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Subcutaneous primitive neuroectodermal tumour in the abdominal wall of a child: long-term survival after local excision.

Tumours of the peripheral primitive neuroectodermal tumour/Ewing's sarcoma (PNET/ES) family can rarely occur as primary lesions within the skin and subcutis. We present a case of subcutaneous PNET within the abdominal wall of a 33-month-old child. Histologically it was a small round cell tumour that marked strongly for CD99 and displayed ultrastructual evidence of neural differentiation. The tumour was completely excised, but due to an initial misdiagnosis no adjuvant therapy was given. Despite this, the patient is well without evidence of disease 10 years and 3 months after surgery. A review of similar cases reveals not all patients are as fortunate, suggesting combination therapy, including chemotherapy, is still the best treatment for these tumours, even when small and superficial. Our report therefore highlights the importance of recognising PNET/ES in the skin and subcutis so appropriate therapy can be administered.

12E7 Antigen↗

The influence of CO2 versus helium insufflation or the abdominal wall lifting technique on the systemic immune response.

BACKGROUND: Both laparoscopic and conventional surgery result in activation of the systemic immune response; however, the influence of the laparoscopic approach, using CO2 insufflation, is significantly less. Little is known about the influence of alternative methods for performing laparoscopy, such as helium insufflation and the abdominal wall lifting technique (AWLT), and the systemic immune response. METHODS: Thirty-three patients scheduled for elective cholecystectomy were randomly assigned to undergo laparoscopy using either CO2 or helium for abdominal insufflation or laparoscopy using only the AWLT. The postoperative inflammatory response was assessed by measuring the white blood cell count, C-reactive protein (CRP) and interleukin-6 (IL-6). The postoperative immune response was assessed by measuring monocyte HLA-DR expression. RESULTS: CRP levels were significantly higher 1 day after helium insufflation when compared with CO2 insufflation; however, no differences were observed 2 days after surgery. The AWLT resulted in significantly higher levels of CRP both 1 and 2 days after surgery when compared with either CO2 or helium insufflation. A small increase in postoperative IL-6 levels was observed in all groups, but no significant differences were seen between the groups. After both helium insufflation and AWLT a significant decrease in HLA-DR expression was observed, in contrast to the CO2 group. CONCLUSION: Carbon dioxide used for abdominal insufflation seems to limit the postoperative inflammatory response and to preserve parameters reflecting the immune status. These findings may be of importance in determining the preferred method of laparoscopy in oncologic surgery.

Abdominal Muscles↗

Transcatheter arterial embolization of internal mammary artery in a hepatocellular carcinoma with abdominal wall invasion.

Transcatheter arterial embolization (TAE) is alternatively employed to surgical resection in the management of hepatocellular carcinoma (HCC). TAE through the hepatic artery is sometimes insufficient since the blood supply to HCC may be from the collateral vessels as well. We report a case of HCC with abdominal wall invasion who underwent TAE through the right internal mammary artery after insufficient embolization of the tumor through the hepatic artery.

Abdominal Muscles↗

Spontaneous extrusion of peritoneal catheter through intact abdominal wall.

A rare occurrence of spontaneous extrusion of a Denver peritoneal catheter through the right flank in a 14-year-old boy is reported. The firm texture and short length of the catheter coupled with its movements with respiration produced a hammer effect and eroded the abdominal wall. Disconnection of the peritoneal catheter from the chamber and pulling out the extruded catheter is suggested as a simple and effective method of removal of the shunt.

Abdominal Muscles↗

[Recurrent pneumothorax in interstitial lung disease, anogenital and abdominal wall exanthema and secondary amenorrhea in a 20-year-old patient. Langerhans-cell histiocytosis].

CASE REPORT: A 20-year-old female patient was admitted to the hospital because of a pneumothorax. A secondary amenorrhea was coexisting. On the abdominal wall and in the anogenital area a maculopapular exanthema was visible. Chest X-ray and HR-CT showed an interstitial lung disease with high probability of histiocytosis X which was confirmed by biopsies of lung and skin tissue. The cause of amenorrhea was a histiocytic infiltration of the pituitary stalk. Conventional "consensus-treatment" for adults with vinblastine, prednisone and etoposide did not prevent relapsing bilateral pneumothoraces. Treatment was successful with the protocol as proposed by the international study for children. This treatment is characterized by higher dosage and combination with 6-mercaptopurine.

Adult↗

Effects and distribution of the enamel matrix derivative Emdogain in the periodontal tissues of rat molars transplanted to the abdominal wall.

The enamel matrix derivative Emdogain (EMD) has been found to promote regeneration of lost periodontal tissues. We have studied the effects and distribution of EMD in the periodontal tissues of maxillary rat molars transplanted to a subcutaneous position in the abdominal wall. The molars were transplanted with or without EMD either immediately after extraction or after drying for 30 min. After 2 days, 1, 2 or 4 weeks the rats were killed and the teeth were examined by means of light microscopy and immunohistochemistry with anti-amelogenin antibodies. Teeth transplanted immediately after extraction showed formation of alveolar bone separated from the dental roots by a periodontal space, regardless of the use of EMD. Among the teeth that were transplanted with EMD after drying for 30 min, new alveolar bone was formed in five out of eight teeth after 2 and 4 weeks. None of the teeth that were dried for 30 min and transplanted without EMD showed alveolar bone formation. Only one tooth transplanted with EMD showed root resorption after drying, while resorption was noted in all teeth transplanted without EMD. All teeth that were transplanted with EMD and none of the teeth that were transplanted without EMD showed an immunohistochemical reaction for amelogenin. After 2 days, amelogenin was precipitated on all surfaces exposed at the transplantation procedure. Later, the immunoreactive material was redistributed to cells at the root surface, where it was still demonstrable after 4 weeks. In conclusion, EMD is accumulated in cells at the root surface and promotes regeneration of the periodontal tissues of the transplanted teeth. It also seems to promote healing of root resorption.

Abdomen↗

Necrotizing fasciitis of abdominal wall in AIDS.

Necrotizing fasciitis (NF) is an uncommon but potentially lethal soft-tissue infection. Mortality rate is high and has not changed since it was first described by Meleny. Although immunodeficiency is a risk factor for NF, there is only one reported case of NF in AIDS involving the cervical region. We report the first case of necrotizing fasciitis of the abdominal wall in an AIDS patient.

Abdominal Muscles↗

Injury to abdominal wall vessels during laparoscopy in three horses.

Epigastric vessels were inadvertently injured during placement of instrument portals in 3 horses undergoing laparoscopy for bilateral cryptorchidectomy, bilateral ovariectomy, and removal of electrode wires surgically implanted in the large colon. The resulting hemorrhage increased surgery time, caused hematoma formation or hemoperitoneum, and obscured the surgical field. Hemostasis was achieved by direct pressure or vessel ligation. This complication can be attributed to the high degree of vascularity of the ventral aspect of the abdominal wall.

Abdominal Muscles↗

Spontaneous large intra-abdominal wall haematoma as a rare complication in a maintenance haemodialysis patient.

The incidence of spontaneous bleeding in various parts of the body has been reported to be high in patients receiving maintenance haemodialysis. We present a case of spontaneous large haematoma of the intra-abdominal wall which developed in a 71-year-old Japanese man with 9 years' maintenance haemodialysis. Due to the clinical symptoms and signs, ileus was suspected and an emergency operation was performed. In maintenance haemodialysis the possibility of spontaneous bleeding should always be considered whenever unexplained and unexpected symptoms and signs are apparent.

Abdominal Muscles↗

Facilitating the operative exposure of the portal plate in cases of biliary atresia by dislocating the whole liver onto the abdominal wall.

Obtaining adequate exposure of the portal plate in cases with biliary atresia can tax the ingenuity of the surgeon. The successful completion of a hepatic portoenterostomy depends on it. Mobilising the liver and dislocating it into an ex vivo-like position on the anterior abdominal wall simplifies this step of the operation. It achieves maximal visualisation and access to the anatomy of the liver port. When used correctly by the surgeon this technique is not complicated by hepatic or caval blood flow occlusion. Its use in over 40 clinical cases has not resulted in any major mishap.

Abdominal Muscles↗

Scintigraphic detection of abdominal wall and diaphragmatic peritoneal leaks in patients on continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) is utilized with increasing frequency for patients with end stage renal disease (ESRD). Several complications have been observed including catheter malfunction due to pericatheter leaks, abdominal wall and inguinal hernias and diaphragmatic leaks. Occasionally special diagnostic procedures are necessary to determine the nature of the abnormality and guide the surgical approach to correction. The four cases herein illustrate the usefulness of radionuclide imaging in diagnosing leakage of dialysate fluid in patients on CAPD.

Adult↗

[The combined subdermal vascular network skin flaps of the abdominal wall for the repair of soft tissue defects on the dorsum of hand].

Successful reconstructive surgery was performed on ten patients with skin and soft tissue defects on the dorsum of their hand and fingers using combined subdermal vascular network flaps of the abdominal wall. The pedicle of the flap was divided on 7-10 postoperative day when wound was closed, finger and web reconstruction were completed at the same stage. The operative results were satisfactory. The authors discussed the technique of the method, the blood supply of the flap, the principle of the design and the advantages of the operation.

Adolescent↗

The use of biomaterials in the repair of abdominal wall defects: a comparative study between polypropylene meshes (Marlex) and a new polytetrafluoroethylene prosthesis (Dual Mesh).

In this study we compared the behaviour of the non-porous on one side ePTFE Dual Mesh prosthesis and the macroporous polypropylene mesh Marlex in the repair of abdominal wall defects in rabbits. We evaluated the degree of integration with recipient tissue, biological tolerance, adhesion formation with viscera and the biomechanical resistance of the repair zone. Our results showed good biological tolerance of both prostheses and a high degree of adhesion formation in Marlex implants. In animals with Dual Mesh implants, only loose adhesions were seen. Marlex implants induced the presence of disorganized scar tissue, while the Dual Mesh prostheses were encapsulated by organized tissue. The macrophage response was similar in both decreasing with time. The resistance to traction was higher when the reparation was done with polypropylene. We concluded that the structure of the prosthesis determines its degree of integration and the resistance to traction of the repaired zone.

Abdominal Muscles↗

[Selection of the method of plastic surgery of the abdominal wall in ventral hernia].

Materials on surgical treatment of 365 patients with various types of ventral hernias are discussed. The authors describe original methods of ventroplasty which they developed and approved . The methods comprise duplication of the whole peritoneal-muscular-cicatricial-aponeurotic complex of the abdominal wall by means of a double-row suture passed through all these layers and application of a third reinforcing row of sutures; whenever necessary, the operation is divided into two stages. Preoperative compression training of the abdomen is conducted in cases of a large hernia. Attention is focused on the need to choose the method of plasty for each individual patient, which makes it possible to avoid serious complications and fatal outcomes and produce good results of the treatment. Recurrences in large ventral hernias occurred in 8% of cases.

Abdominal Muscles↗

[Hernias of the abdominal wall in old age].

Following a review of the literature on the topic, the authors examined all patients admitted to the Institute of Surgical Pathology 1st at the University of Pavia between 1-1-1974 and 31-12-1988 affected by hernias of the abdominal wall or surgical laparoceles, paying special attention to those patients aged over 65. Attention was focused on concomitant diseases, the acuteness of the basic pathology and possible recurrence. From the results obtained it was concluded that the associated pathology and the acute state of the basic diseases condition the successful outcome of the operation more than age itself. For this reason, it is important that patients affected by these pathologies are operated as soon as possible in order to carry out an elective operation which reduces postoperative complications and reduces the risk of recurrence.

Acute Disease↗