Tension pneumoperitoneum is a potentially lethal complication of many procedures, including endoscopic ultrasound guided aspiration. We report the case of a 57-year-old male with pancreatic pseudo-cysts who developed tension pneumoperitoneum and circulatory collapse after endoscopic ultrasound. Initial treatment was successful with needle decompression. Emergency surgery revealed two perforations in the stomach which were manually sutured. The patient had an uneventful recovery and was discharged home on the seventh postoperative day. Tension pneumoperitoneum is a life-threatening complication and ...
Study patients: 11 consecutive adults with a diagnosis of pneumoperitoneum by CT. Control patients: 11 consecutive adults with severe acute abdominal pain with a diagnosis other than pneumoperitoneum by CT. US examination has been performed with a convex and a linear probe using the following scans: epigastrium, right and left hypocondrium, umbelical area and right hypocondrium. All exams were recorded in a video of 5 seconds and each videos reviewed by 2 radiologists and 2 senior physicians blinded to other imaging studies. The reviewers fulfilled a standardized form signing for each scan either presence or absence of pneumoperitonem signs (enhancement of the peritoneum stripe with ring-down artifacts or "comet tails" starting from peritoneum). If one of the signs of pneumopeitoneum was present in at least one scan, the patient was considered to have a US diagnosis of pneumoperitoneum. The reviewers also evaluated abdomen radiography for the presence/absence of pneumoperitoneum. CT was ...
OBJECTIVE To find out the duration of postoperative pneumoperitoneum and the factors that are responsible for its persistence. DESIGN Prospective open (non-random) study. SETTING County hospital, Denmark. SUBJECTS 32 patients over 18 years of age undergoing abdominal operations during a 6 month period. INTERVENTIONS Abdominal radiographs with the patient in the left lateral position were taken at fixed time intervals until no free air could be seen. MAIN OUTCOME MEASURES The amount of free air and the time postoperatively by which it had disappeared. RESULTS In 20 [corrected] patients the air had disappeared within 48 hours and only one patient (3%) had free air for more than five days postoperatively. High body mass index and a small initial amount of free air were associated with the shortest period of postoperative pneumoperitoneum. CONCLUSION Postoperative pneumoperitoneum disappeared within two days in most patients. Heavier patients and patients with small volumes of free air
On the third re-laparotomy, the silo was removed and the decision was made to definitively close his abdomen. Fascial suture was not possible because the central section remained with an insurmountable gap of 6 cm. We performed the posterior part of the components separation technique (CST) described by Ramirez et al. [4]. Longitudinal incisions of the two posterior rectal sheaths parallel and near his linea alba were made. We bluntly separated these sheaths from his rectus muscles, paying attention not to disturb the neurovascular bundles at the lateral rectal borders. This led to a good mobilization of the two rectal myofascial complexes (RMFCs), allowing apposition under acceptable tension. We used the Kloppel interrupted suture technique, and placed four Smead-Jones internal retention sutures. Our patient made an uneventful recovery, with the wound healing by primary intention.. The sample of the peritoneal exudate for culture and sensitivity taken during the initial operation did not grow ...
A recent JAMA article out of USC+LAC Medical Center investigated an alternative site for needle decompression in tension pneumothorax from the standard 2nd intercostal space (ICS) at the mid-clavicular line. Using CT scans in 680 trauma patients, they compared the 2nd ICS MCL to the 5th ICS at the anterior axillary line (AAL) using a…
This master thesis study uses seismic modeling to better understand the seismic response of the free gas that accumulates beneath hydrate-bearing sediments. To this end, I developed 12 different geological models ranging from very simple geometries to anticline structures. Within these models, I varied the distribution of free gas in the layers beneath the BSR. Sediment properties were taken from velocity profiles of the Storegga gas hydrate system and the density approximately estimated from a computed Gassmann diagram. Norsar 2D, Norsar 3D and Seisrox modeling programs were used to generate PSDM seismic images. Higher frequencies, large incident angle and long horizontal sampling distances has resulted in the generation of BSR as termination of enhanced reflection. The termination of the enhanced reflections coincided with anticlinal and dipping BSR in this study. The presence of intercalation of gas free and hydrate bearing layers above the dipping BSR and gas free and gas bearing sediments ...
Boockvar, K. S., Halm, E. A., Litke, A., Silberzweig, S. B., McLaughlin, M., Penrod, J. D., Magaziner, J., Koval, K., Strauss, E. and Siu, A. L. (2003), Hospital Readmissions After Hospital Discharge for Hip Fracture: Surgical and Nonsurgical Causes and Effect on Outcomes. Journal of the American Geriatrics Society, 51: 399-403. doi: 10.1046/j.1532-5415.2003.51115.x ...
Background The frequency of intraperitoneal free tumor cells (IPTC) is considered to reflect the severity of peritoneal metastasis (PM). We quantified the relative number of IPTC against leukocytes in...
All patients were immediately treated with broad-spectrum antibiotics and underwent subsequent surgical exploration. Patients A and C had a pneumoperitoneum, indicating free gas trapped within the peritoneal cavity but outside the lumen of the bowel. Patient B had a pneumomediastinum due to mediastinitis. Afterwards, they were admitted to the ICU for postoperative care. Patients A and B both went into severe septic shock. Against all odds, patient C recovered without any clinical sequelae. A complete summary of differential diagnoses regarding free gas can be found in table 1. Up to 49% of cases of a pneumoperitoneum may not be detected using conventional radiography. Therefore, it is recommended to make a CT scan, which can correctly identify the site of perforation in 86% of the cases.2 After taking microbiological cultures, broad-spectrum antibiotics should be started immediately if sepsis is suspected. However, there may also be causes of free gas for which antibiotics are not the direct ...
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Answers from experts on symptoms of pneumoperitoneum. First: Infection of the interior abdominal lining is commonly called peritonitis. It is a very painful problem that frequently requires surgical intervention. You must treat the cause of the infection - commonly the appendix, gall bladder, colon, etc. To resolve the peritonitis.
New life-saving treatments for Pneumoperitoneum | pain | inflammation | quality of life in clinical trial on Comparison of Pneumoinsufflation Modes and Pressure Settings in Gynecology
Pneumoperitoneum Market is driven by the growing awareness, gradual adoption of improved technologies, emerging health care infrastructure, increased purchasing power of hospitals, and rising population.
Objectives: In patients with gastric cancer, peritoneal dissemination is the most common metastasis. To predict future peritoneal recurrences, peritoneal lavage cytology is performed during operation. But even cytology-negative patients sometimes develop peritoneal recurrences. Thus an additional method to detect intraperitoneal free gastric cancer cells is necessary. We have developed a genetically engineered adenovirus, TelomeScan, which replicates and expresses GFP only in telomerase-activated cancer cells. Here we detected intraperitoneal free gastric cancer cells using TelomeScan, and investigated the correlation between the number of GFP-positive cells and patient prognosis.. Methods: Peritoneal wash was obtained from 69 gastric cancer patients during operation. The cells in the wash were infected with TelomeScan for 24 hours. Finally, GFP-positive cells were counted under a fluorescence microscope. In some GFP-positive cases immunofluorescence assay was added. Clinicopathological data ...
We have conducted a trial investigating the role of an increased dose of inhaled steroids within the context of an asthma action plan. In our study a double dose of inhaled beclomethasone had no beneficial effect on an asthma exacerbation compared with placebo, and this is evidence against using such an approach in asthma management. This finding has several implications, but these should be applied with due consideration to the limitations of this study.. The first criticism directed at many studies resulting in a negative outcome is that they lacked the power to detect an effect. Before commencing our study, we were unable to find any good data on which to perform power calculations and estimate sample size requirements and so we performed retrospective power calculations. Using the baseline PEFR data we can say that a sample of 28 children gave us an 80% chance of detecting a difference of 0.55 SD (5% of baseline PEFR) at the 5% level of significance. The 18 pairs of exacerbations available ...
In the above cases, we used the ultrasound to observe three abnormal air patterns that should alert the clinician to an intra-abdominal pathology, namely intraperitoneal air (case#2), portal venous gas (case#1), and intramural air (case#1).. Intraperitoneal air can be seen using the liver as an acoustic window. Indeed, the liver offers a unique echogenic window. Although the hepatic flexure of the colon can sometimes be found interposed, there is generally no bowel that creates artifact in the right upper quadrant. Free air will accumulate anteriorly in the supine position and create an air artifact interfering with the normal liver texture (Fig. 1). It is of importance not to press deeply with the ultrasound probe as this can shift small amount of free air away from the US field. This phenomenon of air interposition should be considered abnormal and is similar to the "lung point" shadow that occurs in a pneumothorax where ultrasound reveals loss of normal lung sliding [10]. We propose the term ...
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in Acta Chirurgica Belgica (2014, May), 114(3), 117. Laparoscopic liver surgery has evolved over the last 2 decades. Advancements in surgical technology, surgical technique, and postoperative care have aided in lifting barriers to laparoscopic liver ... [more ▼]. Laparoscopic liver surgery has evolved over the last 2 decades. Advancements in surgical technology, surgical technique, and postoperative care have aided in lifting barriers to laparoscopic liver resections (LLR). LLR might decrease morbidity and hospitalisation stay compared to open approach, and importantly in liver surgery, may decrease postoperative costal pain. However, in hepatic surgery as in all abdominal procedures, laparoscopic approach is a mean but not a goal. The possibility of LLR should neither modify indications for surgery nor the type of resection. Physiologic modifications induced by CO2 pneumoperitoneum should be known by the surgical and anaesthetic team involved in LLR. Pneumoperitoneum decreases cardiac output, ...
Background: Natural killer (NK) activity plays an important role in the prevention of tumor metastasis. However, few studies compa
M2.OR.4757) A 69-year-old male presents to the emergency department after a car crash. The patient is unconscious and his shirt is covered in blood. The patient has severe JVD and seems to be struggling to breathe. His temperature is 99.5°F (37.5°C), pulse is 160/min, blood pressure is 90/50 mmHg, respirations are 18/min, and oxygen saturation is 93% on room air. Large needle decompression is performed, and IV fluids are started. A pelvic binder is placed and a full trauma assessment is started. The patients physical exam is notable for multiple bruises and erythema over the ventral chest, arms, and pelvis. The patient has a type and screen sent off and a radiograph of the pelvis is ordered and is in Figure A. A radiograph of the chest is performed and is notable for multiple broken ribs. A FAST exam is ordered and returns negative for any signs of abdominal bleeding or cardiac tamponade. During this time, IV fluids are continued and a chest tube is placed. There is no drainage of blood from ...
Theres a saying in paramedicine: trauma is trauma. Basically that just means that it is what it is. Unlike a complex medical emergency with co-morbid factors on a patient with chronic conditions who takes ten medications, treatment for trauma is actually pretty simple. If it bleeds, plug it. If its floppy, splint it. Then go find a trauma surgeon quickly. Yet the real nuance to effective trauma care is staying ahead of injuries by anticipating problems before they happen and caring for the injuries that you cant see.. All of Marias vitals are recovering nicely and shes answering my questions well enough, although shes understandably in a lot of distress and on the verge of freaking out on me. I made sure to apply the occlusive Asherman dressing to the chest wound. In a perfect world that will reduce the risk of a collapsed lung. In the imperfect world that I live in Im not certain I could do a needle decompression to re-inflate a lung on Maria because shes just too fat. But for now shes ...
Developed by NAEMTs Prehospital Trauma Life Support (PHTLS) Committee, the TECC program is based on the guidelines from the Committee on Tactical Emergency Casualty Care (Co-TECC) and the Tactical Combat Casualty Care (TCCC) program. TECC uses lessons learned from our military and applies them to the civilian world of tactical medicine.. This 16-hour course covers topics designed to decrease preventable death in the tactical situation. Topics include: Hemorrhage control; surgical airway control and needle decompression; strategies for treating wounded responders in threatening environments; caring for pediatric patients; and techniques for dragging and carrying victims to safety.. At the core of the TECC program are three distinct phases that have been well-proven by TCCC-trained personnel in the war against terrorism in Iraq and Afghanistan. The phases are as follows: Direct Threat Care: Care that is rendered while under attack or in adverse conditions.. Indirect Threat Care:. Care that is ...
|p||em|Despite good pathological prognoses, 5% of patients studied experienced relatively rapid cancer relapses. Pneumoperitoneum may have played a role, according to new study published in |/em|The Journal of Urology|sup|®|/sup||/p|
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Assuming that the background geometry is filled with free gas consisting of matter and radiation and no phase transitions being occurred in the early Universe, we discuss the thermodynamics of this {\it closed} system using classical approaches. We find that … - 1109.6469
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19 A recently published systematic review based on 11 studies, evaluating the severity of STP found a significant reduction associated to low-pressure pneumoperitoneum and also mentioned that the reduction was mostly evident during the first 24 hours of surgery.11,16-20. Another effective way of assessing pain is through the analgesic requirements of the patient. Reduced analgesic requirements not only signify improved patient wellbeing but also indicate a reduction of workload on the nursing staff. In our study the difference in the number of times the analgesic had to be administered between the two groups was statistically significant with the requirement being low in the LPLC group. Reduction in analgesic demand has also been confirmed by the Cochrane review by Gurusamy in 2009. 12 Our findings were also in concordance with those of Yasir et al who concluded their study with the remarks that the analgesic requirement is reduced significantly in LPLC and thus recuperates the quality of life ...
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THIS STUDY IS DESIGNED TO DEVELOP AND EVALUATE A METHOD OF REPLACING A HOLLOW VISCUS WITH A PROSTHESIS THAT ALLOWS PRIMARY MUCOSAL HEALING AND INCORPORATION OF THE PROSTHETIC INTO THE HEALING PROCESS. ... ...