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PubMed2005

Anisakis infestation: a case of acute abdomen mimicking Crohn's disease and eosinophilic gastroenteritis.

Anisakiasis is a rare parasitic disease transmitted to humans by the ingestion of raw fish, which can initially present with acute abdomen. We report the case of a man, a habitual consumer of raw fish, who underwent surgery for acute abdomen, initially attributed to Crohn's disease and then later interpreted as eosinophilic enteritis. Only the subsequent careful histological examination of the surgical specimen, revealing full thickness eosinophilic infiltrate, generally typical of infestation, led to the detection of Anisakis simplex larva. In cases of acute abdomen, in the presence of a positive history of raw fish ingestion, it is therefore reasonable to consider the possibility of anisakiasis.

Abdomen, Acute↗
PubMed2005

Magnetic material in head, thorax, and abdomen of Solenopsis substituta ants: a ferromagnetic resonance study.

Ferromagnetic resonance temperature dependence is used to study the magnetic material in smashed head, thorax, and abdomen of Solenopsis substituta ants. These three body parts present the five lines previously observed in other social insects. The magnetic material content is slightly higher in heads with antennae than in abdomen with petiole. Isolated nanoparticle diameters were estimated as 12.5 +/- 0.1 and 11.0 +/- 0.2 nm in abdomen with petiole and head with antennae, respectively. The presence of linear chains of these particles or large ellipsoidal particles are suggested. A bulk-like magnetite particle was observed in the thorax. The Curie-Weiss, the structural-electronic and ordering transition temperatures were obtained in good agreement with those proposed for magnetite nanoparticles.

Abdomen↗
PubMed2000

Examination of the chin or lower abdomen only for the prediction of hirsutism.

OBJECTIVE: To test the hypothesis that scoring terminal hair growth on only the chin or abdomen can serve as a reliable predictor for hirsutism. DESIGN: A prospective observational study. PATIENT(S): Six hundred and ninety-five consecutive hyperandrogenic women seen between June 1987 and December 1997. MAIN OUTCOME MEASURE(S): All hirsutism exams were performed by one examiner. Hirsutism was scored using a modification of the Ferriman-Gallwey (F-G) method. An F-G score of > or = 8 defined hirsutism. RESULT(S): Of the 695 women examined 352 (50.1%) had hirsutism scores of 8. Thirty percent (79 of 344) of women who had an F-G score of <8 had previously underwent electrology. If either the chin or lower abdomen hair growth score was > or = 2, the sensitivity was 100% for the prediction of hirsutism, although the specificity was 27%. The positive predictive value (PPV) for hirsutism using a hair score of > or = 2 at either of these sites was 58%. CONCLUSION(S): A hair growth score of > or = 2 on the chin or lower abdomen only was found to be a highly sensitive predictor for hirsutism. However, because of its very low PPV, this screening method is virtually useless in populations where the hirsutism frequency is expected to be low, about 5%. However, this screening method for the detection of hirsutism would be useful for the study of high-risk populations with an expected hirsutism prevalence of >20% (e.g., family studies).

Abdomen↗
PubMed1995

Acute abdomen in the hemodialysis patient population.

BACKGROUND: The cause and frequency of the acute abdomen in patients undergoing hemodialysis are not well reported. Previous studies associate bowel infarction with hemodialysis, but dialysis generally is not implicated as a risk factor for mesenteric ischemia. METHODS: The records of 567 patients undergoing long-term hemodialysis during the period from July 1988 to June 1993 were retrospectively reviewed. RESULTS: Twelve patients (2.1% of the hemodialysis population) were admitted with acute abdominal pain or sepsis. They were demographically no different than their counterparts who did not have an acute abdomen. The final diagnoses were bowel infarction in 11 patients and acute pancreatitis in one. Principal areas of involvement were equally divided between large and small intestine and were due to nonocclusive mesenteric ischemia in all cases. Six patients had an occluded hemodialysis fistula on admission, suggesting hypotension and/or hypovolemia as a possible etiologic factor. Overall, mortality and major morbidity rates were 50% and 25%, respectively. CONCLUSIONS: An acute abdomen is a relatively uncommon problem in the hemodialysis population but is associated with a high mortality. Mesenteric infarction is the most common cause and should be the presumptive diagnosis until proven otherwise.

Abdomen, Acute↗
PubMed1996

Cost-effective evaluation and management of the acute abdomen.

1. Managed care gate-keeper financial responsibility must be balanced with specialist diagnostic and therapeutic responsibility to maximize cost effectiveness and quality of medical service. 2. Cost in health care is closely tied to length of stay and operating room time; extremes of patient age are associated with increased costs. 3. Through years of training and subsequent experience, surgeons are best qualified to direct work-up of patients with an acute abdomen, especially when the work-up requires costly imaging (e.g., CT scan, ultrasonography, angiography). 4. Cost is increased when the surgeon is not involved early in cases of acute abdomen. 5. Surgeons must be willing to enter the evaluation phase of the patient with an acute abdomen patient early and follow during the observation period to best reduce unnecessary laboratory work or tests. 6. Health care teams willing to implement pathways and then document the effect such pathways exert will be most successful in assessing new technologies' cost effectiveness.

Abdomen, Acute↗
PubMed1998

Laparoscopy for the acute abdomen in the postoperative urologic patient.

OBJECTIVES: Exploratory laparotomy offers the greatest diagnostic accuracy of intra-abdominal pathologic processes, but can be associated with significant morbidity. Laparoscopy provides diagnostic capabilities equivalent to that of open exploration, but with potentially less morbidity. We present 3 cases in which laparoscopy was used to diagnose and manage urologic patients with an acute abdomen in a postoperative period. METHODS: Three patients underwent laparoscopy between 1 and 14 days postoperatively for an acute abdomen (fever, elevated white blood cell count, and peritoneal signs). The initial procedures included a pubovaginal sling repair with fascia lata, endoscopic placement of a percutaneous gastrostomy tube, and a laparoscopic ureterolithotomy for a distal stone. RESULTS: In each of the 3 patients laparoscopy revealed misplacement or malfunction of a previously placed tube. In all cases, the patient was managed laparoscopically without the need for laparotomy. CONCLUSIONS: These cases demonstrate the feasibility of laparoscopy to provide diagnostic and therapeutic solutions to postoperative urologic patients presenting with an acute abdomen.

Abdomen, Acute↗
PubMed1992

Ascariasis mimicking an acute abdomen.

Infection with the roundworm Ascaris lumbricoides is common in children and may mimic an acute abdomen. The cases of two pediatric patients who presented to the emergency department with signs and symptoms of a surgical abdomen are presented to highlight the presentation of this infection. Both cases were diagnosed by physical examination and radiographs and were treated successfully without surgical intervention. These cases illustrate the need for heightened awareness by the emergency physician of ascariasis in the differential diagnosis of acute abdomen.

Abdomen, Acute↗
PubMed1999

"Three-dimensional tumescent liposculpture" of the abdomen, waist, and flanks.

Treating the entire area as a cosmetic unit is the best approach to tumescent liposculpture of the abdomen, waist, and flanks. This "Three-Dimensional Tumescent Liposculpture" procedure is performed under tumescent local anesthesia with optional intraoperative external ultrasound. Areas treated are the abdomen, waist, flanks, and infrascapular fat pad if indicated. Postoperatively, patients show a flatter abdomen, a smaller and better-defined waist (the "Cook waist"), reduction of unsightly bulges, and a smoother, better proportioned and more attractive overall contour. Patient recovery is rapid with minimal complications.

Abdomen↗
PubMed1999

Liposuction of the abdomen. The basics.

As one of the most frequent regions treated by liposuction in both men and women, the abdomen presents unique learning opportunities for the liposuction surgeon. Because of anatomic variation, the upper abdomen is more fibrous than the lower abdomen, requiring a slightly different approach to achieve optimal fat removal. The periumbilical area also provides unique challenges for the operator and care must be taken to avoid leaving a ring of residual fat. Potentially excellent skin retraction in the area, combined with relatively aggressive fat removal can lead to dramatic results including, in some cases, significant contraction of a long-standing panniculus. In this article, the basic techniques and potential pitfalls of abdominal liposuction are presented in detail.

Abdomen↗
PubMed1999

Informed consent and general surgeons' attitudes toward the use of pain medication in the acute abdomen.

To determine general surgeons' attitudes about the use of pain medications in the acute abdomen, a questionnaire was mailed to all practicing general surgeons in Iowa. The questionnaire sought to determine the frequency with which pain medications were administered either before informed consent was obtained or before the patient with an acute abdomen was examined, and, in cases when pain medications were withheld, the reasons for withholding. The response rate was 72% (131 of 182). Seven percent of patients with an acute abdomen received pain medications by a general surgeon before being seen and 22% received pain medication by another physician in the emergency department (ED). Fifty-three percent of general surgeons responded that they believe pain medications preclude a patient from signing a valid informed consent; 78% reported that concerns about informed consent enter into their decision to withhold pain medications. Sixty-seven percent agreed that pain medications interfere with diagnostic accuracy, and 82% consider diagnostic accuracy when deciding to withhold pain medication.

Abdomen, Acute↗
PubMed2001

Influence of pneumoperitoneum and patient positioning on preload and splanchnic blood volume in laparoscopic surgery of the lower abdomen.

STUDY OBJECTIVE: To determine the hemodynamic effects of pneumoperitoneum and patient positioning during laparoscopic surgery of the lower abdomen. DESIGN: Prospective study. SETTING: University-affiliated medical center. PATIENTS: 10 ASA physical I and II female patients scheduled for laparoscopic surgery of the lower abdomen. INTERVENTIONS: Patients were anesthetized with propofol and an alfentanil infusion, then intubated, and normoventilated. MEASUREMENTS: After intubation, a transesophageal multiplane probe for measurements of right (RVESA) and left (LVESA) ventricular end-systolic and end-diastolic areas (RVEDA and LVEDA) and ejection fraction area (RVEFa, LVEFa) was introduced; heart rate (HR) and noninvasive blood pressure (BP) were recorded every minute. Ventilation was not changed during the measurements. A transvaginal ultrasound probe was inserted to measure the diameter of the common iliac vein. Measurements were performed 15 minutes after induction of anesthesia and while patients were in the supine position (P 0), 10 minutes after CO(2) insufflation to 10 mmHg IA pressure (P 10), 10 minutes after a further increase to 15 mmHg (P 15), 10 minutes after 20 degrees Trendelenburg (P 15 T), and 20 degrees reverse Trendelenburg positions (P 15 RT). Data are shown as medians, 25th to 75th percentiles, and comparisons between P 0, P 10, P 15, and P15 T were made with the Friedman test, followed by Wilcoxon test, when significant. Data at P 15 T, P 15 RT, and P 15 were compared using the Wilcoxon test, with a p-value < 0.05 regarded as significant. MAIN RESULTS: Pneumoperitoneum at 10 mmHg abdominal pressure caused a significant increase of LVESA by 78% (RVESA: 61%) and LVEDA by 48.5% (RVEDA: 45%). The diameter of the common iliac vein was decreased by 6%. A further increase of abdominal pressure to 15 mmHg led to an additional increase of 20% (LVESA) and 17% (LVEDA). Mean arterial pressure increased by a significant 7% at P 10, decreasing subsequently by 5% at P 15. The Trendelenburg position did not alter any hemodynamic findings. Reverse Trendelenburg position, however, caused a significant LVEDA-and RVEDA-decrease by 18% and 27%, respectively, and an increase in the diameter of the common iliac vein by 22%. The LVEFa and RVEFa decreased significantly after abdominal CO(2) insufflation by 18% each (P 10) without further change. CONCLUSIONS: The lithotomy position and subsequent pneumoperitoneum increased preload, probably as a result of blood shifting from the abdomen to the thorax by compression of splanchnic vessels caused by the pneumoperitoneum. Careful fluid management, maintaining low abdominal pressure, and use of the reverse Trendelenburg position are favored to prevent adverse hemodynamic effects in laparoscopic surgery.

Abdomen↗
PubMed1999

Phenotypic plasticity of abdominal pigmentation in Drosophila kikkawai: multiple interactions between a major gene, sex, abdomen segment and growth temperature.

Drosophila kikkawai is known to be polymorphic for a single autosomal locus controlling abdomen pigmentation in females. Two strains homozygous at this locus (Abdomen pigmentation, Abp) were established from a polymorphic Indian population: one was homozygous (DD) for the dark allele, the other (LL) for the light allele. A Mendelian analysis of crosses at 25 degrees C confirmed the occurrence of a major locus, with dominance of the D allele. Phenotypic variation of pigmentation according to growth temperature was then analyzed in DD and LL male and female flies, and in reciprocal F1. A slight difference was found between reciprocal F1--females from a dark mother were darker but not at all temperatures. In females, the D allele exhibited an antero-posterior gradient of increasing expression from segment 2-7, with dominance over L and an increased expression at low temperatures. In males, abdomen pigmentation was uniformly light in segments 2-5, the D allele being repressed by the sex genotype. In segment 6, the D allele was expressed but only at low temperatures, and was either recessive to L or codominant. Phenotypic plasticity that is, amount of change induced by different growth temperatures, was variable according to genotype and segment. It always corresponded to a darkening of the fly at lower temperatures, but was generally much less than in D. melanogaster. In D. kikkawai, climatic adaptation might occur more by changing the frequency of the D allele than by phenotypic plasticity.

Abdomen↗
PubMed1980

Inhibition of artificial lung metastases in mice by pre-irradiation of abdomen.

A phenomenon by which pre-irradiation of the abdomen of mice reduced the lung-colony-forming efficiency of i.v.-injected tumour cells is described. The extent of lung-colony inhibition was shown to depend on both the dose and timing of abdominal irradiation. The maximum inhibitory effect was obtained when mice received 1200 rad gamma-irradiation to the abdomen 5--7 days before tumour-cell challenge, but there was no effect when abdominal irradiation was given 1 or greater than or equal to 14 days before challenge, or when radiation doses were less than 600 rad. In mice less than 3 weeks old, the effect was much less marked than in adults. The target tissue which, when irradiated, exerted the inhibitory influence on lung-colony formation was located in the ventral half of the abdomen in all 4 quadrants, and was probably gut. Radioactively labelled tumour cells were arrested normally in the lungs of irradiated mice, but were cleared more rapidly without evidence of sequestration in the irradiated gut. The most plausible mechanism seems to be that irradiation of the gut induces the production of natrual killer cells with anti-tumour activity, though this has not been conclusively established.

Abdomen↗
PubMed1983

Speech production with flaccid paralysis of the rib cage, diaphragm, and abdomen.

Anteroposterior diameter changes of the rib cage and abdomen were measured during breathing maneuvers and utterance activities in an adult subject with flaccid paralysis of the rib cage, diaphragm, and abdomen. Data were charted to solve for lung volume, volumes of the rib cage and abdomen, chest wall configuration, and inferred neck muscle actions. Free breathing was accomplished through an alternate waxing and waning of neck muscle drive or through step-wise glossopharyngeal pumping. Connected speech was performed in breath groups begun by neck gestures that "cocked" the breathing apparatus and stored recoil energy in it for use during ensuing expirations. Some breath groups were also extended through intermittent glossopharyngeal pumping. Connected speech was characterized by frugal control of the air supply through compensatory adjustments in the larynx and upper airway. Compensations involved in the breathing maneuvers and utterance activities are described, and consideration is given to two understandings--the human potential for functional restoration and the clinical evaluation and management of individuals with neuromuscular impairment.

Abdomen↗
PubMed2000

Primary omentitis as a cause of acute abdomen.

A 5-year-old boy admitted with localized lower abdominal pain and tenderness simulating acute appendicitis underwent surgery, and primary omentitis without appendicitis or other cause of an acute abdomen was diagnosed. The absence of other concomitant signs and symptoms of acute abdomen was remarkable. This is the first case of primary omentitis as a cause of acute abdomen in the English-language literature.

Abdomen, Acute↗
PubMed1985

[Sonographically guided percutaneous fine needle puncture of space occupying processes of the abdomen and retroperitoneum].

In the past four years percutaneous ultrasonically guided fine needle aspiration biopsies of space occupying lesions of the abdomen and retroperitoneum wee performed on 180 patients. There were 71 aspirations of cystic and 169 aspirations of solid lesions. Amongst the latter pancreas was first with 67 followed by the liver with 58, the kidney with 31 and other organs of the abdomen with 13 aspirations. No diagnostic material was obtained in 27 percent of aspirations of the pancreas and in 18 percent of kidney aspirations. The cytological diagnoses were right positive in 88 percent and false negative in 12 percent. There was no false positive result. 5 pseudocysts of the pancreas wee aspirated therapeutically, in one case 8 times subsequently. The only complication of all aspirations was a pancreatitis which healed under conservative treatment. There were 4 therapeutic aspirations of kidney cysts. 860 ml urine was drained from the largest cyst. We conclude that percutaneous ultrasonically guided fine needle aspiration biopsy is an easy, safe and painless method of diagnosis of space occupying lesions of the abdomen and retroperitoneum. The same applies to therapeutic aspirations of cysts of the pancreas and kidney.

Abdomen↗
PubMed2004

Torsion of a wandering spleen presenting with acute abdomen: a case report.

Wandering spleen is a rare condition characterized by increased splenic mobility due to the absence or laxity of its suspensory ligaments that may present as acute abdomen when it is twisted on its pedicle. Herein we report a case of torsion of a wandering spleen in a 17-year-old male patient with communicating hidrocephalus and ventriculoperitoneal shunt. The patient presented with suspicious clinical findings of acute abdomen, a laparotomy was performed and the infarcted spleen was removed. Although wandering spleen is a rare clinical entity, the possibility of torsion should be kept in mind in the differential diagnosis of acute abdomen.

Abdomen, Acute↗
PubMed2005

Prospective assessment of quality of life in ovarian cancer patients receiving whole abdomen hyperthermia and liposomal doxorubicin.

PURPOSE: Prospective assessment of quality of life (QoL) in patients with refractory, residual or recurrent ovarian cancer receiving whole abdomen hyperthermia and intravenous liposomal doxorubicin chemotherapy. METHODS: Treatment consisted of six cycles of intravenous liposomal doxorubicin at 40 mg m2 followed by whole abdomen hyperthermia with each cycle delivered every 4 weeks. QoL assessment was performed at baseline, prior to each cycle of chemotherapy and every 3 months during follow-up using self-administered questionnaires. Global QoL was rated on a seven-point scale and specific domains of QoL, disease related symptoms and treatment related toxicity were rated on a four-point scale. RESULTS: Thirty-two patients were enrolled on the study and 129 QoL questionnaires were completed. Average age was 57.9 (range 45-76); nine patients had persistent and 23 recurrent disease. Ten patients completed six cycles of therapy. Three patients returned follow-up surveys. Subjects rated their overall QoL and health at baseline as above average with mean scores 5.10 (95% CI=4.62-5.58) and 4.66 (95% CI=4.23-5.08), respectively. No significant change in overall QoL was found between baseline and cycles 4-6 of therapy. Mean ratings of overall health and subject reported differences in QoL between cycles were not significantly changed during therapy. Limited follow-up data were available, but scores suggest possible improvement in QoL for patients completing all therapy. Subjects rated the greatest negative impact on QoL in areas of role functioning and social functioning, where the mean (SD) over all cycles was 2.00 (0.67) and 1.98 (0.70), respectively. For physical symptoms, fatigue and sleep disturbance had the most negative impact on QoL with means (SD) of 2.26 (0.62) and 1.91 (0.70). The moderate treatment related toxicity seen in this study did not significantly impact patients reported QoL. CONCLUSIONS: Patients with unfavourable ovarian cancer responding to intravenous liposomal doxorubicin and whole abdomen hyperthermia maintained above average QoL during therapy. Limited data on patients completing protocol therapy demonstrated possible improvement in QoL.

Abdomen↗