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PubMed1992

Heat leakage across the abdominal wall and meal-induced thermogenesis in normal-weight and obese subjects.

The mechanism behind the meal-induced increase in energy expenditure in humans and its reduction in obesity was examined in 15 normal-weight and seven obese subjects. The subjects were studied by indirect calorimetry in the basal state and during 2 hours after a mixed meal corresponding to 40% of the 24-hour basal energy requirement. Artificial thermal insulation was applied over the abdominal area before the study in seven of the normal-weight subjects. Thermistor catheters were inserted into a hepatic vein, the pulmonary artery, and a systemic artery for blood sampling and recording of blood temperatures. Basal hepatic venous drainage of heat in relation to the splanchnic oxygen uptake in the normal-weight subjects was low (12 +/- 1 J/mL O2) and became even lower after the meal (5 +/- 3 J/mL). In the obese individuals and the insulated subjects, blood-drained splanchnic heat amounted to 19 to 21 J/mL oxygen both before and after the meal. The postprandial increase in whole body energy expenditure was diminished both in the obese (12% +/- 1% above basal) and in the insulated subjects (15% +/- 1%) compared with the noninsulated controls (22% +/- 2%). In normal-weight subjects, there is a leakage of heat across the abdominal wall. Reduction or prevention of this leakage by artificial thermal insulation or by obesity is accompanied by a reduction of the postprandial increase in energy expenditure.

Abdominal Muscles↗
PubMed2000

Evaluation of the acute scarring response to the implant of different types of biomaterial in the abdominal wall.

Since the short-term, acute scarring process induced by a biomaterial may condition the evolution of the repair process, the present investigation evaluates the behavior of polytetrafluoroethylene (PTFE) and polypropylene (PL) biomaterials in the initial stages of repair. Three PTFE biomaterials (Mycro Mesh, Dual Mesh and Soft Tissue Patch) and one PL biomaterial (Marlex) were employed to repair defects created in the abdominal wall of New Zealand rabbits. Animals were sacrificed at 3 or 7 days. Specimens were obtained for light and scanning electron microscopy, and immunohistochemical analysis using the RAM-11 monoclonal antibody for rabbit macrophages. The PL implants showed substantial adhesion formation with viscera. Lower adhesion formation was detected in the PTFE implants. The evolution of the acute phase of the repair process was similar for each PTFE biomaterial. At 3 days post implant, an incipient neoperitoneum was detected which was fully established after 7 days. The behavior of the PL implant was similar, although a greater amount of reticular granulation was detected. The neoformed peritoneum was irregular. Few RAM-11-labeled macrophages were detected in all cases. The acute phase of the tissue repair process induced by the implant of PTFE and PL biomaterials generally proceeds along similar lines to a normal repair process. However, the use of microporous, laminar materials seems to favor the early establishment of a well-defined neoperitoneal layer.

Journal Article↗
PubMed1997

Splanchnic and renal deterioration during and after laparoscopic cholecystectomy: a comparison of the carbon dioxide pneumoperitoneum and the abdominal wall lift method.

UNLABELLED: Carbon dioxide (CO2) pneumoperitoneum together with an increased intraabdominal pressure (IAP) induces a hemodynamic stress response, diminishes urine output, and may compromise splanchnic perfusion. A new retractor method may be less traumatic. Accordingly, 30 ASA physical status I or II patients undergoing laparoscopic cholecystectomy were randomly allocated to a CO2 pneumoperitoneum (IAP 12-13 mm Hg) (control) or to a gasless abdominal wall lift method (retractor) group. Anesthesia and intravascular fluids were standardized. Direct mean arterial pressure (MAP), urine output, urine-N-acetyl-beta-D-glucosaminidase (U-NAG), arterial blood gases, gastric mucosal PCO2, and intramucosal pH (pHi) were measured. Normoventilation was instituted in all patients. MAP increased (P < 0.001) only with CO2 pneumoperitoneum. Minute volume of ventilation had to be increased by 35% with CO2 insufflation. PaCO2 was significantly higher (P < 0.05) for 3 h postoperatively in the control group. Diuresis was less (P < 0.01) and U-NAG levels (P < 0.01) higher in the control group. The pHi decreased after induction of pneumoperitoneum up to three hours postoperatively and remained intact in the retractor group. We conclude that the retractor method for laparoscopic cholecystectomy ensures stable hemodynamics, prevents respiratory acidosis, and provides protection against biochemical effects, which reveal the renal and splanchic ischemia caused by CO2 insufflation. IMPLICATIONS: A mechanical retractor method (gasless) was compared with conventional CO2 pneumoperitoneum for laparoscopic cholestectomy. The gasless method ensured stable hemodynamics, prevented respiratory acidosis, and provided protection against the renal and splanchnic ischemia seen with CO2 pneumoperitoneum.

Adult↗
PubMed1996

Abdominal wall stability: a comparison of the optical trocar with a reusable laparoscopic trocar.

The principal reason for employing an optical trocar has been described by Kaali.' The potential clinical benefits of a visually directed trocar entry system have been identified in a follow-up clinical series. 2 Current experience with the commercially developed Endopath Opt.iview" trocar has suggested an ad- ditional surgical advantage through an enhanced abdominal wall stability of the trocar sheath. The purpose of the current investigation was to determine whether or not this clinical observation could be mechanically quantified.

Journal Article↗
PubMed2000

The soft tissue response to contaminated and cleaned titanium surfaces using CO2 laser, citric acid and hydrogen peroxide. An experimental study in the rat abdominal wall.

The soft tissue response to clinically retrieved and decontaminated cover screws was evaluated in a rat model. The cover screws were cleaned by using citric acid, sterile water, hydrogen peroxide and CO2 laser alone or with a combination of these. In addition, decontaminated but not cleaned and unused cover screws were used as negative and positive controls, respectively. After cleaning the cover screws were implanted in the abdominal wall of the rat for 6 weeks. The thickness of the fibrous capsule and the number of macrophages within the capsule were measured by means of light microscopical morphometry. As compared to the negative control, CO2 laser on dry surface, CO2 laser + hydrogen peroxide and the positive control had statistically significant thinner fibrous capsules. As compared to the positive, only laser alone resulted in a similar tissue response. It is concluded that CO2 laser used alone or in combination with hydrogen peroxide may be used clinically for sufficient decontamination of titanium surfaces.

Abdomen↗
PubMed1994

Small-bowel disorders and abdominal wall hernia in the elderly patient.

Small-bowel disorders in the elderly, whether primary or secondary, are characterized by vague complaints and misleading signs and symptoms. Diagnosis is frequently unclear, and delays in initiating treatment often result in loss of tissue and life. Successful management is possible, with an increased awareness of the subtleties of presentation of these disorders and an aggressive diagnostic response to initial complaints. Abdominal wall hernias in the elderly, on the other hand, usually present no diagnostic dilemma. However, these hernias are frequently neglected by both the patient and the physician. Emergency repair for incarceration is associated with excessive mortality and morbidity. Expeditious elective repair can be performed with minimal risk and therefore is indicated in nearly all cases.

Aged↗
PubMed1997

[Plastic surgery of the abdominal wall in laparocele in a patient with previous kidney transplant].

The authors report the case of a patient undergoing kidney transplant from a non-related but compatible living donor who subsequently developed a voluminous incisional hernia affecting almost the entire small intestine in the right iliac fossa, the site of earlier surgery. After having analysed the problems involved when a transplant patient requires further surgery owing to the chronic administration of drugs, the authors describe the case. The patient was treated using the insertion of a prolene graft and remodelling the abdominal wall in correspondence with the lower quadrants using abdominoplasty without repositioning the umbilicus.

Abdominal Muscles↗
PubMed1993

Abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarcinoma of the colon. Report of a case.

PURPOSE: To report an unusual mode of colorectal carcinoma recurrence after laparoscopic-assisted right hemicolectomy. METHODS: Retrospective case review. RESULTS: Laparoscopic-assisted colectomy has been shown in a variety of settings to be safe and technically feasible. The question of its efficacy in treating colorectal carcinoma remains uncertain. We report a case of a 71-year-old male who presented with a trocar site abdominal wall recurrence 10 months after a laparoscopic-assisted right hemicolectomy. To our knowledge, this represents the first such reported case in the literature. CONCLUSION: Questions surrounding the efficacy of laparoscopic colectomy in eradicating colorectal carcinoma support the need for rigorous prospective study of this new technique.

Abdominal Muscles↗
PubMed1994

Does the frequency of paracolostomy hernias depend on the position of the colostomy in the abdominal wall?

The aim of this study was to determine the rate of paracolostomy hernia in relation to transrectal or pararectal position of a colostomy. Fifty-four consecutive patients who had undergone an abdomino-perineal excision for rectal neoplasia were studied. The location of the colostomy was assessed by physical examination. Computerised Tomography (CT) scanning was used in the cases where its anatomical position remained in doubt. The colostomy was in a pararectal position in 29 (54%), while in 25 (46%) it was transrectal. CT was necessary to determine the location of the colostomies in 9 cases (16%), eight of which had a parastomal hernia. The colostomy was pararectal in 15 (52%) of the 26 patients who had a paracolostomy hernia, and in 14 (48%) of the 28 patients without a paracolostomy hernia. No statistically significant correlation was found between the presence of a parastomal hernia and the position of the stoma in the abdominal wall.

Abdominal Muscles↗
PubMed1984

The muscles of the abdominal wall: a new functional approach with anatomoclinical deductions.

The basic functional anatomy of muscle can be investigated by histochemical analysis of the muscle fibers and kinesiologic electromyography. The results of these techniques lead to anatomoclinical deductions based on the structure of muscle. Histochemical analysis of the striated fibers of a given muscle shows the existence of three functionally different populations of fibers. The relative abundance of each category of muscle fibers (expressed as a percentage) demonstrates the basic function of the muscle. The investigation of muscle function by kinesiologic electromyography shows that there are three categories of motor activity in the course of movement. These different types of motor activity are dependent upon the muscle fibers which display different physiological features, especially with respect to their contraction time. These two investigative techniques, the overall results of which are concordant, were applied to the study of the function of the muscles of the abdominal wall and led to the following anatomo-clinical deduction: tonico-postural motor activity is predominant in the rectus abdominis and flat abdominal muscles. Kinesiologic electromyography also allowed to demonstrate the functional development of these muscles according to the age, sex, corpulence and physical activity of the subjects studied.

Abdominal Muscles↗
PubMed2000

Ultrastructural alterations of polytetrafluoroethylene prostheses implanted in abdominal wall provoked by infection: clinical and experimental study.

Infection of an expanded polytetrafluoroethylene (ePTFE) prosthesis after implant is a major drawback of its use in current clinical practice. The aim of the present study was to compare the behavior of such prostheses implanted into New Zealand rabbits with that of prostheses infected after clinical implant. Experimental implants of ePTFE Soft Tissue Patch were performed to repair defects (7 x 5 cm) created in the abdominal wall of 10 rabbits. Prior to implant the prostheses were contaminated with Staphylococcus aureus. Five animals implanted with noncontaminated ePTFE prostheses served as controls. All the animals were sacrificed at 30 days after implant. For the clinical study, specimens were taken from three ePTFE implants that had been found to be infected after intervention. The clinical and experimental implant specimens were processed for light microscopy and scanning electron microscopy. Macroscopic and microscopic examination of experimental and clinical implants revealed alterations to the ePTFE structure, such as areas of fragmentation, fracture lines, and detachment of fine layers of ePTFE that harbored numerous Staphylococcus colonies. Neoformed tissue around contaminated implants was arranged more loosely, and on occasion large spaces between fibers gave rise to an "unknitted" appearance with respect to the control implants. It may be concluded that microporous ePTFE prostheses show similar behavior following experimental or clinical implant in the presence of infection. Irreversible changes to the structure of the prosthesis are produced owing to colonization of the biomaterial by microorganisms, which in most cases necessitates total replacement of the prosthesis.

Abdominal Muscles↗
PubMedDate not supplied

A double-blind comparison of the abdominal wall relaxation produced by epidural 0.75% ropivacaine and 0.75% bupivacaine in gynecologic surgery.

BACKGROUND AND OBJECTIVES: Ropivacaine is a long-acting local anesthetic agent with similar potency to that of bupivacaine when administered for epidural anesthesia. Ropivacaine, however, may be less cardiotoxic than bupivacaine. Epidural bupivacaine and ropivacaine have been shown to be equally effective in providing sensory block for lower extremity surgery, but they have not been compared for their ability to produce abdominal wall relaxation. METHODS: Sixty-six American Society of Anesthesiologists I-III women, 18-70 years old undergoing elective gynecologic surgery were studied in a randomized, double-blind manner after giving informed consent in an institutionally approved protocol. Thirty-four patients received a single epidural injection of 20 ml 0.75% bupivacaine at the L2-L3-L4 interspace and 32 patients received 20 ml 0.75% ropivacaine in a similar manner. Sensory block was tested with pinprick; motor block with a modified Bromage scale, rectus abdominis muscle (RAM) test and surgeon satisfaction. Statistical analysis was performed using the SigmaStat for Windows computer software. Parametric data were analyzed with Student's t-test, while nonparametric data was analyzed using the Mann-Whitney rank sum test. RESULTS: Results are expressed as mean +/- SD. Times to maximal sensory block and peak sensory level achieved were similar in both groups. However, time to complete sensory regression was significantly longer with bupivacaine than ropivacaine (458 +/- 77 vs. 404 +/- 62 minutes, P < .03). Bupivacaine lower extremity motor block onset was significantly faster than ropivacaine (9 +/- 3 vs. 12 +/- 3 minutes, P < .0013). Time to maximum lower extremity motor block was significantly shorter with bupivacaine than ropivacaine (28 +/- 12 vs. 40 +/- 15 minutes, P < .0234). Duration of lower extremity motor block was significantly longer with bupivacaine than ropivacaine (371 +/- 97 vs. 310 +/- 65 minutes P < .069). There was no significant difference between the two groups for changes in RAM scores or the time to achieve those changes. Maximum motor block scores using the modified Bromage score and surgeon satisfaction with operating conditions also did not demonstrate a significant difference between the two groups. In one instance (with ropivacaine), anesthesia was judged clinically inadequate despite evidence of bilateral epidural anesthesia. CONCLUSIONS: Both 0.75% ropivacaine and 0.75% bupivacaine provide adequate surgical anesthesia for lower abdominal surgery when administered epidurally. However, lower extremity motor block with ropivacaine is significantly shorter and of slower onset and sensory block shorter at these concentrations.

Abdominal Muscles↗
PubMed1995

Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging.

Herniography is an accurate means of identifying groin hernias when the clinical diagnosis is uncertain. Its role in evaluation of other types of ventral hernias is less clear; however, with minor modifications in technique, herniography is also useful in these cases. This article reviews the technique of herniography, normal variations in anatomy, and interpretation of herniograms of the groin and anterior abdominal wall on the basis of 72 patients studied over 3 1/2 years. Herniography is also compared with cross-sectional imaging techniques. Inguinal and femoral hernias are best shown and classified with herniography. Ventral hernias are well demonstrated by both herniography and cross-sectional imaging; however, herniation of only fat and supine imaging may lead to misdiagnosis with computed tomography or ultrasound. Spigelian hernias are probably best depicted with cross-sectional imaging. Diagnostic pitfalls of herniography are reviewed, including the need for obtaining postexercise radiographs, oblique radiographs, and tangential radiographs.

Female↗