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Undescended testis (UDT) is a common abnormality, affecting about 1/20 males at birth. Half of these have delayed testicular descent, with the testis in the scrotum by 10-12 weeks after term. Beyond this spontaneous descent is rare. Current treatment recommendations are that UDT beyond 3 months of age need surgery before 12 months of age. Some children have scrotal testes in infancy but develop UDT later in childhood because the spermatic cord does not elongate with age, leaving the testes behind as the scrotum moves further from the groin with growth of the pelvis. This is now known as ascending/acquired cryptorchidism, and orchidopexy is controversial. Many authors recommend surgery once the testes no longer reside spontaneously in the scrotum, but some groups recommend conservative treatment. The fetal testis descends in 2 separate hormonal and anatomical steps, with the first step occurring between 8-15 weeks' gestation. Insulin-like hormone 3 (INSL3) from developing Leydig cells stimulates the genito-inquinal ligament, or gubernaculum, to swell where it ends in the inguinal area of the abdominal wall. This holds the testis near the future inguinal canal as the fetal abdomen enlarges. By contrast, in female fetuses, lack of INSL3 allows the gubernaculum to elongate into a round ligament and lets the ovary move away from the groin. The second or inguinoscrotal phase is controlled by androgen and occurs between 25-35 weeks' gestation, where the gubernaculum and testis migrate together to the scrotum. Androgens guide this complex process, both directly and indirectly via a neurotransmitter, calcitonin gene-related peptide (CGRP), released from the genitofemoral nerve. After migration is complete the proximal processus vaginalis closes (preventing inguinal hernia) and then the fibrous remnant disappears completely, allowing the spermatic cord to elongate with age, to keep the testis scrotal. The transabdominal phase is a simple mechanical process, and abnormalities are uncommon, with intra-abdominal testes found in 5-10% of boys with UDT. Anomalies of the complex inguinoscrotal phase account for most UDT seen clinically. The undescended testis suffers heat stress when not at the lower scrotal temperature (33 degrees Celsius), interfering with testicular physiology and development of germ cells into spermatogonia. UDT interrupts transformation of neonatal gonocytes into type-A spermatogonia, the putative spermatogenic stem cells at 3-9 months of age. Recent evidence suggests orchidopexy between 6-12 months improves germ cell development, with early reports of improved fertility, but little evidence yet for changes in malignancy prognosis. Hypospadias is also a common abnormality in newborn males, affecting about 1/150 boys. Androgens control masculinization of the genital tubercle into penis between 8-12 weeks' gestation, with tubularization of the urethra from the perineum to the tip of the glans. If this process is disrupted hypospadias occurs, with a variable proximal urethral meatus, failed ventral preputial development producing a dorsal hood, and discrepancy in the ventral versus dorsal penile length, causing a ventral bend in the penis, known as chordee. Surgery to correct hypospadias is recommended between 6-18 months, as technical advances now allow operation to be done before the infant acquires long-term memory of the surgery. Severe hypospadias overlaps with disorders of sex development (DSD), so that babies without a fused scrotum containing 2 testes and who present with 'hypospadias' need full DSD investigations at birth. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG. | Hutson JM. (2000). Cryptorchidism and Hypospadias.. No Source. |
Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are neural crest-derived tumors. PHEOs are chromaffin cell tumors that produce, store, metabolize, and secrete catecholamines [1-3]. The 2004 World Health Organization classification of endocrine tumors defines pheochromocytoma as a tumor arising from catecholamine-producing chromaffin cells in the adrenal medulla, an intra-adrenal PGL. Closely related tumors of extra-adrenal paraganglia are classified as extra-adrenal PGL. While these definitions serve to distinguish the two types of tumor based on location, this does not take into account differences in functional characteristics related to other differences in cellular origin. More specifically, while extra-adrenal PGLs derived from sympathetic nervous system-associated chromaffin tissue almost always produce catecholamines and often lead to hypertension, those derived from parasympathetic tissue (mainly head and neck PGLs) rarely, in less than 20% of cases, produce significant amounts of catecholamines or their metabolites and usually do not cause hypertension; these tumors may be locally invasive but are rarely metastatic. These head and neck PGLs were formerly known as glomus tumor or carotid body tumors. It therefore seems likely that PHEOs will be continued to be defined as catecholamine-producing tumors of intra- and extra-adrenal chromaffin cells, with those derived from the latter types of chromaffin cells classified as extra-adrenal PHEOs. PHEOs typically occur in about 80-85% of cases from adrenal medullary chromaffin tissue and in about 15-20% of cases from extra-adrenal chromaffin tissues [4]. Extra-adrenal PHEOs in the abdomen most commonly arise from a collection of chromaffin tissue around the origin of the inferior mesenteric artery (the organ of Zuckerkandl) or aortic bifurcation [5, 6]. Most PHEOs represent sporadic tumors and about 35% of PHEOs are of familial origin [7]. Sporadic PHEOs are usually unicentric and unilateral while familial PHEOs are often multicentric and bilateral. Both adrenal and extra-adrenal PGLs display similar histopathological characteristics. Unusual sites in the abdomen and pelvis include kidney, bladder, urethra, prostate, spermatic cord, genital tract, and liver. About 4-10% of patients with PHEO present with adrenal incidentaloma, whereas approximately 5% are diagnosed at surgery [8-10]. Although metastases may be rare for adrenal (about 10%) and familial (less than 5%) PHEOs [11], the prevalence is up to 36-50% for extra-adrenal abdominal PHEOs or even higher in those with succinate dehydrogenase subunit B gene mutation [12-15]. Finally, up to 10% of intra-adrenal PHEOs recur locally [16, 17]. PHEOs occur in about 0.05% to 0.1% of patients with sustained hypertension. However, this probably accounts for only 50% of persons harboring PHEO, when it is considered that about half the patients with PHEO have only paroxysmal hypertension or are normotensive. Also, it must also be considered that the prevalence of sustained hypertension in the adult population of Western countries is between 15 to 20% [1, 5, 18]. Thus, in Western countries the prevalence of PHEO can be estimated at 1:2,500 to 1:6,500 patients, with an annual incidence in the United States of 500 to 1,100 cases per year. Despite this low incidence, PHEO must always be considered because if identified, it can be cured in about 90% cases, whereas left untreated, the tumor is likely to be fatal due catecholamine-induced malignant hypertension, heart failure, myocardial infarction, stroke, ventricular arrhythmias, or metastatic disease. | Pacak K; Del Rivero J. (2000). Pheochromocytoma.. No Source. |
The insect fat body is generally described as a uniform tissue with multiple functions, but we have found evidence of cell differentiation in the Monomorium fat body. We show that the fat body of a mature egg-laying pharaoh's ant queen is a result of a preceding remodeling of cell material comprising at least 11 different fat cell types, located at specific positions in the head, alitrunk (thorax) and gaster (abdomen). The cell types are classified based on their position, histochemistry, ultrastructure, and immunoreactivity for vitellogenin/vitellin. Some of these cells are primordial cells present at emergence, others invade the histolysing flight muscle tissue, and still others disappear during the maturation process. Only one type, the subepidermal fat cell of the gaster, is active in vitellogenin synthesis and is the only cell type in close association with oenocytes. Although only this type produces vitellogenin, our material indicates that most fat cell types are essential to support egg production. In some queens vitellogenin was found to form crystals in ventral vitellogenin-producing fat cells. This indicates an imbalance between vitellogenin production in the fat cells and uptake in the oocytes, which is probably related to a cyclic regulation of egg production. | Jensen PV; Borgesen LW. (2000 Apr). Regional and functional differentiation in the fat body of pharaoh's ant queens, Monomorium pharaonis (L.).. Arthropod Struct Dev. 2000 Apr;29(2):171-84. doi: 10.1016/s1467-8039(00)00021-9.. |
Previous studies have hypothesized that the shoulder may be used to absorb some impact energy and reduce chest injury due to side impacts. Before this hypothesis can be tested, a good understanding of the injury mechanisms and the kinematics of the shoulder is critical for occupant protection in side impact. However, existing crash dummies and numerical models are not designed to reproduce the kinematics and kinetics of the human shoulder. The purpose of this study was to develop a finite element model of the human shoulder in order to achieve a deeper understanding of the injury mechanisms and the kinematics of the shoulder in side impact. Basic anthropometric data of the human shoulder used to develop the skeletal and muscular portions of this model were taken from commercial data packages. The shoulder model included three bones (the humerus, scapula and clavicle) and major ligaments and muscles around the shoulder. This model was then integrated into a human thorax model developed at Wayne State University (WSU) along with pre-existing models of other body parts such as the pelvis and the lower extremities. Material properties used for the model were taken from the literature. The model was first used to simulate lateral shoulder impact study by the Association Peugeot- Renault (APR) followed by simulations of several of the 17 rigid and padded cadaveric impacts conducted on a side impact sled at WSU. Contact forces measured at the levels of shoulder, thorax, abdomen and pelvis were used as response variables to validate the model. Additionally, a cadaveric test involving the deployment of a generic side airbag was also used to check the validity of the model. Model prediction of accelerations of the shoulder matched well against those measured experimentally. The role of the shoulder in side impact protection and the reduction of injury to the ribcage are discussed, based on model results. | Iwamoto M; Miki K; Mohammad M; Nayef A; Yang KH; Begeman PC; King AI. (2000 Nov). Development of a finite element model of the human shoulder.. Stapp Car Crash J. 2000 Nov;44:281-97. doi: 10.4271/2000-01-SC19.. |
CASE: An 11-year-old female domestic shorthaired cat presenting with clinical signs of depression, anorexia, weight loss, fever, anaemia and a mid-abdominal mass was referred for abdominal ultrasound examination. CLINICAL FINDINGS: Ultrasonography of the abdomen identified a markedly enlarged spleen. Ultrasound-guided fine-needle aspiration biopsy of the spleen revealed a uniform population of mast cells, 11% of which were observed to have phagocytosed erythrocytes. It is speculated that this may have been a contributing factor in the development of anaemia in this case. Mast cells were detected in a peripheral-blood smear and a diagnosis of systemic mastocytosis (splenic mast cell tumour together with mastocytaemia) was made. This diagnosis was subsequently confirmed by histopathology of the spleen. CONCLUSION: Splenectomy and treatment with corticosteroids appears to have resulted in remission of clinical signs and anaemia. A reduction in the concentration of mast cells in the peripheral blood had not occurred 6 weeks postsplenectomy, but was evident by 10 months post-splenectomy. | Allan R; Halsey TR; Thompson KG. (2000 Aug). Splenic mast cell tumour and mastocytaemia in a cat: case study and literature review.. N Z Vet J. 2000 Aug;48(4):117-21. doi: 10.1080/00480169.2000.36176.. |
The ventral abdominal approach for laparoscopy is versatile. Reported techniques using a ventral approach in the mare include bilateral ovariectomy and granulosa cell tumor removal. Laparoscopic ovariectomy is performed by way of four instrument portals in the caudoventral aspect of the insufflated abdomen. The procedure has several advantages over the traditional approaches of colpotomy and celiotomy, including tension-free closure of all incisions and minimal invasiveness. | Ragle CA. (2000 Aug). Dorsally recumbent female equine urogenital endoscopic surgery.. Vet Clin North Am Equine Pract. 2000 Aug;16(2):317-28, vi. doi: 10.1016/s0749-0739(17)30107-4.. |
The high mortality rate in hepatic trauma is a concern for the surgeons on duty, who most know the physiopathological problems and the decisions needed in view of both hepatic and extrahepatic injures. The mortality rate from liver trauma has fallen from 60% at the beginning of this century, blunt trauma to the abdomen from accidents, is responsible for 80-90% of all liver injures in Europe. The severity of liver injuries in 268 patients in a prospective study (1978-1998), were treated according to a defined protocol. Non operative management was used in first day, for those who were haemodynamically stable on admission. In unstable patients who proceeded to surgery, under optimal condition the mortality rate was 34.3%. Death in patients with multiple injures should only rarely result from liver trauma. 92 patients with minor injures (grade I-II) were treated by simple suture, with mortality rate of 6%. 116 patients (43%) sustained complex hepatic injures (grade III to V); 64 patients with grade III (23%), 36 with grade IV (13%). 16 Patients (5%) grade V, injury under went finger fracture of hepatic parenchyma alone 36. The mortality rate in this group was 18% (III), 36% (IV). 16 patients with grad V injury were managed with 68% mortality rate. Juxtahepatic veins and retrohepatic V.C.I. injury continue to carry a prohibitive mortality rate (90-100%). | Kiss L; Nica C. (2000 Jul-Aug). [Observations regarding surgical treatment in liver trauma].. Chirurgia (Bucur). 2000 Jul-Aug;95(4):335-46.. |
We have presented two cases of traumatic diaphragmatic hernia which have been diagnosed and operated in late stages, 6 months and 4 years, respectively, after the abdominal and thoracical traumatism causing diaphragmatic injure. The diagnosis was based on clinical and imaging results, while the treatment was meant to reduce the herniated organs in the abdomen and the closing up of the diaphragmatic defect, followed by good postoperative results. We have discussed the peculiarities of both case, the difficulty of early diagnosis and the techniques used to treat these cases. We have also presented data regarding posttraumatic diaphragmatic hernia and their treatment techniques. | Todor V; Pop T; Turdeanu N; Istoan S; Porumbel S; Chirila D; Tompa S; Palade E. (2000 Mar-Apr). [Traumatic diaphragmatic hernia. 2 case reports and review of the literature].. Chirurgia (Bucur). 2000 Mar-Apr;95(2):197-202.. |
OBJECTIVE: To present a case of acute appendicitis in a premature infant. METHODS: Retrospective review of the literature using Medline and Lilacs databases, as well as the necropsy report. CLINICAL REPORT: A white male preterm infant born at 34 weeks of gestation weighing 1,750g to a primiparous mother. The Apgar score was 4 and 8 at 1st and 5th minutes, respectively. The physical exam was normal until the 9th day of life when the child developed clinical features suggestive of acute abdomen, possibly due to necrotizing enterocolitis with perforation. He was submitted to exploratory laparotomy, which leaded to the diagnostic of acute appendicitis. CONCLUSION: Acute appendicitis must be discarded on the differential diagnostic when there is a suspicion of necrotizing enterocolitis with perforation, and risk factors are not present. | Barbosa AD; Junior IF; Caetano RR; Lopes VG; Santos AM; Franco ED. (2000 Nov-Dec). [Appendicitis in the premature newborn].. J Pediatr (Rio J). 2000 Nov-Dec;76(6):466-8. doi: 10.2223/jped.97.. |
We examined lymph node metastasis clinicopathologically in 236 cases of superficial cancer (T1, Tis) of the thoracic esophagus surgically resected at our department without adjuvant treatment. Mucosal cancer was observed in 112 cases (47%) and submucosal cancer in 124 cases (53%). Lymph node metastasis was present in 3% of mucosal cancer cases and 41% of submucosal cancer cases. By the recent pathologic subclassification of the extent of the cancerous invasion in superficial esophageal cancer, mucosal cancer and submucosal cancer were each divided into three subtypes according to the extent of invasion, i.e. m1, m2, m3, sm1, sm2 and sm3 cancers. There was no case of lymph node metastasis in m1 and m2 cases, but it was observed in 8% of m3 cases, in 11% of sm1 cases, in 30% of sm2 cases and in 61% of sm3 cases. The number of involved nodes was three or less in m3 and sm1 cases, however four or more involved nodes were observed in 14% of sm2 cases and in 24% of sm3 cases. Positive lymph nodes were found only in the mediastinum in m3 and sm1 cases. On the contrary, they were found extensively in the mediastinum, the abdomen and the neck and in two or more regions in 27% of sm2 cases and in 38% of sm3 cases. Considering the location of positive nodes, the recurrent nerve lymph nodes were most frequently involved, followed by the cardiac lymph nodes. A similar tendency was observed in cases with single node metastasis. The 5-year survival rate of cases from m1 to sm1 was similar. That of sm3 cases was significantly worse than that of other groups. Based on the clinical results, the therapeutic guidelines for superficial cancer of the thoracic esophagus are considered to be as follows: (i) in m1 and m2 cancer, endoscopic mucosal resection is generally indicated in principle, although transhiatal esophagectomy may be indicated in some cases; (ii) in m3 and sm1 cancer, endoscopic mucosal resection is performed initially, then subsequent treatment is selected if necessary; (iii) in sm2 and sm3 cancer, conventional transthoracic esophagectomy with systematic lymph node dissection is indicated. | Endo M; Yoshino K; Kawano T; Nagai K; Inoue H. (2000). Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus.. Dis Esophagus. 2000;13(2):125-9. doi: 10.1046/j.1442-2050.2000.00100.x.. |
OBJECTIVE: To study the presentation, management and outcome of undescended testes in children in a northern Nigerian population. DESIGN: Retrospective study. SETTING: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. SUBJECTS: Thirty six children aged < or = 12 years with 43 undescended testes managed in 10 years. INTERVENTIONS: Orchidopexy, orchidectomy, herniotomy. RESULTS: The age at surgery was fourteen months to 12 years (median six years); four (11%) had correction before two years, 15 (42%) before five years and 21 (57%) at age > or = 5 years. Thirty two (74%) testes were palpable and eleven (26%) non-palpable. Evaluation was mainly clinical. Ultrasonography was performed for three non-palpable testes but was not helpful. Laparoscopy was not used in any patient. The condition was unilateral in 29 (81%) and bilateral in seven (19%). Forty five per cent of the testes were in the inguinal canal, 31% at the external ring, and 12% each at the internal ring and abdomen respectively. Ten (24%) testes were macroscopically atrophic (canalicular five, abdominal four, internal ring one). Orchidopexy was performed for 37 undescended testes and orchidectomy for four. Groin and scrotal haematoma developed following one orchidopexy. Following orchidopexy, four (10%) testes retracted necessitating repeat surgery. CONCLUSION: There is a need to educate parents, traditional birth attendants, midwives and doctors in our environment to ensure earlier presentation and treatment. | Ameh EA; Mbibu HN. (2000 Sep). Management of undescended testes in children in Zaria, Nigeria.. East Afr Med J. 2000 Sep;77(9):485-7. doi: 10.4314/eamj.v77i9.46694.. |
The oviposition of female locusts is a complex behaviour that includes a dramatic extension of the abdomen. The role of internal pressure during oviposition was investigated by monitoring the intra-tracheal pressure and the activity of selected longitudinal muscles, while movements of the abdomen were visualised with a video imaging system. Locust oviposition consists of a sequence of four distinct phases: (i) probing the substrate and digging without elongation of the abdomen, (ii) longitudinal extension of the abdomen up to four times its normal length, (iii) laying packages of eggs while (iv) gradually withdrawing the abdomen. During extension, neurograms and myograms of selected longitudinal muscles revealed a decreased level of activity. When the abdomen retracted to its normal length, muscle activity re-appeared. In phases two and three, rising internal pressure prevented the abdomen from slipping back when the valves released their lateral grip from the substrate. Locking the genital segments in the hole by relative bending kept the abdomen in place when producing foam or laying eggs. Intra-abdominal pressure, therefore, is not the main cause of abdominal extension, but rather maintains extension when no mechanical locking in the hole prevents the abdomen from elastic retraction. | Rose U; Seebohm G; Hustert R. (2000 Jan). The role of internal pressure and muscle activation during locust oviposition.. J Insect Physiol. 2000 Jan;46(1):69-80. doi: 10.1016/s0022-1910(99)00103-1.. |
Diapetimorpha introita is an ichneumonid ectoparasitoid of the fall armyworm, Spodoptera frugiperda. Since it has been reported that D. introita wasps reared on an artificial diet exhibit a significantly lower percentage of adult eclosion and fecundity than host-reared wasps, this study was undertaken to elucidate the factors responsible for the reduced viability observed in diet-reared wasps. A system of markers has been devised to track the development (from the initiation of cocooning through adult eclosion) of D. introita. Although wasps reared on artificial diet developed more slowly than did those reared on host pupae, both diet- and host-reared wasps passed through the same stages of development - the eyes enlarged and moved backward, the gut was purged and upon ecdysis the exarate pupa emerged. The thorax was the first to darken, followed by the head and then the abdomen. Pharate pupal formation occurred before gut purge. Two peaks of hemolymph ecdysteroids were observed, one in wasps in which gut purge was almost complete and the second in day-2 exarate pupae. Ecdysone and 20-hydroxyecdysone were the major ecdysteroids present in hemolymph sampled at these times. Small quantities of 20,26-dihydroxyecdysone, polar ecdysteroids and/or possibly 26-hydroxyecdysone were also present. In six stages of development, hemolymph ecdysteroid titers were significantly higher in host-reared than in diet-reared wasps (Eye 1, Eye 2, Gut Purge 2, Pharate Pupa, Head/Thorax Dark, and Abdomen Dark). Relatively high percentages of mortality were observed in diet-reared wasps in four of these stages and in two others which occurred in close proximity to one of the stages, the Abdomen Dark stage. Thus, insufficient ecdysteroid in the hemolymph may be responsible, in part, for the relatively high percentage of mortality that occurred in wasps reared on an artificial diet. | Gelman DB; Carpenter JE; Greany PD. (2000 Apr). Ecdysteroid levels/profiles of the parasitoid wasp, Diapetimorpha introita, reared on its host, Spodoptera frugiperda and on an artificial diet.. J Insect Physiol. 2000 Apr;46(4):457-465. doi: 10.1016/s0022-1910(99)00132-8.. |
Secondary splenic rupture after thrombolysis for acute myocardial infarction. HISTORY AND ADMISSION FINDINGS: A 67-year-old male patient was admitted with acute chest pain and signs of an acute anterior myocardial infarction in the ECG. The usual contraindications were excluded and after a systemic lysis with rt-PA the ECG-alterations as well as the symptoms of angina resolved completely. 2 hours later the patient developed an acute abdomen with a severe circulatory shock. INVESTIGATIONS: On ultrasound and CT a massive intraabdominal bleeding was found. TREATMENT AND COURSE: Emergency laparotomy revealed a splenic rupture. Retrospectively, 6 weeks before admission, the patient had fallen from a ladder to his left side. This is a rare case of a secondary splenic rupture during thrombolysis for acute myocardial infarction. 2 weeks later the patient developed rein-farction with angiographically shown two vessel disease. After angioplasty of the ramus interventricularis anterior (RIVA) he was stable. CONCLUSIONS: Intravenous thrombolysis in case of acute myocardial infarction is the method of choice. In the past a great number of patients were excluded from thrombolysis because of an extensive interpretation of contraindications. The aim to reach an alteration in this use may not risk health of patients by insufficient history. | Krankenberg H; Doll S; Zotz R; Walther C; Schuler G. (2000). [Secondary splenic rupture after thrombolysis for acute myocardial infarction].. Dtsch Med Wochenschr. 2000;125(37):T5-T7. doi: 10.1055/s-2000-7371.. |
Variants of forming of the arteries of upper abdomen were studied. Peculiarities of their location in different variants were considered using 75 visceral complexes. A description of the original variant of hepatic artery is given. 2 laws of arrangement of the arteries in the upper abdomen were formulated corresponding with all the anatomic variants known that explain predominant location of right and left hepatic arteries. | Simbirtsev SA; Loit AA; Lebedev AK; Panshin AA; Koreshkin IA. (2000). [Variants and regularities of hepatic artery topography (practical aspects)].. Morfologiia. 2000;118(4):57-61.. |
INTRODUCTION: The increasing number of enterococcal infections in hospitals and reports about the development of resistance of these bacteria make it necessary to review their importance as co-pathogens in secondary peritonitis. MATERIALS AND METHODS: A prospective randomized controlled trial on primary therapy of secondary peritonitis was carried out in six centers comparing cephalosporin-based antibiotic therapy to acylaminopenicillin-based therapy. RESULTS: Enterococci were only cultured in 6 of 110 cases from the abdomen and were found in only 5 cases of postoperative complications. No differences were found between penicillin-based vs. cephalosporin-based therapy. CONCLUSION: The study supports the view that these bacteria continue to play a minor role in secondary peritonitis. The point has to be emphasized, however, that the patients under study were in relatively good condition (APACHE II median 9 for cephalosporins and 10 for penicillins) and that postoperative cases of peritonitis were excluded. | Rohrborn A; Wacha H; Schoffel U; Billing A; Aeberhard P; Gebhard B; Bocker I; Schafer V; Ohmann C. (2000 Summer). Coverage of enterococci in community acquired secondary peritonitis: results of a randomized trial.. Surg Infect (Larchmt). 2000 Summer;1(2):95-107. doi: 10.1089/109629600321137.. |
OBJECTIVE: Profound neuromuscular block (NMB) quantified by post-tetanic count (PTC) may prevent all muscle activity during anesthesia. We studied whether monitoring of PTC prevents airway pressure alarms or visible movements of the vocal cords and the abdomen during endolaryngeal procedures (ELPs). METHODS: In this prospective, double blind, study 50 healthy (ASA 1-3) patients scheduled for ELPs were randomized into five groups: atracurium, mivacurium, rocuronium, vecuronium and succinylcholine. During alfentanil-propofol anaesthesia, profound NMB was controlled by monitoring the PTC (target level PTC 0-2, 50 Hz tetanic stimulation) of the adductor pollicis muscle. The muscle relaxants were administered using bolus dosing in all groups but in the succinylcholine group. The early signs of recovery of NMB to be observed were: 1) airway pressure alarms, 2) movements of vocal cords on the laryngeal video monitor and 3) movements of the abdomen. The inference was based on 90% confidence interval tests. RESULTS: During 50 ELP:s following signs of early recovery of NMB were recognized: 2 alarms of airway pressure, 16 laryngeal movements and 11 movements of the abdomen. The proportion of airway pressure alarms was significantly lower than proportion of all detectable movements (95% confidence interval analysis). Twelve of the movements were recorded at PTC zero level. The signs of early recovery of NMB were detected in all groups. CONCLUSIONS: PTC-monitoring following 50 Hz stimulation does not ensure total inactivity of muscles during alfentanil-propofol anesthesia, regardless which relaxant has been chosen. During ELPs, simultaneous observation of the vocal cords and the abdomen is more sensitive in detecting early recovery of NMB compared to our method of airway pressure monitoring. | Puura AI; Rorarius MG; Laippala P; Baer GA. (2000). Does monitoring of post-tetanic count prevent alarms of airway pressure or visible muscle activity during intratracheal jet ventilation? A prospective study with five different neuromuscular blocking agents.. J Clin Monit Comput. 2000;16(7):523-8. doi: 10.1023/a:1011431723515.. |
This study was aimed at the preparation of 131I-vasoactive intestinal peptide (VIP) and its preliminary application in clinical imaging. VIP was labeled with Na 131I using chloramine-T method, then isolated by Sephadex G-10 column chromatography and examined by silica 60F254 thin layer chromatography. The bacteria and pyrogen were examined and the safety test was carried out. One control and two patients suffering from abdomen tumor were investigated. The results showed that the labeling rate of 131I was 80% and the specific activity of 131I-VIP was 36 TBq/mmol. The radiochemical purity of 131I-VIP was over 98%, and it decreased to 95% after six hours' storage at 4 degrees C. It was proved that the 131I-VIP eluate had no bacteria, no pyrogen and no poison. The injected 131I-VIP was distributed into the lungs immediately and was eliminated through kidneys. The primary tumor could be visualized about half an hour to 3 hours after injection. This study demonstrates that 131I-VIP is suitable for in vivo imaging and may be used as an effective tracer to identify the tumor site in patients with VIP receptor positive carcinoma. | Shi Y; Tan T. (2000 Sep). [Preparation of 131I-VIP and 131I-VIP receptor imaging].. Hua Xi Yi Ke Da Xue Xue Bao. 2000 Sep;31(3):292-4.. |
OBJECTIVE: The absorption of the polysaccharide-protein complex to the implant surface may be the first reaction between the implant and the surrounding tissue. So we observed the distribution and the relative amount of the polysaccharide-protein complex and glycosyls in order to find out the possible functions and changing rules of these substances. METHODS: 12 rabbits were selected according to the age, sex, weight, and health conditions. Bilateral mandibular premolar teeth of rabbits were extracted under abdomen anesthesia (2% glutababituratic acid), then 12 titanium implants were placed into the teeth extraction holes of one side and left the other side to be the control one. All of the implants were required to be placed 2 mm below the alveolar crest, and tissue closure was achieved with mattress and interrupted single sutures. Antibiotic injections were given to the rabbits in the following 3 days. The animals were sacrificed at the end of 1 week, 4 weeks and 24 weeks. Tissue blocks (4 mm x 4 mm x 4 mm) containing the titanium implants and the control ones were removed, then fixed with 10% formaldehyde for 2 weeks, and decalcified with 10% EDTA (pH7.0) for 8 weeks. Carefully removed the titanium implants, the tissue blocks were embedded into the paraffin wax, then the sections were obtained and stained using following methods. 1. Alcian Blue Method: Alcian blue (pH 2.5) staining displayed the acidic proteoglycans; Alcian blue (pH 1.0) displayed the proteoglycans containing sulfonyl; Alcian blue/periodix acid-shiff staining demonstrated the acidic and neutral proteoglycans respectively. Alcian blue-MgCl2 with different ionic concentration identified the different kinds of proteoglycans. 2. Lectin Method: 5 kinds of lectins were used to locate 5 kinds of glycosyls. 2.5 micrograms/ml ConA located the glucose; 10 micrograms/ml PNA located the galactose; 10 micrograms/ml WGA located the N-acetylglucosamine; 25 micrograms/ml PHA-E located N-acetylgalactosamine, 10 micrograms/ml WPL loacted the fucose. RESULTS: High level of proteoglycans and glycosyls were observed in the peri-implant connective tissue during all phases of the experiment. It was also observed that polysaccharide-protein complex and glycosyls reached a high level in new bone matrix as well as osteoblasts. CONCLUSION: Polysaccharide-protein complex and glycosyls do play an important role in the implant-bone attachment, and titanium compatibility and may be closely related to the bone metabolic activity. | Bai W; Gong P; Xiao B; Xian S. (2000 Feb). [A study of polysaccharide-protein complex and glycosyls in the tissue surrounding titanium implant of rabbit].. Hua Xi Kou Qiang Yi Xue Za Zhi. 2000 Feb;18(1):20-2, 33.. |
We report a case of acute abdomen that is operated with the presumptive diagnosis of complicated acute appendicitis. In the histologic examination we make the diagnosis of complicated amoebic appendicitis. We discuss clinical manifestations and histopathologic findings of this unusual presentation of amoebic infection. | Casavilca Zambrano S; Gomez Anchante V; Cisneros Gallegos E. (2000 Jul-Sep). [COMPLICATED AMOEBIC APENDICITIS.REPORT OF A CASE].. Rev Gastroenterol Peru. 2000 Jul-Sep;20(3):296-299.. |
OBJECTIVE: To investigate the location of transverse rectus abdominis musculocutaneous (TRAM) flap perforators on abdomen skin and the peak systolic flow velocities of the perforators. METHODS: A series of 94 consecutive patient's TRAM flap perforators were detected by color-flow duplex Doppler scanning peroperatively. Perforator locations were tabulated on the abdomen skin according to their vertical position relative to the umbilicus and their lateral location relative to the abdominal midline. RESULTS: The perforators on both left and right side of TRAM flap were quite not symmetry. The peri-umbilical region contained 81.1% of the perforators. All perforators were detected with peak systolic flow velocities ranging from 5 to 81 cm/s. CONCLUSION: The preoperative color-flow Doppler localization of TRAM flap perforators improves the surgeon's ability to design the flap in order to capture the dominant vessels, and select single- or double-pedicle and free TRAM flaps based on each patient's individual characteristics. | Liu LG. (2000 Jul). [Color-flow duplex Doppler scanning study in the tram flap perforators: a report of 94 consecutive patients].. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2000 Jul;14(4):213-6.. |
The approach to the management of retroperitoneal tumors begins with a complete history and physical examination. Imaging of the abdomen and pelvis by computed tomography (CT) provides both an imaging modality and a method by which to obtain tissue for diagnosis. Because a histologic diagnosis is essential in treatment planning, adequate tissue can usually be obtained by a CT-guided core biopsy. If the diagnosis is sarcoma, additional tests necessary for staging include plain chest radiography and evaluation of the liver by either CT scan or magnetic resonance imaging (MRI). The treatment options for primary retroperitoneal sarcomas include chemotherapy, radiation therapy, surgery, or a combination of these modalities; therefore, a multidisciplinary group best manages treatment planning. Primary radiation therapy for cure is seldom effective for retroperitoneal sarcomas but can provide palliation in select cases. Systemic chemotherapy for chemosensitive lesions, such as poorly differentiated liposarcoma, malignant fibrous histiocytoma (MFH), synovial cell sarcoma, and primitive neuroectodermal tumors (PNET), can be useful when used in a neoadjuvant manner. Consequently, surgical resection continues to be the mainstay of treatment for retroperitoneal sarcomas and requires en bloc resection of the primary tumor. Frequently this includes adjacent organs such as colon, small bowel, kidney, adrenal, and pancreas. Postoperative adjuvant therapy with chemotherapy or radiation has not been proven to be of any additional benefit. Overall treatment results are predominantly influenced by tumor stage, grade, size, and margins of surgical resection. Follow-up CT scans at 6-month intervals and surgical resection of recurrences can be valuable. | Eilber FC; Eilber KS; Eilber FR. (2000 Aug). Retroperitoneal sarcomas.. Curr Treat Options Oncol. 2000 Aug;1(3):274-8. doi: 10.1007/s11864-000-0040-y.. |
In-situ coagulation of keloid with Nd:YAG laser irradiation was carried out in in a cohort study of 17 patients, each with one keloid scar situated on either the sternum (six), abdomen (seven), shoulder (two), hip (one), or ear lobe (one). The duration of scarring was three to 17 years and size varied from 3-8 cm long. One to two doses of laser irradiation was required for complete coagulation. At three months, 10 (58.8%) keloids had completely healed; but in seven (41.1%), 25-50% of residual keloid persisted. Intralesional triamcinolone injection, once in four patients and twice in three patients, produced complete resolution in all seven patients. At 18 months to five years follow-up, 14 patients remain keloid-free but in three keloid recurred and was re-treated with laser coagulation with complete resolution. The treatment was carried out as an outpatient procedure under local anaesthesia. There were no complications. The results of this initial study suggest that Nd:YAG laser irradiation coagulation is effective treatment for keloid scarring. | Kumar K; Kapoor BS; Rai P; Shukla HS. (2000 May). In-situ irradiation of keloid scars with Nd:YAG laser.. J Wound Care. 2000 May;9(5):213-5. doi: 10.12968/jowc.2000.9.5.25985.. |
OBJECTIVE: To assess the sensitivity and specificity of the serum carboxypeptidase B activation peptide in diagnosing and determining the severity of acute pancreatitis. PATIENTS: Twenty consecutive patients with acute pancreatitis were studied on admission to the Emergency Room: 11 patients had mild pancreatitis, and 9 patients, severe pancreatitis. Twenty consecutive patients with non-pancreatic acute abdomen and 20 healthy subjects were also studied. MAIN OUTCOME MEASURES: Serum carboxypeptidase B activation peptide was determined using radioimmunoassay. RESULTS: Nineteen of the 20 patients with acute pancreatitis (95.0%) had serum carboxypeptidase B activation peptide concentrations above the upper reference limit, whereas 1 of the 20 patients with non-pancreatic acute abdomen (5.0%) and none of the healthy subjects had serum levels of this protein above the upper reference limit. The serum carboxypeptidase B activation peptide concentrations of patients with severe acute pancreatitis were significantly higher than those of patients with mild acute pancreatitis on the 2(nd) (P=0.044) and 3(rd) days (P=0.028) of the study. The overall sensitivity and specificity of carboxypeptidase B activation peptide in assessing the severity of acute pancreatitis were 84.6% and 59.4%, respectively. CONCLUSIONS: Serum carboxypeptidase B activation peptide may be used simultaneously both to diagnosis and assess the severity of acute pancreatitis on admission to the Emergency Room. | Pezzilli R; Morselli-Labate AM; Barbieri AR; Plate L. (2000 Sep). Clinical usefulness of the serum carboxypeptidase B activation peptide in acute pancreatitis.. JOP. 2000 Sep;1(3):58-68.. |
OBJECTIVE: To evaluate the effects of surgery of Pheo. METHODS: Pheochromocytoma was removed in 89 patients. RESULTS: In 39 patients, pheochromocytoma was removed by intercostal incision at the 11th rib and 15 at the 10th rib, 14 by transrectal incision, 9 by abdominothoracic incision, 5 by abdominal subcostal oblique incision, 3 by inferior abdominal incision, 3 by posterolateral incision. One patient received laparoscopic surgery. CONCLUSIONS: Pheochromocytoma definitely localized was removed by intercostal incision at the 10th or 11th rib. The suitable pathway for removal giant pheochromocytoma or pheochromocytoma related big vessels is transrectal incision or abdominothoracic incision. The incision of multiple pheochromocytoma or extra-adrenal pheochromocytoma may be in the middle of the abdomen. | Sun F; Zhang Z; Wu Y; Zhu Y. (2000 Oct). [Surgical approaches of pheochromocytoma].. Zhonghua Wai Ke Za Zhi. 2000 Oct;38(10):764-6.. |
The vascular endothelial growth factor (VEGF) plays a central role in promoting angiogenesis, and it is the target of innovative anti-cancer therapies. In colorectal carcinomas, differences in the VEGF expression have been found between the primary tumor and its metastases. We postulated that differences in the VEGF expression may also exist between liver and abdominal metastases from colon cancer. Consecutive colon cancer patients with liver or abdominal metastases were considered eligible for the study. Biopsies had to be performed before chemotherapy and the VEGF analysis were conducted through immunohistochemistry. The staining results were correlated to the metastatic pattern. The study population consisted of 41 patients with a metastatic site in the liver in 19 patients and the abdomen in 22 patients. A positive VEGF staining was found in 19 of the 41 metastatic samples (46%). Cases with positive VEGF expression were found more frequently in abdominal (15 out of 22 patients; 68%) than in liver metastases (4 out of 19 patients; 21%). Also, the degree of VEGF immunoreactivity was significantly higher in abdominal than in liver metastases. Evidence is supported that the VEGF expression may be different between colon cancer metastatic sites. The efficacy of anti-VEGF treatments may depend on the VEGF expression status, and this finding deserves further investigation. | Cascinu S; Graziano F; Catalano V; Staccioli MP; Barni S; Giordani P; Rossi MC; Baldelli AM; Muretto P; Valenti A; Catalano G. (2000). Differences of vascular endothelial growth factor (VEGF) expression between liver and abdominal metastases from colon cancer. Implications for the treatment with VEGF inhibitors.. Clin Exp Metastasis. 2000;18(8):651-5. doi: 10.1023/a:1013133224044.. |
Intraabdominal infections are usually polymicrobial, including both aerobes and anaerobes. To assess the importance of anaerobes in intraabdominal infection, a bacteriological study was performed. The subjects studied were 28 inpatients with acute abdomen who visited Gifu Red Cross Hospital, Gifu, Japan, between May 1996 and July 1998. Twenty-one patients had abscess or peritonitis caused by perforation of the gastrointestinal tract, 4 had liver abscess, 2 had pelvic abscess, and 1 had retroperitoneal and subcutaneous abscess. Most specimens were cultured within 6 h after sampling. Using the E test, we tested the susceptibilities of isolates to 11 antimicrobial agents. Anaerobes were predominantly recovered from intraabdominal infection caused by perforation of the small bowel, appendix, and large bowel. The anaerobes isolated were resistant to the cephems tested, to which the aerobic strains were susceptible. It is suggested that carbapenems may be the choice for treatment of severe intraabdominal infection, especially that resulting from perforation of the small bowel, appendix, and large bowel. | Ito Y; Kato N; Kato H; Watanabe K. (2000 Sep). Bacteriological study of 28 patients with intraabdominal infection in Japan.. J Infect Chemother. 2000 Sep;6(3):168-72. doi: 10.1007/s101560070017.. |
In order to relieve mechanical obstruction caused by rectal carcinoma, a bare rectal stent was inserted in the sigmoid colon of a 70-year-old female. The procedure was successful, and for one month the patient made good progress. She then complained of abdominal pain, however, and plain radiographs of the chest and abdomen revealed the presence of free gas in the subdiaphragmatic area. Surgical findings showed that a spur at the proximal end of the bare rectal stent had penetrated the rectal mucosal wall. After placing a bare rectal stent for the palliative treatment of colorectal carcinoma, close follow-up to detect possible perforation of the bowel wall is necessary. | Han YM; Lee JM; Lee TH. (2000 Jul-Sep). Delayed colon perforation after palliative treatment for rectal carcinoma with bare rectal stent: a case report.. Korean J Radiol. 2000 Jul-Sep;1(3):169-71. doi: 10.3348/kjr.2000.1.3.169.. |
This is the first of two chapters dealing with some 60 years of accumulated knowledge in the field of impact biomechanics. The regions covered in this first chapter are the head, neck, and thorax. The next chapter will discuss the abdomen, pelvis, and the lower extremities. Although the principal thrust of the research has been toward the mitigation of injuries sustained by automotive crash victims, the results of this research have applications in aircraft safety, contact sports, and protection of military personnel and civilians from intentional injury, such as in the use of nonlethal weapons. The reader should be keenly aware of the wide variation in human response and tolerance data in the cited results. This is due primarily to the large biological variation among humans and to the effects of aging. Average values are useful in design but cannot be applied to individuals. | King AI. (2000). Fundamentals of impact biomechanics: Part I--Biomechanics of the head, neck, and thorax.. Annu Rev Biomed Eng. 2000;2:55-81. doi: 10.1146/annurev.bioeng.2.1.55.. |
BACKGROUND: Recent clinical and experimental studies investigated the problem and possible pathomechanisms of portsite metastases after laparoscopic resection of malignant tumours. A generally accepted approach to prevent these tumour implantations does not exist so far. METHODS: After subcutaneous and intraperitoneal injection of 10(4) cells of colon adenocarcinoma (DHD/K12/TRb) the influences of either taurolidine or taurolidine/heparin on intraperitoneal and subcutaneous tumour growth were investigated in 105 rats undergoing laparoscopy with carbon dioxide. The animals were then randomised into seven groups. A pneumoperitoneum was established using carbon dioxide for 30 min (8 mmHg). Three incisions were used: median for the insufflation needle, and a right and left approach in the lower abdomen for trocars. To investigate the intraperitoneal (local) influence of either taurolidine and heparin on tumour growth the substances were instilled intraperitoneally. Systemic effects were expected when the substances were applied intravenously (iv). Synergistic influences were tested when both application forms were combined. The number and the weight of tumours as well as the incidence of abdominal wall and port-site metastases were determined four weeks after intervention. Blood was taken to evaluate the influences of taurolidine and heparin on systemic immunologic reactions: seven days before laparoscopy. two hours, two days. seven days, and four weeks after operation, and the peripheral lymphocytes were determined. RESULTS: Intraperitoneal (ip) tumour weight in rats receiving taurolidine (median 7 mg) and taurolidine/heparin (0 mg) intraperitoneally was significantly reduced when compared to the control group (52 mg) (P = 0.001). There was no difference of subcutaneus tumour growth among the groups (P = 0.4). Trocar recurrences were decreased when taurolidine was applied ip (3115). ipiv (4/15), and ip in combination with heparin (4/15) in comparison to the control group (10/15). Immediately after intervention treated and untreated groups showed a peripheral lymphopenia. CONCLUSIONS: The intraperitoneal therapy with taurolidine and the combination with heparin inhibits the intraperitoneal tumour growth and trocar recurrences. Neither the intraperitoneal nor the systemic application or the combination of taurolidine and heparin did reduce the subcutaneous tumour growth. The intervention caused a lymphopenia which was compensated on day two. | Braumann C; Ordemann J; Wildbrett P; Jacobi CA. (2000). Influence of intraperitoneal and systemic application of taurolidine and taurolidine/heparin during laparoscopy on intraperitoneal and subcutaneous tumour growth in rats.. Clin Exp Metastasis. 2000;18(7):547-52. doi: 10.1023/a:1011988923523.. |
A rare case of Ewing's sarcoma/peripheral primitive neuroectodermal tumor arising in the greater omentum in a 41-year-old man is reported. The patient presented with a hemorrhagic mesenteric cyst that was disclosed by the results of an abdominal echogram, a computed tomography scan, and magnetic resonance imaging. A laparotomy showed a multilocular cyst with intra-cystic hemorrhage. Histologically, the tumor wall consisted of sheets of small round cells separated by thick desmoplastic stroma. Rosette formations or ribbon-like cell arrangements were absent. Further pathological examination revealed that the membrane of the tumor cells was positive for MIC-2, and negative for epithelial membrane antigen, cytokeratin, and desmin, which are usually positive in intra-abdominal desmoplastic small round-cell tumors. An EWS/FLI1 fused transcript was detected by reverse transcription-polymerase chain reaction. These findings confirmed the diagnosis of Ewing's sarcoma/peripheral primitive neuroectodermal tumor. The patient died of tumor recurrence 4 months after his first admission. The autopsied tumor tissue exhibited neural differentiation in certain regions. To our knowledge, this is the first case to be reported of Ewing's sarcoma/peripheral primitive neuroectodermal tumor arising in the omentum with unique pathological features and the occurrence of partial neural differentiation during the clinical course. This case pointed out to us, as gastroenterologists, that only thorough examination confirms a definitive diagnosis of small round-cell tumor of the abdomen, it also shows that Ewing's sarcoma/peripheral primitive neuroectodermal tumor should be included in the differential diagnosis of cystic lesions in the omentum. | Tanida S; Tanioka F; Inukai M; Yoshioka N; Saida Y; Imai K; Nakamura T; Kitamura H; Sugimura H. (2000 Dec). Ewing's sarcoma/peripheral primitive neuroectodermal tumor (pPNET) arising in the omentum as a multilocular cyst with intracystic hemorrhage.. J Gastroenterol. 2000 Dec;35(12):933-40. doi: 10.1007/s005350070009.. |
Field accident data from NASS/CDS in the US and CCIS in the UK are compared. The UK sample is deliberately weighted to conform to the same AIS proportions (within AIS 2-6) as the weighted NASS data so that crash severity distributions can be compared for various selected outcomes. Age and gender have a significant effect on the delta V distributions and median delta V values. These differences are documented both for overall AIS 2-6, 3-6, and 4-6, and also for body regions of the head, neck, chest, abdomen and upper and lower extremities. Anomalies between the two samples are profound which raises doubts about the recording of belt use in NASS and the calculation of delta V at lower crash severities. | Mackay M; Hassan AM. (2000). Age and gender effects on injury outcome for restrained occupants in frontal crashes: a comparison of UK and US data bases.. Annu Proc Assoc Adv Automot Med. 2000;44:75-91.. |
Occupants exposed to far-side crashes are those seated on the side of the vehicle opposite the struck side. This study uses the NASS/CDS 1988-98 to determine distributions of AIS 3+ injuries among occupants exposed to far-side crashes and the sources of the injuries. The William Lehman Injury Research Center (WLIRC) data from 1994-98 is used to assess injury mechanisms among seriously injured crash exposed far-side occupants. The NASS/CDS indicated that injury patterns for far-side restrained drivers were different from far-side restrained front passengers. For the driver, the head accounted for 40% of the AIS 3+ injuries in far-side collisions and the chest/abdomen accounted for 45.5%. For the right front passengers, head injuries contributed 27.2%, while chest and abdominal injuries accounted for 64.5%. The opposite-side interior was the most frequent contact associated with driver AIS 3+ injuries (30.5%). The seat belt was second, accounting for 22.6%. Among thirteen WLIRC cases of far-side belted occupants with MAIS 3+ injuries, five of the most serious injuries were attributed to the seat belt. The liver or the spleen was the most seriously injured body organ in all five cases. The seat was the most frequent source of passenger AIS 3+ injuries for the NASS/CDS weighted cases. However, non-contacts, contacts with other occupants, and the seat belt contacts were more frequent sources when considering the raw number of injuries. Overall, contacts with the opposite side of the car interior and with safety belts were the most frequent causes of AIS 3+ injuries in far-side crashes. The presence of an occupant on the near-side changed the injury pattern of the far-side occupant, mitigating injuries from contacts with the opposite side interior of the vehicle. | Augenstein J; Perdeck E; Martin P; Bowen J; Stratton J; Horton T; Singer M; Digges K; Steps J. (2000). Injuries to restrained occupants in far-side crashes.. Annu Proc Assoc Adv Automot Med. 2000;44:57-66.. |
Public awareness for safety and vehicle improvements has contributed to significant reduction in injuries secondary to motor vehicle crashes. The spectrum of trauma has shifted from one region of the body to another with varying consequences. For example, airbags have minimized head and neck injuries for adults while emphasizing the lower regions of the human body. Studies have concentrated on the changing patterns of these injuries in frontal impacts. However, there is almost a paucity of data with regard to the characterization of abdominal injuries. Consequently, this study was conducted to determine the patterns of abdominal injuries in frontal and side impacts with an emphasis on more recent crashes. In particular, the frequency and severity of trauma were investigated with a focus on the various abdominal organs (e.g., spleen and liver). Results indicate that side crashes contribute to a large percentage of injuries to the abdomen. The liver and spleen organs are most vulnerable; therefore, it may be beneficial to apply concerted efforts to focus on injury biomechanics research and prioritization activities in these areas of the abdomen. These data may be of benefit to develop anthropomorphic dummies with improved biofidelity. | Yoganandan N; Pintar FA; Gennarelli TA; Maltese MR. (2000). Patterns of abdominal injuries in frontal and side impacts.. Annu Proc Assoc Adv Automot Med. 2000;44:17-36.. |
This study addresses whether the expected relationship of 15 specified subcutaneous adipose tissue layers (SAT layers) from 1-neck to 15-calf and body fat mass (FM) with leptin was influenced by a weight-loss program. In 30 obese girls (10 prepubertal, 15 pubertal, and 5 late/postpubertal) SAT layers were measured by means of the optical device Lipometer. Fat mass (FM) was estimated indirectly by means of bioelectrical impedance. Leptin and insulin were determined by means of radioimmunoassays. All measurements were performed before (pre) and after (post) 3 weeks of low-caloric diet and physical training. At the beginning of the study, there were significant correlations for all estimates of adiposity and leptin (0.67 to 0.79; P < 0.0001). Five SAT layers from the upper body and the trunk (0.48 to 0.67; P < 0.01) but none from the abdominal region and lower extremities were correlated with leptin. FM together with SAT layers 4-upper back and 8-lower abdomen (negative slope) explained 79% of the variation in pre leptin values (P < 0.0001). The weight-loss program significantly reduced leptin (P < 0.0001), insulin (P = 0.04), estimates of adiposity (P < 0.0001), and SAT layers 4-upper back (P = 0.0006), 11-front thigh, 13-rear thigh, and 14-inner thigh (P between <0.03 and <0.01). Although significant, the reductions in the four SAT layers were small. Estimated fat-free mass was significantly increased after three weeks (P < 0.05). Changes in SAT layers from the upper extremities and from the trunk were inversely correlated to the decrease in leptin (P between <0.05 and <0.001). Initial leptin was the best correlate of the decrease in leptin (adj. R(2) = 0.815; P < 0.0001). However, when only changes in adiposity and insulin were considered in the regression model, changes in insulin contributed to the fall in leptin (adj. R(2) = 0.23; P = 0.004). When changes in SAT layers were added to the model, changes in SAT layers 2-triceps and 10-hip (negative slopes) contributed to the decrease in leptin (adj. R(2) = 0.48; P < 0.0001). After weight loss, correlations between estimates of post adiposity and post leptin (0.40, P = 0.01 to 0.57, P = 0.0005) were lower compared with pre values. SAT layers 4-upper back and 3-biceps contributed independently to post leptin values (adj. R(2) = 0.50; P < 0.0001). It is suggested that fat mass and SAT layers from the upper body are the main determinants of leptin in obese girls before weight loss. The diet and sports intervention program reduced leptin independent of the reduction in adiposity. The distribution of subcutaneous fat might be a stable correlate of circulating leptin after a short-term reduction in energy intake. Am. J. Hum. Biol. 12:803-813, 2000. Copyright 2000 Wiley-Liss, Inc. | Sudi KM; Tafeit E; Moller R; Reiterer E; Gallistl S; Borkenstein MH. (2000 Nov 1). Relationship between different subcutaneous adipose tissue layers, fat mass, and leptin in response to short-term energy restriction in obese girls.. Am J Hum Biol. 2000 Nov 1;12(6):803-813. doi: 10.1002/1520-6300(200011/12)12:6<803::AID-AJHB8>3.0.CO;2-0.. |
The relationship between somatotype and somatotype components with coronary artery disease (CAD) and regional adiposity was considered in 58 males (age 60.2 +/- 9.4 years) undergoing investigative coronary angiography for suspected atherosclerotic CAD. Severity of CAD was determined in terms of both the degree of stenosis and the anatomical position of the lesions on the coronary arteries (myocardial score). Six patients had negative angiographic findings but three of these had impaired left ventricular function as determined by left ventriculography. The mean (+/-SD) somatotype of the group was 5.7 / 5.6 / 1.2 (1.7 / 1.4 / 1.0), illustrating a clear dominance of the first two somatotype components. Canonical correlation analysis showed that somatotype was not significantly related to the angiography results (P > 0.05). However, correlations between the somatotype components and the angiography results with their respective first canonical variates showed that the somatotype variate was one of high mesomorphy and low ectomorphy and the angiography variate was essentially one of a high myocardial score. After adjustment for the confounding interrelationship among the somatotype components, endomorphy was significantly correlated with abdominal circumference (r = 0.65, P < 0.001), the abdomen-to-hip ratio (r = 0.53, P < 0.001) and the abdominal sagittal diameter (r = 0.60, P < 0.001). Mesomorphy was not related to these indicators of android or abdominal adiposity following partial adjustment. Ectomorphy was inversely related to the indices of general and regional adiposity. This study suggests that adiposity and muscularity are important features in terms of increased CAD risk, whereas linearity is beneficial. Am. J. Hum. Biol. 12:128-138, 2000. Copyright 2000 Wiley-Liss, Inc. | Williams SR; Goodfellow J; Davies B; Bell W; McDowell I; Jones E. (2000 Jan). Somatotype and angiographically determined atherosclerotic coronary artery disease in men.. Am J Hum Biol. 2000 Jan;12(1):128-138. doi: 10.1002/(SICI)1520-6300(200001/02)12:1<128::AID-AJHB14>3.0.CO;2-X.. |
Darwinian natural selection is the only factor in evolution that maintains and improves adaptation. It does so by favoring genes that enhance the genetic success of their bearers under historically prevalent conditions, and need not favor health or happiness or conformity to some universally normal state. It may favor unpleasant departures from medical normalcy if they contribute to long-term genetic success, either directly or as unavoidable costs of features that make such contributions. It is also blind to future consequences of current evolution, so that every evolving lineage accumulates historical legacies that may seriously constrain future adaptation. Examples of adaptive but unpleasant abnormality are found in infectious diseases and other instances of conflict (between the sexes, between parent and offspring, between competitors for limited resources). Examples of unfortunate historical legacies are found in limitations on numbers of parts (limbs, sense organs) and in the tight human birth passage. Adaptation is a more useful medical concept than normalcy, but the purpose of medicine is not to facilitate natural selection or uncritically encourage biological adaptations. Medical intervention may legitimately promote human values by frustrating adaptations (e.g., by anesthesia) or by seeking the grossly abnormal (e.g., birth through the abdomen rather than the vagina). Am. J. Hum. Biol. 12:10-16, 2000. Copyright 2000 Wiley-Liss, Inc. | Williams GC. (2000 Jan). The Raymond Pearl memorial lecture, 1997: The quest for medical normalcy-who needs it?. Am J Hum Biol. 2000 Jan;12(1):10-16. doi: 10.1002/(SICI)1520-6300(200001/02)12:1<10::AID-AJHB2>3.0.CO;2-N.. |
OBJECTIVE: To diagnose parasitic ova or worms during endoscopy, surgery or by histology from endoscopic or surgical specimen in our patients. METHODS: The diagnosis of parasitic disease in our patients was made by histological examinations from biopsies obtained either during an upper gastrointestinal or lower gastrointestinal endoscopy or from surgical specimens. RESULTS: Parasites were seen in endoscopic biopsies from upper gastrointestinal tract in 21 patients. Schistosoma ova was seen in biopsies from stomach or duodenum (12 patients). Small intestine biopsies showed Giardiasis (8 patients) and strongyloides (1 patient). Colonic biopsies showed schistosoma ova by paraffin section or by squash technique in 216 patients. Surgical specimens from 12 patients, who presented with acute abdomen and had surgery, due to appendicitis in 8 patients, in whom specimens showed (Schistosoma in 5 patients, amoebiasis in 2 patients and Trichuria in 1 patient). Four other patients presented with acute abdomen, where ischemic bowel necrosis or mesenteric vein thrombosis was found during surgery, specimens showed schistosoma ova. CONCLUSION: The diagnosis of gastrointestinal parasites is not only made by stool but the diagnosis can be made by histology from endoscopic biopsies or surgical specimens. | Mohamed AE; Ghandour ZM; Al-Karawi MA; Yasawy MI; Sammak B. (2000 Jul). Gastrointestinal parasites presentations and histological diagnosis from endoscopic biopsies and surgical specimens.. Saudi Med J. 2000 Jul;21(7):629-34.. |
The aim of this study was to investigate whether increased hepatic oxidative stress could be visualised in living animals before the onset of obvious liver injury. Acute hepatic injury was induced in mice by priming with heat-killed Corynebacterium parvum followed by injection of a low dose of lipopolysaccharide (LPS). Low frequency band electron spin resonance-computed tomography (ESR-CT) with 3-carbamoyl-2,2,5,5-tetramethylpyrrolidine-1-oxyl (carbamoyl-PROXYL) was used to visualize hepatic oxidative stress. Biochemical and histological investigations performed 3 h after injection of LPS revealed no obvious injury to the liver. Conversely, significant hepatic oxidative stress could be detected at this time. Nitroxides such as carbamoyl-PROXYL are rapidly reduced to the corresponding hydroxylamine in vivo. resulting in the disappearance of their ESR signals. The kinetic clearance of carbamoyl-PROXYL after intravenous administration was delayed significantly in mice that had received LPS, due to impairment of the reduction system by hepatic oxidative stress. ESR-CT of the murine abdomen revealed a high intensity area of carbamoyl-PROXYL which consisted mainly of the liver and enlarged spleen. Time-course observations with ESR-CT using carbamoyl-PROXYL showed that the high intensity area in the liver disappeared rapidly due to reduction of carbamoyl-PROXYL. Three hours after LPS injection into the same mouse, ESR-CT images were obtained again by intravenous injection of carbamoyl-PROXYL. The ESR-CT images of the mouse with hepatic oxidative stress clearly showed that the high intensity area of carbamoyl-PROXYL in the liver persisted for a long period of time. This study is the first report to describe the use of in vivo ESR-CT for visualizing the state of increased oxidative stress in the liver before the onset of obvious hepatic injury. | Togashi H; Matsuo T; Shinzawa H; Takada Y; Watanabe H; Saito T; Oikawa K; Kamada H; Takahashi T. (2000). In vivo imaging of increased oxidative stress in the liver by electron spin resonance-computed tomography.. Res Commun Mol Pathol Pharmacol. 2000;107(3-4):197-217.. |
BACKGROUND: Orally inhaled insulin may provide a convenient and effective therapy for prandial glucose control in patients with diabetes. This study evaluated the influence of formulation pH and concentration and different respiratory maneuvers on pharmacokinetic and pharmacodynamic properties of inhaled insulin. METHODS: Three, open-label crossover studies in a total of 23 healthy subjects were conducted in which the safety, pharmacokinetics, and pharmacodynamics of insulin inhalation were compared to subcutaneous (SC) injection into the abdomen of commercially available regular insulin. A novel, aerosol generating system (AERx Diabetes Management System, Aradigm Corporation, Hayward, CA) was used to deliver aqueous insulin bolus aerosols to the lower respiratory tract from formulations at pH 3.5 or 7.4 and concentrations of U250 (250 U/mL) or U500 (500 U/mL). RESULTS: Time to maximum insulin concentration in serum (Tmax) after SC dosing occurred approximately 50-60 minutes with the time to minimum plasma glucose concentration (i.e., maximum hypoglycemic effect), (TGmin), occurring later, at around 100-120 minutes. In contrast, pulmonary delivery led to a significantly earlier Tmax (7-20 minutes) and TGmin (60-70 minutes), parameters that were shown to be largely unaffected by changing the pH or concentration of the insulin. However, investigation of changes in inhaled volume (achieved by different programming of the AERx system) for administration of the same sized aerosol bolus revealed significant effects. Significantly slower absorption and time to peak hypoglycemic activity occurred when aerosol delivery of insulin occurred during a shallow (approximately 40% vital capacity) as opposed to a deep (approximately 80% vital capacity) inspiration. In addition, it was shown that serum concentration of insulin increased immediately after a series of forced expiraratory maneuvers 30 minutes after inhaled delivery. CONCLUSIONS: Pulmonary delivery of aqueous bolus aerosols of insulin in healthy subjects resulted in rapid absorption with an associated hypoglycemic effect quicker than is achieved after subcutaneous dosing of regular insulin. Inhaled insulin pharmacokinetics and pharmacodynamics were independent of formulation variables (pH, concentration) but affected by certain respiratory maneuvers. | Farr SJ; McElduff A; Mather LE; Okikawa J; Ward ME; Gonda I; Licko V; Rubsamen RM. (2000 Summer). Pulmonary insulin administration using the AERx system: physiological and physicochemical factors influencing insulin effectiveness in healthy fasting subjects.. Diabetes Technol Ther. 2000 Summer;2(2):185-97. doi: 10.1089/15209150050025131.. |
Acute mesenteric ischemia is an abdominal emergency due to inadequate tissue perfusion with a mortality rate between 60 and 100%. Intestinal damage by ischemia depends on general circulation, collateral blood flow, response of the mesenteric vasculature to autonomic stimuli, circulating vasoactive substances, local humoral factors, and the normal and abnormal products of cellular metabolism before and after reperfusion of the ischemic segment. Four physiopathologic phenomenon are present: superior mesenteric artery embolism; superior mesenteric artery thrombosis; non-occlusive acute mesenteric ischemia, and superior mesenteric venous thrombosis; embolism event is the most frequent. The injury observed after 3 of ischemia (blood flow reduced to 20% of normal) and 1 of reperfusion is more severe than 4 of ischemia. Clinical diagnosis of mesenteric ischemia required a high suspect index, specially in elderly patients with cardiovascular problems. Abdominal pain and hemodynamic and/or metabolic changes are the most frequent symptoms. Although some authors have questioned the need for angiography, this study is the key not only to making a diagnosis of acute mesenteric ischemia before bowel infarction and prior to laparotomy, but also to initiate intra-arterial mesenteric angiography therapy with vasodilators. Patients who persist with acute abdomen will require exploratory celiotomy and vascular exploration. The outcome depends on early diagnosis and therapy to avoid ischemia progression and reperfusion injury. | Sanchez-Fernandez P; Mier y Diaz J; Blanco-Benavides R. (2000 Jul-Sep). [Acute mesenteric ischemia. Profile of an aggressive disease].. Rev Gastroenterol Mex. 2000 Jul-Sep;65(3):134-40.. |
INTRODUCTION: A case of child with acute pancreatitis associated with typhoid fever is reported herein. CASE REPORT: A four years old child was admitted to the pediatric emergency room with an acute abdomen and fever. He was submitted to a diagnostic laparotomy and mesenteric adenitis was the only finding. During the postoperative period, he persisted with abdominal pain and fever. Laboratory studies and abdominal ultrasonography revealed an acute pancreatitis. Also, Salmonella typhi was isolated from blood and stool cultures. Treatment for pancreatitis included nasogastric catheter and total parenteral nutrition. Typhoid fever was treated with ampicillin. Thereafter, his clinical course was uneventful and he was discharged 13 days after being admitted. CONCLUSIONS: Acute pancreatitis has been associated with typhoid fever. To the best of our knowledge, this is the youngest patient reported in the literature with this association. Possible pathophysiologic mechanisms are reviewed. | Yacaman-Handal R; Flores-Nava G; Escobedo-Chavez E; Perez-Bernabe MM. (2000 Jan-Mar). [Acute pancreatitis secondary to typhoid fever in a preschool child].. Rev Gastroenterol Mex. 2000 Jan-Mar;65(1):30-3.. |
Primary non-Hodgkin lymphoma of the gallbladder is a very rare location of extranodal non-Hodgkin lymphomas. A patient with a primary non-Hodgkin lymphoma of the gallbladder is reported and in addition, the English literature is reviewed. Clinical presentation, diagnostic evaluation, histopathologic findings, treatment modalities and prognosis of primary gallbladder lymphomas reported up to date are reviewed and discussed. Our patient was diagnosed as a T-cell lymphoblastic lymphoma, after cholecystectomy, and had no evidence of disease elsewhere. She was treated with combination chemotherapy and complete remission was achieved. She remains free of disease 9 years later. Review of the literature over a 30-year period revealed only 12 cases of well-documented primary non-Hodgkin lymphoma involvement of the gallbladder, including the present case. Patients present clinically with symptoms and signs indicating either biliary tract pathology or a gastrointestinal tumor. Diagnostic investigation included ultrasound of the upper abdomen, computed tomography of the abdomen and pelvis, oral cholecystography, percutaneous cholangiography and endoscopic retrograde cholangiopangreatography. Preoperative diagnosis was established in none of the patients. Treatment modalities included surgery and postoperative chemotherapy and irradiation. The prognosis is overall poor and only 2 patients are alive after 1 and 9 years respectively, the latter being our case. Here we document the first reported case of a patient with primary T-cell lymphoblastic non-Hodgkin lymphoma of the gallbladder. Review of the literature shows the existence of non-Hodgkin lymphoma of the gallbladder, its rarity and its general dismal prognosis. | Mitropoulos FA; Angelopoulou MK; Siakantaris MP; Rassidakis G; Vayiopoulos GA; Papalampros E; Kalovidouris A; Pangalis GA. (2000 Dec). Primary non-Hodgkin's lymphoma of the gall bladder.. Leuk Lymphoma. 2000 Dec;40(1-2):123-31. doi: 10.3109/10428190009054889.. |
OBJECTIVE: To evaluate, by 3rd trimester ultrasound examination, fetal adipose tissue to predict fetal growth and birthweight. PATIENTS AND METHODS: Thirteen pregnant women (group 1) with uncomplicated pregnancy and 9 diabetic women (group 2) have been enrolled. We have examined adipose tissue at the cross sectional level of arm, thigh and abdomen and at the longitudinal sectional level of shoulder. During 3rd trimester measurements were taken at the beginning (28-32 gestational weeks), at the middle (34-38 gestational weeks) and at term (39-41 gestational weeks). At birth we recorded the skinfolds of arm, thigh and shoulder and the neonatal weight. Subsequently, by regression analyses ultrasound parameters of physiological pregnancies were correlated to skinfolds measurements at birth, while abdomen thickness was compared to birthweight. In addition, ultrasound markers of the physiological pregnancies were compared to those of diabetic pregnancies by the t-test. RESULTS: Fetal limbs examination had not a prognostic value at any gestational week. Shoulder ultrasound measurements appeared well correlated to the shoulder skinfold after birth since the 34th week. Diabetic mothers' fetuses presented much more adipose tissue than control cases, particularly of arm and thigh at 28-32 weeks, of shoulder at 34-38 weeks and in all the markers at term pregnancy. CONCLUSION: Ultrasound examination of fetal adipose tissue seems to have a predictive value for fetal growth both in physiological and diabetic pregnancy. | Rossi AC; Vimercati A; Greco P; Baldassarra PF; Lestingi D; Laforgia N; Mautone A; Selvaggi L. (2000). [Echographic measurement of subcutaneous adipose tissue as fetal growth index].. Acta Biomed Ateneo Parmense. 2000;71 Suppl 1:379-82.. |
OBJECTIVE: To report two cases misdiagnosed as bilateral anorchism in midchildhood on the basis of multiple conventional human chorionic gonadotropin (HCG) stimulation tests and sonograms of the abdomen and pelvis. METHODS: In two young male patients with cryptorchidism who were considered to have anorchism, we describe the findings on clinical examination, the testosterone levels before and after standard HCG stimulation testing, and sonographic findings during the midchildhood period. In both cases, as the children approached puberty the diagnosis was found to be incorrect. RESULTS: Two boys, 8 and 91/2 years old, were seen in consultation in our Pediatric Endocrine Clinic with a presumed diagnosis of anorchism. In the first case, multiple conventional HCG stimulation tests were done. In the second case, a single stimulation test was performed during routine follow-up assessments. In both cases, testosterone levels before and after HCG stimulation were consistent with the diagnosis of absent functional testicular tissue. Sonograms of the abdomen and pelvis also failed to detect the testicles. Both patients were ultimately noted to be pubertal (at 14 1/2 and >13 1/2 years, respectively) and to have early pubertal testosterone levels. A testicle was detected in one patient by abdominal computed tomographic scan and in the other by palpation of the inguinal canal. CONCLUSION: Conventional dosing and duration of the HCG stimulation test, as widely recommended in standard textbooks and in articles in the medical literature, may not elicit positive HCG-induced testosterone responses during midchildhood for detection of functional testicular tissue. During the midchildhood period, which is characterized by low gonadotropin, low sex steroid production, and a highly sensitive hypothalamic-pituitary-gonadal axis to feedback inhibition, a prolonged HCG stimulation test-perhaps of 4 to 6 weeks' duration-may be necessary. In addition, other investigational modalities may need to be used to detect the presence of functional testicular tissue during this developmental period. | Bhowmick SK; Gidvani VK. (2000 Jan-Feb). Pitfalls of conventional human chorionic gonadotropin stimulation test to detect hormonally functional cryptorchid testes in midchildhood.. Endocr Pract. 2000 Jan-Feb;6(1):8-12. doi: 10.4158/EP.6.1.8.. |
Secondary sexual characteristics such as softening and rounding of the abdomen as well as reddening and protrusion of the anal papilla and vent can be of help to breeders in selecting common carp (Cyprinus carpio) females prepared for propagation. To assess the reliability of this method, long-term data obtained on induced spawning of common carp at a large-scale fish hatchery were evaluated. The average spawning ratio of 2,620 females receiving hormonal injections was 79.8%. The average pseudogonadosomatic index (PGSI) calculated from data on the egg production of 2,086 females was 16.3 +/- 5.87% (mean +/- SD) for the same period. There was a correlation between fish weight and the time of induction determined by the breeder on the basis of external morphological characteristics. The similarity of the responses of females, including both spawning ratio and PGSI, among the different weight categories proved the reliability of this method for identification. | Szabo T; Szabo R; Urbanyi B; Horvath L. (2000). Assessment of ovulation of common carp (Cyprinus carpio) females selected for induced spawning on the basis of external morphological characteristics.. Acta Vet Hung. 2000;48(1):1-8. doi: 10.1556/AVet.48.2000.1.1.. |
Purpose: In this work, we describe five oncology patients whose clinical management were uniquely benefited by a novel scanner that acquires positron emission tomography (PET) and x-ray computed tomography (CT) in the same imaging session.Procedures: Co-registered 2-[F(18)]-fluoro-2-deoxy-D-glucose (FDG)-PET and CT images were acquired using a combined PET/CT scanner. Pathology and clinical follow-up data were used to confirm PET/CT scan results.Results: The combined PET/CT scanner demonstrated the ability to distinguish malignant lesions from normal physiologic FDG uptake in the striated muscles of the head and neck as well as excretory and bowel activity in the abdomen and pelvis. Additionally, the technology positively affected patient management through localization for surgical and radiation therapy planning as well as assessment of tumor response.Conclusion: Our experience indicates that simultaneous acquisition of co-registered PET and CT images enabled physicians to more precisely discriminate between physiologic and malignant FDG uptake and more accurately localize lesions, improving the value of diagnostic PET in oncologic applications. | Kluetz PG; Meltzer CC; Villemagne VL; Kinahan PE; Chander S; Martinelli MA; Townsend DW. (2000 Nov). Combined PET/CT Imaging in Oncology. Impact on Patient Management.. Clin Positron Imaging. 2000 Nov;3(6):223-230. doi: 10.1016/s1095-0397(01)00055-3.. |
Inflammation of an epiploic appendage is considered to be a rare cause of acute abdomen. Recently, it has been reported that typical computed tomography (CT) findings of primary epiploic appendagitis (PEA) provide a definitive diagnosis in most of the cases. However, since these papers are only few, they are easily overlooked by the practicing radiologists. Our purpose is to add four new cases to the existing literature and to perform a review of the literature. | Sirvanci M; Tekelioglu MH; Duran C; Yardimci H; Onat L; Ozer K. (2000 Nov-Dec). Primary epiploic appendagitis: CT manifestations.. Clin Imaging. 2000 Nov-Dec;24(6):357-61. doi: 10.1016/s0899-7071(00)00236-9.. |
BACKGROUND: Acute pancreatitis ranks third among the inflammatory diseases causing acute abdomen; it accounts for about 2% of all cases of acute surgical abdomen. The clinical course of the disease is characterised by a number of local and systemic complications, the most frequent being respiratory disorders. METHODS: In the present study we review our experience with the management of acute pancreatitis in 75 patients complicated by pleural effusions in some of them. The patients were allocated into two groups depending on the severity of the disease: group I included patients with mild pancreatitis and group II--with severe acute pancreatitis. RESULTS: Pleural effusions were found in 4.7% of the patients in group I and in 24.2% in group II. They were given conservative treatment; it included puncture in three patients. CONCLUSIONS: Pleural effusions, which are indicators of poor prognosis, are observed most often in severe acute pancreatitis. | Uchikov AP; Shipkov HD; Markova DI. (2000). Pleural effusions in acute pancreatitis.. Folia Med (Plovdiv). 2000;42(3):34-6.. |
Pheochromocytoma of the adrenal gland can be the cause of massive and lethal retroperitoneal haemorrhage presenting as acute abdomen. Here we report a case of retroperitoneal hematoma, with concomitant peritoneal spillage, due to the spontaneous rupture of a silent pheochromocytoma. The main clinical findings of this disease will be described. Therapy and prognosis will be also discussed. | Gulla N; Patriti A; Capitanucci L; Fabbri B; Patriti A; Tristaino B. (2000 Nov-Dec). A case of "silent" pheochromocytoma presenting as spontaneous retroperitoneal hematoma.. Ann Ital Chir. 2000 Nov-Dec;71(6):735-7.. |
A 45 year old patient wad admitted with pain abdomen and a palpable mass in the epigastrium of 3 months duration. Endoscopy revealed growth in the stomach and biopsy showed poorly differentiated Carcinoma. Distal radical subtotal gastrectomy was done. Histopathology revealed choriacarcinoma with Syncytiotrophoblastic and cytotrophoblastic and foci of adenocarcinoma. Postoperatively urine and serum had very high levels of beta-human chorionic gonogotrophins (B-HCG). Immunochemistry showed positivity for B-HCG. Clinically and on scan both the testis were normal. Because of its rarity, we are presenting this case with brief review of literature. | Anjaneyulu; Rao SC; Rao RV. (2000 Oct). Primary choriocarcinoma of stomach.. Indian J Pathol Microbiol. 2000 Oct;43(4):471-4.. |
The clinical presentation of Burkitt's lymphoma (BL) and it's association with the Epstein-Barr virus (EBV) varies in different geographic areas, BL in developing countries being "intermediate" between the sporadic and endemic types, both in it's clinical presentation and it's association with EBV, which varies from 25-80%. In this study we have analysed the clinical features, EBV association, subtype and prevalence of the deleted variant of the Latent Membrane Protein-1 (LMP-1) of EBV in forty-two cases from two developing countries- India (n = 25) and Argentina (n = 17). In both countries the abdomen was the site most commonly involved while jaw involvement was rare. EBV was detected by in-situ hybridization using the EBER-1 RNA probe. 47% of cases from Argentina and 80% of cases from India were EBER positive. EBV typing using EBNA-3C primers showed a predominance of Type A in both countries (India-13/16 and Argentina-(7/8)). The 30bp deletion of the LMP-1 gene was detected in all evaluated cases from Argentina while the wild type of the gene was seen in all the evaluable Indian cases. Our study highlights the similarities and differences in the clinical presentation and EBV association of BL in two developing countries and also indicates that the subtype of EBV and prevalence of the LMP-1 deletion may reflect the predominant subtype in a particular population. | Rao CR; Gutierrez MI; Bhatia K; Fend F; Franklin J; Appaji L; Gallo G; O'Conor G; Lalitha N; Magrath I. (2000 Oct). Association of Burkitt's lymphoma with the Epstein-Barr virus in two developing countries.. Leuk Lymphoma. 2000 Oct;39(3-4):329-37. doi: 10.3109/10428190009065832.. |
BACKGROUND: The complete or almost complete resection of peritoneal carcinomatosis (PC) followed by intraperitoneal chemohyperthermia (IPCH) is potentially capable of curing some patients presenting with disease confined to the peritoneum. AIMS: The aim of this prospective phase I-II study was to develop an efficient IPCH procedure with good thermal homogeneity and good spatial diffusion, that would be reproducible (and thus could be standardized and exported), and to evaluate patient tolerance and its efficiency in eradicating tumor tissue. METHODS: Seven IPCH procedures were tested successively in 32 patients (up to a total of 35 IPCH). Each procedure was tested in at least 4 patients before modifications for technical reasons or due to inacceptable tolerance. Five of them were followed by early postoperative intraperitoneal chemotherapy (EPIC) lasting 4 days. Thermal homogeneity was measured with 6 thermal probes placed in different positions inside the abdominal cavity. Spatial diffusion was studied in the last patients by adding methylene blue to the IPCH liquid. The mean follow-up was 23.85 months for the series. RESULTS: From the technological point of view, we have progressively shown that procedures with closure of the abdomen are not satisfactory: it was impossible to obtain thermal homogeneity when the entire parietal wound was closed, but markedly improved when only the skin was closed. However, these "closed" procedures did not allow us to treat all surfaces at risk. The peritoneal cavity "expander" did not permit treatment of the parietal wound and an indeterminate amount of the perfusion oozed out at its periphery. The open technique with traction of the skin upwards was superior. Using different procedures successively undermined the quality of the postoperative results. Three patients (8.6%) died and morbidity (albeit minimal) occurred in 27 patients (77%) during the postoperative course. Mortality and morbidity were significantly correlated (P = 0.02) with the peritoneal index (scoring the extent of PC). The 2-year survival rate was 60% and PC did not recur in 49% of the patients. The survival rate was correlated with the extent of PC (peritoneal index greater than or below 15) (P = 0.004), and with the absence of extraperitoneal disease (P = 0.01). | Elias D; Antoun S; Goharin A; Otmany AE; Puizillout JM; Lasser P. (2000). Research on the best chemohyperthermia technique of treatment of peritoneal carcinomatosis after complete resection.. Int J Surg Investig. 2000;1(5):431-9.. |
A 50-year-old male patient continued to experience syncope after implantation of a pacemaker. During cardiovascular examination, the patient showed a typical vasovagal response, with normal pacemaker function. Leg crossing, which prohibits the pooling of blood in the legs and abdomen, at the onset of symptoms helped to prevent this response. The authors recommend a course of leg crossing as a measure to treat vasovagal syncope. | van Dijk N; Harms MP; Linzer M; Wieling W. (2000 Dec). Treatment of vasovagal syncope: pacemaker or crossing legs?. Clin Auton Res. 2000 Dec;10(6):347-9. doi: 10.1007/BF02322259.. |
PURPOSE: Penetrating liver wounds are related to many causes and rank second after blunt abdominal and liver trauma. We will report the clinical and radiological findings of our personal series of patients with penetrating trauma, especially by firearms and stab and cut wounds. We will also try to define the diagnostic workup of these traumas, which is especially based on CT signs of liver damage and associated changes and which is of basic importance for following treatment, both surgical or conservative. MATERIAL AND METHODS: In the last seven years we retrospectively reviewed 31 cases of penetrating liver trauma. The patients were 19 men and 12 women, ranging in age 18 to 73 (mean 42), with penetrating liver injuries from firearms (16 patients) and stab (9 cases) wounds; 6 patients had injuries from different causes. Abdominal CT was carried out in emergency with the CT Angiography (CTA) technique in all patients. In the patients with suspected chest and abdomen involvement CT was performed from the mid-chest for accurate assessment of diaphragm and lung bases and to exclude associated pleuropulmonary damage. RESULTS: Penetrating liver wounds were caused by firearms in 70% of cases, by stabbing in 12% and, in the extant 18%, by other causes such as home accidents, road and work traumas, and liver biopsy. In our series, the liver was most frequently involved, especially by firearms wounds; in our 16 cases the most frequent injuries were hemorrhagic tears. We found bullets in the liver in 6 cases. In one case of home accident the patient wounded himself while slicing bread with a long knife, which cut into the anterior abdominal wall and tore the anterior liver capsule, as seen at CTA. DISCUSSION AND CONCLUSIONS: Penetrating wounds to liver and abdomen are less frequent than those to the chest. In the past decade the use of CT has changed the diagnostic and therapeutic approach to such injuries completely, decreasing the resort to explorative laparotomy and hepatorrhaphy. Indeed, CT provides a clear picture of the extent and severity of damage, which permits to choose a conservative treatment in case of intraparenchymal hematomas and lacerocontusive foci without hemoperitoneum, which can be followed-up with physical and CT examinations. Moreover, Helical CT could provide the early diagnosis of active bleeding in the peritoneum and of focal bleeding in the liver, thus permitting prompt hepatorrhaphy or targeted hepatectomy. A diaphragm injury suspected at CT should always prompt the surgeon to intervention, especially when hemothorax, lung base pneumothorax, large liver hematoma or tear of the liver dome are associated. Finally, subdiaphragmatic free gas indicates gut perforation associated with liver damage, in which case surgery is necessary too. | Salzano A; Nocera V; De Rosa A; Rossi E; Carbone M; Gatta G; Vitale L; Vigliotti A. (2000 Dec). [Liver trauma due to penetrating lesions: miscellanea, personal case series, clinical and CT findings].. Radiol Med. 2000 Dec;100(6):465-9.. |
The aim of this study was to compare the performance of 3D MRI in conjunction with an intravascular contrast agent to spiral contrast-enhanced CT, regarding the detection of abdominal parenchymal injuries as well as peritoneal hemorrhage in an animal model. Liver and kidney injuries were created surgically in six female pigs under general anesthesia. All pigs underwent contrast-enhanced spiral CT and 3D MR imaging following administration of an intravascular contrast agent (NC100150 Injection). Two readers rated their confidence independently on MR and CT data sets using a five-point scale for the presence of organ injury and hemoperitoneum. Autopsy findings served as standard of reference. Sensitivity and specificity for MR in detecting hepatic and renal injuries as well as hemoperitoneum was 100%. Computed tomography was less accurate with sensitivity and specificity values of 90 and 94%, respectively. Receiver operating characteristics (ROC) analysis revealed a higher confidence when interpretation was based on MR images. In an animal model 3D MR imaging in conjunction with an intravascular contrast agent proved highly accurate in detecting and localizing parenchymal injuries to the upper abdomen as well as in detecting intraperitoneal blood collections. | Weishaupt D; Hetzer FH; Ruehm SG; Patak MA; Schmidt M; Debatin JF. (2000). Three-dimensional contrast-enhanced MRI using an intravascular contrast agent for detection of traumatic intra-abdominal hemorrhage and abdominal parenchymal injuries: an experimental study.. Eur Radiol. 2000;10(12):1958-64. doi: 10.1007/s003300000519.. |
OBJECTIVE: To evaluate an abdominoplasty technique combined with lipectomy and liposuction. METHODS: Twenty-five patients were undergoing for the abdominoplasty with lipectomy and liposuction in the same operation procedure. A public incision with W-shape was used for the lower abdominal lipectomy, and the upper abdomen was treated with an electronic liposuction technique. After the operation, each patient was followed up for evaluation of the results. RESULT: All of the patients got good contour of the abdomen without obvious complications. The abdominal perimeter was shrunk form 5 cm to 15 cm with over 3 months follow-ups. CONCLUSIONS: The combination of lipectomy and liposuction may be a good and safe method for abdominoplasty. The abdominal flap during the lipectomy could achieve higher survival rate than the traditional technique, due to the less injury on the neurovascular structures sustained by the liposuction procedure. | Cao H; Zheng Z; Song W. (2000 Nov). [Abdominoplasty with a combined technique of lipectomy and liposuction].. Zhonghua Zheng Xing Wai Ke Za Zhi. 2000 Nov;16(6):348-50.. |
Preparing the operation site by painting a solution of something onto the skin is one of the best preserved rituals in surgery. There appears to be something really satisfying about this precursor to the main event, and if the solution used is brightly coloured, or stains the skin, then so much the better--you can actually see where you've been! I hope than no-one is under the illusion that because the whole leg (or arm, or abdomen or anywhere else) is now a sickly shade of brown or alarmingly pink, that no pathogenic organisms can possibly have survived the onslaught. In this comprehensive review of the literature and practice audit, Sally Kent revisits the reasons for skin preparation, and recommends the use of well proven research to determine correct practice. | Kent S. (2000 Jul). Antiseptic skin preparation revisited.. Br J Perioper Nurs. 2000 Jul;10(7):364-72. doi: 10.1177/175045890001000703.. |
We report a case of gastric neurofibroma encountered in 41-year-old woman who complained of dyspepsia and physical examination revealed palpable mass in her abdomen. It was not possible to determine the nature and origin of the tumor by radiological and endoscopic investigations. At laparotomy the tumor was found to be pendiculated and growing extramurally from the anterior wall of the stomach. Wedge gastric resection, including the mass, was performed. Histological examination revealed a spindle cell gastric tumor, immunohistochemically differentiated as a neurofibroma. | Basta P; Sznajd J; Wachol D. (2000). [Gastric neurofibroma--still a diagnostic problem].. Przegl Lek. 2000;57(11):678-9.. |
The location of the reproductive timer for the post-copulatory, time-fixed, sexually refractory stage was investigated in the male cricket Gryllus bimaculatus. This stage was defined as the interval between spermatophore protrusion and recommencement of copulation or a calling song. To inactivate the central nervous system locally and reversibly, different body regions were cooled to 10 degrees C for 20-30 min after spermatophore protrusion. A behavioural test then measured the duration of the refractory stage after males recovered from cooling. Males with the head, thorax and anterior abdomen cooled did not show a lengthening of that stage. In contrast, males with the entire abdomen or even the posterior abdominal segments containing only the 6th and terminal (7th-11th) abdominal ganglia showed a lengthening of the refractory stage up to, but not exceeding, the cooling duration. When 20-min cooling was interposed twice after spermatophore protrusion, the refractory stage was lengthened by about 40 min, indicating that interposed cooling did not reset the timer. These results are in agreement with our previous hypothesis that the reproductive timer for the refractory stage in the male cricket is located in the posterior abdominal ganglia, possibly within the terminal abdominal ganglion. | Ureshi M; Sakai M. (2000-2001). Location of the reproductive timer in the male cricket Gryllus bimaculatus DeGeer as revealed by local cooling of the central nervous system.. J Comp Physiol A. 2000-2001;186(12):1159-70. doi: 10.1007/s003590000168.. |
A pelvic neurogenic tumor resected endoscopically through the retroperitoneal approach is described. Close examination of a 62-year-old man who complained of dull pain in the lower abdomen revealed a tumor on the posterior surface of the iliacus muscle. The tumor was extracted endoscopically without the need for a laparotomy. This procedure involves a less invasive approach that may be useful for benign retroperitoneal pelvic tumors. | Nishi H; Kido T; Yamanishi H; Nakahara M; Nakao K; Tsujimoto M. (2000 Aug). Endoscopic resection of a pelvic neurogenic tumor through the retroperitoneal approach.. Surg Endosc. 2000 Aug;14(8):767. doi: 10.1007/s004640040009. Epub 2000 Jul 10.. |
Colonic perforation is a dangerous complication of colonoscopy, both diagnostic and therapeutic, and its management has become controversial. The question of conservative vs operative treatment is still under debate. Despite the recent expansion and wide acceptance of laparoscopy by surgeons, the feasibility of this technique as a means of treating abdominal emergencies has also been questioned. Of 575 patients admitted to our institution for abdominal emergencies between 1993 and 1998, 365 were treated via a laparoscopic approach. Two of these patients were treated for colonoscopic perforations, one after a diagnostic procedure and one after an operative procedure. Our technique employs an open umbilical approach with two other trocars introduced in the right iliac fossa and left flank. In the first case, a diverticular perforation of the subperitoneal rectum was suspected. The abdomen was copiously irrigated with saline solution and a drain was left in the pelvis. In the second patient, localized peritonitis was found in the left iliac fossa due to a microperforation of the sigmoid colon. It was repaired with a single absorbable suture. The postoperative course was unremarkable in both cases. In patients with an emergency abdomen due to a postcolonoscopy perforation, we consider the laparoscopic approach feasible and safe in experienced hands. It allowed us to avoid an unnecessary laparotomy and other time-consuming and expensive diagnostic investigations. This approach represents an excellent means of managing this type of emergency abdominal situation. | Agresta F; Michelet I; Mainente P; Bedin N. (2000 Jun). Laparoscopic management of colonoscopic perforations.. Surg Endosc. 2000 Jun;14(6):592-3. doi: 10.1007/s004640000178. Epub 2000 May 8.. |
The incidence of abdominal pain in patients with systemic lupus erythematosus (SLE) is very high. Most patients do not require surgical treatment (serositis). Some cases such as appendicitis, perforated ulcer, cholecystitis or, rarely, intestinal infarction are surgical. Differential diagnosis is difficult, partly because noninvasive examinations do not provide enough evidence to rule out a diagnosis. On the other hand, in patients with SLE who have acute abdomen, it is dangerous to delay surgery by attempting conservative therapy. In fact, a better survival rate has been associated with early laparotomy. We report a case of acute abdomen in a patient affected by SLE, in which the diagnostic problem was solved by means of laparoscopy and the treatment was laparoscopically assisted. A 45-year-old woman with a 25-year history of SLE was admitted with abdominal pain and fever. Her physical examination revealed a painful right iliac fossa with rebound tenderness. Her WBC count was normal. Abdominal x-ray, ultrasonography, paracentesis, and peritoneal lavage did not provide a diagnosis. A diagnostic laparoscopy was performed, showing segmentary small bowel necrosis. The incision of the umbilical port site was enlarged to allow a small laparatomy, and a small bowel resection was performed. The histopathologic finding was "leucocytoclasic vasculitis, with infarction of the intestinal wall." The patient recovered uneventfully. In conclusion, this case report shows that emergency diagnostic laparoscopy is feasible and useful for acute abdomen in SLE. Currently, this diagnostic possibility could be considered the technique of choice in these cases, partly because, when necessary, it also can allow for mini-invasive treatment therapy. | Gobbi S; Sarli L; Violi V; Roncoroni L. (2000 Nov). Laparoscopically assisted treatment of acute abdomen in systemic lupus erythematosus.. Surg Endosc. 2000 Nov;14(11):1085-6. doi: 10.1007/s004640040013. Epub 2000 Sep 7.. |
Chilaiditi syndrome is interposition of the intestine between liver and diaphragm. It is often asymptomatic but there were cases presented as acute pain in the abdomen, needing corrective surgical procedure; or as mistaken renal colic, or as suspected subphrenic abscess, or as pneumoperitonium. The interposition of proximal transverse colon was found to be more common than the small intestine. Chilaiditi syndrome was associated with colonic volvulus. The colonic interposition then progressed from mild abdominal discomfort to intermittent bowel obstruction. Some patients needed surgical operation like hepatic extraperitonealization, after replacement of the dislocated gastroenteric tract, bringing the superior surface of the liver again into direct contact with the related diaphragmatic dome. A rare case of Chilaiditi syndrome incidentally associated with hypertension and ischaemic heart disease, in a male aged 50 years is reported. | Pranava VM; Prakash NS; Srinivas PS; Srinivas V; Srinivas GV. (2000 Jun). Chilaiditi syndrome with hypertension.. J Assoc Physicians India. 2000 Jun;48(6):641-2.. |
BACKGROUND: Diagnosis of Budd-Chiari syndrome (BCS) is often missed unless its possibility has been kept in mind. Obstruction of inferior vena cava (IVC) is reportedly the most frequent cause of BCS in Afro-Asian variety. AIM: An attempt was made to classify BCS (in an eastern Indian population) etiopathologically. PATIENTS AND METHODS: Thirty consecutive cases of BCS presenting over a period of five years were included. Following a thorough physical examination, necessary investigations (including coagulation profile, ultrasonography (with Doppler study) of hepatobiliary tract, hepatic vein and IVC angiography (n = 22) and liver biopsy (n = 26, including autopsy in two cases) were performed. RESULTS: Mean age at presentation was 32.7 +/- 10.36 years (range 12-60 years) with M:F = 21:9. Clinical presentations included, hepatomegaly in 28 (93.3%), ascites in 27 (90%), splenomegaly in 15 (50%), pain in abdomen in 26 (86.6%), jaundice in 10 (33.3%), back veins in 20 (66.6%) and gastrointestinal bleeding in three (10%) cases. Amongst the total of 30 patients, four, six and 20 cases presented as fulminant, acute and chronic BCS respectively. Twenty four cases of BCS could be diagnosed by ultrasonography alone, while the remainder required angiography for diagnosis. IVC and hepatic vein angiography revealed membranous obstruction in nine, partial stricture of IVC in six, and IVC and/or hepatic vein block in others. The etiopathological nature in 30 cases were as follows: idiopathic membranous obstruction in nine (30%), hepatocellular carcinoma in six (20%), idiopathic stricture in six (20%) cases and one case (3.3%) each of the following: cholangiocarcinoma, renal cell carcinoma, chronic pancreatitis, hydatid cyst in liver, protein S deficiency, oral contraceptive use, nephrotic syndrome (with antithrombin III deficiency), polycythemia rubra vera and chronic lymphatic leukemia. CONCLUSION: Idiopathic membranous obstruction and stricture of IVC are the commonest cause of BCS in the eastern part of India. Hepatocellular carcinoma is also a common cause, presenting in the fulminant form. Ultrasonography may be a helpful screening test for BCS, but IVC and hepatic vein catheterisation is essential for a complete work up of these patients. | De BK; De KK; Sen S; Biswas PK; Das TK; Das S; Hazra B. (2000 Aug). Etiology based prevalence of Budd-Chiari syndrome in eastern India.. J Assoc Physicians India. 2000 Aug;48(8):800-3.. |
Intraarterial angiography was performed on a patient with peripheral arterial occlusive disease (Fontaine IIb). No relevant risk factors were known, and a previous angiography had been undertaken without incident. After administration of contrast medium, the patient complained of acute pain in the lower abdomen and both legs, and a sudden rise in blood pressure was observed. The patient subsequently lost consciousness and died within 1.5 h. Postmortem examination showed that death was due to peripheral atheromatous microembolism of lipids, and not cholesterol as is usual in these cases. The differential diagnosis is discussed and a review of the literature is presented. | Kutzner D; Ritz-Timme S; Kaatsch HJ; Muller-Hulsbeck S. (2000 Oct). Fatal lipid embolism following intraarterial angiography at an early stage of arteriosclerosis.. Br J Radiol. 2000 Oct;73(874):1108-11. doi: 10.1259/bjr.73.874.11271906.. |
INTRODUCTION: The vast majority of tumours in the cervix are either primary carcinomas or direct extension of primary tumours from nearby sites such as the endometrium, myometrium, rectum and bladder. Patients usually present with abnormal bleeding, pain and dyspareunia. A smaller number of patients are asymptomatic and their tumours can be diagnosed early by PAP smears. CLINICAL PICTURE: We present an unusual case of an elderly lady with breast cancer that had metastasized to the cervix 4 years after primary treatment of the breast malignancy. Although the appearance of the cervix was "normal looking", it was firm and indurated on palpation. PATHOLOGY: A definite diagnosis of metastatic infiltration could only be made by colposcopic biopsy. Early PAP smears had shown some abnormal cells suggestive of metastatic lobular carcinoma but were not conclusive of metastasis from breast carcinoma. Subsequent bone scans and CT scans of the abdomen revealed metastatic lesions in the skull, spine, left femoral shaft and liver. | Kesavan S; Lee IW. (2000 Nov). An unusual tumour metastasis to the cervix.. Ann Acad Med Singap. 2000 Nov;29(6):780-2.. |
Trichobezoars are masses of entangled material, found in the stomach and intestines, composed of hair ingested by the patient. When the mass grows, symptoms of intestinal occlusion can appear. Trichobezoars in pediatrics are usually found in adolescent females presenting personality disorders and trichophagia. This work describes a case of trichobezoar diagnosed in a 13 year-old girl, wearing a brace for serious scoliosis but absolutely normal from the emotional and psychical point of view, with normal scholastic and familiar situation. Already hospitalized three months before for pneumonia from mycoplasma, the girl comes to our observation for the appearance of vomiting and constipation. The clinical examination reveal an epigastric mass as big as an orange. General conditions and hematochemical tests are good. Lab tests are performed (abdomen echography and upper abdomen MNR) but is the oesophago-gastroscopy which allows the diagnosis. A big trichobezoar is then surgically removed and the gastroenteric symptoms completely disappear. | Candelotti P; Tulli M; Pasquini R; Carlucci A; Tomassini N; Tosti M. (2000 Dec). [Obstructive syndrome caused by trichobezoars: historical disease or disease still current? Description of a case in adolescence].. Minerva Pediatr. 2000 Dec;52(12):739-42.. |
Primary mucinous cystadenoma of the mesocolon is a rare tumor with an uncertain histogenesis. A 38-year-old woman was diagnosed with a 17-cm cystic lesion in the left abdomen, identified as a mucinous cystadenoma of the mesocolon. This type of tumor appears rarely in extraovarian sites. We believe that metaplasia, either celomic or mucinous, is the most likely pathogenic mechanism. On rare occasions, a borderline or invasive component may be present. | Vrettos ME; Kostopoulou E; Papavasileiou C; Sikas N; Agelidou S. (2000 Jun). A mucinous tumor of the mesocolon with features of borderline malignancy.. Surg Endosc. 2000 Jun;14(6):595. doi: 10.1007/s004640000126. Epub 2000 Apr 28.. |
Gallbladder perforation with loss of calculi in the abdomen is frequent during laparoscopic cholecystectomy and can cause serious late complications. We report on a 65-year-old woman who underwent laparoscopic cholecystectomy for gallbladder empyema, during which a stone spilled into the peritoneal cavity. The spilled gallstone was not noticed during the initial operation. Three months later, she reported left upper quadrant pain of recent onset without associated symptoms such as fever, nausea, or weight loss. On examination, a palpable 2-cm tender subcutaneous mass was found. Abdominal ultrasound demonstrated an incarcerated hernia, and computed tomography (CT) scan showed an intraperitoneal abscess located in the back of the anterior abdominal wall in the left upper quadrant, which contained a recalcification figure. The patient was brought to surgery, at which time an incision was made over the mass. A chronic abscess in the back of the abdominal wall, also spreading into the subfascial space, was drained, and purulent material was obtained with a large stone, 2.8 cm in diameter, which had become lodged in the rectus abdominis after an undetected stone spillage during laparoscopic cholecystectomy. The patient continued receiving antibiotic treatment for 7 days, recovered well, and was discharged 7 days after drainage of the abscess. | Simopoulos C; Polychronidis A; Perente S; Botaitis S; Zoumpos I. (2000 Jun). Intraperitoneal abscess after an undetected spilled stone.. Surg Endosc. 2000 Jun;14(6):594. doi: 10.1007/s004640000133. Epub 2000 Apr 28.. |
PURPOSE: To assess the yield of US in the study of salivary glands and other organs involved in post-pubertal mumps. PATIENTS AND METHODS: We examined 68 patients with serologically proven post-pubertal mumps (age range 14-34 years). All patients were symptomatic, with fever and salivary gland swelling in 25 cases, marked hyperamylasemia in 32, epigastric pain in 9, unilateral scrotal swelling and/or pain in 19 cases and acute bronchitis in 1 case. All patients underwent US of salivary glands, neck lymph nodes, abdomen and scrotum with 48 hours of admission. RESULTS: Salivary glands: Parotid and submandibular glands showed normal echotexture in all patients. The parotid glands also showed multiple hypeoechoic intraparenchymal lymph nodes which were, ovoid or rounded, with smooth margins and a central hyperechoic area, with diameter ranging 3-14 mm (mean 5.4). No intraparenchymal lymph nodes were observed in submandibular glands. Neck: All patients had enlarged submandibular lymph nodes (maximum diameter ranging 5-22 mm; mean 11 mm); swelling was always bilateral and it was symmetric in 19/68 patients (30%) versus asymmetric because of prevailing right side involvement (more numerous and bigger nodes) in the other 47/68 cases (70%). All lymph nodes showed a benign pattern, with an ovoid or elongated shape, homogeneous hypoechoic echotexture and a hyperechoic hilum. Abdomen: The pancreas showed normal volume and normal parenchymal echotexture in all patients. Liver and spleen were always normal. Testes: US showed mild unilateral hydrocele in 10 cases, hydrocele and unilateral swelling of epidymis in 5 cases, hydrocele and swelling of both epidymis and didymis with inhomogeneous echotexture because of intraparenchymal hypeoechoic areas in 2 cases. There were no US changes in 2 cases. CONCLUSIONS: US of the salivary glands shows a specific pattern in post-pubertal mumps which has never been reported for other salivary gland diseases. In contrast US signs in other organs are not specific. | Tarantino L; Giorgio A; De Stefano G; Farella N. (2000 Jun). [Ultrasonography in the diagnosis of post-pubertal epidemic parotitis and its complications].. Radiol Med. 2000 Jun;99(6):461-4.. |
PURPOSE: Rectus sheath hematomas are a frequent but sometimes misdiagnosed disease in patients under anti-coagulative drugs, hemodialysis, or simply in the elderly. The most frequent localization is in the lower part of the abdomen: the explanation lies in the anatomy of the abdominal wall, especially in the arcuate line of the rectus sheath. Aim of this work is to explain the reason of the almost constant location correlating the anatomy with the CT features. ANATOMIC CONSIDERATIONS: The rectus abdominis muscle lies between the aponeuroses of the transverse and oblique muscles which form the so called rectus sheath. This arrangement is found from the costal arch to a level approximately between the umbilicus and the pubic symphisis, where the rear layer of the rectus sheath ends with a curved edge, called the arcuate or semicircular line of Douglas. Beneath this line the aponeuroses of the three muscles pass in front of the rectus which is separated from the peritoneum only by the fascia trasversalis, a thin connective layer between the rectus and the preperitoneal fat. In this lower aspect of the muscle the perforating branches of the inferior epigastric artery running in the preperitoneal fat may rupture causing a large hematoma widely spreading in this loose space. MATERIAL AND METHODS: 11 cases of rectus sheath hematoma diagnosed over 5 years were reviewed. They were referred to US because of a rapidly growing palpable mass or painful swelling of the abdominal wall with acute anemia. Sonography was performed in 11 patients and CT in 7. RESULTS: 10 hematomas were located in the lower third of the rectus muscle below the arcuate line in the pelvis, 1 was in the upper third of the muscle: the vast majority of pelvic hematomas is easily accounted for by the peculiar anatomy of the region. DISCUSSION: The diagnosis of hematoma of the rectus abdominis, sometimes misleading, should be included as a differential in all the patients who present with acute abdominal pain and blood loss. The anatomy of abdominal wall correlates well with CT findings and explains the reason why most hematomas are found in the lower third of the muscle. CONCLUSIONS: The diagnosis, whether clinical or based on imaging findings, needs accurate pathoanatomic knowledge of the anterior abdominal wall. Once the diagnosis has been confirmed (by US or CT) patients should be treated conservatively as those that are operated are at risk of developing complications, mainly hemorrhagic. | Cavagna E; Carubia G; Schiavon F. (2000 Jun). [Anatomo-radiologic correlations in spontaneous hematoma of the rectus abdominis muscles].. Radiol Med. 2000 Jun;99(6):432-7.. |
We report a case of corneal perforation secondary to bacterial keratitis caused by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A 43-year-old man was involved in a motorcycle crash and suffered multiple injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently P. aeruginosa was cultured from his sputum, blood, and open abdomen. He developed a bacterial keratitis in his right eye, which also grew P. aeruginosa. This infection rapidly progressed to corneal perforation requiring a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to aggressive antibiotic treatment. At the time of discharge from the hospital the patient had the return of vision to light only in his right eye. Corneal perforation is an unusual event in the ICU. Prevention or early detection of bacterial keratitis with aggressive antibiotic treatment is needed to prevent such complications. Pseudomonas is one of the more virulent organisms that can infect the cornea and early identification is paramount for a good outcome. Management of this complicated case is discussed and the limited amount of literature on nosocomial bacterial keratitis in the ICU is reviewed. | Johnson JL; Sagraves SG; Feild CJ; Block EF; Cheatham ML. (2000 Oct). An unusual case of corneal perforation secondary to Pseudomonas keratitis complicating a patient's surgical/trauma intensive care unit stay.. Am Surg. 2000 Oct;66(10):972-4.. |
Ruptured infrarenal aortic aneurysms and mesenteric ischemia are abdominal emergency situations, which should be treated by vascular surgeons. Modern means of patient transport and specialized emergency centers make it possible to bring patients suspect of having a ruptured aneurysm or a mesenteric ischemia to experienced clinics. Indication for surgery in case of symptomatic or ruptured aortic aneurysms is doubtless absolute. If there is suspicion for a ruptured aneurysm, emergency operation is indicated. In patients having undergone emergency surgery for a ruptured aneurysm of the infrarenal aorta, hospital mortality was 41%. The initial indication for surgery for patients with mesenteric ischemia usually is the "acute abdomen". Mostly only the patient's history reveals the suspicion for this disease. There are no valid radiologic examinations for proving or ruling out mesenteric ischemia. Most of our patients had arterial embolism (64%) as a source of mesenteric ischemia, followed by arterial thrombosis (28%), venous thrombosis (3%) and non-occlusive ischemia (5%). Monitoring of levels of serum lactate can be an additional tool for decision making, if a second look operation is discussed. The key for surgical success with these critically ill patients is shortening of the interval between the first symptoms of the patient and the start of surgical therapy. | Prager M; Teufelsbauer H; Nanobashvili J; Kretschmer G; Trubel W; Huk I; Laggner A; Zimpfer M; Haider W; Herold C; Polterauer P. (2000). [Abdominal vascular surgery emergencies: abdominal aortic aneurysm, acute mesenteric ischemia--indications, technique, results].. Acta Med Austriaca. 2000;27(5):145-51.. |
Cirripedes (barnacles) are crustaceans that are characterized by a very peculiar body plan, in particular by the lack of an abdomen. To study their body plan, we searched for their engrailed gene. We found two engrailed (en.a/en.b) genes in cirripedes. The two engrailed genes of the rhizocephalan barnacle Sacculina carcini are expressed in the posterior compartment of developing segments and appendages. When the neuroectoderm differentiates into epidermis and neuroderm the expression patterns of en.a and en.b diverge dramatically. en.a expression fades in segment epidermis whereas it is subsequently detected ventrally in reiterated putative neural cells. At the same time, en.b expression increases in the epidermis, which makes it a very good segmentation marker. Five tiny en.b stripes are observed between the sixth thoracic segment and the telson. We interpret these stripes as the molecular definition of vestigial abdominal segments, being the remnant of an ancestral state in keeping with the bodyplan of maxillopod crustaceans. engrailedexpression is the first molecular evidence for a segmented abdomen in barnacles. | Gibert JM; Mouchel-Vielh E; Queinnec E; Deutsch JS. (2000 Jul-Aug). Barnacle duplicate engrailed genes: divergent expression patterns and evidence for a vestigial abdomen.. Evol Dev. 2000 Jul-Aug;2(4):194-202. doi: 10.1046/j.1525-142x.2000.00059.x.. |
Variation of dark pigmentation according to developmental temperature was investigated in two geographic populations (France and India) with the isofemale line technique (20 lines for each population). The response curves called the reaction norms, were established in females for seven different segments: the mesothorax and abdomen segments 2-7 (Abd 2-7). In all cases the response curves were non-linear and had to be described either by a quadratic convex polynomial for thorax and Abd 2-5, or by a cubic polynomial for Abd 6 and 7. Among abdomen segments, increasing antero-posterior gradients were observed for several traits, including average pigmentation, overall phenotypic plasticity, the temperature of minimum pigmentation, and the curvature parameter of quadratic norms. Genetic correlations between abdomen segments were high when adjacent segments were considered, but became nil when more distant segments were correlated, suggesting that different pigmentation genes are expressed in the anterior and the posterior part of the abdomen. Characteristic values of reaction norms provided information either on trait value (i.e., the extension of pigmentation) or on plasticity. Correlations between plasticity and pigmentation were generally low and non-significant, suggesting their genetic independence. The overall darker pigmentation which is observed at low temperatures is assumed to be an adaptive plasticity. However, the differences which are evidenced among segments reveal strong interactions with developmental genes. These interactions are less likely to be a consequence of natural selection and are better interpreted as developmental constraints. The reaction norms analysis reveals the complexity of these interactions and should help, in the future, in the identification of the responsible thermosensitive genes. | Gibert P; Moreteau B; David JR. (2000 Sep-Oct). Developmental constraints on an adaptive plasticity: reaction norms of pigmentation in adult segments of Drosophila melanogaster.. Evol Dev. 2000 Sep-Oct;2(5):249-60. doi: 10.1046/j.1525-142x.2000.00064.x.. |
In order to ascertain the kinetics of absorption and metabolism of transdermally administered dehydroepiandrosterone (DHEA), 10 men 29-72 years old (mean 52.4+/-14.5) received 50 mg DHEA/day in a gel applied onto the skin of the abdomen for 5 consecutive days. The objective was to establish the extent to which DHEA influences the levels of gonadotropins, sex hormone-binding globulin and lipids. It was found that DHEA is well absorbed and rapidly metabolized to its sulfate (DHEAS), androstenedione, and consequently to testosterone and estradiol. The DHEA levels that markedly increased after the first doses gradually declined already during the application, and this decline proceeded even after it was discontinued, reaching levels significantly lower than the original ones. On the other hand, the levels of DHEA metabolites (with the exception of DHEAS) rose during the application and reached values significantly higher than the basal ones within 5 weeks. This effect was accompanied by significantly decreased levels of LH. The serum levels of lipids, namely of cholesterol (both HDL and LDL cholesterol), triglycerides, apolipoproteins A-I and B and lipoprotein(a) after DHEA application were not changed significantly, and the atherogenic index (AI) remained unaltered. However, some correlations between hormones and lipids were found. Negative correlations concerned the following indices: DHEA/Lp(a); DHEAS/cholesterol; DHEA, DHEAS, testosterone/TG; testosterone/AI. On the other hand, LH, FSH/cholesterol, FSH, SHBG/LDL cholesterol, FSH/Apo B, Lp(a) correlated positively. It can be concluded that transdermal short-time application of DHEA results in a decrease of endogenous DHEA after finishing the treatment, with a parallel marked increase in the levels of sex hormones. Using this application protocol, exogenous DHEA neither altered the lipid spectrum, nor did it influence the atherogenic index. | Sulcova J; Hill M; Hampl R; Masek Z; Novacek A; Ceska R; Starka L. (2000). Effects of transdermal application of DHEA on the levels of steroids, gonadotropins and lipids in men.. Physiol Res. 2000;49(6):685-93.. |
The diagnosis of acute diaphragmatic rupture can be a challenge for even the most experienced clinician. The treatment of the rupture and its concomitant injuries, particularly in the elderly, can be associated with significant morbidity and mortality. The advent of laparoscopy for both the diagnosis and repair of this condition has allowed a more minimally invasive approach. We present the case of a 70-year-old woman who was hurt in a motor vehicle crash. On admission, her physical exam showed left upper quadrant tenderness and bruising. The chest radiograph was suggestive of a ruptured diaphragm. She was taken to the operating room and explored laparoscopically. After a thorough exploration of all the abdominal contents, a tear in the diaphragmatic hiatus to the right of the esophagus was noted. The stomach and small intestine were returned to the abdomen, and the diaphragmatic rupture was repaired. We conclude that laparoscopic exploration and repair of a ruptured diaphragm in a bluntly injured patient is a safe and effective option in selected cases. | Smith CH; Novick TL; Jacobs DG; Thomason MH. (2000 May). Laparoscopic repair of a ruptured diaphragm secondary to blunt trauma.. Surg Endosc. 2000 May;14(5):501-2. doi: 10.1007/s004649901213. Epub 2000 Mar 24.. |
Pulmonary embolism is a major cause of death in hospitalized patients in the United States. Significant morbidity is a characteristic of this phenomenon and its common antecedent, deep venous thrombosis. Research has shown that pulmonary embolism is rarely a consequence of superficial venous thrombosis. Because the signs and symptoms of these disorders are often nonspecific and not readily apparent, prevention is the goal of patient care. Nurses play a critical role in the prevention process. The recognition of persons at risk, the assessment of these patients for early signs and symptoms, and the institution of prophylactic measures to minimize the effect of any existing factors or to deter their development are essential components of nursing care. The administration of anticoagulation therapy, with the concomitant monitoring of its effectiveness, and the education of persons regarding precautions associated with the indicated medications and relevant lifestyle modifications are also fundamental aspects of care. This article provides a review of risk factors associated with pulmonary embolism and deep venous thrombosis, particularly prolonged immobility and surgery involving the abdomen or lower extremities, as well as a review of the respective etiologies, most notably those encompassing Vichow's triad. In addition, current modalities to diagnose, treat, and prevent these allied disorders are discussed, as well as the associated nursing management. | Epley D. (2000 Jun). Pulmonary emboli risk reduction.. J Vasc Nurs. 2000 Jun;18(2):61-8; quiz 69-70. doi: 10.1016/s1062-0303(00)90029-3.. |
The experience of examination and treatment of 126 patients with severity trauma of abdomen was summarized. The performance of decompressive laparostomy in treatment of the abdominal compression syndrome was suggested. In 28 patients temporary closure of abdominal cavity by polychlorvinyl blend was applied. | Roshchin GG. (2000 Oct). [Decompressive laparostomy as the method of choice in the treatment of the abdominal compression syndrome].. Klin Khir. 2000 Oct;(10):38-40.. |
Two cases of primary small bowel volvulus in neonates are presented. On abdominal plain radiographs pseudotumor sign was seen in both cases. CT showed intensely distended fluid-filled small bowel loops on the right side of the abdomen and diffuse distention of the proximal small bowel loops with air-fluid levels. US also showed distended fluid-filled loops containing echogenic foci without peristalsis. We consider that CT and US can play important roles in the diagnosis of small bowel volvulus in neonates. | Makino K; Kohzaki S; Mori M; Amamoto Y; Matsumoto A; Mori H; Hayashi K. (2000 Jul-Aug). Primary ileal volvulus in neonates: radiologic findings in two cases.. Radiat Med. 2000 Jul-Aug;18(4):257-9.. |
The aim of our study was to find a way of preserving the ilioinguinal nerve during surgical procedures for the repair of inguinal hernias. 40 inguinal regions were dissected, 37 ilio-inguinal nerves studied. The emergence of the nerve was at 4.21 cm of the anterior superior iliac spine, at 0.78 cm of the inguinal ligament on average. Its course was parallel to the inguinal ligament, always lay under the aponevrosis of the external oblique abdominal muscle, it passed through the superficial abdominal ring in 67.56% before proceeding on anterior side of spermatic cord. This result allowed us to examine the possibility of the nerve course variation's, of anastomosis with iliohypogastric nerve and particularly the best way to identify it when surgical procedures are performed in the lower portion of the abdomen. | Diop M; Dia A; Ndiaye A; Lo EA; Sow ML; Ndiaye PD. (2000 Sep). [Emergence and course of the ilioinguinal nerve of the groin].. Morphologie. 2000 Sep;84(266):29-32.. |
Secondary iodine deficiency was experimentally produced in growing male lambs by oral administration of 50 mg/kg bodyweight of Thiourea daily for 3.5 months. At the end of the experiment the animals became weak, emaciated, anaemic, significantly reduced in body weight with facial oedema and alopecia at thigh, legs and abdomen. The clinical analysis showed significant reduction in erythrocyte and leucocyte numbers and in levels of triiodothyronine and testosterone at the end of the experiment. The histopathological picture of the thyroid gland revealed hyperplasia of the follicle-lining epithelial cells which project into the lumen. The lumens of the follicles are devoid of colloid. The testes showed ill-developed small, empty seminiferous tubulcs. In the liver, the hepatocytes showed degeneration and vacuolation with proliferation of Kupffer cells, which contain haemosiderin pigment. The kidney showed glomerular lipidosis with accumulation of haemosiderin pigment in the cytoplasm of the renal tubules. Hyperkeratosis of the epidermis associated with excessive keratin formation within the hair follicles was detected. In conclusion, deficiency of iodine causes hypothyroidism which leads to retardation of growth, reduced wool production and interferes with sexual maturity of growing male lambs. | Sokkar SM; Soror AH; Ahmed YF; Ezzo OH; Hamouda MA. (2000 Nov). Pathological and biochemical studies on experimental hypothyroidism in growing lambs.. J Vet Med B Infect Dis Vet Public Health. 2000 Nov;47(9):641-52. doi: 10.1046/j.1439-0450.2000.00394.x.. |
A 54-year-old premenopausal woman presented with abdominal pain, constipation, and raised serum CA-125 levels during routine follow-up of a low-grade endometrial stromal sarcoma with prominent sex cord-like features, which had been treated by vaginal hysterectomy 4 years previously. The findings at laparotomy included: a 100-mm unilocular thick-walled right ovarian cyst, a solid 25-mm nodule in the left meso-ovarium, and a phlegmonous mass in the wall of the sigmoid colon, which proved to be a pericolic abscess due to diverticular disease. The ovarian cyst was a histologically benign endometrioid cystadenoma with stromal luteinization in the wall. Small islands of morphologically benign endometrial tissue were present in vessels of the meso-ovarium. The left adnexal nodule exhibited florid morphologically benign endometriosis, much of which was within and occluding large vascular spaces, and of apparently recent onset. No lesions resembled, in any way, the original stromal sarcoma. There was no evidence of endometriosis elsewhere in the pelvis or abdomen. The patient has made an uneventful recovery and is being monitored, as before, by tumor markers only. The discordance in morphology between the uterine sarcoma and the subsequent pelvic lesions was so complete as to raise doubts about any pathogenetic relationship between them. We propose the use of the term aggressive endometriosis to describe the changes observed. | Scolyer RA; Carter J; Russell P. (2000 May). Aggressive endometriosis: report of a case.. Int J Gynecol Cancer. 2000 May;10(3):257-262. doi: 10.1046/j.1525-1438.2000.010003257.x.. |
Boswellin (BE), a methanol extract of the gum resin exudate of Boswellia serrata, contains naturally occurring triterpenoids, beta-boswellic acid and its structural related derivatives, has been used as a traditional medicine for the treatment of inflammatory and arthritic diseases. Topical application of BE to the backs of mice markedly inhibited 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced increases in skin inflammation, epidermal proliferation, the number of epidermal cell layers, and tumor promotion in 7,12-dimethylbenz[a]anthracene (DMBA)-initiated mice. Feeding 0.2% of BE in the diet to CF-1 mice for 10-24 weeks reduced the accumulation of parametrial fat pad weight under the abdomen, and inhibited azoxymethane (AOM)-induced formation of aberrant crypt foci (ACF) by 46%. Addition of pure beta-boswellic acid, 3-O-acetyl-beta-boswellic acid, 11-keto-beta-boswellic acid or 3-O-acetyl-11-keto-beta-boswellic acid to human leukemia HL-60 cell culture inhibited DNA synthesis in HL-60 cells in a dose-dependent manner with IC50 values ranging from 0.6 to 7.1 microM. These results indicate that beta-boswellic acid and its derivatives (the major constituents of Boswellin) have anti-carcinogenic, anti-tumor, and anti-hyperlipidemic activities. | Huang MT; Badmaev V; Ding Y; Liu Y; Xie JG; Ho CT. (2000). Anti-tumor and anti-carcinogenic activities of triterpenoid, beta-boswellic acid.. Biofactors. 2000;13(1-4):225-30. doi: 10.1002/biof.5520130135.. |
Hepatic artery aneurysm caused by tuberculosis is extremely rare, the commonest being atherosclerosis and vasculitis. A 13 year boy admitted with suspected disseminated tuberculosis had a hepatic bruit. Patient died of aneurysmal rupture before antemortem etiological diagnosis could be established. Postmortem examination revealed widespread tubercular lesions in the chest and abdomen and hepatic artery aneurysm. | Beeresha; Ghotekar LH; Dutta TK; Verma SK; Elangovan S. (2000 Feb). Hepatic artery mycotic aneurysm of tubercular aetiology.. J Assoc Physicians India. 2000 Feb;48(2):247-8.. |
We present a case of renal cell carcinoma diagnosed in 1982; aged 20 years. Regular follow up of the abdomen by USG noted first the presence of 2 nodules in the remaining kidney in 1994, age 30 and more lesions in 1997, aged 35. These were suspected to be angiomyolipomas on USG. The radiologist on this basis raised the question of tuberous sclerosis. Subsequent evaluation by internist/neurologist showed few adenoma sebaceum lesions a single ash leaf macule, a shagreen patch on the back, and characteristic multiple subependymal calcifications diagnostic of tuberous sclerosis on CT scan brain. The mentation was normal, there was history of only a single fit in childhood. The renal cell carcinoma was thus the first significant manifestation of tuberous sclerosis complex (TSC). | Kulkarni S; Uddar M; Deshpande SG; Vaid S; Wadia RS. (2000 Mar). Renal cell carcinoma as significant manifestation of tuberous sclerosis complex.. J Assoc Physicians India. 2000 Mar;48(3):351-3.. |
OBJECTIVE: To evaluate the sensitivity and specificity of palpation and percussion for splenic enlargement, as the accuracy of many of the clinical maneuvers we perform remains largely unstudied. METHODS: One hundred cases were selected at random from medical wards, and splenic enlargement was assessed by palpation and percussion of the Traube's space (Barkuns method), which was confirmed by the ultrasonography of the abdomen. The results of the various tests were tabulated and assessed statistically. RESULTS: 1) Performance of Traube's space percussion shows 24 true positive and 48 true negative cases, the test thus had an overall sensitivity of 67% and specificity of 75%. It was also found that the BMI of the false negative cases was significantly higher (29.43 Kg/m2). 2) Palpation as a diagnostic maneuver had a high specificity of 96.87% along with high false negative rate with overall low sensitivity of 44.44%. 3) Interpolation of findings of Traube's space percussion and palpation showed that maximum clinical utility could be achieved when both percussion and palpation were positive. CONCLUSION: Percussion of the Traube's space is a useful clinical screening test for splenomegaly, with a sensitivity of 67% and specificity of 75%, as compared to palpation (sensitivity of 44.44% and specificity of 96.87%). And maximum clinical utility is achieved when both percussion and palpation are combined. | Dubey S; Swaroop A; Jain R; Verma K; Garg P; Agarwal S. (2000 Mar). Percussion of Traube's space--a useful index of splenic enlargement.. J Assoc Physicians India. 2000 Mar;48(3):326-8.. |
Patients with Parkinson's disease (PD) may develop pulmonary dysfunction, but the pathogenesis remains unclear. We investigated a correlation between thoracoabdominal movements and pulmonary function in seven patients with PD and 14 healthy controls. We measured vital capacity (VC) and forced vital capacity (FVC) using an autospirometer, and measured chest and abdominal movements using a respiratory inductance plethysmography by fixing transducers on the rib cage and umbilicus. Patients with PD had significantly decreased % VC (90.3 +/- 17.1 vs 105.8 +/- 13.9%), chest movement (271.3 +/- 79.6 vs. 375.2 +/- 126.7% VT) and abdominal movement (217.6 +/- 93.5 vs. 247.4 +/- 100.2% VT) with 100% VT being an average volume of chest and abdomen at rest during measurement of VC. Patients with PD also had significantly decreased % FVC (74.4 +/- 20.6 vs. 97.6 +/- 14.1%), chest movement (246.2 +/- 115.2 vs. 344.5 +/- 126.4% VT) and abdominal movement (160.3 +/- 105.6 vs 207.6 +/- 104.7% VT) with 100% VT being an average volume of chest and abdomen at rest during forced maximal inspiration. Based on the results, we conclude that a reduction of % VC in patients with PD correlated with chest movements, while a reduction of % FVC correlated with abdominal movement in patients with PD. | Tamaki A; Matsuo Y; Yanagihara T; Abe K. (2000). Influence of thoracoabdominal movement on pulmonary function in patients with Parkinson's disease: comparison with healthy subjects.. Neurorehabil Neural Repair. 2000;14(1):43-7. doi: 10.1177/154596830001400105.. |
Although a standardized and uniformly accepted cancer staging system is an essential and fundamental requirement to enable meaningful comparisons across patient populations, the sometimes capricious biologic behavior of melanoma makes developing such a staging system particularly difficult. Since the earliest well-documented attempts at classifying patients with cutaneous melanoma were described more than 50 years ago, the identification of increasingly powerful prognostic factors has led to sequential modifications of the cutaneous melanoma staging system. The current AJCC staging system is based on relatively well-established prognostic factors; however, several recent reports have identified additional prognostic factors not included in the current system, and other studies support the re-evaluation of some of the currently employed staging criteria. Some of the more controversial areas include the relevance of level of invasion versus tumor thickness, optimal cutoffs for tumor thickness, importance of ulceration, the grouping of satellites with in-transit metastases, the inclusion of microsatellites and local recurrences as a separate staging criterion, the replacement of size of nodal mass with number of positive nodes, the importance of nodal metastases in more than one nodal basin, and the prognostic significance of distant metastases. Future modifications of the staging system are anticipated to better incorporate these observations. Stage-specific staging recommendations for the patient with melanoma provide the clinician with a framework to most efficiently assess extent of disease in an era of cost-conscious clinical practice. In the asymptomatic patient with primary melanoma (stage I or II), we recommend a chest roentgenogram and evaluation of alkaline phosphatase and LDH levels; extensive radiologic evaluations are not indicated, because the rate of detection in this population is extremely low. Additional staging information should also be obtained by the technique of lymphatic mapping and sentinel lymphadenectomy. For patients with local-regional disease (stage III, satellites, and local recurrence), a selective approach to imaging studies is warranted. For this patient population, we recommend complete blood count, liver function tests including alkaline phosphatase and LDH, a chest roentgenogram, and a CT scan of the abdomen. Although the yield of these tests, particularly CT of the abdomen, in detecting distant metastases in asymptomatic patients is low, they may identify false-positive abnormalities and provide an important baseline for future studies in this high-risk population. For patients with disease below the waist or in the head and neck region, we recommend CT of the pelvis and CT of the neck, respectively. Additional studies should be done only if clinically indicated. Finally, patients with known systemic disease (stage IV) should be more comprehensively evaluated, because the likelihood of detecting asymptomatic metastases is higher. Accordingly, in addition to the work-up outlined previously for stage III patients, we also perform a CT scan of the chest and MR imaging of the brain; other studies (e.g., bone scan, gastrointestinal series) are performed on the basis of symptoms. | Gershenwald JE; Buzaid AC; Ross MI. (2000 Dec). Classification and staging of melanoma.. Clin Lab Med. 2000 Dec;20(4):785-815.. |
From 10th September 1998 till 5th June 1999, the Paediatric and Cardiothoracic Surgery Units of Sultanah Aminah Hospital Johor Bahru managed three children with lung collapse secondary to pneumonia. The dominant initial clinical presentation in all three cases was acute abdominal pain. Basal pneumonia was diagnosed in two cases post-operatively after surgical contributory causes were excluded intra-operatively. Thoracotomy, evacuation of infected debris and decortication of the collapsed lung was done in all three cases. In children presenting with acute abdominal pain, basal pneumonia should be considered as a possible contributory cause. | Vendargon S; Wong PS; Tan KK. (2000 Dec). Pneumonia presenting as acute abdomen in children: a report of three cases.. Med J Malaysia. 2000 Dec;55(4):520-3.. |
PURPOSE: The aim of this study was to assess late effects of long-term exposure to alpha irradiation caused by paravascular Thorotrast deposits. SUBJECTS AND METHODS: 899 patients, who had received the radioactive contrast medium Thorotrast for angiography in the 1930s and 1940s, and 662 controls were followed-up since 1968 every two years by standardized clinical and laboratory examinations. Initially, X-ray plain films of the thorax, upper abdomen and the former injection site were performed. In selected patients the sites of paravascular Thorotrast deposits were evaluated by ultrasonography, CT and MRI. RESULTS: Paravascular Thorotrast deposits were detected in 245 patients. Clinical symptoms related to deposits appeared 10 to 30 years after Thorotrast administration. The severity of symptoms depended on the location and extension of granulomas and were mainly caused by fibrosis, nerve paralysis and vascular changes. Four malignant tumors adjacent to granulomas were observed (one soft tissue sarcoma in the groin, two squamous cell carcinomas of the parotid gland and one lymphoepithelial carcinoma of the nasopharynx). MRI including MRA allowed an accurate determination of tissue damage, whereas the utility of US and CT was restricted due to strong sound attenuation and streak artefacts caused by the high X-ray absorption of Thorotrast. DISCUSSION AND CONCLUSION: Locoregional late effects of paravascular Thorotrast deposits mainly comprise radiation induced, fibrotic tissue destruction. The incidence of malignant tumors, in particular sarcomas, adjacent to deposits, however, is much lower than initially expected. | Schlemmer HP; Liebermann D; Naser V; Van Kaick G. (2000 Dec). Locoregional late effects of paravascular thorotrast deposits: results of the german thorotrast study.. J Neuroradiol. 2000 Dec;27(4):253-63.. |
Starting from the observation of a case of late diagnosed left-side hernia after traumatic rupture of diaphragma, the authors consider the increasing incidence of this pathology during the years. The increased frequency of thoraco-abdominal traumas and the more sophisticated diagnostic tools, permit an earlier diagnosis nowadays. In our patient the diagnosis was made late on the basis of the standard x-ray of the thorax. The CT scan of the thorax and of the abdomen gave more informations. Left thoracotomy enabled a wide exposure of the herniated viscera; the breakthrough of the diaphragm was repaired by means of interrupted suture and it was necessary to apply two prostheses of synthetic material. | Cristofaro MG; Lazzaro F; Cafaro D; Natale R; Mauro P; Savino N; Musella S. (2000 Sep-Oct). [Post-traumatic diaphragmatic hernia with late diagnosis. Report of a clinical case].. Ann Ital Chir. 2000 Sep-Oct;71(5):595-8.. |
We report a case of disseminated histoplasmosis in a 60-year-old non-immunocompromised patient who presented to us with fever and hepatosplenomegaly. Sonographic & CT examination of the abdomen showed bilateral adrenal masses. Cytological examination of the aspirated material from the mass showed yeast forms of H. capsulatum. | Mahajan R; Sharma U; Trivedi N; Prasad M; Kansra U; Bhandari S; Talib VH. (2000 Apr). Histoplasma capsulatum in adrenal gland aspirate--a case report.. Indian J Pathol Microbiol. 2000 Apr;43(2):165-8.. |
BACKGROUND: Smooth muscle tumours are common in the genito-urinary and gastro-intestinal tracts, but primary leiomyoma of the liver is extremely rare. Only a few cases have been reported to date. CASE OUTLINE: We report a case of giant leiomyoma of the liver in a 67-year-old woman that was treated by an extended right hepatectomy. There was no evidence of leiomyoma elsewhere in the abdomen (including the uterus). DISCUSSION: This appears to be the largest hepatic leiomyoma reported in the literature. | Belli G; Ciciliano F; Lannelli A; Marano I. (2001). Hepatic resection for primary giant leiomyoma of the liver.. HPB (Oxford). 2001;3(1):11-2. doi: 10.1080/136518201753173692.. |
H.G. Wells called her 'that unforgettable heroine'. But she was forgotten, most particularly in New Zealand, where she was banned from mention in the newspapers under the War Regulations for her 'safe sex' work during the First World War - a very hypocritical move as it happened just as her work was officially taken on by the army. For this work she was dubbed the 'guardian angel of the ANZACs' by a French venereal disease specialist and awarded the Reconnaissance Franaise by the French. After the war she settled in London, marrying her long-time friend and wartime colleague, physical culturist Fred Hornibrook. Rout went on with her venereal disease prophylaxis campaign after the war. She also entered the birth control movement in the 1920s, playing a major role in the last big birth control court case, a role often attributed to Dora Russell, while Rout again is 'forgotten'. In her books, like the best selling Safe Marriage, a safe sex guide (which was banned in New Zealand), she encouraged women to own their own bodies and take responsibility for their own sexual health. She linked exercise and sex, arguing in books like Sex and Exercise, that exercise would enhance women's sex lives. She and Hornibrook, who wrote a best-selling book entitled The Culture of the Abdomen, presaging the current obsession with rocklike 'abs', made a pair, teaching fitness techniques, holding 'native dance' evenings, and being hailed as modern dance proponents. Rout also wrote books on vegetarianism, wholemeal cookery and Maori culture. The word most commonly used by people describing her throughout her life was 'energy'. She herself was very fit. But she did not fit in. Once her marriage to Hornibrook was over, in 1936, she returned to New Zealand, was rebuffed by former friends. She sailed for Rarotonga and died there, of a self-administered overdose of quinine that September. As she had remarked to H.G. Wells, 'It is a mixed blessing to be born too soon'. She anticipated many of the enthusiasms of our own time - in diet, in dance, in ideas about exercise and sexuality. But because she was so far ahead of her own time in her 'safe sex' campaign, she became persona non grata in her own country. With the advent of AIDS her contribution snaps into focus - and the AIDS clinic in the city of Christchurch where she used to live has been named after her. | Tolerton J. (2001). A lifetime of campaigning: Ettie Rout, emancipationist beyond the pale.. Int J Hist Sport. 2001;18(1):73-97. doi: 10.1080/714001491.. |
We report the association of partial lipodystrophy (PL) and nephritis in an 11-year-old boy. He had symmetric absence of facial fat with retention of adipose tissue in the arms, chest, abdomen and hips associated with macroscopic hematuria, proteinuria combined with depression of the complement C3 level. The patient had rapidly progressive glomerulonephritis (RPGN) and the histopathological study showed findings of mesangio-capillary glomerulonephritis (MCGN) and crescents. We managed and followed up this patient for three years. At the last follow-up visit, he still has mild proteinuria and microscopic hematuria and stable renal function. | Hasan MA; Al Raqad M. (2001 Apr-Jun). Partial lipodystrophy and rapidly progressive nephritis.. Saudi J Kidney Dis Transpl. 2001 Apr-Jun;12(2):183-6.. |
The results of biomechanical testing of the WorldSID prototype dummy are presented in this paper. The WorldSID dummy is a new, advanced Worldwide Side Impact Dummy that has the anthropometry of a mid-sized adult male. The first prototype of this dummy has been evaluated by the WorldSID Task Group against previously established corridors for its critical body regions. The response corridors are defined in the International Organization of Standardization (ISO) Technical Report 9790. The prototype is the first version of the WorldSID dummy to be built and tested. This dummy has been subjected to a rigorous program of testing to evaluate, first and foremost its biofidelity, but also its repeatability. Following this initial evaluation, any required modifications will be incorporated into a pre-production version of the WorldSID dummy so that it rates "good" to "excellent" on the ISO dummy biofidelity scale - a rating exceeding that of all current side impact dummies. Also, the overall WorldSID repeatability must not exceed a coefficient of variation of 7% at injury assessment level and this has to be verified for the different body regions. The dummy's head, neck, thorax, abdomen and pelvis were evaluated against the ISO technical report requirements. Testing included drop tests, pendulum impacts, and sled tests. The biofidelity rating of the WorldSID prototype was calculated using the weighted biomechanical test response procedure developed by ISO. The paper presents the results of the testing, which give a very positive indication of the dummy's potential. Based on this evaluation of the dummy biofidelity, the WorldSID prototype dummy exhibits a biofidelity rating of 6.15 that corresponds to an ISO biofidelity classification of "fair". In addition, the dummy shows good repeatability with a global coefficient of variation of 3.30% for the pendulum and rigid sled tests. | Cesari D; Compigne S; Scherer R; Xu L; Takahashi N; Page M; Asakawa K; Kostyniuk G; Hautmann E; Bortenschlager K; Sakurai M; Harigae T. (2001 Nov). WorldSID Prototype Dummy Biomechanical Responses.. Stapp Car Crash J. 2001 Nov;45:285-318. doi: 10.4271/2001-22-0013.. |
Currently, three-dimensional finite element models of the human body have been developed for frequently injured anatomical regions such as the brain, chest, extremities and pelvis. While a few models of the human body include the abdomen, these models have tended to oversimplify the complexity of the abdominal region. As the first step in understanding abdominal injuries via numerical methods, a 3D finite element model of a 50(th) percentile male human abdomen (WSUHAM) has been developed and validated against experimental data obtained from two sets of side impact tests and a series of frontal impact tests. The model includes a detailed representation of the liver, spleen, kidneys, spine, skin and major blood vessels. Hollow organs, such as the esophagus, stomach, small and large intestines, gallbladder, bile ducts, ureters, rectum and adrenal glands are grouped into three bodybags in order to provide realistic inertial properties and to maintain the position of the solid organs in their appropriate locations. Using direct connections, the model was joined superiorly to a partial model of the human thorax, and inferiorly to models of the human pelvis and the lower extremities that have been previously developed. Material properties for various tissues of the abdomen were derived from the literature. Data obtained in a series of cadaveric pendulum impact tests conducted at Wayne State University (WSU), a series of lateral drop tests conducted at Association Peugeot-Renault (APR) and a series of cadaveric lower abdomen frontal impact tests conducted at WSU were used to validate the model. Results predicted by the model match these experimental data for various impact speeds, impactor masses and drop heights. Further study is still needed in order to fully validate WSUHAM before it can be used to assess various impact loading conditions associated with vehicular crashes. | Lee JB; Yang KH. (2001 Nov). Development of a finite element model of the human abdomen.. Stapp Car Crash J. 2001 Nov;45:79-100. doi: 10.4271/2001-22-0004.. |
A new prototype pregnant abdomen for the Hybrid III small-female ATD is being developed and has been evaluated in a series of component and whole-dummy tests. The new abdomen uses a fluid-filled silicone-rubber bladder to represent the human uterus at 30-weeks gestation, and incorporates anthropometry based on measurements of pregnant women in an automotive driving posture. The response of the new pregnant abdomen to rigid-bar, belt, and close-proximity airbag loading closely matches the human cadaver response, which is thought to be representative to the response of the pregnant abdomen. In the current prototype, known as MAMA-2B (Maternal Anthropomorphic Measurement Apparatus, version 2B), the risk of adverse fetal outcome is determined by measuring the peak anterior pressure within the fluid-filled bladder. Peak internal bladder pressures measured in a series of sled-test simulations of frontal crashes of different severities and occupant-restraint conditions have been correlated to the likelihood of adverse fetal outcome based on risk curves developed from in-depth investigations of real-world crashes involving pregnant occupants. Compared to the original pregnant abdomen, the new prototype has improved geometry and improved impact response to a range of potential in-vehicle loading conditions, However, additional instrumentation development and more rigorous testing are needed before the MAMA-2B can be confidently used to assess restraint system performance with regard to reducing the likelihood of adverse fetal outcome in motor-vehicle crashes. | Rupp JD; Klinich KD; Moss S; Zhou J; Pearlman MD; Schneider LW. (2001 Nov). Development and Testing of a Prototype Pregnant Abdomen for the Small-Female Hybrid III ATD.. Stapp Car Crash J. 2001 Nov;45:61-78. doi: 10.4271/2001-22-0003.. |
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