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Jaan A, Sarfraz Z, Farooq U, Malik S, Ur Rahman A, Okolo P. Incidence, implications and predictors of abdominal compartment syndrome in acute pancreatitis: A nationwide analysis. Pancreatology 2024; 24:370-377. [PMID: 38431446 DOI: 10.1016/j.pan.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Acute pancreatitis (AP) often presents with varying severity, with a small fraction evolving into severe AP, and is associated with high mortality. Complications such as intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are intricately associated with AP. OBJECTIVE To assess the clinical implications and predictors of ACS in AP patients. METHODS We conducted a retrospective study using the National Inpatient Sample (NIS) database on adult AP patients, further stratified by the presence of concurrent ACS. The data extraction included demographics, underlying comorbidities, and clinical outcomes. Multivariate linear and logistic regression analyses were performed using STATA (v.14.2). RESULTS Of the 1,099,175 adult AP patients, only 1,090 (0.001%) exhibited ACS. AP patients with ACS had elevated inpatient mortality and all major complications, including septic shock, acute respiratory distress syndrome (ARDS), requirement for total parenteral nutrition (TPN), and intensive care unit (ICU) admission (P < 0.01). These patients also exhibited increased odds of requiring pancreatic drainage and necrosectomy (P < 0.01). Predictor analysis identified blood transfusion, obesity (BMI ≥30), and admission to large teaching hospitals as factors associated with the development of ACS in AP patients. Conversely, age, female gender, biliary etiology of AP, and smoking were found less frequently in patients with ACS. CONCLUSION Our study highlights the significant morbidity, mortality, and healthcare resource utilization associated with the concurrence of ACS in AP patients. We identified potential factors associated with ACS in AP patients. Significantly worse outcomes in ACS necessitate the need for early diagnosis, meticulous monitoring, and targeted therapeutic interventions for AP patients at risk of developing ACS.
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Affiliation(s)
- Ali Jaan
- Department of Internal Medicine, Rochester General Hospital, NY, USA.
| | - Zouina Sarfraz
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Umer Farooq
- Department of Gastroenterology, Saint Louis University, MO, USA
| | - Sheza Malik
- Department of Internal Medicine, Rochester General Hospital, NY, USA
| | - Asad Ur Rahman
- Department of Gastroenterology, Cleveland Clinic Florida, FL, USA
| | - Patrick Okolo
- Department of Gastroenterology, Rochester General Hospital, NY, USA
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2
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Liu L, Shang L, Zhuang Y, Su X, Li X, Sun Y, Long B. Exploration of factors affecting hemodynamic stability following pheochromocytoma resection - cohort study. Front Endocrinol (Lausanne) 2024; 15:1336128. [PMID: 38650714 PMCID: PMC11033385 DOI: 10.3389/fendo.2024.1336128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Purpose Surgery is the only way to cure pheochromocytoma; however, postoperative hemodynamic instability is one of the main causes of serious complications and even death. This study's findings provide some guidance for improved clinical management. Patients and methods This study was to investigate the factors leading to postoperative hemodynamic instability in the postoperative pathology indicated pheochromocytoma from May 2016 to May 2022. They were divided into two groups according to whether vasoactive drugs were used for a median number of days or more postoperatively. The factors affecting the postoperative hemodynamics in the perioperative period (preoperative, intraoperative, and postoperative) were then evaluated. Results The median number of days requiring vasoactive drug support postoperatively was three in 234 patients, while 118 (50.4%) patients required vasoactive drug support for three days or more postoperatively. The results of the multivariate analysis indicated more preoperative colloid use (odds ratio [OR]=1.834, confidence interval [CI]:1.265-2.659, P=0.001), intraoperative use of vasoactive drug (OR=4.174, CI:1.882-9.258, P<0.001), and more postoperative crystalloid solution input per unit of body weight per day (ml/kg/d) (OR=1.087, CI:1.062-1.112, P<0.001) were risk factors for predicting postoperative hemodynamic instability. The optimal cutoff point of postoperative crystalloid use were 42.37 ml/kg/d. Conclusion Hemodynamic instability is a key issue for consideration in the perioperative period of pheochromocytoma. The amount of preoperative colloid use, the need for intraoperative vasoactive drugs, and postoperative crystalloid solution are risk factors for predicting postoperative hemodynamic instability (registration number: ChiCT2300071166).
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Affiliation(s)
| | | | | | | | | | | | - Bo Long
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
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3
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El Shamarka AH, Zidan MH, Youssef MS, El Banna AH, Mourad M. A case of giant inguinoscrotal hernia managed by preoperative pneumoperitoneum with an unforeseen complication and outcome: a case report and review of literature. Hernia 2023; 27:1611-1615. [PMID: 37672132 DOI: 10.1007/s10029-023-02870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023]
Affiliation(s)
- A H El Shamarka
- General Surgery Department, Main University Hospital, Alexandria University, Alexandria, 21568, Egypt.
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt.
| | - M H Zidan
- General Surgery Department, Main University Hospital, Alexandria University, Alexandria, 21568, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
| | - M S Youssef
- General Surgery Department, Alexandria Medical Research Institute Hospital, Alexandria University, Alexandria, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
| | - A H El Banna
- General Surgery Department, Main University Hospital, Alexandria University, Alexandria, 21568, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
| | - M Mourad
- General Surgery Department, Main University Hospital, Alexandria University, Alexandria, 21568, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
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Lee T, Roth E, Shukla A, Gupta N, Lee R, Kryger J, Groth T, Canning D, Mitchell M, Weiss D, Borer J. Pelvic Ectopic Kidney Prevalence and Pressure Changes During Cloacal Exstrophy (Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome) Closure. Urology 2023; 181:124-127. [PMID: 37634851 DOI: 10.1016/j.urology.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES To assess the prevalence of pelvic ectopic kidneys (PEK) and compare renal parameters of the PEK to the orthotopic kidney following pubic bone approximation. METHODS In four Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome (OEIS) patients undergoing second-stage repair with known pelvic and orthotopic kidneys, changes in the renal pelvis pressure (RPP), peak systolic velocity (PSV), and resistive index (RI) were measured in the pelvic and orthotopic kidneys following pubic bone approximation. A paired t-test was performed for analysis. Prevalence was tabulated using a multi-institutional retrospective review. RESULTS Mean rise in RPP was +26.0 mmHg in the PEK and +10.3 mmHg in the orthotopic kidney (P = .55). One patient had immediate increase in RPP of 66 mmHg in the PEK (7 mmHg in the orthotopic kidney) which decreased to +17 mmHg in the PEK upon release of the pubic approximation stitch. Mean change in PSV was +67.7 cm/s in the PEK compared to - 25.7 cm/s in the orthotopic kidney (P = .09). Mean change in renal RI was + 0.06 in PEK compared to - 0.01 in the orthotopic kidney (P = .29). Among 80 OEIS patients, 24 (30%) had a PEK. 3 (4%) had a solitary PEK. CONCLUSION During second-stage OEIS closure, we witnessed patterns of higher change in RPP, PSV, and RI of the PEK compared to the orthotopic kidney. Furthermore, PEKs were found in nearly a third of our OEIS patients. Real-time RPP monitoring, especially those with solitary PEK, may aid in the management of OEIS patients during the perioperative period.
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Affiliation(s)
- Ted Lee
- Boston Children's Hospital, Department of Urology, Boston, MA.
| | - Elizabeth Roth
- Children's Wisconsin, Department of Urology, Milwaukee, WI
| | - Aseem Shukla
- Children's Hospital of Pennsylvania, Department of Urology, Philadelphia, PA
| | - Naveen Gupta
- Boston Children's Hospital, Department of Urology, Boston, MA
| | - Richard Lee
- Boston Children's Hospital, Department of Urology, Boston, MA
| | - John Kryger
- Children's Wisconsin, Department of Urology, Milwaukee, WI
| | - Travis Groth
- Children's Wisconsin, Department of Urology, Milwaukee, WI
| | - Douglas Canning
- Children's Hospital of Pennsylvania, Department of Urology, Philadelphia, PA
| | | | - Dana Weiss
- Children's Hospital of Pennsylvania, Department of Urology, Philadelphia, PA
| | - Joseph Borer
- Boston Children's Hospital, Department of Urology, Boston, MA
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5
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Salomão EDA, do Nascimento VA, de Oliveira CFR, Silva IS, Guimarães RDCA, Bogo D. Investigating Effects of IR-780 in Animal Models of B16-F10 Melanoma: New Approach in Lung Metastasis. Molecules 2023; 28:6942. [PMID: 37836787 PMCID: PMC10574439 DOI: 10.3390/molecules28196942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 10/15/2023] Open
Abstract
IR-780 is a fluorescent marker, photostable and non-toxic, and is widely used in tumor targeting; however, studies on the impact of IR-780 in animal models of B16-F10 melanoma are scarce in the literature. Therefore, this study aims to analyze behavior of this marker in melanoma cells using in vitro and in vivo analyses with fluorescence microscopy to conduct an analysis of cell culture, and an in vivo imaging system for an analysis of cell culture, tumor targeting on animals, and organ examination. In vitro analysis showed that B16-F10 cells at a concentration of 2 × 105 cells.plate-1 allowed a better visualization using 20 μM of IR-780. Furthermore, the location of IR-780 accumulation was confirmed by its fluorescence microscopy. Through in vivo studies, fluorescence was not observed in subcutaneous nodules, and it was found that animals that received intraperitoneal injection of B16-F10 cells presented ascites and did not absorb IR-780. Additionally, animals exhibiting lung metastasis showed fluorescence in ex vivo lung images. Therefore, use of the IR-780 marker for evaluating the progression of tumor growth did not demonstrate efficiency; however, it was effective in diagnosing pulmonary metastatic tumors. Although this marker presented limitations, results of evaluating pulmonary involvement through ex vivo fluorescence imaging were determined based on intensity of fluorescence.
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Affiliation(s)
- Evelyn de Andrade Salomão
- Graduate Program in Health and Development in Central-West Region, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (D.B.)
| | - Valter Aragão do Nascimento
- Graduate Program in Health and Development in Central-West Region, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (D.B.)
| | | | | | - Rita de Cássia Avellaneda Guimarães
- Graduate Program in Health and Development in Central-West Region, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (D.B.)
| | - Danielle Bogo
- Graduate Program in Health and Development in Central-West Region, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (D.B.)
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Yang VB, Shu H, Shah MM, Zhao X, Muquit ST, Greenberg M, Whitman G, Cho SM, Kim BS, Shafiq B. Atraumatic Polycompartment Syndrome Secondary to Cardiogenic Shock: A Case Report. Cureus 2023; 15:e44519. [PMID: 37790054 PMCID: PMC10544627 DOI: 10.7759/cureus.44519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
We report the case of a 53-year-old male who developed polycompartment syndrome (PCS) secondary to cardiogenic shock. After suffering a cardiac arrest, a self-perpetuating cycle of intra-abdominal hypertension (IAH) and vital organ damage led to abdominal compartment syndrome (AbCS), which then contributed to the precipitation of extremity compartment syndrome (CS) in bilateral thighs, legs, forearms, and hands. This report is followed by a review of the literature regarding the pathophysiology of this rare sequela of cardiogenic shock. While the progression from cardiogenic shock to AbCS and ultimately to PCS has been hypothesized, no prior case reports demonstrate this. Furthermore, this case suggests more generally that IAH may be a risk factor for extremity CS. Future studies should examine the potential interplay between IAH and extremity CS in patients at risk, such as polytrauma patients with tibial fractures.
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Affiliation(s)
- Victor B Yang
- Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Henry Shu
- Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Manuj M Shah
- General Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Xiyu Zhao
- Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Siam T Muquit
- Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Marc Greenberg
- Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Glenn Whitman
- Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sung-Min Cho
- Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Bo Soo Kim
- Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Babar Shafiq
- Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
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Lee T, Borer J. Exstrophy-Epispadias Complex. Urol Clin North Am 2023; 50:403-414. [PMID: 37385703 DOI: 10.1016/j.ucl.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Exstrophy-epispadias complex encompasses a spectrum of disorders with lower abdominal midline malformations, including epispadias, bladder exstrophy, and cloacal exstrophy, also known as Omphalocele-Exstrophy-Imperforate Anus-Spinal Anomalies Complex. In this review, the authors discuss the epidemiology, embryologic cause, prenatal findings, phenotypic characteristics, and management strategies of these 3 conditions. The primary focus is to summarize outcomes pertaining to each condition.
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Affiliation(s)
- Ted Lee
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue Boston, MA 02115, USA; Department of Surgery (Urology), Harvard Medical School, Boston, MA, USA.
| | - Joseph Borer
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue Boston, MA 02115, USA; Department of Surgery (Urology), Harvard Medical School, Boston, MA, USA
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8
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Jena A, Singh AK, Kochhar R. Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis. Indian J Gastroenterol 2023; 42:455-466. [PMID: 37418050 DOI: 10.1007/s12664-023-01407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023]
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are underrecognized entities in patients of acute pancreatitis (AP). IAH develops in 30% to 60% and ACS in 15% to 30% of all AP patients and they are markers of severe disease with high morbidity and mortality. The detrimental effect of increased IAP has been recognized in several organ systems, including the central nervous system, cardiovascular, respiratory, renal and gastrointestinal systems. The pathophysiology of IAH/ACS development in patients with AP is multifactorial. Pathogenetic mechanisms include over-zealous fluid management, visceral edema, ileus, peripancreatic fluid collections, ascites and retroperitoneal edema. Laboratory and imaging markers are neither sensitive nor specific enough to detect IAH/ACS and intra-abdominal pressure (IAP) monitoring is vital for early diagnosis and the management of patients of AP with IAH/ACS. The treatment of IAH/ACS requires a multi-modality approach with both medical and surgical attention. Medical management consists of nasogastric/rectal decompression, prokinetics, fluid management and diuretics or hemodialysis. If conservative management is not effective, percutaneous drainage of fluid collection or ascites is necessary. Despite medical management, if IAP worsens, surgical decompression is warranted. The review discusses the relevance of IAH/ACS in patients of AP and its management.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, Topiwala National Medical College and B Y L Nair Hospital, Mumbai 400 008, India
| | - Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
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9
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Stojanovic B, Jovanovic IP, Stojanovic MD, Jovanovic M, Vekic B, Milosevic B, Cvetkovic A, Spasic M, Stojanovic BS. The Emerging Roles of the Adaptive Immune Response in Acute Pancreatitis. Cells 2023; 12:1495. [PMID: 37296616 PMCID: PMC10253175 DOI: 10.3390/cells12111495] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Acute pancreatitis (AP) is an abrupt, variable inflammatory condition of the pancreas, potentially escalating to severe systemic inflammation, rampant pancreatic necrosis, and multi-organ failure. Its complex pathogenesis involves an intricate immune response, with different T cell subsets (Th1, Th2, Th9, Th17, Th22, TFH, Treg, and CD8+ T cells) and B cells playing pivotal roles. Early T cell activation initiates the AP development, triggering cytokines associated with the Th1 response, which stimulate macrophages and neutrophils. Other T cell phenotypes contribute to AP's pathogenesis, and the balance between pro-inflammatory and anti-inflammatory cytokines influences its progression. Regulatory T and B cells are crucial for moderating the inflammatory response and promoting immune tolerance. B cells further contribute through antibody production, antigen presentation, and cytokine secretion. Understanding these immune cells' roles in AP could aid in developing new immunotherapies to enhance patient outcomes. However, further research is required to define these cells' precise roles in AP and their potential as therapeutic targets.
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Affiliation(s)
- Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.S.)
| | - Ivan P. Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | | | - Marina Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Berislav Vekic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.S.)
| | - Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.S.)
| | - Aleksandar Cvetkovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.S.)
| | - Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (B.S.)
| | - Bojana S. Stojanovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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10
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Liu SH, Yen CH, Tseng HP, Hu JM, Chang CH, Pu TW. Repair of a giant inguinoscrotal hernia with herniation of the ileum and sigmoid colon: A case report. World J Clin Cases 2023; 11:401-407. [PMID: 36686360 PMCID: PMC9850964 DOI: 10.12998/wjcc.v11.i2.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/11/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Giant inguinoscrotal hernias are huge inguinal hernias that extend below the midpoint of the inner thigh in the standing posture. Giant inguinoscrotal hernias are rare in developed countries because of their better medical resources and early treatment. However, they can develop in patients who refuse surgery or ignore their condition. Intervention is inevitable because strangulation and organ perforation can occur, leading to peritonitis and sepsis. Common surgical approaches include open abdominal and inguinal approaches or a combination of both.
CASE SUMMARY We present the case of a 73-year-old man who visited our emergency department with a huge mass in his left scrotum and septic complications. Abdominal computed tomography revealed a large left inguinoscrotal hernia that contained small bowel loops and the colon. Emergency surgical intervention was performed immediately because intestinal strangulation was highly suspected. The operative repair was performed using a combination of mini-exploratory laparotomy and the inguinal approach. The incarcerated organs, which included the ileum and sigmoid colon, had relatively good intestinal perfusion without perforation or ischemic changes. They were successfully reduced into the abdomen, and bowel resection was not necessary. A tension-free prosthetic mesh was used for the hernia repair. Two weeks after the initial surgery, and with adequate antimicrobial therapy, the patient recovered and was discharged from our hospital. No evidence of hernia relapse was noted during the outpatient follow-up examination 3 mo after surgery.
CONCLUSION Emergency surgery involving combined mini-exploratory laparotomy and the inguinal approach should be performed for serious incarcerated giant inguinoscrotal hernias.
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Affiliation(s)
- Shih-Hung Liu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Ching-Hen Yen
- Division of Urological Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 10581, Taiwan
| | - Hsu-Ping Tseng
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Je-Ming Hu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Ching-Han Chang
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 802, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 10581, Taiwan
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11
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Gyselaers W. Origins of abnormal placentation: why maternal veins must not be forgotten. Am J Obstet Gynecol 2022:S0002-9378(22)02292-X. [PMID: 36539026 DOI: 10.1016/j.ajog.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
The importance of uterine microvascular adaptations during placentation in pregnancy has been well established for decades. Inadequate dilatation of spiral arteries is associated with gestational complications, such as preeclampsia and/or intrauterine growth restriction. More recently, it has become clear that trophoblast cells invade and adapt decidual veins and lymphatic vessels 1 month before spiral arteries become patent and before intervillous space perfusion starts. Normal intervillous space hemodynamics is characterized by high volume flow at low velocity and pressure in the interseptal compartments surrounding the chorionic villi, hereby facilitating efficient maternal-fetal exchange. In case of shallow decidual vein dilatation, intervillous arterial supply exceeds venous drainage. This will cause congestion in the interseptal compartments with subsequently reduced perfusion and increased pressure. An efficient mechanism to counteract venous congestion and safeguard the viability of the conceptus is by reducing arterial inflow via shallow dilatation of the spiral arteries. This review made the case for intervillous space congestion as an unexplored trigger for inadequate spiral artery dilatation during the placentation process, eventually leading to abnormal systemic circulatory dysfunctions. An abnormal maternal venous function can result from an abnormal maternal immune response to paternal antigens with an imbalanced release of vasoactive mediators or can exist before conception. To get the full picture of abnormal placentation, maternal veins must not be forgotten.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium; Faculty Medicine and Life Sciences, Department of Physiology, Hasselt University, Diepenbeek, Belgium.
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12
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Role of Intra-Abdominal Pressure as a Prognostic Marker and Its Correlation with APACHE II and SOFA Scores in Patients of Acute Pancreatitis. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Al Sadairi AR, Durtette-Guzylack J, Renard A, Durot C, Thierry A, Kianmanesh R, Passot G, Renard Y. A simplified method to evaluate the loss of domain. Hernia 2022; 26:927-936. [PMID: 34341871 DOI: 10.1007/s10029-021-02474-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The treatment of giant incisional hernia (IH) with loss of domain (LOD, IHLD) is considerably challenging due to technical difficulties and subsequent post-operative complications. These post-operative risks may be anticipated by calculating the abdominal cavity (AC) volume (ACV) and the IH volume (IHV) on the preoperative CT-scans, using the AC and IH dimensions (Tanaka's method) or using tridimensional volumetry (Sabbagh's method). These techniques are often time-consuming and require specific softwares. The aim of the present study was to develop a simple method to rapidly obtain the LOD-ratio on the preoperative CT-Scan. METHODS The CT-scans (n = 89) of patients with IHLD were retrospectively studied. Several ratios were calculated using different parameters of the AC and the IH, including width, height and depth, the areas (axial and sagittal ellipse, as well as freehand sagittal surface areas) and these were compared with the reference methods of Sabbagh et al. and Tanaka et al. RESULTS: The LOD ratios calculated from the two reference methods gave similar results (ICC = 0.82, p < 0.0001). The new "R-ratios" (Reims-ratios) obtained from the IH and AC surface areas measured using the "freehand ROI" tool on sagittal view or roughly evaluated by an ellipse on axial view showed excellent correlation with both reference ratios (all ICC ≥ 0.71, p < 0.0001). CONCLUSION The LOD ratio may be quickly obtained by drawing two circles on the pre-operative CT scan ("R ratios") and available on the webpage https://romeo.univ-reims.fr/Rratio/ . This will certainly help surgeons to routinely anticipate the post-operative complications before IHLD repair.
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Affiliation(s)
- Abdul Rahman Al Sadairi
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France.
- Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Jules Durtette-Guzylack
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
| | - Arnaud Renard
- Laboratory Liciis and ROMEO, University of Reims Champagne-Ardenne, Reims, France
| | - Carole Durot
- Department of Radiology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Aurore Thierry
- Methodological Aid To Clinical Research Unit CHU Reims, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Reza Kianmanesh
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
| | - Guillaume Passot
- Department of Digestive Surgery, Hopital Lyon Sud, Pierre Bénite, University of Lyon, Lyon, France
| | - Yohann Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France
- Laboratory Liciis and ROMEO, University of Reims Champagne-Ardenne, Reims, France
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Validity and reliability of a novel, non-invasive tool and method to measure intra-abdominal pressure in vivo. J Biomech 2022; 137:111096. [DOI: 10.1016/j.jbiomech.2022.111096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
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15
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Coca A, Arias-Cabrales C, Pérez-Sáez MJ, Fidalgo V, González P, Acosta-Ochoa I, Lorenzo A, Rollán MJ, Mendiluce A, Crespo M, Pascual J, Bustamante-Munguira J. Impact of intra-abdominal pressure on early kidney transplant outcomes. Sci Rep 2022; 12:2257. [PMID: 35145181 PMCID: PMC8831606 DOI: 10.1038/s41598-022-06268-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/06/2022] [Indexed: 12/13/2022] Open
Abstract
Increased intra-abdominal pressure (IAP) is common among post-surgical patients and may cause organ dysfunction. However, its impact after kidney transplantation on early postoperative complications and graft recovery remains unclear. We designed a prospective, observational cohort study to describe the prevalence and determinants of IAP, as well as its effect on delayed graft function, postoperative complications, and graft recovery. IAP was measured in 205 kidney transplant recipients every 8 h during the first 72 h after surgery using the urinary bladder technique. Intra-abdominal hypertension was defined as IAP ≥ 12 mmHg. Patients were followed for 6 months or until graft failure/death. Mean IAP was 12 ± 3.3 mmHg within the first 24 h. 78% of subjects presented with intra-abdominal hypertension during the first 72 h. Increased IAP was associated with higher renal resistive index [r = 0.213; P = 0.003] and lower urine output [r = - 0.237; P < 0.001]. 72 h mean IAP was an independent risk factor for delayed graft function [OR: 1.31; 95% CI: 1.13-1.51], postoperative complications [OR: 1.17; 95% CI: 1.03-1.33], and absence of graft function recovery [HR for graft function recovery: 0.94; 95% CI: 0.88-0.99]. Increased IAP was highly prevalent after transplantation and was independently associated with delayed graft function, postoperative complications, and absence of graft function recovery. Routine IAP monitoring should be considered post-transplantation to facilitate early recognition of relevant complications.
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Affiliation(s)
- Armando Coca
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain.
| | - Carlos Arias-Cabrales
- Department of Nephrology, Hospital del Mar, Paseo Marítimo de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - María José Pérez-Sáez
- Department of Nephrology, Hospital del Mar, Paseo Marítimo de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Verónica Fidalgo
- Department of Nephrology, Hospital General, C/ Luis Erik Clavería Neurólogo s/n, 40002, Segovia, Spain
| | - Pablo González
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Isabel Acosta-Ochoa
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Arturo Lorenzo
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - María Jesús Rollán
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Alicia Mendiluce
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Paseo Marítimo de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Paseo Marítimo de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Juan Bustamante-Munguira
- Department of Cardiac Surgery, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
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16
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Zhao Z, Guo Z, Yin Z, Qiu Y, Zhou B. Gut Microbiota Was Involved in the Process of Liver Injury During Intra-Abdominal Hypertension. Front Physiol 2021; 12:790182. [PMID: 34955896 PMCID: PMC8703017 DOI: 10.3389/fphys.2021.790182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Intestinal damage caused by intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) can lead to the ectopic gut microbiota, which can contribute to liver injury via portal veins. Therefore, it is speculated that gut microbiota disorder caused by IAH/ACS may result in liver injury. The relationship between gut microbiota and IAH/ACS-related liver injury was investigated in this study. Methods: A model of IAH was established in rats, and 16S rRNA sequencing was analyzed for gut microbiota in the feces of rats. The elimination of gut microbiota was completed by antibiotics gavage, and fecal microbiota transplantation (FMT) was used to change the composition of gut microbiota in rats. Results: In addition to the traditional cause of liver blood vessel compression, liver injury caused by IAH was also associated with gut microbiota dysbiosis. Gut microbiota clearance can relieve liver injury caused by IAH, while FMT from IAH-intervened rats can aggravate IAH-related liver injury. Conclusion: The gut microbiota was one of the most important factors contributing to the IAH-related liver injury, and the JNK/p38 signaling pathway was activated in this process.
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Affiliation(s)
- Zeyu Zhao
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhengchang Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhengliang Yin
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Qiu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bo Zhou
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Richer-Séguin É, Ayoub C, Lebon JS, Cogan J, Jarry S, Lamarche Y, Denault AY, Beaubien-Souligny W. Intra-abdominal pressure during and after cardiac surgery: a single-centre prospective cohort study. Can J Anaesth 2021; 69:234-242. [PMID: 34850369 DOI: 10.1007/s12630-021-02141-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/20/2021] [Accepted: 09/12/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE While intra-abdominal hypertension (IAH) has been associated with adverse outcomes in multiple settings, the epidemiology and clinical implications of IAH in the context of cardiac surgery are less known. In this study, we aimed to describe the prevalence of IAH in patients undergoing cardiac surgery and determine its association with patient characteristics and postoperative outcomes. METHODS We conducted a single-centre prospective cohort study in which intra-abdominal pressure was measured in the operating room after general anesthesia (T1), after the surgical procedure (T2), and two hours after intensive care unit (ICU) admission (T3) in a subset of patients. Intra-abdominal hypertension was defined as intra-abdominal pressure (IAP) ≥ 12 mm Hg. Postoperative outcomes included death, acute kidney injury (AKI), and length of stay in the ICU and hospital. RESULTS A total of 513 IAP measurements were obtained from 191 participants in the operating room and 131 participants in the ICU. Intra-abdominal hypertension was present in 105/191 (55%) at T1, 115/191 (60%) at T2, and 31/131 (24%) at T3. Intra-abdominal pressure was independently associated with body mass index, central venous pressure, and mean pulmonary artery pressure but was not associated with cumulative fluid balance. Intraoperative IAH was not associated with adverse outcomes including AKI. CONCLUSIONS Intra-abdominal hypertension is very common during cardiac surgery but its clinical implications are uncertain.
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Affiliation(s)
- Émilie Richer-Séguin
- Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada
| | - Christian Ayoub
- Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada
| | - Jean-Sébastien Lebon
- Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada
| | - Jennifer Cogan
- Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada
| | - Stéphanie Jarry
- Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - André Y Denault
- Department of Anesthesia, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, Canada.
| | - William Beaubien-Souligny
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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18
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The role of Cushing's reflex and the vasopressin-mediated oligoanuric response to intracranial hypertension in patients with abdominal compartment syndrome. Surgery 2021; 171:399-404. [PMID: 34706825 DOI: 10.1016/j.surg.2021.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND We examined the link between increased intra-abdominal pressure, intracranial pressure, and vasopressin release as a potential mechanism. Intra-abdominal pressure, produced by abdominal-cavity insufflation with carbon dioxide (CO2) during laparoscopic abdominal procedures to facilitate visualization, is associated with various complications, including arterial hypertension and oliguria. METHODS Mean arterial pressure, optic nerve sheath diameter, measured as a proxy for intracranial pressure, plasma vasopressin, serum and urine osmolarity, and urine output were measured 4 times during laparoscopic sleeve gastrectomy in 42 patients: before insufflation with CO2 (T0); after insufflation to 15 cm water (H2O) pressure, with 5 cm H2O positive end-expiratory pressure (T1); after positive end-expiratory pressure was raised to 10 cm H2O (T2); and after a return to the baseline state (T3). Mean values at T0 to T3 and the directional consistency of changes (increase/decrease/ unchanged) were compared among the 4 data-collection points. RESULTS Statistically significant elevations (all P ≤ .001) were noted from T0 to T1 and from T0 to T2 in mean arterial pressure, optic nerve sheath diameter, and vasopressin, followed by decreases at T3. For optic nerve sheath diameter and vasopressin, the increases at T1 and T2 occurred in 98% and 100% of patients, ultimately exceeding normal levels in 88 and 97%, respectively. Conversely, urine output fell from T0 to T1 and T2 by 60.9 and 73.4%, decreasing in 88.1% of patients (all P < .001). Patients with class II obesity exhibited statistically greater increases in optic nerve sheath diameter and vasopressin, but statistically less impact on urine output, than patients with class III obesity. CONCLUSION Increased mean arterial pressure, intracranial pressure, and vasopressin release appear to be intermediary steps between increased intra-abdominal pressure and oliguria. Further research is necessary to determine any causative links between these physiological changes.
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19
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Ghosh L, Gantioque R, Sotelo C. Abdominal Compartment Syndrome in Adult Trauma Patients. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Ba M, Cui S, Long H, Gong Y, Wu Y, Lin K, Tu Y, Zhang B, Wu W. Safety and Effectiveness of High-Precision Hyperthermic Intraperitoneal Perfusion Chemotherapy in Peritoneal Carcinomatosis: A Real-World Study. Front Oncol 2021; 11:674915. [PMID: 34422631 PMCID: PMC8378327 DOI: 10.3389/fonc.2021.674915] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background Hyperthermic intraperitoneal chemotherapy (HIPEC) has been reported to effectively control peritoneal carcinomatosis (PC) in various patient populations, but there is a lack of real-world data. This study aimed to examine the safety and effectiveness of HIPEC in patients with PC in a real-world setting. Methods This was a retrospective study of patients with PC treated with the high-precision BR-TRG-I type HIPEC device between December 2006 and December 2016. Vital signs during HIPEC and adverse events were recorded. Effectiveness was evaluated by total objective remission rate (ORR), which was based on ascites’ remission 4 weeks after HIPEC. Results A total of 1,200 patients were included. There were 518 males and 682 females, with a mean age of 58.6 ± 6.5 years (range, 32–76 years). Among the patients, 93.6% of the patients (1123/1200) successfully received the three sessions of HIPEC, 158 had massive ascites. The changes of vital signs during HIPEC were within acceptable ranges, and patients only had a transient fever and abdominal distension. Regarding the HIPEC-related complications, hemorrhage was observed in seven (0.6%) patients, anastomotic leakage in four (0.5%), and intestinal obstruction in eight (0.7%). Nine (0.8%, 9/1200) patients had CTCAE grade IV bone marrow suppression, and three (0.3%, 3/1200) patients had severe renal failure (SRF), which were considered to be drug-related. The ORR of malignant ascites was 95.6% (151/158). Conclusion This real-world study strongly suggests that HIPEC was safe in treating PC patients with a low rate of adverse events and leads to benefits in PC patients with massive malignant ascites.
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Affiliation(s)
- Mingchen Ba
- Intracelom Hyperthermic Perfusion Therapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Shuzhong Cui
- Intracelom Hyperthermic Perfusion Therapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Hui Long
- Department of Pharmacy, Guangzhou Dermatology Institute, Guangzhou, China
| | - Yuanfeng Gong
- Intracelom Hyperthermic Perfusion Therapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yinbing Wu
- Intracelom Hyperthermic Perfusion Therapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Kunpeng Lin
- Intracelom Hyperthermic Perfusion Therapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yinuo Tu
- Intracelom Hyperthermic Perfusion Therapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Bohuo Zhang
- Intracelom Hyperthermic Perfusion Therapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Wanbo Wu
- Intracelom Hyperthermic Perfusion Therapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
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Liao CH, Cheng CT, Chen CC, Wang YH, Chiu HT, Peng CC, Jow UM, Lai YL, Chen YC, Ho DR. Systematic Review of Diagnostic Sensors for Intra-Abdominal Pressure Monitoring. SENSORS 2021; 21:s21144824. [PMID: 34300564 PMCID: PMC8309748 DOI: 10.3390/s21144824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
Intra-abdominal pressure (IAP) is defined as the steady-state pressure within the abdominal cavity. Elevated IAP has been implicated in many medical complications. This article reviews the current state-of-the-art in innovative sensors for the measurement of IAP. A systematic review was conducted on studies on the development and application of IAP sensors. Publications from 2010 to 2021 were identified by performing structured searches in databases, review articles, and major textbooks. Sixteen studies were eligible for the final systematic review. Of the 16 articles that describe the measurement of IAP, there were 5 in vitro studies (31.3%), 7 in vivo studies (43.7%), and 4 human trials (25.0%). In addition, with the advancement of wireless communication technology, an increasing number of wireless sensing systems have been developed. Among the studies in this review, five presented wireless sensing systems (31.3%) to monitor IAP. In this systematic review, we present recent developments in different types of intra-abdominal pressure sensors and discuss their inherent advantages due to their small size, remote monitoring, and multiplexing.
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Affiliation(s)
- Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Chih-Chi Chen
- Department of Rehabilitation and Physical Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan;
| | - Yu-Hsin Wang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Hsin-Tzu Chiu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Cheng-Chun Peng
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Uei-Ming Jow
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Yen-Liang Lai
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Ya-Chuan Chen
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Dong-Ru Ho
- Department of Urology, Chiayi Chang Gung Memorial Hospital, Chang Gung University, Chiayi 613016, Taiwan
- Correspondence: ; Tel.: +886-975-353-211
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22
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Du L, Zhao Y, Yin C, Liu S, Cui Z, Zhang M. The applied research on the intra-abdominal pressure monitoring in early enteral nutrition in patients with severe pneumonia. Am J Transl Res 2021; 13:6987-6993. [PMID: 34306453 PMCID: PMC8290670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the applied value of intra-abdominal pressure (IAP) monitoring in early enteral nutrition (EEN) in patients with severe pneumonia. METHODS 96 patients with severe pneumonia who underwent EEN treatment in our hospital from June 2017 to June 2019 were selected. According to the random number table method, they were divided into a control group (48 patients) and an observation group (48 patients). The control group was treated using the conventional EN method, and the observation group was treated using the intra-abdominal pressure monitoring besides the conventional EN method. The incidence of EN intolerance, the acute physiology and chronic health evaluation (APECHEll) scores, the positive end expiratory pressure (PEEP) value, mechanical ventilation time, EN implementation days, length of stay in ICU, the incidence of ventilator-associated pneumonia, mortality, and the incidence of multiple organ dysfunction syndrome were compared between the two groups. RESULTS Compared with the control group, the incidence of EEN intolerance in the observation group was significantly reduced. The results of univariate analysis showed that, in the EN intolerance group, the IAP, the PEEP value and APACHEII scores after 3 days of EEN implementation were higher than the EEN tolerance group, indicating a influencing factor of EEN intolerance (P<0.05). The results of multivariate analysis showed that IAP value was a risk factor for EEN intolerance (P<0.05). The ROC curve analysis result for IAP to predict EEN tolerance showed that the area under the curve for IAP value to predict EN tolerance was 0.856, the optimal cut-off value was 10.73 mmHg, the sensitivity was 95.10%, and the specificity was 89.60%. CONCLUSION The intra-abdominal pressure monitoring during the EEN in patients with severe pneumonia is a preferred method to guide the patients' EEN.
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Affiliation(s)
- Liqiang Du
- Department of Gastrointestinal Surgery, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Yuanyuan Zhao
- Department of Intensive Care Unit, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Changheng Yin
- Department of Gastrointestinal Surgery, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Shuhong Liu
- Department II of Geriatrics, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Zhaobo Cui
- Department of Intensive Care Unit, The People’s Hospital of HengshuiHengshui, Hebei, China
| | - Min Zhang
- Department of Orthopaedics, The Second People’s Hospital of HengshuiHengshui, Hebei, China
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Leon M, Chavez L, Surani S. Abdominal compartment syndrome among surgical patients. World J Gastrointest Surg 2021; 13:330-339. [PMID: 33968300 PMCID: PMC8069070 DOI: 10.4240/wjgs.v13.i4.330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
Abdominal compartment syndrome (ACS) develops when organ failure arises secondary to an increase in intraabdominal pressure. The abdominal pressure is determined by multiple factors such as blood pressure, abdominal compliance, and other factors that exert a constant pressure within the abdominal cavity. Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction. Among surgical and trauma patients, aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS. Other conditions that have also been identified as risk factors are ascites, hemoperitoneum, bowel distention, and large tumors. All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension (IAH). Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery, abdominal aortic aneurysm repair, and liver transplantation among others. Close monitoring of organ function and intra-abdominal pressure (IAP) allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP. Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction. There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.
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Affiliation(s)
- Monica Leon
- Department of Medicine, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Luis Chavez
- Department of Medicine, University of Texas, El Paso, TX 79905, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University, Corpus Christi, TX 78405, United States
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Jacobson N, Driscoll M. Design Synthesis and Preliminary Evaluation of a Novel Tool to Noninvasively Characterize Pressurized, Physiological Vessels. J Med Device 2020. [DOI: 10.1115/1.4049088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
A prolonged increase in intra-abdominal pressure (IAP) is life-threatening, yet commonly seen in intensive care units (ICUs). Despite this, existing clinically accepted IAP measurement techniques are invasive and not inter-rater reliable. As such, it is the effort of this research to develop a direct, noninvasive, handheld tool to measure internal pressures in pressurized, physiological vessels. The novel device uses a localized known pressure (namely, aspiration) to measure resulting tissue deformation, from which internal pressures can be divulged considering the extended Hencky solution. Two male participants were tested with the device to confirm feasibility of the theoretical device function for IAP measurement. Participants' Young's moduli of the abdominal wall were calculated with measured IAP values. Results were consistent with participant body mass indices and overall health. Average measured IAP was 0.42 kPa and 0.46 kPa at supine and inclined positions, respectively. Average measured abdominal wall elasticity was 14.91 kPa and 23.09 kPa at supine and inclined positions, respectively. These preliminary findings suggest the potential use of the device described herein as a measurement system for pressurized vessels, whereas the system will be tested on a larger sample size before recommending clinical use.
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Affiliation(s)
- Natasha Jacobson
- Deparment of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, QC H3A 0C3, Canada
| | - Mark Driscoll
- Deparment of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, QC H3A 0C3, Canada
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Gioia S, Franceschetto L, Carlini L, Suadoni F, Lancia M. A case of a head-down position death in a six-months old baby with concurrent pneumonia. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2020. [DOI: 10.1016/j.fsir.2019.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Denkler C, Sterbling HM, Seoudi H. Tension pneumoperitoneum following upper endoscopy. J Surg Case Rep 2020; 2020:rjaa401. [PMID: 33214866 PMCID: PMC7660036 DOI: 10.1093/jscr/rjaa401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/29/2020] [Indexed: 11/12/2022] Open
Abstract
Perforation of the digestive tract is a rare complication of endoscopy. Massive accumulation of air within the peritoneum resulting in the abdominal compartment syndrome is much less common with <20 cases reported. In this report we present a case of jejunal perforation during an upper gastrointestinal endoscopy that resulted in tension physiology with mesenteric ischemia, severe acidosis, renal failure, coagulopathy and massive gastrointestinal hemorrhage. The patient had a sudden onset of shock as soon as her abdomen was decompressed, indicating that she possibly developed a reperfusion injury. She did not respond to resuscitative efforts and ultimately died.
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Affiliation(s)
- Catherine Denkler
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Helene M Sterbling
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Hani Seoudi
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
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Liu H, Hu T, Li Y, Yue Z, Zhang F, Fu J. Successful intraoperative management in patients with abdominal compartment syndrome induced by giant liposarcomas: Two case reports. Medicine (Baltimore) 2020; 99:e22575. [PMID: 33019471 PMCID: PMC7535561 DOI: 10.1097/md.0000000000022575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Giant intra-abdominal liposarcomas weighing over 20 kg often increase the intra-abdominal pressure (IAP), which has severe effects on the cardiovascular and respiratory systems. Abdominal compartment syndrome is defined typically as the combination of a raised IAP of 20 mm Hg or higher and new onset of organ dysfunction or failure. The anesthetic management and perioperative management are very challenging. PATIENTS CONCERNS We presented 2 patients with rare giant growing liposarcoma of the abdomen, weighing 21 kg and over 35 kg, respectively. Circulatory management was particularly difficult in the first case, while respiratory management and massive blood loss was very challenging in the second one. DIAGNOSIS With a computed tomography scan and peritoneal-to-abdominal height ratio measurement, preoperatively the risk of developing intra-abdominal hypertension and abdominal compartment syndrome was recognized early in each patient. The inferior vena cava and right atrium of the first patient was compressed and malformed due to the uplifted diaphragm, while there was severe decreased lung volume and increased airway resistance, because of rare giant retroperitoneal liposarcomas in the second case. Histologic examination revealed dedifferentiated liposarcoma in both cases. INTERVENTIONS Both of the patients underwent resection surgery with multiple monitoring; transesophageal echocardiography monitoring in the first case and pressure-controlled ventilation volume guaranteed mechanical ventilation mode in both cases. OUTCOMES Intraoperatively and postoperatively no cardiopulmonary complications in both patients. The first patient was discharged without any complications on postoperative day 10, and the second patient underwent another surgery because of anastomotic leakage resulting from bowel resection. LESSONS Multiple monitorings, in particular transesophageal echocardiography should be considered in patients with increased IAP due to a giant mass, while an appropriate lung protection ventilation strategy is crucial in these patients.
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Affiliation(s)
| | - Tao Hu
- Department of Anesthesiology
| | - Yuekao Li
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Ahmad I, Ilyas M, Rather AA. Aortic Occlusion Syndrome Secondary to Abdominal Compartment Syndrome, a Case Series of 2 Cases. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Fluid Overload and Mortality in Adult Critical Care Patients—A Systematic Review and Meta-Analysis of Observational Studies*. Crit Care Med 2020; 48:1862-1870. [DOI: 10.1097/ccm.0000000000004617] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Montalvo-Jave E, Espejel-Deloiza M, Chernitzky-Camaño J, Peña-Pérez C, Rivero-Sigarroa E, Ortega-León L. Abdominal compartment syndrome: Current concepts and management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020. [DOI: 10.1016/j.rgmxen.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Montalvo-Jave EE, Espejel-Deloiza M, Chernitzky-Camaño J, Peña-Pérez CA, Rivero-Sigarroa E, Ortega-León LH. Abdominal compartment syndrome: Current concepts and management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 85:443-451. [PMID: 32847726 DOI: 10.1016/j.rgmx.2020.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/05/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022]
Abstract
Abdominal compartment syndrome occurs when 2 or more anatomic compartments have a sustained intra-abdominal pressure >20mmHg, associated with organ failure. Incidence is 2% and prevalence varies from 0% to 36.4%. A literature search was conducted utilizing different databases. Articles published from 1970 to 2018 were included, in English or Spanish, to provide the concepts, classifications, and comprehensive management in the approach to abdominal compartment syndrome, for its treatment and the prevention of severe complications associated with the entity. Intravesical pressure measurement is the standard diagnostic method. Treatment is based on evacuation of the intraluminal content, identification and treatment of intra-abdominal lesions, improvement of abdominal wall compliance, and optimum administration of fluids and tissue perfusion. Laparotomy is generally followed by temporary abdominal wall closure 5 to 7 days after surgery. Reconstruction is performed 6 to 12 months after the last operation. Abdominal compartment syndrome should be diagnosed and operated on before organic damage from the illness occurs. Kidney injury can frequently progress and is a parameter for considering abdominal decompression. Having a biomarker for early damage would be ideal. Surgical treatment is successful in the majority of cases. A multidisciplinary focus is necessary for the intensive care and reconstructive needs of the patient. Thus, efforts must be made to define and implement strategies for patient quality of life optimization.
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Affiliation(s)
- E E Montalvo-Jave
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México; Clínica de Gastroenterología, Hospital Médica Sur, Ciudad de México, México.
| | - M Espejel-Deloiza
- Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
| | - J Chernitzky-Camaño
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - C A Peña-Pérez
- Unidad de Terapia Intensiva, Hospital Médica Sur, Ciudad de México, México
| | - E Rivero-Sigarroa
- Departamento de Terapia Intensiva, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - L H Ortega-León
- Clínica de Cirugía Hepato-Pancreato-Biliar, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
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Sieloff EM, Baumgartner M, Schauer M, Shattuck B. A Case of Lethal Abdominal Compartment Syndrome due to Rapidly Expanding Ovarian Small Cell Carcinoma Pulmonary Type. Cureus 2020; 12:e9879. [PMID: 32839683 PMCID: PMC7440890 DOI: 10.7759/cureus.9879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 53-year-old woman presented with a rapidly growing pelvic mass suspected to be endometrial cancer due to endometrial biopsy showing grade 1 endometrioid adenocarcinoma. Due to severe aortic valve stenosis, she underwent a transcatheter aortic valve replacement (TAVR) for surgical optimization for a planned total abdominal hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking. She was discharged on dual antiplatelet therapy with plans for future surgery, but was readmitted with abdominal distension, constipation, and urinary retention. The pelvic mass seen on prior imaging studies had increased in size. Unanticipated asystole cardiac arrest occurred two days after readmission, which on autopsy was found to be secondary to abdominal compartment syndrome from a rapidly enlarging ovarian small cell carcinoma pulmonary type.
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Affiliation(s)
- Eric M Sieloff
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Michael Baumgartner
- Internal Medicine , Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Mark Schauer
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Brandy Shattuck
- Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
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Yu Q, Lou C, Feng T, Liu Y. Ventriculoperitoneal shunt malfunction due to chronic cholecystitis: A case report. Medicine (Baltimore) 2020; 99:e20565. [PMID: 32569180 PMCID: PMC7310882 DOI: 10.1097/md.0000000000020565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ventriculoperitoneal shunt (VPS) is the most common treatment for idiopathic normal pressure hydrocephalus, a subtype of hydrocephalus characterized by gait disturbance, dementia, and urinary incontinence. However, while the malfunction of VPS is reported at a high rate, the involvement of chronic cholecystitis in shunt malfunction is rare. PATIENT CONCERNS A 73-year-old woman with idiopathic normal pressure hydrocephalus who received a VPS but subsequently developed chronic cholecystitis. The patient suffered from drowsiness and was unable to walk. Her family found that she presented with poor appetite and was bloated. DIAGNOSES Chronic cholecystitis was confirmed through abdominal computed tomography, which showed a swollen, and enlarged gallbladder, and flatulence. A head computed tomography scan indicated hydrocephalus with enlarged ventricular system and paraventricular edema. INTERVENTIONS Laparoscopic cholecystectomy was performed successfully, requiring no further shunt manipulation. OUTCOMES The patient's memory and cognitive ability were slightly impaired without a positive sign in the abdomen. No catheter or abdominal infection signs were observed during the following 3 months of follow-up. CONCLUSION To the best of our knowledge, this report is the first to reveal that shunt malfunction may result from chronic cholecystitis, which induced the presently observed intra-abdominal hypertension.
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Affiliation(s)
- Qi Yu
- Department of Neurosurgery, Shengjing Hospital of China Medical University
- Liaoning Clinical Medical Research Center in Nervous System Disease
- Liaoning Key Laboratory of Neuro-Oncology, Shenyang, China
| | - Chengjian Lou
- Department of Neurosurgery, Shengjing Hospital of China Medical University
- Liaoning Clinical Medical Research Center in Nervous System Disease
- Liaoning Key Laboratory of Neuro-Oncology, Shenyang, China
| | - Tianda Feng
- Department of Neurosurgery, Shengjing Hospital of China Medical University
- Liaoning Clinical Medical Research Center in Nervous System Disease
- Liaoning Key Laboratory of Neuro-Oncology, Shenyang, China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital of China Medical University
- Liaoning Clinical Medical Research Center in Nervous System Disease
- Liaoning Key Laboratory of Neuro-Oncology, Shenyang, China
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Golshani K, Azizkhani R, Foroutan F. Inpatient Evaluation of Intra-abdominal Pressure Completed With a Urinary Catheter as Compared With Ultrasonographic Vessel Measurements. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319879072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study was to evaluate the diagnostic value of ultrasonography as compared with intra-abdominal pressure (IAP) measured with a urinary catheter. Methods: This was a cross-sectional study. The participants consisted of 146 patients hospitalized in the emergency wards of two hospitals in Isfahan (2017-2018). Following measurement of IAP through a urinary catheter, ultrasonographic measurement of the inferior vena cava (IVC) diameter, internal jugular vein diameter, common femoral vein (CFV) diameter, and ratio between the IVC and abdominal aortic diameters was completed. Correlation between these methods of measurements for IAP was investigated. Results: There was a significant positive correlation between intrabladder pressure and the right internal jugular vein (RIJV) and CFV ( P < .001, R > 0). There was also a reverse significant correlation between intrabladder pressure and RIJV, IVC, IVC:aorta diameter, systolic blood pressure, and tricuspid annular plane systolic excursion ( P < .001, r < 0). RIJV, CFV, and tricuspid annular plane systolic excursion were suitable predictors for the estimation of intrabladder pressure or IAP ( P < .05), but IVC, IVC:aorta, and systolic blood pressure were not suitable factors for estimating IAP ( P > .05). Conclusion: Ultrasonographic measurement is a noninvasive method for determining IAP.
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Affiliation(s)
- Keihan Golshani
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Azizkhani
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereidon Foroutan
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Aguilera-Bohórquez B, Cantor E, Ramos-Cardozo O, Pachón-Vásquez M. Intraoperative Monitoring and Intra-abdominal Fluid Extravasation During Hip Arthroscopy. Arthroscopy 2020; 36:139-147. [PMID: 31864567 DOI: 10.1016/j.arthro.2019.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/15/2019] [Accepted: 07/24/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the relationship between the intraoperative monitoring factors with intra-abdominal fluid extravasation (IAFE) in patients who underwent hip arthroscopy. The secondary purpose was to describe the main intraoperative variables between cases with and without IAFE. METHODS We carried out a prospective observational study of 106 hip arthroscopies between June 2017 and June 2018. Within procedures, 54 cases with deep gluteal syndrome (DGS) were included. Ultrasonography was performed by a trained anesthesiologist before and after the surgery to identify the presence of fluid. The hepatorenal (Morison's pouch), splenorenal, retroaortic, suprapubic (longitudinal and transverse), and pleural spaces were examined. During the surgery, the blood pressure, heart rate, temperature, peak inspiratory pressure (PIP), pulmonary compliance, oxygen saturation, and end-tidal carbon dioxide were registered. RESULTS The incidence of IAFE was 31.1% (33/106; 95% confidence interval 23.0%-40.5%). IAFE in cases with isolated FAI was 15.9% (7/44) in comparison with 52.9% (9/17) of the cases with isolated DGS. Maximum values of PIP greater than 20 mm Hg were associated with fluid extravasation (odds ratio 3.22; 95% confidence interval 1.07-9.68). No statistically significant relationship was found in blood pressure, heart rate, temperature, oxygen saturation, end-tidal carbon dioxide, and pulmonary compliance between cases with and without IAFE. CONCLUSIONS Asymptomatic IAFE, as measured by ultrasound, is a frequent event in patients who underwent hip arthroscopy, mainly in cases with DGS. PIP was found to be a useful intraoperative monitoring parameter for the early identification of IAFE in hip arthroscopy. LEVEL OF EVIDENCE Level II, observational prospective cohort study.
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Affiliation(s)
- Bernardo Aguilera-Bohórquez
- Orthopedics and Traumatology, Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia
| | - Erika Cantor
- Research Institute, Centro Médico Imbanaco, Cali, Colombia
| | | | - Mauricio Pachón-Vásquez
- Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia.
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The Cushing reflex and the vasopressin-mediated hemodynamic response to increased intracranial pressure during acute elevations in intraabdominal pressure. Surgery 2019; 167:478-483. [PMID: 31813477 DOI: 10.1016/j.surg.2019.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/24/2019] [Accepted: 10/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Abdominal compartment syndrome has been linked to detrimental hemodynamic side effects that include increased intracranial pressure and diminished renal function, but the mechanisms behind this continue to be elucidated. In this study, we sought to investigate any direct association between acute elevations in intra-abdominal pressure and intracranial hypertension during experimentally induced abdominal compartment syndrome and between acutely elevated intracranial pressure and the hemodynamic response that might be elicited by a vasopressin-induced Cushing reflex affecting urine osmolality and urine output. The aim of this study is to explain the Cushing reflex and the vasopressin-mediated hemodynamic response to intracranial pressure during acute elevations in intra-abdominal pressure. METHODS We measured intra-abdominal pressure, intrathoracic pressure, optic nerve sheath diameter as an indirect sign of intracranial pressure, vasopressin levels in blood, urine osmolality, and urine output at 4 time points during surgery in 16 patients undergoing sleeve gastrectomy for morbid obesity. Values for the 4 time points were compared by repeated-measures analysis of variance. RESULTS More than 50-fold elevations in serum vasopressin paralleled increases in optic nerve sheath diameter, rising throughout prepneumoperitoneum and tapering off afterward, in conjunction with a marked decrease in urine but not serum osmolality. Mean arterial pressure rose transiently during pneumoperitoneum without elevated positive end-expiratory pressure but was not significantly elevated thereafter. CONCLUSIONS These findings support our hypothesis that the oliguric response observed in abdominal compartment syndrome might be the result of the acutely elevated intra-abdominal pressure triggering increased intrathoracic pressure, decreased venous outflow from the central nervous system, increased intracranial pressure, and resultant vasopressin release via a Cushing reflex.
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Current Approach to the Evaluation and Management of Abdominal Compartment Syndrome in Pediatric Patients. Pediatr Emerg Care 2019; 35:874-878. [PMID: 31800499 DOI: 10.1097/pec.0000000000001992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abdominal compartment syndrome is an emergent condition caused by increased pressure within the abdominal compartment. It can be caused by a number of etiologies, which are associated with decreased abdominal wall compliance, increased intraluminal or intraperitoneal contents, or edema from capillary leak or fluid resuscitation. The history and physical examination are of limited utility, and the criterion standard for diagnosis is intra-abdominal pressure measurement, which is typically performed via an intravesical catheter. Management includes increasing abdominal wall compliance, evacuating gastrointestinal or intraperitoneal contents, avoiding excessive fluid resuscitation, and decompressive laparotomy in select cases.
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Evaluation and Management of Abdominal Compartment Syndrome in the Emergency Department. J Emerg Med 2019; 58:43-53. [PMID: 31753758 DOI: 10.1016/j.jemermed.2019.09.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Abdominal compartment syndrome is a potentially deadly condition that can be missed in the emergency department setting. OBJECTIVE The purpose of this narrative review article is to provide a summary of the background, pathophysiology, diagnosis, and management of abdominal compartment syndrome with a focus on emergency clinicians. DISCUSSION Abdominal compartment syndrome is caused by excessive pressure within the abdominal compartment due to diminished abdominal wall compliance, increased intraluminal contents, increased abdominal contents, or capillary leak/fluid resuscitation. History and physical examination are insufficient in isolation, and the gold standard is intra-abdominal pressure measurement. Abdominal compartment syndrome is defined as an intra-abdominal pressure >20 mm Hg with evidence of end-organ injury. Management involves increasing abdominal wall compliance (e.g., analgesia, sedation, and neuromuscular blocking agents), evacuating gastrointestinal contents (e.g., nasogastric tubes, rectal tubes, and prokinetic agents), avoiding excessive fluid resuscitation, draining intraperitoneal contents (e.g., percutaneous drain), and decompressive laparotomy in select cases. Patients are critically ill and often require admission to a critical care unit. CONCLUSIONS Abdominal compartment syndrome is an increasingly recognized condition with the potential for significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.
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Denault A, Shaaban Ali M, Couture EJ, Beaubien-Souligny W, Bouabdallaoui N, Brassard P, Mailhot T, Jacquet-Lagrèze M, Lamarche Y, Deschamps A. A Practical Approach to Cerebro-Somatic Near-Infrared Spectroscopy and Whole-Body Ultrasound. J Cardiothorac Vasc Anesth 2019; 33 Suppl 1:S11-S37. [DOI: 10.1053/j.jvca.2019.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shanmugakrishnan RR, Loh CYY, Wakure A, El-Muttardi N. Serial abdominal closure with Gore-tex mesh and Rives-Stoppa for an open abdomen secondary to intra-abdominal hypertension in burns. Indian J Plast Surg 2019; 51:324-326. [PMID: 30983735 PMCID: PMC6440362 DOI: 10.4103/ijps.ijps_75_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS) commonly occurs in major burns. To relieve the excess pressure, decompressive laparotomy is done which can lead to an open abdomen. Closure of the abdomen after a decompressive laparotomy is very difficult with bowel oedema. We describe our technique of closing the open abdomen in such situations with a combination of serial abdominal wall closure with a layered mesh and the Rives-Stoppa component separation technique.
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Affiliation(s)
- R Raja Shanmugakrishnan
- St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, UK
| | - Charles Yuen Yung Loh
- St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, UK
| | - Abhijeet Wakure
- St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, UK
| | - Naguib El-Muttardi
- St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, UK
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Sawosz P, Kacprzak M, Pulawski P, Morawiec M, Bejm K, Bielacz M, Maniewski R, Liebert A, Dabrowski W. Influence of intra-abdominal pressure on the amplitude of fluctuations of cerebral hemoglobin concentration in the respiratory band. BIOMEDICAL OPTICS EXPRESS 2019; 10:3434-3446. [PMID: 31467788 PMCID: PMC6706036 DOI: 10.1364/boe.10.003434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/04/2019] [Accepted: 05/17/2019] [Indexed: 05/15/2023]
Abstract
An intra-abdominal pressure (IAP) is correlated with cerebral perfusion, in a mechanism of reducing venous outflow. The elevated intra-abdominal pressure leads to an increase in the intracranial pressure and a decrease in the cerebral perfusion pressure. We studied the relationship between the IAP and the cerebral oxygenation with the use of the near infrared spectroscopy technique during a gynecological surgery. The changes in hemoglobin concentrations were analyzed in the time-frequency domain in the frequency band related to respiration. The measurements were carried out in 15 subjects who underwent laparoscopic surgery. During the laparoscopy, the intra-abdominal cavity was insufflated with CO2, which caused a controlled increase in the IAP. It was observed that the amplitudes of respiration-related waves present in hemoglobin concentration signals show an increase of 1.5 to 8.5 times during elevation of the IAP by 15 mmHg.
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Affiliation(s)
- Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Michal Kacprzak
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Przemyslaw Pulawski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Magdalena Morawiec
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Karolina Bejm
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Magdalena Bielacz
- Institute of Tourism and Recreation, State Vocational College of Szymon Szymonowicz, Zamosc, Poland
| | - Roman Maniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Wojciech Dabrowski
- Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
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Kakisis JD. Abdominal Compartment Syndrome. Caution: Contents Under Pressure. Eur J Vasc Endovasc Surg 2019; 58:680. [PMID: 31202579 DOI: 10.1016/j.ejvs.2019.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/25/2022]
Affiliation(s)
- John D Kakisis
- Department of Vascular Surgery, "Attikon" University Hospital, School of Medicine, National and Kapodistrian, University of Athens, Athens, Greece.
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Ovarian hyperstimulation syndrome: A review for emergency clinicians. Am J Emerg Med 2019; 37:1577-1584. [PMID: 31097257 DOI: 10.1016/j.ajem.2019.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION A great deal of literature has recently evaluated the prevention and management of ovarian hyperstimulation syndrome (OHSS) in the outpatient setting, but there remains a dearth of research evaluating OHSS in the emergency department (ED) and its management. OBJECTIVE This narrative review evaluates the underlying pathophysiology and clinical manifestations of OHSS and discusses approaches to patient care in the ED based on current literature. DISCUSSION OHSS is an iatrogenic complication caused by an excessive response to controlled ovarian stimulation during assisted reproductive cycles (ART). OHSS complicates up to 30% of ART cycles, and many of these patients seek initial care in the ED. Risk factors for the development of OHSS include age < 35, history of polycystic ovarian syndrome or previous OHSS, and pregnancy. Emergency physicians will be faced with several complications including ascites, abdominal compartment syndrome, renal dysfunction, acute respiratory distress syndrome, thromboembolic disease, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary obstetrics/gynecology team is needed, which improves patient outcomes. This review provides several guiding principles for management of OHSS and associated complications. CONCLUSIONS OHSS occurs in up to 30% of IVF cycles and carries a high morbidity. Effective care of the OHSS patient begins with early diagnosis while evaluating for other diseases and complications. Understanding these complications and an approach to the management of OHSS is essential to optimizing patient care.
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Yin J, Pan X, Jia J, Sun S, Wan B. Comparison of pressure-regulated volume control ventilation and pressure control ventilation in patients with abdominal compartment syndrome. Exp Ther Med 2019; 17:1952-1958. [PMID: 30783471 DOI: 10.3892/etm.2019.7157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022] Open
Abstract
Mechanical ventilation support is commonly required in abdominal compartment syndrome (ACS). In the present study, pressure-regulated volume control ventilation (PRVCV) was compared to pressure control ventilation (PCV) in patients with ACS. The prospective study included 40 patients with ACS who were randomized into the PCV or PRVCV groups and subjected to the different modes of ventilation. After 6 h of ventilation, arterial blood gas, respiratory mechanics and hemodynamics parameters, as well as the intra-abdominal pressure (IAP) and Sequential Organ Failure Assessment (SOFA) scores were calculated. Compared to the PCV mode, mechanical ventilation with PRVCV lead to a significant decrease in the partial pressure of carbon dioxide, the peak inspiratory pressure, the mean inspiratory pressure, the central venous pressure, the heart rate and the extravascular lung water index. In addition, a marked improvement in pH, partial pressure of oxygen, oxygenation index and pulmonary static compliance was noted. However, no significant differences in airway resistance, mean arterial pressure, or IAP and SOFA scores were obtained. In conclusion, the PRVCV mode is better than the PCV mode in ventilation patients with ACS, and should therefore be used as a lung protective strategy. The present study was registered at Chictr.org (no. ChiCTR1800016869).
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Affiliation(s)
- Jiangtao Yin
- Department of Intensive Care Unit, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Xin Pan
- Emergency Department, Zhenjiang Emergency Center, Zhenjiang, Jiangsu 212001, P.R. China
| | - Jue Jia
- Department of Emergency, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Shuangshuang Sun
- Department of Intensive Care Unit, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, P.R. China
| | - Bing Wan
- Department of Respiratory and Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 210002, P.R. China
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Papakrivou E, Manoulakas E, Zakynthinos E, Makris D. Is intra-abdominal hypertension a risk factor for ventilator-associated pneumonia? ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:419. [PMID: 30581827 DOI: 10.21037/atm.2018.08.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the last years, there has been a significant amount of research about the impact of intra-abdominal hypertension (IAH) on the outcomes of critical care patients. IAH is increasingly recognized as potential complication in intensive care unit (ICU) patients. IAH affects all body systems, most notably the cardiac, respiratory, renal, and neurologic systems. IAH affects blood flow to various organs and plays a significant role in the prognosis of the patients. Recognition of IAH, its risk factors and clinical signs can reduce the morbidity and mortality associated. Moreover, knowledge of the pathophysiology may help rationalize the therapeutic approach. On the other hand, ICU patients present frequently ventilator- associated respiratory infections. Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection (HAI) in adult critical care units. It is associated with increased ICU stay, patient ventilator days and mortality. This paper reviews the relationship between IAH and VAP. Despite animal experimentation and physiological studies on humans, in favor of the impact of IAH to VAP, there is no definitive clinical data that IAH is associated with VAP. Microaspirations form the gastrointestinal track is a pathophysiological mechanism for VAP. This review provides data suggesting that under IAH conditions bacterial translocation might be an additional responsible mechanism for VAP in those patients that merits further investigation in the future.
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Affiliation(s)
- Eleni Papakrivou
- Department of Critical Care Medicine, University Hospital of Larisa, University of Thessaly School of Medicine, Larisa, Greece
| | - Eustratios Manoulakas
- Department of Critical Care Medicine, University Hospital of Larisa, University of Thessaly School of Medicine, Larisa, Greece
| | - Epaminondas Zakynthinos
- Department of Critical Care Medicine, University Hospital of Larisa, University of Thessaly School of Medicine, Larisa, Greece
| | - Demosthenes Makris
- Department of Critical Care Medicine, University Hospital of Larisa, University of Thessaly School of Medicine, Larisa, Greece
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Chandra R, Jacobson RA, Poirier J, Millikan K, Robinson E, Siparsky N. Successful non-operative management of intraabdominal hypertension and abdominal compartment syndrome after complex ventral hernia repair: a case series. Am J Surg 2018; 216:819-823. [PMID: 30243791 DOI: 10.1016/j.amjsurg.2018.07.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/21/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are devastating complications of surgery. Patients who undergo complex ventral hernia repair (CVHR) may be at risk for IAH and ACS. METHODS We performed a retrospective review of 175 patients who underwent CVHR by a single surgeon. Body mass index (BMI), prior hernia repair, operative time, bladder pressure, serum creatinine, sedation, paralytic therapy, and ventilator support were reviewed. RESULTS IAH was identified in 33 patients; 11 patients developed ACS. Paralytic therapy was employed in 29 patients for an average of 1.4 days. Elevated BMI was independently associated with an increased risk of IAH (p = 0.006) and ACS (p = 0.02). CONCLUSION Patients who undergo CVHR are at risk of developing IAH and ACS in the postoperative period. Elevated BMI and longer operative time are independent risk factors for the development of IAH. IAH and ACS can be successfully managed with surgical critical care.
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Affiliation(s)
- Raghav Chandra
- Department of Surgery, Rush Medical College, 1725 W. Harrison St., Suite 810/818, Chicago, IL, USA.
| | - Richard A Jacobson
- Department of Surgery, Rush Medical College, 1725 W. Harrison St., Suite 810/818, Chicago, IL, USA.
| | - Jennifer Poirier
- Department of Surgery, Rush Medical College, 1725 W. Harrison St., Suite 810/818, Chicago, IL, USA.
| | - Keith Millikan
- Department of Surgery, Rush Medical College, 1725 W. Harrison St., Suite 810/818, Chicago, IL, USA.
| | - Emilie Robinson
- Department of Surgery, Rush Medical College, 1725 W. Harrison St., Suite 810/818, Chicago, IL, USA.
| | - Nicole Siparsky
- Department of Surgery, Rush Medical College, 1725 W. Harrison St., Suite 810/818, Chicago, IL, USA.
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Gray S, Christensen M, Craft J. The gastro-renal effects of intra-abdominal hypertension: Implications for critical care nurses. Intensive Crit Care Nurs 2018; 48:69-74. [PMID: 29937073 DOI: 10.1016/j.iccn.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/16/2018] [Accepted: 06/01/2018] [Indexed: 12/29/2022]
Abstract
Intra-abdominal hypertension is classified as either primary or secondary - primary occurs due to intra-abdominal or retro-peritoneal pathophysiology, whereas secondary results in alterations in capillary fluid dynamics due to factors, such as massive fluid resuscitation and generalised inflammation. The renal and gastro-intestinal effects occur early in the progression of intra-abdominal hypertension, and may lead to poor patient outcomes if not identified. As a direct response to intra-abdominal hypertension, renal function is reduced with remarkable impairment from pressures of around 10 mmHg, oliguria developing at 15 mmHg and anuria developing at 30 mmHg. Intestinal micro-circulation is significantly reduced by up to 50% with intra-abdominal pressures as low as 15 mmHg. Mucosal and submucosal tissue hypo-perfusion causes considerable damage to the intestinal cells, potentially resulting in bacterial translocation, endotoxin release, sepsis and multiple organ failure. The critical care nurse plays an important role in the early identification of intra-abdominal hypertension however, without this essential knowledge base and comprehension of intra-abdominal hypertension, clinical signs and symptoms may go unnoticed or be misinterpreted as signs of other critical illnesses.
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Affiliation(s)
- Sherree Gray
- School of Nursing, Queensland University of Technology, Caboolture Campus, Caboolture, Queensland 4510, Australia.
| | - Martin Christensen
- Centre for Applied Nursing Research (CANR), Western Sydney University, South Western Sydney Local Health District (SWSLHD), Locked Bag 7103, Liverpool, NSW 1871, Australia.
| | - Judy Craft
- School of Biomedical Sciences, Queensland University of Technology, Caboolture Campus, Caboolture, Queensland 4510, Australia.
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Chmieliauskas S, Mundinas E, Fomin D, Andriuskeviciute G, Laima S, Jurolaic E, Stasiuniene J, Jasulaitis A. Sudden deaths from positional asphyxia: A case report. Medicine (Baltimore) 2018; 97:e11041. [PMID: 29901602 PMCID: PMC6023692 DOI: 10.1097/md.0000000000011041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/18/2018] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Positional asphyxia is a rare cause of sudden death and a difficult diagnosis, based mostly on the circumstances of the incident, along with particular external and internal findings, frequent in asphyxia (signs of sudden death). PATIENT CONCERNS In this report, we are describing one case of adult who was found positioned in a way that led to eventual asphyxiation. DIAGNOSES The final diagnosis of positional asphyxia was determined after the autopsy. INTERVENTIONS In a head-down position, gravitation and mechanical forces lead to an increased pressure on the diaphragm from the weight of the abdominal organs. Abdominal breathing, and later, chest breathing were hindered by the raised diaphragm and the difference between abdominal and breathing pressures. OUTCOMES It is known that death from positional asphyxia can emerge in several ways, such as the external breathing suppression when the victim's torso is compressed or deformed. LESSONS Therefore, the current criteria for positional asphyxia are based on the obstruction of normal gas exchange caused by the body position, the impossibility to move to another position, and the exclusion of other causes of death. The forensic medical examination must also be started at the scene of the incident.
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Affiliation(s)
- Sigitas Chmieliauskas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius
- State Forensic Medicine Service, Vilnius, Lithuania
| | - Eimantas Mundinas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius
| | - Dmitrij Fomin
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius
- State Forensic Medicine Service, Vilnius, Lithuania
| | | | - Sigitas Laima
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius
- State Forensic Medicine Service, Vilnius, Lithuania
| | - Eleonora Jurolaic
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius
| | - Jurgita Stasiuniene
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius
| | - Algimantas Jasulaitis
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius
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Braha B, Mahmutaj D, Maxhuni M, Neziri B, Krasniqi S. Correlation of Procalcitonin and C-Reactive Protein with Intra-Abdominal Hypertension in Intra-Abdominal Infections: Their Predictive Role in the Progress of the Disease. Open Access Maced J Med Sci 2018; 6:479-484. [PMID: 29610604 PMCID: PMC5874369 DOI: 10.3889/oamjms.2018.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 01/17/2023] Open
Abstract
AIM To analyse the correlation of procalcitonin (PCT) and C-reactive protein (CRP) values with increased intra-abdominal pressure and to evaluate their predictive role in the progression of Intra-abdominal infections. MATERIALS AND METHODS A non-randomized prospective study conducted in the group of 80 patients. We have measured the PCT, CRP and intra-abdominal pressure (IAP). RESULTS According to IAH grades (G), there was a significant difference of PCT values: G I 3.6 ± 5.1 ng/ml, G II 10.9 ± 22.6 ng/ml, G III 15.2 ± 30.2 ng/ml (p = 0.045) until: CRP values were increased in all IAH groups but without distinction between the groups: GI 183 ± 64.5, GII 196 ± 90.2, GIII 224 ± 96.3 (p = 0.17). According to the severity of the infection, we yielded increased values of PCT, IAP and CRP in septic shock, severe sepsis and SIRS/sepsis resulting in significant differences of PCT and IAP. CONCLUSION Based on the results of our research, we conclude that the correlation of PCT values with IAH grades is quite significant while the CRP results remain high in IAH but without significant difference between the different grades of IAH.
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Affiliation(s)
- Bedri Braha
- Clinic of Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Dafina Mahmutaj
- Clinic of Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Mehmet Maxhuni
- Clinic of Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Burim Neziri
- Faculty of Medicine, University of Prishtina “Hasan Prishtina”, Prishtina, Kosovo
| | - Shaip Krasniqi
- Faculty of Medicine, University of Prishtina “Hasan Prishtina”, Prishtina, Kosovo
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