ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010
I. M. SAADAWY
Background: This double-blinded study aimed at evaluating and comparing the effects of magnesium and lidocaine on pain, analgesic requirements, bowel function, and quality of sleep in patients undergoing a laparoscopic cholecystectomy (LC). Methods: Patients were randomized into three groups (n=40 each). Group M received magnesium sulfate 50 mg/kg intravenously (i.v.), followed by 25 mg/kg/h i.v., group L received lidocaine 2 mg/kg i.v., followed by 2 mg/kg/h i.v., and group P received saline i.v. Bolus doses were given over 15 min before induction of anesthesia, followed by an i.v. infusion through the end of surgery. Intraoperative fentanyl consumption and averaged end-tidal sevoflurane concentration were recorded. Abdominal and shoulder pain were evaluated up to 24 h using a visual analog scale (VAS). Morphine consumption was recorded at 2 and 24 h, together with quality of sleep and time of first flatus. Results: Lidocaine or magnesium reduced anesthetic requirements (P<0.01), pain scores (P<0.05), and morphine consumption (P<0.001) relative to the control group. Lidocaine resulted in lower morphine consumption at 2 h [4.9 ± 2.3 vs. 6.8 ± 2.8 (P<0.05)] and lower abdominal VAS scores compared with magnesium (1.8 ± 0.8 vs. 3.2 ± 0.9, 2.2 ± 1 vs. 3.6 ± 1.6, and 2.1 ± 1.4 vs. 3.3 ± 1.9) at 2, 6, and 12 h, respectively (P<0.05). Lidocaine was associated with earlier return of bowel function and magnesium was associated with better sleep quality (P<0.05). Conclusion: I.v. lidocaine and magnesium improved post-operative analgesia and reduced intraoperative and post-operative opioid requirements in patients undergoing LC. The improvement of quality of recovery might facilitate rapid hospital discharge. [source]

Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2008
Elizabeth K Speliotes
Abstract Background and Aims:, Fatty liver is the hepatic manifestation of obesity, but community-based assessment of fatty liver among unselected patients is limited. We sought to determine the feasibility of and optimal protocol for quantifying fat content in the liver in the Framingham Heart Study using multidetector computed tomography (MDCT) scanning. Methods:, Participants (n = 100, 49% women, mean age 59.4 years, mean body mass index 27.8 kg/m2) were drawn from the Framingham Heart Study cohort. Two readers measured the attenuation of the liver, spleen, paraspinal muscles, and an external standard from MDCT scans using multiple slices in chest and abdominal scans. Results:, The mean measurement variation was larger within a single axial computed tomography (CT) slice than between multiple axial CT slices for the liver and spleen, whereas it was similar for the paraspinal muscles. Measurement variation in the liver, spleen, and paraspinal muscles was smaller in the abdomen than in the chest. Three versus six measures of attenuation in the liver and two versus three measures in the spleen gave reproducible measurements of tissue attenuation (intraclass correlation coefficient [ICCC] of 1 in the abdomen). Intrareader and interreader reproducibility (ICCC) of the liver-to-spleen ratio was 0.98 and 0.99, the liver-to-phantom ratio was 0.99 and 0.99, and the liver-to-muscle ratio was 0.93 and 0.86, respectively. Conclusion:, One cross-sectional slice is adequate to capture the majority of variance of fat content in the liver per individual. Abdominal scan measures as compared to chest scan measures of fat content in the liver are more precise. The measurement of fat content in the liver on MDCT scans is feasible and reproducible. [source]

HELICOBACTER INFECTION IN CHILDREN WITH APPENDICITIS AND LACTOSE INTOLERANCE

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
Eva J. Soelaeman
Helicobacter pylori eradication has been debated. Most investigators do not recommended treating the infection except in severe case. We report a unique case: H. pylori infection with appendicitis and lactose intolerance. Case report: A 6 year old girl was brought to children and maternity Hospital Harapan Kita due to abdominal pain and vomiting. She had 6- month history of epigastric pain. In the past 2 days, she suffered from abdominal pain arround Mc. Burney area. On physical examination, she was in pain. Her weight was 19 Kg. Vital signs were normal. Findings in heart, lung and extremities were also normal. Abdomen: severe pain in the epigastric and Mc. burney area.Laboratory investigations showed hemoglobin 12 g/dl, leukocyte 12800/ul. Platelets 289000/ul. Bleeding and clotting time were normal. Abdominal ultrasonography revealed inflammation of appendix with 9-mm diameter. Stool examination was normal.Appendectomy was done at the same time with esofagogastroduodenoscopy (EGD). On EGD, we found moderete anthral gastritis. On histopathological examination, we found H. pylori at antral of the stomach. Breath hydrogen test was positive. After H. pylori eradication and milk avoidance, abdominal pain has never occurred. Conclusion: Abdominal: pain is not specific for H. pylori infection. The pain caused by many diseases including H. pylori infection. In our case, we can control abdominal pain by H. pylori eradication. [source]

Initial feasibility of a multi-station high resolution three-dimensional dark blood angiography protocol for the assessment of peripheral arterial disease

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2009
Georgeta Mihai PhD
Abstract Purpose To evaluate the feasibility of a multi-station three dimensional (3D) T1-weighted turbo spin echo (TSE) dark-blood Sampling Perfection with Application optimized Contrasts using different flip angle Evolution sequence (T1w-SPACE), to assess aorta, iliac, and superficial femoral (SFA) arteries (inflow vessels) by comparing it with a multi-station contrast enhanced MR angiography (CE-MRA) with identical resolution. Materials and Methods A total of 6 volunteers and 14 peripheral arterial disease (PAD) patients were included in the study. Abdominal and thigh T1w-SPACE and lower leg time-resolved MRA (TR-MRA) with low dose contrast were followed by 3-station CE-MRA. Quantitative measurements of lumen area at 17 locations from T1w-SPACE and CE-MRA were obtained. Additionally, vessel wall areas at the same locations were obtained from the T1w-SPACE images. Results Quantitative comparison of lumen areas with T1w-SPACE and CE-MRA revealed strong correlation between the two techniques and strong inter-observer agreement for each of the two imaging methods (r > 0.9; P < 0.001). Localized vessel wall area measurements obtained in PAD patients were significantly greater compared with those obtained in normal volunteers (mean difference 43.75 ± 12.46 mm2; P < 0.001). Stenosis severity obtained from T1w-SPACE localized measurements showed significant arterial area stenosis in PAD patients. Conclusion T1w-SPACE imaging of inflow vessels is feasible, and in addition to CE-MRA has the ability to assess atherosclerotic plaque and vascular remodeling. J. Magn. Reson. Imaging 2009;30:785,793. © 2009 Wiley-Liss, Inc. [source]

Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal pain

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009
K. THAKKAR
Summary Background, Abdominal pain is the most common indication for oesophagogastroduodenoscopy (OGD) in children. However, existing studies examining the diagnostic outcomes of OGD in children with abdominal pain are limited. Aim, To examine the diagnostic yield of OGD with biopsy in the evaluation of abdominal pain and to describe the endoscopic and histological findings in patients undergoing OGD for abdominal pain of unclear aetiology. Methods, We performed a retrospective cross-sectional cohort study in children under 18 years of age who had OGD for the primary indication of abdominal pain, at Texas Children's Hospital and Children's Hospital of The King's Daughters from 1 January 2002 to 30 June 2005. Results, Overall, OGD was diagnostic in 454 (38.1%) of the 1191 procedures, including reflux oesophagitis (23%, n = 271), Helicobacter pylori infections (5%, n = 55), peptic ulcers (3%, n = 32), eosinophilic oesophagitis (2%, n = 25), celiac disease (1%, n = 9) and Crohn's disease (0.5%, n = 7). Male gender, older age, elevated C-reactive protein and vomiting were associated with increased diagnostic yield. Conclusions, Our findings suggest that OGD is valuable for the evaluation of chronic abdominal pain in children, with a diagnostic yield of 38%. The majority of alarm symptoms and routine laboratory tests are not significantly associated with diagnostic yield. [source]

Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2005
A. P. S. Hungin
Summary Background :,The impact of irritable bowel syndrome, a gastrointestinal motility disorder, is underestimated and poorly quantified, as clinicians may see only a minority of sufferers. Aim :,To determine the prevalence, symptom patterns and impact of irritable bowel syndrome in the US. Methods :,This two-phase community survey used quota sampling and random-digit telephone dialling (screening interview) to identify individuals with medically diagnosed irritable bowel syndrome or individuals not formally diagnosed, but fulfilling irritable bowel syndrome diagnostic criteria (Manning, Rome I or II). Information on irritable bowel syndrome symptoms, general health status, lifestyle and impact of symptoms on individuals' lives was collected using in-depth follow-up interviews. Data were also collected for healthy controls identified in the screening interviews. Results :,The total prevalence of irritable bowel syndrome in 5009 screening interviews was 14.1% (medically diagnosed: 3.3%; undiagnosed, but meeting irritable bowel syndrome criteria: 10.8%). Abdominal pain/discomfort was the most common symptom prompting consultation. Most sufferers (74% medically diagnosed; 63% undiagnosed) reported alternating constipation and diarrhoea. Previously diagnosed gastrointestinal disorders occurred more often in sufferers than non-sufferers. Irritable bowel syndrome sufferers had more days off work (6.4 vs. 3.0) and days in bed, and reduced activities to a greater extent than non-sufferers. Conclusions :,Most (76.6%) irritable bowel syndrome sufferers in the US are undiagnosed. Irritable bowel syndrome has a substantial impact on sufferers' well-being and health, with considerable socioeconomic consequences. [source]

Immediate and associated complications of hysterectomy for benign disease

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2002
O Tamizian
ABSTRACT Abdominal and vaginal hysterectomy are common operations for benign gynaecological conditions. Though safe operations, they are not without complications. Good medical practice requires that patients be fully counselled regarding risks involved in undergoing medical interventions. This can only be done by regular review of local practice and comparison with national and international standards. We have reviewed 502 case notes of patients who have undergone a hysterectomy for benign conditions over an 18-month period. [source]

Diabetes: insulin resistance and derangements in lipid metabolism.

DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2005
Cure through intervention in fat transport, storage
Abstract We present multiple findings on derangements in lipid metabolism in type 2 diabetes. The increase in the intracellular deposition of triglycerides (TG) in muscles, liver and pancreas in subjects prone to diabetes is well documented and demonstrated to attenuate glucose metabolism by interfering with insulin signaling and insulin secretion. The obesity often associated with type 2 diabetes is mainly central, resulting in the overload of abdominal adipocytes with TG and reducing fat depot capacity to protect other tissues from utilizing a large proportion of dietary fat. In contrast to subcutaneous adipocytes, the central adipocytes exhibit a high rate of basal lipolysis and are highly sensitive to fat mobilizing hormones, but respond poorly to lipolysis restraining insulin. The enlarged visceral adipocytes are flooding the portal circulation with free fatty acids (FFA) at metabolically inappropriate time, when FFA should be oxidized, thus exposing nonadipose tissues to fat excess. This leads to ectopic TG accumulation in muscles, liver and pancreatic beta-cells, resulting in insulin resistance and beta-cell dysfunction. This situation, based on a large number of observations in humans and experimental animals, confirms that peripheral adipose tissue is closely regulated, performing a vital role of buffering fluxes of FFA in the circulation. The central adipose tissues tend to upset this balance by releasing large amounts of FFA. To reduce the excessive fat outflow from the abdominal depots and prevent the ectopic fat deposition it is important to decrease the volume of central fat stores or increase the peripheral fat stores. One possibility is to downregulate the activity of lipoprotein lipase, which is overexpressed in abdominal relatively to subcutaneous fat stores. This can be achieved by gastrointestinal bypass or gastroplasty, which decrease dietary fat absorption, or by direct means that include surgical removal of mesenteric fat. Indirect treatment consists of the compliant application of drastic lifestyle change comprising both diet and exercise and pharmacotherapy that reduces mesenteric fat mass and activity. The first step should be an attempt to effectively induce a lifestyle change. Next comes pharmacotherapy including acarbose, metformin, PPAR,, or PPAR,, agonists, statins and orlistat, estrogens in postmenopausal women or testosterone in men. Among surgical procedures, gastric bypass has been proven to produce beneficial results in advance of other surgical techniques, the evidence basis of which still needs strengthening. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Novel SDHD germ-line mutations in pheochromocytoma patients

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2007
C. Neumayer
Abstract Background,SDHD germ-line mutations predispose to pheochromocytoma (PCC) and paraganglioma (PGL). Material and methods, The incidence and types of SDHD germ-line mutations are determined in 70 patients with apparently sporadic adrenal and extra-adrenal PCC. Results,SDHD sequence variants were identified in the germ line of five patients. Two of three novel mutations were in exon 1 and one in exon 3. One patient had a codon 1 missense mutation (M1K) and a concurrent 3-bp deletion in intron 1. Three of 10 family members had only the exon 1 mutation, whereas one had only the intron 1 mutation. The other exon 1 mutation resulted from a deletion of nucleotides 28,33 with a 12-bp in-frame insertion (c.28_33 del ins TAGGAGGCCCTA). This mutation generated a premature stop codon after codon 9 and was also present in the brother who had a bilateral PCC. The third patient with a carotid body tumour, with an abdominal and a thoracic PGL had a 12-bp deletion in exon 3 (codons 91,94, c.271_282 del). Her father carried the same mutation and had bilateral carotid body tumours. Two further patients, one with six PGL, carried a previously described H50R polymorphism, whose disease-specific relevance is currently unclear. The three patients with bona fide SDHD mutations were younger than those without germ-line mutations. Conclusion,SDHD germ-line mutations are rare in patients with PCC, but their identification is an important prerequisite for the clinical care and appropriate management of affected individuals and their families. [source]

Silencing of an abdominal Hox gene during early development is correlated with limb development in a crustacean trunk

EVOLUTION AND DEVELOPMENT, Issue 2 2010
Cheryl C. Hsia
SUMMARY We tested whether Artemia abd-A could repress limbs in Drosophila embryos, and found that although abd-A transcripts were produced, ABD-A protein was not. Similarly, developing Artemia epidermal cells showed expression of abd-A transcripts without accumulation of ABD-A protein. This finding in Artemia reveals a new variation in Hox gene function that is associated with morphological evolution. In this case, a HOX protein expression pattern is completely absent during early development, although the HOX protein is expressed at later stages in the central nervous system in a "homeotic-like" pattern. The combination of an absence of ABD-A protein expression in the Artemia limb primordia and the weak repressive function of Artemia UBX protein on the limb-promoting gene Dll are likely to be two reasons why homonomous limbs develop throughout the entire Artemia trunk. [source]

Surgical treatment options for hidradenitis suppurativa and critical review of own experience

EXPERIMENTAL DERMATOLOGY, Issue 6 2006
Wolfgang Christian Marsch
HS (acne inversa) is a chronic, progressive, initially inflammatory, ultimately a fistulating and scarring disease affecting apocrine gland-bearing skin areas. Late phases afford a broad surgical removal of affected skin areas including subcutaneous fatty tissue, with secondary mesh grafting after a period of granulation tissue formation. Fifty-three patients have been treated surgically at our Dermatology Department. Long-term results are excellent concerning satisfaction of the patients and functional objectives. Local recurrences or development of new lesions in formerly unaffected areas were noticed only in some patients who did not stop smoking. Patient details were as follows: gender distribution: male (M) 20 (38%), female (F) 33 (62%), age: M 19,62 (average 40.7), F 15,56 (average 35.4), onset: M 16,57 (32.2), F 8,50 (25.5), duration: 3 months to 37 years (8.0), F 6 months to 37 years (9.9). Sites mainly affected: axillary and perigenital. Specific regions for men: perineum and rima ani, for women: inguinal, submammary and abdominal. Multiple anatomical regions involved: men 40%, women 91%. Familiarity 0.4%. Associated acne papulo-pustulosa or nodulo-cystica (=conglobata): 19%. Cigarette smokers: men 100%, women 67%. Excised material from each operation was carefully examined histologically. The results endorse the concept of ,acne inversa' by recognizing a perifollicular accumulation of lymphocytes simultaneously at different infrainfundibula of terminal hair follicles. However, a follicular hyperkeratosis seems secondary to this, follicular perforation, and a combination of sinus, abscess and scar formation are most obviously tertiary events. Therefore, HS seems to be an inflammatory, probably an immunological disease with an initially strictly dermal target, even followed by an intradermal horizontal propagation. Laser flux imaging could visualize the subclinical peripheral extension of the basically dermal perifollicular inflammation. Biologics may have a beneficial effect on these early or perpetuating inflammatory events; however, thus far surgery remains the first-line therapy in late phases of the disease. [source]

Ultrastructural clues for the potent therapeutic effect of melatonin on aging skin in pinealectomized rats

FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 6 2006
Mukaddes E
Abstract Recently we have reported a significant reduction in the thickness of epidermis and epidermis + dermis in the back, abdominal and thoracic skin of the long-term pinealectomized rats and the potent therapeutic effect of melatonin on the pinealectomy-induced morphometric changes. The present study was aimed to determine the fine structure of the abdominal and thoracic skin in pinealectomized rats and the effect of melatonin on skin ultrastructure. Rats were pinealectomized or sham operated (control) for 6 months. Half of the pinealectomized rats were treated with 4 mg/kg melatonin during the last month of the experiment. Pinealectomy resulted in prominent ultrastructural changes in the skin. Epidermal atrophy, disorganization and cytological atypia were obvious. Tonofilament distribution was not uniform, and intercellular space was narrow. Nuclear irregularity and heterochromatin condensation were detected. Many mitochondria were irregular and edematous with increased translucence of the matrix, either partial or total destruction of crests and frequently the presence of vacuoles, myelin figures and dense bodies. Microprojections of basal cells into the dermis were observed. The dermis was thin, and collagenous fibers were loosely arranged. The epidermis in melatonin administered pinealectomized rats was obviously thicker than that of pinealectomized rats. The cells of each layers had characteristic morphological and ultrastructural features. Nuclear irregularity and heterochromatin condensation were not seen. Mitochondria were generally normal in ultrastructural appearance but rarely vacuoles and myelin figures were observed. The dermis was thick, and collagenous fibers were closely packaged. This paper provides an additional ultrastructural evidence that the damage to mitochondria is the major contributory factor to skin aging and that melatonin has potent therapeutic effects in reducing age-related changes via protecting fine structure of the skin. [source]

Case Report: Atheroembolic renal disease in a 72-year-old patient through coronary intervention after myocardial infarction

HEMODIALYSIS INTERNATIONAL, Issue 4 2008
Anna Laura HERZOG
Abstract Cholesterol embolization or atheroembolic renal disease (AERD) is an often underdiagnosed issue in patients featuring a prevalent risk profile. It is a multisystemic disease with progressive renal insufficiency due to foreign body reaction of cholesterol crystals flushed into a small vessel system of the kidneys from the arteriosclerotic plaques. The most common setting in which it occurs is iatrogenic after vascular catheterization and less frequent spontaneously. Typical clinical symptoms are delayed impairment of renal function, cutaneous manifestations such as livedo reticularis or purple toes with persistingly palpable arterial pulse, myalgia, systemic symptoms such as weight loss and fever, and abdominal and neurological symptoms. Diagnosis is generally made by clinical appearance, risk profile, and interval of time from intervention; a definitive diagnosis can only be made by renal biopsy. Even though the exact incidence is not known because most patients do not undergo biopsy due to older age, comorbidity, and other explanations for loss of renal function, it is estimated to be 4% after vascular intervention. Patient and renal outcome is dependent on comorbidity, risk profile, and preexisting chronic kidney disease (CKD). About 30% of patients are estimated to require maintenance dialysis and these patients have a high risk of death within 24 months after the first renal replacement therapy. Prognosis is also influenced by severity. The case reported is a 72-year-old male patient with preexisting CKD stage 3 undergoing percutaneous coronary intervention after myocardial infarction and consecutive AERD with typical clinical appearance 6 weeks after the event. [source]

Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss,

HEPATOLOGY, Issue 4 2009
Nathan A. Johnson
Weight loss remains the most common therapy advocated for reducing hepatic lipid in obesity and nonalcoholic fatty liver disease. Yet, reduction of body weight by lifestyle intervention is often modest, and thus, therapies which effectively modulate the burden of fatty liver but are not contingent upon weight loss are of the highest practical significance. However, the effect of aerobic exercise on liver fat independent of weight loss has not been clarified. We assessed the effect of aerobic exercise training on hepatic, blood, abdominal and muscle lipids in 19 sedentary obese men and women using magnetic resonance imaging and proton magnetic resonance spectroscopy (1H-MRS). Four weeks of aerobic cycling exercise, in accordance with current physical activity guidelines, significantly reduced visceral adipose tissue volume by 12% (P < 0.01) and hepatic triglyceride concentration by 21% (P < 0.05). This was associated with a significant (14%) reduction in plasma free fatty acids (P < 0.05). Exercise training did not alter body weight, vastus lateralis intramyocellular triglyceride concentration, abdominal subcutaneous adipose tissue volume, 1H-MRS,measured hepatic lipid saturation, or HOMA-IR (homeostasis model assessment of insulin resistance; P > 0.05). Conclusion: These data provide the first direct experimental evidence demonstrating that regular aerobic exercise reduces hepatic lipids in obesity even in the absence of body weight reduction. Physical activity should be strongly promoted for the management of fatty liver, the benefits of which are not exclusively contingent upon weight loss. (HEPATOLOGY 2009.) [source]

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following instrumental vaginal delivery

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2006
A. KAKARLA
Summary Acute pseudo-obstruction of the colon (Ogilvie's syndrome) is an adynamic ileus without mechanical obstruction of the bowel. Predisposing factors include: abdominal and pelvic surgery, or trauma, or severe pre-existing systemic illness. In obstetrics, many cases have been reported after caesarean delivery, but none following a vaginal delivery. Conservative and pharmacological therapies are effective in many patients, but surgical intervention may be required. Early diagnosis and appropriate treatment is imperative to avoid caecal rupture, faecal peritonitis and the associated high maternal mortality. High index of clinical suspicion and proper assessment of the gastrointestinal system in the post-surgical patient are vital to the management of this uncommon but potentially serious condition met with in obstetrics practice. [source]

Effects of restricted thoracic movement on the regional distribution of ventilation

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010
S. PULLETZ
Background: Restricted thoracic movement is often encountered in patients, necessitating mechanical ventilation during surgery or intensive care treatment. High intraabdominal pressure, obesity or thorax rigidity and deformity reduce the chest distensibility and deteriorate the lung function. They render the selection of proper ventilator settings difficult and complicate the weaning process. Electrical impedance tomography (EIT) is currently being proposed as a bedside imaging method for monitoring regional lung ventilation. The objective of our study was to establish whether the effects of decreased chest compliance on regional lung ventilation can be determined by EIT. Methods: Ten healthy male volunteers were studied in our pilot study under three conditions: (1) unrestricted breathing and (2) restricted breathing by abdominal and (3) lower rib cage strapping. The subjects were followed during spontaneous tidal breathing in five postures (sitting, supine, prone, left and right side). EIT and spirometry data were acquired in each condition. Results: The distribution of ventilation in subjects with unrestricted breathing corresponded with the physiologically expected values. In the left and right lateral postures, abdominal and thoracic cage restrictions reduced the ventilation in the dependent lung areas; the non-dependent areas were unaffected. In the prone position, the ventilation of the dependent and non-dependent areas was reduced. The effects of strapping were least pronounced in the supine posture. Conclusions: We conclude that EIT is able to measure changes in the regional distribution of ventilation induced by restricted chest movement and has the potential for optimising artificial ventilation in patients with limited chest compliance of different origins. [source]

Presentation and therapy of myelolipoma

INTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2005
ANDREAS MEYER
Abstract, Background:, Adrenal myelolipoma is a rare and benign, hormonally inactive tumor frequently discovered incidentally. Because of the increasing rate of detection of adrenal myelolipoma, use of the correct diagnostic examination and treatment, with respect to surgical excision or regular controls, is continually gaining importance. We report herein on the largest series of surgically treated patients with adrenal myelolipoma from a single institute. Methods:, The clinical charts of 12 patients who underwent adrenal surgery for myelolipoma were reviewed. Follow up was carried out by means of re-examination or by personal contact with the primary physician. It was possible to perform a re-examination on eight of the 12 patients 6.9 years after the operation: one patient had died 5.2 years after surgery. Results:, Diagnosis of adrenal myelolipoma was made incidentally in seven patients, and during examination for reasons of unspecific abdominal or flank pain in five patients. A transabdominal approach was taken in five patients, a subcostal approach was taken in three patients and a translumbal approach was taken in four patients. At the follow up, all formerly symptomatic patients were free of symptoms. No recurrence could be seen; however, in one patient a contralateral adrenal myelolipoma had developed. Conclusions:, Symptomatic tumors, growing tumors or tumors larger than 10 cm should be excised surgically by means of an endoscopic or conventional approach, depending on the size. Surgical indication should not be liberalized by the introduction of more gentle operative techniques such as the translumbal or the endoscopic approach. A close follow up should be maintained in the case of patients free of symptoms, and for those with a definite diagnosis from imaging procedures. [source]

Congenital absence of the testis in human fetuses and in cryptorchid patients

INTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2004
LUCIANO A FAVORITO
Abstract, Background, The aim of the present study is to make a comparative study in human fetuses and in patients with cryptorchidism, analyzing the incidence of a number anomalies of the testes for both populations. Methods, We studied 326 testes from 163 human fetuses ranging in age from 10 to 35 weeks postconception (WPC) and 133 testes from 101 cryptorchid patients aged from 1 to 15 years old (mean, 6.4 years). The Fisher's exact test was used for comparison. Results, Among 326 fetal testes, 224 (68.7%) were abdominal, 45 (13.8%) were inguinal and 55 (16.8%) were scrotal. In one fetus at 23 WPC, both testes (0.6%) were absent. Of the 133 cryptorchid testes, 17 (12.78%) were abdominal, 92 (69.1%) were inguinal and 24 (18%) were high scrotal. Of the 17 abdominal testes, three (17.6%) were atrophic and two were vanished (11.7%). Of the 92 inguinal testes, one (1.08%) was vanished. Twenty-eight (21%) of the cryptorchid testes were impalpable and among these, 17 were located in the abdomen (60.7%) and 11 (38.2%) in the inguinal region (internal ring). Conclusions, Testicular agenesis is a very rare anomaly, both in fetuses and patients with cryptorchidism. [source]

Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic review

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010
J. ÖRMAN
A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanical device in spontaneously breathing adult patients after abdominal or thoracic surgery via thoracotomy. The methodological quality score varied between 4 and 6 on the Physiotherapy Evidence Database score. The studies were published between 1979 and 1993. Only one of the included trials showed any positive effects of PEP compared to other breathing techniques. Today, there is scarce scientific evidence that PEP treatment is better than other physiotherapy breathing techniques in patients undergoing abdominal or thoracic surgery. There is a lack of studies investigating the effect of PEP over placebo or no physiotherapy treatment. [source]

Endoscopic investigation of the internal organs of a 15th-century child mummy from Yangju, Korea

JOURNAL OF ANATOMY, Issue 5 2006
Seok Bae Kim
Abstract Our previous reports on medieval mummies in Korea have provided information on their preservation status. Because invasive techniques cannot easily be applied when investigating such mummies, the need for non-invasive techniques incurring minimal damage has increased among researchers. Therefore, we wished to confirm whether endoscopy, which has been used in non-invasive and minimally invasive studies of mummies around the world, is an effective tool for study of Korean mummies as well. In conducting an endoscopic investigation on a 15th-century child mummy, we found that well-preserved internal organs remained within the thoracic, abdominal and cranial cavities. The internal organs , including the brain, spinal cord, lung, muscles, liver, heart, intestine, diaphragm and mesentery , were easily investigated by endoscopy. Even the stool of the mummy, which accidentally leaked into the abdominal cavity during an endoscopic biopsy, was clearly observed. In addition, unusual nodules were found on the surface of the intestines and liver. Our current study therefore showed that endoscopic observation could provide an invaluable tool for the palaeo-pathological study of Korean mummies. This technique will continue to be used in the study of medieval mummy cases in the future. [source]

Application of ECMO in Multitrauma Patients With ARDS as Rescue Therapy

JOURNAL OF CARDIAC SURGERY, Issue 3 2007
Navid Madershahian M.D.
The final rescue therapy for patients with severe hypoxia refractory to conventional therapy modalities is the extracorporeal gas exchange. Methods: We report the management of three polytraumatized patients with life-threatening injuries, severe blunt thoracic trauma, and consecutive ARDS treating by extracorporeal membrane oxygenation (ECMO). Two patients suffered a car accident with severe lung contusion and parenychmal bleeding. Bronchial rupture and mediastinal emphysema was found in one of them. Another patient developed ARDS after attempted suicide with multiple fractures together with blunt abdominal and thoracic trauma. Results: All patients were placed on ECMO and could be rapidly stabilized. They were weaned from ECMO after a mean of 114 ± 27 hours of support without complications, respectively. Mean duration of ICU stay was 37 ± 23 days. Conclusions: Quick encouragement of ECMO for the temporary management of gas exchange may increase survival rates in trauma patients with ARDS. [source]

Local regulation of human breast xenograft models,,

JOURNAL OF CELLULAR PHYSIOLOGY, Issue 3 2010
Jodie M. Fleming
Breast cancer studies implant human cancer cells under the renal capsule, subcutaneously, or orthotopically and often use estrogen supplementation and immune suppressants (etoposide) in xenograft mouse models. However, cell behavior is significantly impacted by signals from the local microenvironment. Therefore, we investigated how the combinatorial effect of the location of injection and procedural differences affected xenograft characteristics. Patient-derived breast cancer cells were injected into mouse abdominal or thoracic mammary glands,±,estrogen and/or etoposide pretreatment. Abdominal xenografts had increased tumor incidence and volume, and decreased latency (P,<,0.001) compared to thoracic tumors. No statistically significant difference in tumor volume was found in abdominal xenografts treated,±,estrogen or etoposide; however, etoposide suppressed tumor volume in thoracic xenografts (P,<,0.02). The combination of estrogen and etoposide significantly decreased tumor incidence in both sites. In addition, mice treated,±,estradiol were injected orthotopically or subcutaneously with well-characterized breast cancer cell lines (MCF7, ZR75-1, MDA MB-231, or MCF10Ca1h). Orthotopic injection increased tumor volume; growth varied with estrogen supplementation. Location also altered methylation status of several breast cancer-related gene promoters. Lastly, vascularization of orthotopic tumors was significantly enhanced compared to subcutaneous tumors. These data suggest that optimal xenograft success occurs with orthotopic abdominal injections and illustrate molecular details of the compelling influence of the local microenvironment on in vivo models. J. Cell. Physiol. 224: 795,806, 2010. Published 2010 Wiley-Liss, Inc. [source]

New method for the detection of intraperitoneal free air by sonography: Scissors maneuver

JOURNAL OF CLINICAL ULTRASOUND, Issue 8 2004
Okkes Ibrahim Karahan MD
Abstract Purpose This study was conducted to investigate the diagnostic value of a new sonographic technique for the detection of intraabdominal free air. Methods Seventy-two patients with a suspected gastrointestinal tract perforation were included in the study and prospectively evaluated by sonography and abdominal and chest radiography for the detection of intraperitoneal free air. A new sonographic technique (the scissors maneuver) was used to detect intraperitoneal free air superficial to the liver; the maneuver consists of applying and then releasing slight pressure onto the abdominal wall with the caudal part of a parasagittaly oriented linear-array probe. The results of the imaging studies were correlated with surgical findings when possible. Results Sixteen patients had a surgically proven gastrointestinal tract perforation causing pneumoperitoneum. Sonography and radiography each showed pneumoperitoneum in 15 patients, with 1 false-negative result for each modality. The sensitivity and specificity values of sonography and radiography were identical; sensitivity was 94% and specificity was 100% for both imaging modalities. The scissors maneuver was positive in all patients with sonographically detected pneumoperitoneum. Conclusions Sonography is an effective tool in the diagnosis of pneumoperitoneum, with sensitivity and specificity equal to those of radiography. The scissors maneuver may be a useful adjunct for improving the diagnostic yield of sonography. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:381,385, 2004 [source]

Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions

JOURNAL OF CLINICAL ULTRASOUND, Issue 2 2003
Igor Kocijan
Abstract Purpose The aim of this prospective study was to assess the value of chest sonography in the radiologic diagnosis of small pleural effusions (relative to expiratory lateral decubitus radiography) and to suggest gray-scale sonographic criteria for detecting the presence of small pleural effusions. Methods Patients referred for abdominal or chest sonographic evaluation for various reasons were also examined for sonographic features of pleural effusion from May 1, 1997, until January 31, 2000. Patients who had evidence of small pleural effusions were included. Patients with no such evidence served as a control group. Subsequently, all patients underwent erect posteroanterior and expiratory lateral decubitus chest radiography. Results On chest sonography, 52 patients were found to have small pleural effusions. The control group consisted of 17 patients. The mean thickness of the pleural effusion was 9.2 mm on sonography and 7.6 mm on expiratory lateral decubitus radiography (p < 0.01). Compared with radiologic examination, chest sonography had a positive predictive value of 92% in the diagnosis of small pleural effusions in our study population. Conclusions Chest sonography showed a high degree of accuracy relative to that of lateral decubitus chest radiography in the diagnosis of small pleural effusions, which appeared as thin (usually 15 mm thick or less) anechoic areas that changed shape with the phases of respiration. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:69,74, 2003 [source]

Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study

Intrathecal neostigmine with bupivacaine for infants undergoing lower abdominal and urogenital procedures: dose response

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009
Y. K. BATRA
Background: Intrathecal (IT) neostigmine produces dose-dependent analgesia in adults. However, the dose of spinal neostigmine has not been investigated in infants. The purpose of this study was to assess spinal anesthesia (SA) duration provided by four doses of spinal neostigmine added to bupivacaine for lower abdominal and urogenital procedures in infants. Methods: Seventy-five infants were randomized into five groups. The control group B received IT plain 0.5% hyperbaric bupivacaine. Groups BN.25, BN.50, BN.75, and BN1.0 received bupivacaine with 0.25, 0.5, 0.75, and 1 ,g/kg of neostigmine, respectively. The primary variable was the duration of anesthesia assessed by recovery of hip flexion. Postoperative pain with facial expression, leg activity, arm activity, crying and consolability scale score,and rescue analgesic requirements were the secondary variables measured, and the side effects were noted. Results: Seventy-three infants completed the study. There was a significant linear increase in SA duration with IT neostigmine to 65.2 (4.3) min with 0.5 ,g/kg (P<0.01), 88.2 (5.1) with 0.75 ,g/kg (P<0.001) and 92 (4.3) with 1 ,g/kg (P<0.001) from 52.4 (4.3) min with bupivacaine alone. SA duration showed no significant difference between plain bupivacaine and BN.25 (P=0.100) or between groups BN.75 and BN1.0 (P=0.451). Groups BN.75 and BN1.0 had significantly reduced pain scores, and the median duration before the first dose rescue analgesic was requested prolonged significantly (P<0.001) compared with the other three groups. Conclusions: IT neostigmine at a dose of 0.75 ,g/kg added to bupivacaine significantly prolonged SA duration with reduced postoperative pain scores and rescue analgesic requirements in infants undergoing lower abdominal and urogenital procedures. No additional benefits were provided on increasing it to 1 ,g/kg. [source]

Increased volume of coverage for abdominal contrast-enhanced MR angiography with two-dimensional autocalibrating parallel imaging: Initial experience at 3.0 Tesla

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 5 2009
Darren P. Lum MD
Abstract Purpose: To assess the feasibility and the quality of abdominal three-dimensional (3D) contrast enhanced MR angiograms acquired at 3.0 Tesla (T) using a new 2D-accelerated autocalibrating parallel reconstruction method for Cartesian sampling (2D-ARC). Materials and Methods: With institutional review board approval and written informed consent, a prospective trial in 6 normal healthy volunteers and 23 patients referred for evaluation of suspected renovascular disease was performed. The volunteers underwent abdominal MRA with and without 2D-ARC acceleration. Images were evaluated independently by two blinded vascular radiologists in randomized order. Vessel conspicuity was rated on a five-point scale. Evaluation for significant differences between the scores for each technique was performed using a Wilcoxon signed-rank test. Results: In the series of six volunteers, no statistical significance was found between the image quality scores for 2D-ARC accelerated and nonaccelerated exams. A high proportion of the 23 clinical 2D-ARC exams were graded as diagnostic (vessel conspicuity score ,2; Reader 1, 96%; Reader 2, 100%) for overall image quality. Conclusion: Subjective image quality of 2D-ARC accelerated MRA was equivalent to the conventional MRA method. However, the 2D-ARC accelerated sequence provided a 3.5-fold increase in imaging volume, complete abdominal coverage, and a 30% reduction in voxel volume, all within the same acquisition time. J. Magn. Reson. Imaging 2009;30:1093,1100. © 2009 Wiley-Liss, Inc. [source]

Fast spin-echo triple-echo Dixon: Initial clinical experience with a novel pulse sequence for fat-suppressed T2-weighted abdominal MR imaging

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2009
Russell N. Low MD
Abstract Purpose To evaluate a prototype fast spin echo (FSE) triple-echo-Dixon (fTED) technique for breath-hold, fat-suppressed, T2-weighted abdominal imaging. Materials and Methods Forty patients underwent breath-hold T2-weighted abdominal imaging with fTED and conventional fast recovery (FR) FSE with chemical shift-selective saturation (CHESS). FRFSE and fTED images were compared for overall image quality, homogeneity of fat suppression, image sharpness, anatomic detail, and phase artifact. Depiction of disease was recorded separately for FRFSE and fTED images. Results FTED successfully reconstructed water-only and fat-only images from source images in all 40 cases. Water and fat separation was perfect in 36 (0.90) patients. Homogeneity of fat suppression was superior on the fTED images in 38 (0.95) of 40 cases. FTED images showed better anatomic detail in 27 (0.68), and less susceptibility artifact in 20 (0.50). FRFSE images showed less vascular pulsation artifact in 30 (0.75) cases, and less phase artifact in 21 (0.53) cases. There was no difference in depiction of disease for FRFSE and fTED images. Conclusion FTED is a robust sequence providing breath-hold T2-weighted images with superior fat suppression, excellent image quality, and at least equal depiction of disease compared to conventional breath-hold T2-weighted FRFSE imaging. J. Magn. Reson. Imaging 2009;30:569,577. © 2009 Wiley-Liss, Inc. [source]

Evaluation of optimized inversion-recovery fat-suppression techniques for T2-weighted abdominal MR imaging

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2008
Thomas C. Lauenstein MD
Abstract Purpose To test the theoretical benefits of a spectral attenuated inversion-recovery (SPAIR) fat-suppression (FS) technique in clinical abdominal MRI by comparison to conventional inversion-recovery (IR) FS combined with T2-weighted (T2W) partial Fourier single shot fast spin echo (SSFSE). Materials and Methods 1.5T MRI studies of the abdomen were performed in 28 patients with liver lesions (hemangiomas n = 14; metastases n = 14). T2W sequences were acquired using IR and SPAIR SSFSE. Measurements included retroperitoneal and mesenteric fat signal-to-noise (SNR) to evaluate FS; liver lesion contrast-to-noise (CNR) to evaluate bulk water signal recovery effects; and bowel wall delineation to evaluate susceptibility and physiological motion effects. Results SPAIR-SSFSE images produce significantly improved FS and liver lesion CNR. The mean SNR of the retroperitoneal and mesenteric fat for SPAIR SSFSE was 20.5 ± 10.2 (±1 SD) and 12.7 ± 6.2, compared to 43.2 ± 24.1 (P = 0.000006) and 29.3 ± 16.8 (P = 0.0000005) for IR-SSFSE. SPAIR-SSFSE images produced higher CNR for both hemangiomas CNR = 164 ± 88 vs. 126 ± 83 (P = 0.00005) and metastases CNR = 75 ± 27 vs. 53 ± 19 (P = 0.007). Bowel wall visualization was significantly improved using SPAIR-SSFSE (P = 0.002). Conclusion The theoretical benefits of SPAIR over conventional IR FS translate into significant multiple improvements that can be measured on clinical abdominal MRI scans. J. Magn. Reson. Imaging 2008;27:1448,1454. © 2008 Wiley-Liss, Inc. [source]