Transmesenteric hernia after laparoscopic-assisted sigmoid colectomy.
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BACKGROUND AND OBJECTIVES: Laparoscopic-assisted surgery has been applied for a variety of colonic surgery. The objective of this paper is to demonstrate a possible and avoidable complication of laparoscopic colonic surgery. CASE PRESENTATION: A 47-year-old woman underwent gasless laparoscopic-assisted sigmoid colectomy. On the 20th postoperative day, she developed bowel obstruction. Decompression with a long tube failed to resolve the bowel obstruction. Open laparotomy was performed. Abdominal exploration revealed a loop of the small bowel incarcerated in the mesenteric defect caused by the previous operation. Adhesiolysis was performed, and the postoperative course was uneventful. DISCUSSION: Despite technical difficulty, complete closure of the mesentery after bowel resection is strongly recommended for prevention of transmesenteric incarcerated hernia after laparoscopic surgery. (+info)
Ring-down artifacts posterior to the right hemidiaphragm on abdominal sonography: sign of pulmonary parenchymal abnormalities.
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The aim of our study was to verify whether ring-down artifacts posterior to the right hemidiaphragm on abdominal sonography reflected pulmonary parenchymal abnormalities. Forty patients (group 1) with abdominal diseases and 32 patients (group 2) with proved various pulmonary abnormalities involving the right lung base underwent abdominal sonography with 2-4 MHz transducers. In these two groups, the presence and number of ring-down artifacts were assessed and correlated with peridiaphragmatic lung findings on chest radiographs or computed tomographic scans. In 21 patients (group 3) with multiple (more than five) or numerous (10 or more) ring-down artifacts, chest radiographs were reviewed to see if any peridiaphragmatic pulmonary abnormalities were present. In group 1, one or several (less than five) ring-down artifacts were shown in 27 of 40 (68%) patients. In these patients, computed tomography showed insignificant focal intra- and interlobular septal thickening in the peridiaphragmatic right lung. In group 2, 31 of 32 (97%) patients showed multiple or numerous ring-down artifacts. In group 3, chest radiographs showed various pulmonary abnormalities in 20 of 21 (95%) patients, including emphysema, idiopathic interstitial pneumonia, bronchopneumonia, and interstitial edema. Although nonspecific, ring-down artifacts posterior to the right diaphragm on abdominal sonography may be used to predict pulmonary abnormalities when encountered on abdominal sonography in patients without specific pulmonary symptoms. (+info)
Altered abdominal fat distribution and its association with the serum lipid profile in non-diabetic haemodialysis patients.
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BACKGROUND: Disturbances of lipid and carbohydrate metabolism may be associated with the distribution of abdominal adiposity. However, little is known about the alteration of abdominal adiposity and its association with the serum lipid profile in haemodialysis patients. METHODS: We evaluated the distribution of abdominal adiposity by using computed tomography and examined its relationship with the serum lipid profile in 92 non-diabetic haemodialysis patients and 80 control subjects with normal renal function. Since the mean body mass index (BMI) and total body fat mass were significantly lower in the haemodialysis patients than in the control subjects, the subcutaneous abdominal fat area and the visceral fat area were standardized by body mass index and compared between the haemodialysis patients and the control subjects. RESULTS: Mean subcutaneous fat area/body mass index (SFA/BMI) was significantly lower, and mean visceral fat area/body mass index (VFA/BMI) was significantly higher in the haemodialysis patients (SFA/BMI, 2.40+/-0.12; VFA/BMI, 2.28+/-0.15) than in the control subjects (SFA/BMI, 3.75+/-0.21, P<0.01; VFA/BMI, 1.65+/-0.15, P<0.01). Consequently, visceral fat area/ subcutaneous fat area ratio was significantly higher in the haemodialysis patients (1.05+/-0.07) than in the control subjects (0.46+/-0.04, P<0.01). A scattered plot of visceral fat area relative to BMI revealed that visceral fat area was higher in the haemodialysis patients than in the control subjects at any BMI level. A simple regression analysis showed that BMI, total body fat mass, subcutaneous fat area and visceral fat area were all associated with serum triglycerides and the atherogenic index, (total cholesterol-HDL cholesterol)/HDL cholesterol. Furthermore, a multiple regression analysis indicated that the visceral fat area was the best predictor for either the atherogenic index or triglycerides among these fat components. CONCLUSIONS: These data indicate that haemodialysis patients exhibited a visceral fat accumulation irrespective of BMI, and this shift of abdominal adiposity might be associated with disturbance of the serum lipid profile in non-diabetic haemodialysis patients. (+info)
Screening admission CT scans in patients with AIDS--a randomized trial.
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OBJECTIVE: To determine if the length of hospital stay could be reduced for patients with AIDS by performing screening head and abdominal-pelvic computed tomography (CT) scans within 24 hours of admission, regardless of presenting signs and symptoms. DESIGN: Randomized, prospective trial. SETTING: Tertiary, academic medical center. PATIENTS: On presentation to the emergency department, 42 patients with AIDS were identified as being eligible to participate in our study. Twenty-two patients consented to participate and were assigned to screening CT or control group. INTERVENTION: Patients assigned to the screening CT group had head and abdominal-pelvic CT scans within 24 hours of admission, regardless of presenting signs or symptoms. The findings of the screening CT scans were immediately communicated to the patient's referring physician. Patients assigned to the control group had CT studies done solely at the discretion of their physician. MAIN OUTCOME MEASURE: Length of stay for patients in the screening CT and control groups. RESULTS: The average length of stay for patients in the screening CT group was 1.3 days longer than the average length of stay for patients in the control group (95% CI, 1.4 days shorter to 4 days longer). The study was terminated after 22 patients were enrolled. CONCLUSION: Screening CT scans of the head and abdomen and pelvis at the time of hospital admission do not reduce the length of stay for patients with AIDS. (+info)
The role of positron emission tomography (PET) in the management of lymphoma patients.
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BACKGROUND: Treatment of both Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL) with abdominal presentation at the time of diagnosis is often followed by detection of residual masses by computed tomography (CT). However, CT is usually unable to discriminate between residual tumor and fibrosis/necrosis. We investigated the ability of fluorine-18 fluorodeoxyglucose positron emission tomography (PET) to differentiate between residual active tumor tissue and fibrosis. PATIENTS AND METHODS: Forty-four patients with HD or aggressive NHL presenting abdominal involvement (41% with bulky mass) were studied with CT and PET at the end of chemotherapy +/- radiation therapy. RESULTS: After treatment, seven patients had negative PET and CT, and none of them relapsed. The remaining 37 patients all had positive CT (abnormalities < or = 10%). All of the 13 who also had positive PET relapsed (100%). By contrast, there was only 1 (4%) relapse among the 24 patients who were positive at CT but negative at PET. The two-year actuarial relapse-free survival rate was 95% for those with negative PET compared with 0% for positive PET patients (P < 0.000000). CONCLUSIONS: In lymphoma patients with abdominal masses who present CT positivity at restaging, PET should be considered the noninvasive imaging modality of choice for differentiating early recurrences or residual disease from fibrosis. (+info)
Renal artery lesions in patients with moyamoya disease: angiographic findings.
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BACKGROUND AND PURPOSE: Renal artery lesions in moyamoya disease have been described sporadically in several case reports. The purpose of this study is to evaluate the angiographic findings of renal artery lesions in moyamoya disease and to determine the prevalence of renal artery lesions in patients with moyamoya disease. METHODS: Eighty-six consecutive patients with idiopathic moyamoya disease were prospectively examined with both cerebral angiography and abdominal aortography. The findings of abdominal aortography were reviewed for the presence and appearance of renal artery lesions and compared with the clinical data and cerebral angiographic findings. RESULTS: Of 86 patients with idiopathic moyamoya disease, 7 patients (8%) were found to have renal artery lesions. Six patients (7%) had stenosis in the renal artery, and 1 patient (1%) had a small saccular aneurysm in the renal artery. Two patients (2%) with a marked renal artery stenosis presented with renovascular hypertension, which resulted in an intraventricular hemorrhage in 1 patient. Furthermore, the renal artery stenosis in the 2 patients with renovascular hypertension was successfully treated with percutaneous transluminal angioplasty. There was no significant correlation between the presence of renal artery lesions and cerebral angiographic findings. CONCLUSIONS: Seven (8%) of 86 patients with moyamoya disease showed renal artery lesions, including 6 stenoses (7%) and 1 aneurysm (1%). Renal artery lesions are a clinically relevant systemic manifestation in patients with moyamoya disease. (+info)
Primary epitheliotropic T-cell lymphoma of the urinary bladder in a dog.
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A 7-year-old, intact female mixed-breed dog was presented for evaluation of hematuria. Physical examination revealed a suprapubic mass. Ultrasonographic examination showed a large lobular mass occupying the urinary bladder. At the owners' request, the dog was euthanatized and a postmortem examination was performed. Necropsy confirmed the presence of a lobular mass of about 5- to 6-cm diameter protruding into the lumen of the bladder. Histologically, the mass was composed of a large number of atypical lymphoid cells in the lamina propria and mucosal epithelium. Immunohistochemically, the neoplastic cells expressed CD3 but not CD79alpha or keratin and vimentin, supporting a diagnosis of T-cell lymphoma. (+info)
What is heartburn worth? A cost-utility analysis of management strategies.
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OBJECTIVE: To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. METHODS: We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. MAIN RESULTS: Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2 receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. CONCLUSIONS: Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life. (+info)