 6 d. The present study, together with previous findings, shows that the materials used in this study elicit different degrees of inflammatory reactions in the chamber exudate. Since the number of leucocytes in the exudate retrieved from the chambers correlated well with the leukotriene B4 levels, it is suggested that leukotriene B4, but not interleukin 1, may be an important mediator for polymorphonuclear granulocyte migration into the implant-tissue interface.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed1995

MR imaging of the peritoneum and abdominal wall.

Knowledge of the peritoneal cavity and the peritoneal folds that subdivide it is useful in evaluating for the presence and spread of disease processes that affect the peritoneum. Many disease processes of the peritoneum and abdominal wall are well evaluated with MR imaging, especially as MR techniques improve. In some cases, information is obtained that is not available with other imaging techniques.

Abdominal Muscles↗
PubMed1989

[Frequency of severe abdominal wall hemorrhage with subcutaneous anticoagulation using calcium-heparin].

Four cases of severe bleeding among 50 elderly patients undergoing subcutaneous calcium heparin treatment are reported. In three patients the bleeding was localized in the abdominal wall and the fourth in the retroperitoneum; 2 patients died. Heparin doses ranged between 2x12,500 and 2x20,000 I.U/day. The thrombin times, measured before the next administration, were in the subtherapeutic range in all patients. We conclude that in elderly patients subcutaneous heparin treatment in therapeutic doses should be reserved for exceptional cases.

Abdominal Muscles↗
PubMed1988

The iliohypogastric and ilioinguinal nerves. Distribution in the abdominal wall, danger areas in surgical incisions in the inguinal and pubic regions and reflected visceral pain in their dermatomes.

The courses of the iliohypogastric and ilioinguinal nerves were studied in 44 adult human cadavers, in order to clarify their relations to incisions in the abdominal wall in appendectomy, inguinal hernial repair, caesarean section and lumbar nephrectomy. If either of these nerves is trapped during suturing of the abdominal layers, especially after inguinal hernia repair and appendectomy typical nerve irritation in the inguinal region is observed. To avoid cutting the anterior branches of the iliohypogastric and ilioinguinal nerves in appendectomy, incisions should be placed at a distance of not less than 3 cm from the anterior superior iliac spine. In inguinal hernial repair, after the external oblique aponeurosis has been opened, the ilioinguinal nerve should be displaced from the spermatic cord cranially. In performing a lower paramedian incision (Lennander) and Pfannenstiel's suprapubic incision, the iliohypogastric nerve will be spared if the incision passes at least 5 cm cranial to the inguinal ligament. During oblique lumbar incision for nephrectomy (Bergmann-Israel) the iliohypogastric nerve can easily be found in the middle third of the lateral margin of the quadratus lumborum muscle. The nerve should be displaced carefully downwards. Positional changes of the kidney or ureter, perinephric inflammation, etc. are often referred to the skin areas (Head, Mackenzie) of the iliohypogastric and ilioinguinal nerves.

Abdominal Muscles↗
PubMed1990

Occult abdominal wall peristomal abscess following percutaneous endoscopic gastrostomy.

This case report describes the complication of peristomal abscess formation associated with the insertion of a percutaneous endoscopic gastrostomy (PEG). The formation of a peristomal anterior abdominal wall abscess in this patient was associated with the failure to give prophylactic antibiotics. The development of this potentially fatal complication may be avoided by strict observance of insertion protocols. This case was treated by removal of the gastrostomy tube after diagnosis which allowed drainage of the abscess. In similar cases of occult abscess formation, where symptoms are present but signs are absent, ultrasonography may be useful in diagnosis.

Journal Article↗
PubMed1990

Difference in tissue response to nitrogen-ion-implanted titanium and c.p. titanium in the abdominal wall of the rat.

Ion implantation modifies the surface properties of different materials. We have compared the biological properties of titanium implanted with nitrogen with those of pure titanium. Implants were inserted in the abdominal wall of rats. The implants with surrounding tissue were excised after 1 and 6 weeks, and embedded in epoxy resin. The bulk metal was removed electrochemically and the tissue cut for light and electron microscopy. Using this technique the implant surface, formed by a thin oxide layer, remains and appears in sections as a dense line. After 1 week both types of implants were surrounded by a fluid space containing proteins and scattered macrophages but few polymorphonuclear granulocytes. The fluid space was wider around ion-implanted titanium (52 +/- 22 microns) than around pure titanium implants (15 +/- 3 microns). After 6 weeks the fluid space had largely disappeared around both type of implants. Around pure titanium implants macrophages and fibroblasts, quantified in 1-micron-thick sections in the light microscope, were present in about the same concentration in the inner tissue zone (within 25 microns from the implant surface). Around ion-implanted titanium macrophages predominated in the inner zone and multinuclear giant cells were present in almost all sections. Around both type of implants fibroblasts increased and macrophages decreased with increasing distance from the surface. In the electron microscope macrophages close to the surface of pure titanium were of small size and had an ultrastructure indicating a low activity. Macrophages close to ion-implanted titanium were large and had an active appearance as indicated by the presence of large amounts of endoplasmic reticulum and large Golgi areas in the cytoplasm. Our observations indicate that modification of the surface properties of titanium implants by ion implantation changes the biological properties.

Abdominal Muscles↗
PubMedDate not supplied

Mucin-hypersecreting papillary cholangiocarcinoma presenting as abdominal wall abscess: CT and spiral CT cholangiography.

We describe CT findings of a case of mucin-hypersecreting papillary cholangiocarcinoma (MHPC), with extrahepatic bile leakage to the rectus abdominis muscle via the ligamentum teres hepatis forming an abdominal wall abscess. Endoscopic retrograde cholangiography was unsatisfactory. Spiral three-dimensional CT cholangiography was helpful in assessing the resectability of MHPC by offering anatomic details of the uninvolved biliary tree.

Abdominal Abscess↗
PubMed1997

Abdominal wall hernia in autosomal dominant polycystic kidney disease.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is a common cause of renal impairment with a number of well recognized extrarenal associations. A high incidence of abdominal wall hernia was noted in patients with ADPKD. METHODS: A retrospective review of the notes of all patients with ADPKD on the South Wales renal replacement therapy database was performed. These patients were compared with age- and sex-matched patients with renal failure but without ADPKD and with general surgical patients. RESULTS: The prevalence of hernia in patients with ADPKD was 38 of 85 (45 per cent) compared with seven of 85 (8 per cent) for other forms of renal failure and three of 85 (4 per cent) for general surgical controls (P < 0.001). There were significantly greater numbers of inguinal (P < 0.001), incisional (P = 0.019) and paraumbilical (P = 0.007) hernias in patients with ADPKD compared with the other two groups. CONCLUSION: These results show a significantly greater incidence of hernia, which could be an additional manifestation of the underlying defect in extracellular matrix production identified in patients with ADPKD.

Adult↗
PubMed1998

Comparison of pneumoperitoneum and abdominal wall lifting as to hemodynamics and surgical stress response during laparoscopic cholecystectomy.

BACKGROUND: Impairments in hemodynamics during pneumoperitoneum (PP) have been noted. This study compared changes in hemodynamics and surgical stress response with PP and abdominal wall lifting (AWL) during laparoscopic cholecystectomy. METHODS: Twenty patients with symptomatic cholecystolithiasis were assigned to PP (n = 10) or AWL (n = 10). Cardiac output (CO), stroke volume (SV), and ejection fraction (%EF) were measured by transesophageal echocardiography. Clearances of para-aminohippurate (CPAH) and sodium thiosulfate (CSTS) were determined as measures of renal function. Levels of interleukin-6, C-reactive protein, white cell count, and neutrophil elastase were evaluated as indicators of surgical stress. RESULTS: In the PP group, CO, SV, and %EF were depressed significantly during pneumoperitoneum. Immediately after and 15 min after insufflation, the CPAH and CSTS were decreased by 78.0% and 73.8%, respectively. None of the hemodynamic parameters changed significantly in the AWL group. Surgical stress response was not different significantly between the two groups. CONCLUSIONS: In contrast to pneumoperitoneum, AWL did not alter cardiac function or renal hemodynamics. AWL may be useful in patients with cardiovascular or renal disorders.

Abdominal Muscles↗
PubMed1991

[Unilateral paralysis of the abdominal wall musculature caused by thoracic intervertebral disk displacement].

Herniated thoracic discs are rare. Many cases present with local radicular or cord symptoms. We describe a case which became symptomatic by a unilateral paresis of the muscles of the abdominal wall. This radicular syndrome has only been described for lumbar disc herniations before. The differential diagnosis is discussed as well as the importance of myelography and the value of Myelo-CT.

Abdominal Muscles↗
PubMed1991

[Method of repair of anterior abdominal wall defects in children].

Experimental studies were conducted on 60 cadavers of children whose ages ranged from 0 to 14 years. A defect measuring 6-10 cm was formed in the muscles of the anterior abdominal wall (an approximate model of a hiatal opening). Several rows of crimping sutures were then applied to the aponeurosis of the rectus abdominis muscle above and below the defect. The force of stretching of the edges of the defect was studied by an elaborated tensiometric device after application of each row of crimping sutures. It was found that application of two or three rows of crimping sutures above and below the ventral defect ensures reliable decrease of the stretching load exerted on its edges and allows them to be sutured without tension. The optimal zones in the operative field for applying the crimping sutures were also determined. On the basis of experimental study the authors developed and used in the clinic a method for autoplasty of ventral hernias based principally on placing sutures through the edges of the ventral defect only after their approximation, after preliminary removal of the stretching load experienced by the laparotomic wound. The authors used this method of plasty successfully in 9 children with ventral hernias whose ages ranged from 2 to 14 years.

Abdominal Muscles↗