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Journal of Endovascular Therapy : An... Feb 2017To provide an updated systematic literature review and summarize current evidence on proximal aortic neck dilatation (AND) after endovascular aneurysm repair (EVAR). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To provide an updated systematic literature review and summarize current evidence on proximal aortic neck dilatation (AND) after endovascular aneurysm repair (EVAR).
METHODS
A review of the English-language medical literature from 1991 to 2015 was conducted using MEDLINE and EMBASE to identify studies reporting AND after EVAR. Studies considered for inclusion and full-text review fulfilled the following criteria: (1) reported AND after EVAR, (2) included at least 5 patients, and (3) provided data on AND quantification. The search identified 26 articles published between 1998 and 2015 that encompassed 9721 patients (median age 71.8 years; 9439 men).
RESULTS
AND occurred in 24.6% of patients (95% CI 18.6% to 31.8%) over a period ranging from 15 months to 9 years after EVAR. No significant dilatation of the suprarenal part of the aorta was reported by most studies. The incidence of combined clinical events (endoleak type I, migration, reintervention during follow-up) was higher in the AND group (26%) when compared with 2% in the group without AND (OR 28.7, 95% CI 5.43 to 151.67, p<0.001).
CONCLUSION
AND affects a considerable proportion of EVAR patients and was related to worse clinical outcome, as indicated by increased rates of type I endoleak, migration, and reinterventions. Future studies should focus on a better understanding of the pathophysiology, predictors, and risk factors of AND, which could identify patients who may warrant a different EVAR strategy and/or a closer post-EVAR surveillance strategy.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Chi-Square Distribution; Dilatation, Pathologic; Endoleak; Endovascular Procedures; Foreign-Body Migration; Humans; Odds Ratio; Retreatment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 27974495
DOI: 10.1177/1526602816673325 -
Neurogastroenterology and Motility Dec 2019Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by... (Comparative Study)
Comparative Study
BACKGROUND
Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence.
METHODS
An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce-induced distension as compared to basal conditions.
KEY RESULTS
Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents.
CONCLUSION AND INFERENCES
Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.
Topics: Abdominal Cavity; Abdominal Wall; Adult; Animals; Anthropometry; Biofeedback, Psychology; Cattle; Diagnosis, Differential; Diaphragm; Digestion; Dilatation, Pathologic; Electromyography; Feces; Female; Fermentation; Flatulence; Gases; Gastrointestinal Microbiome; Humans; In Vitro Techniques; Lactuca; Meat; Middle Aged; Muscle Contraction; Phaseolus; Saline Solution; Tomography, X-Ray Computed; Young Adult
PubMed: 31402544
DOI: 10.1111/nmo.13703 -
BMC Gastroenterology Feb 2023Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity.
AIM
To conduct a systematic review of the prevalence of stricturing disease in abdominal and gastrointestinal tuberculosis and response to antitubercular therapy (ATT).
METHODS
We searched Pubmed and Embase on 13th January 2022, for papers reporting on the frequency and outcomes of stricturing gastrointestinal tuberculosis. The data were extracted, and pooled prevalence of stricturing disease was estimated in abdominal tuberculosis and gastrointestinal (intestinal) tuberculosis. The pooled clinical response and stricture resolution (endoscopic or radiologic) rates were also estimated. Publication bias was assessed using the Funnel plot and Egger test. The risk of bias assessment was done using a modified Newcastle Ottawa Scale.
RESULTS
Thirty-three studies reporting about 1969 patients were included. The pooled prevalence of intestinal strictures in abdominal tuberculosis and gastrointestinal TB was 0.12 (95%CI 0.07-0.20, I = 89%) and 0.27 (95% CI 0.21-0.33, I = 85%), respectively. The pooled clinical response of stricturing gastrointestinal tuberculosis to antitubercular therapy was 0.77 (95%CI 0.65-0.86, I = 74%). The pooled stricture response rate (endoscopic or radiological) was 0.66 (95%CI 0.40-0.85, I = 91%). The pooled rate of need for surgical intervention was 0.21 (95%CI 0.13-0.32, I = 70%), while endoscopic dilatation was 0.14 (95%CI 0.09-0.21, I = 0%).
CONCLUSION
Stricturing gastrointestinal tuberculosis occurs in around a quarter of patients with gastrointestinal tuberculosis, and around two-thirds of patients have a clinical response with antitubercular therapy. A subset of patients may need endoscopic or surgical intervention. The estimates for the pooled prevalence of stricturing disease and response to ATT had significant heterogeneity.
Topics: Humans; Constriction, Pathologic; Tuberculosis, Gastrointestinal; Antitubercular Agents; Intestinal Obstruction; Abdomen
PubMed: 36814249
DOI: 10.1186/s12876-023-02682-x -
Journal of Biological Regulators and... 2016The objective of this study was to investigate early postoperative inflammatory small bowel obstruction (EPISBO) by applying gastrointestinal decompression to relieve... (Randomized Controlled Trial)
Randomized Controlled Trial
The objective of this study was to investigate early postoperative inflammatory small bowel obstruction (EPISBO) by applying gastrointestinal decompression to relieve abdominal distension. Thirty-six cases of patients were randomly divided into two groups: a control group (20 cases) and an observation group (16 cases). Routine continuous gastrointestinal decompression was assigned to the control group, while gastrointestinal decompression with dynamic and profound adjustment of the gastric tube and abdomen movement was assigned to the observation group, to induce abundant gastric juice and gas, and significantly relieve abdominal distension. A test was performed for each of the two groups to observe the relief time of the abdominal distension and the difference of abdominal girth of 5 cm before and after gastrointestinal decompression. Compared with the control group, the patients in the observation group with abdominal distension had earlier pain relief. More patients in the observation group had a difference of abdominal girth of 5 cm before and after gastrointestinal decompression. In gastrointestinal decompression, the method of dynamic and profound adjustment of the gastric tube and abdomen movement improve the effect of the gastrointestinal decompression, which relieves abdominal distention and promotes the postoperative recovery of organ functions.
Topics: Abdomen; Anthropometry; Child; Child, Preschool; Decompression; Digestive System Surgical Procedures; Female; Humans; Infant; Intestinal Obstruction; Intubation, Gastrointestinal; Male; Massage; Pain, Postoperative; Postoperative Complications
PubMed: 27655503
DOI: No ID Found -
Circulation Oct 2018Long noncoding RNAs have emerged as critical molecular regulators in various biological processes and diseases. Here we sought to identify and functionally characterize...
BACKGROUND
Long noncoding RNAs have emerged as critical molecular regulators in various biological processes and diseases. Here we sought to identify and functionally characterize long noncoding RNAs as potential mediators in abdominal aortic aneurysm development.
METHODS
We profiled RNA transcript expression in 2 murine abdominal aortic aneurysm models, Angiotensin II (ANGII) infusion in apolipoprotein E-deficient ( ApoE) mice (n=8) and porcine pancreatic elastase instillation in C57BL/6 wild-type mice (n=12). The long noncoding RNA H19 was identified as 1 of the most highly upregulated transcripts in both mouse aneurysm models compared with sham-operated controls. This was confirmed by quantitative reverse transcription-polymerase chain reaction and in situ hybridization.
RESULTS
Experimental knock-down of H19, utilizing site-specific antisense oligonucleotides (LNA-GapmeRs) in vivo, significantly limited aneurysm growth in both models. Upregulated H19 correlated with smooth muscle cell (SMC) content and SMC apoptosis in progressing aneurysms. Importantly, a similar pattern could be observed in human abdominal aortic aneurysm tissue samples, and in a novel preclinical LDLR (low-density lipoprotein receptor) Yucatan mini-pig aneurysm model. In vitro knock-down of H19 markedly decreased apoptotic rates of cultured human aortic SMCs, whereas overexpression of H19 had the opposite effect. Notably, H19-dependent apoptosis mechanisms in SMCs appeared to be independent of miR-675, which is embedded in the first exon of the H19 gene. A customized transcription factor array identified hypoxia-inducible factor 1α as the main downstream effector. Increased SMC apoptosis was associated with cytoplasmic interaction between H19 and hypoxia-inducible factor 1α and sequential p53 stabilization. Additionally, H19 induced transcription of hypoxia-inducible factor 1α via recruiting the transcription factor specificity protein 1 to the promoter region.
CONCLUSIONS
The long noncoding RNA H19 is a novel regulator of SMC survival in abdominal aortic aneurysm development and progression. Inhibition of H19 expression might serve as a novel molecular therapeutic target for aortic aneurysm disease.
Topics: Angiotensin II; Animals; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Apoptosis; Case-Control Studies; Cells, Cultured; Dilatation, Pathologic; Disease Models, Animal; Disease Progression; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Male; Mice, Inbred C57BL; Mice, Knockout, ApoE; Muscle, Smooth, Vascular; Myocytes, Smooth Muscle; Pancreatic Elastase; RNA, Long Noncoding; Receptors, LDL; Swine; Swine, Miniature; Tumor Suppressor Protein p53; Up-Regulation
PubMed: 29669788
DOI: 10.1161/CIRCULATIONAHA.117.032184 -
BMC Surgery Mar 2021Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported...
BACKGROUND
Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far.
CASE PRESENTATION
This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up.
CONCLUSION
To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).
Topics: Abdomen; Aged; Cerebrospinal Fluid; Cysts; Drainage; Female; Hemorrhage; Humans; Hydrocephalus; Laparoscopy; Postoperative Complications; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt
PubMed: 33743657
DOI: 10.1186/s12893-021-01161-y -
Neurogastroenterology and Motility Sep 2022There is no translation for bloating in Spanish, and distension is very technical.
BACKGROUND
There is no translation for bloating in Spanish, and distension is very technical.
AIMS
To evaluate pictograms for assessing bloating/distension in patients with general gastroenterology (Study 1, n = 88) and in those with irritable bowel syndrome [IBS] (Study 2: n = 144), and to correlate them with verbal descriptors (VDs) and physician's diagnosis (PDx).
METHODS
Patients answered the Rome III Questionnaire with VDs and pictograms, and were consulted by two gastroenterology fellows (PDx). Correlations were conducted with Cohen's kappa, and ROC curves were used to contrast pictograms and VDs with PDx.
RESULTS
"Inflammation" was the most frequent VDs, while distension was commonly interpreted as a sensation ("inflammation") and/or increased abdominal girth. In patients not reporting bloating/distension with VDs, pictograms detected these symptoms in (Study 1 and Study 2) 82.2 and 89.6% of patients. In addition, pictograms showed a positive agreement with PDx, kappa: 0.63 (p < 0.0001) and 0.8 (p < 0.0001); and a negative agreement with VD, kappa: -0.45 (p = 0.05) and -0.1 (p = 0.2), respectively, in studies 1 and 2. Pictograms were more sensitive and specific than VDs (Study 1: ROC = 0.90 (95% CI: 0.80-0.96), p < 0.0001 versus 0.74 (0.62-0.88), p < 0.0001; Study 2: 0.99 (0.98-1.00), p = 0.004 versus 0.32 (0.10-0.54), p = 0.294).
CONCLUSIONS
Pictograms are more effective than Spanish VDs for bloating/distension in patients consulting for gastroenterology problems and those with IBS, supporting their usefulness in the clinic and research studies.
Topics: Dilatation, Pathologic; Flatulence; Humans; Irritable Bowel Syndrome; Sensation; Surveys and Questionnaires
PubMed: 35394646
DOI: 10.1111/nmo.14364 -
Neurogastroenterology and Motility Aug 2022Abdominal bloating and distension are prevalent gastrointestinal symptoms. Our aim was to design and validate a questionnaire to reliably measure the multiple symptom...
BACKGROUND
Abdominal bloating and distension are prevalent gastrointestinal symptoms. Our aim was to design and validate a questionnaire to reliably measure the multiple symptom components of bloating and distension in the outpatient setting.
METHODS
A 45-item questionnaire was developed after an extensive literature review. Face and content validity were established through expert review and a focus group. Validation was achieved by administering an identical questionnaire 1 week apart. Data were assessed using standard methods.
KEY RESULTS
Forty one patients returned both questionnaires (85% women; mean age = 44 years). Respondents reported a variety of diagnoses, including irritable bowel syndrome (63%), gastroesophageal reflux disease (54%), functional dyspepsia (27%), small intestinal bacterial overgrowth (22%), and gastroparesis (17%). Test-retest reliability revealed excellent agreement (k ≥ 0.81) and substantial agreement (0.61 ≤ k < 0.81) for 29% and 43% of categorical questions, respectively. Alternate-parallel form reliability was supported by association between responses for questions that evaluated missing school/work and questions that evaluated symptom impact on daily activities (p < 0.05). Patients who missed school/work due to bloating symptoms were more likely to report a severe impact on their ability to enjoy life (p < 0.05) and their overall well-being (p < 0.01). Contingency analyses revealed an association between overall 7-day symptom severity and impact on daily activities (p < 0.001), enjoying life (p < 0.001), and overall well-being (p < 0.001).
CONCLUSIONS AND INFERENCES
This novel questionnaire demonstrated good validity and reliability in patients with symptoms of bloating and distension. The questionnaire was easy to use and score, making it a potentially useful tool for both research studies and clinical purposes.
Topics: Adult; Dilatation, Pathologic; Dyspepsia; Female; Flatulence; Gastrointestinal Diseases; Humans; Irritable Bowel Syndrome; Male; Reproducibility of Results; Surveys and Questionnaires
PubMed: 35202489
DOI: 10.1111/nmo.14330 -
Prenatal Diagnosis Feb 2017To evaluate prenatal ultrasound parameters as prognostic factors for complex and vanishing gastroschisis.
OBJECTIVE
To evaluate prenatal ultrasound parameters as prognostic factors for complex and vanishing gastroschisis.
METHODS
Retrospective multicentre study of 200 gastroschisis over 13 years (2000-2013). Collection of prenatal ultrasound evaluation on maternal and fetal growth parameters, intra- and extra-abdominal bowel and stomach dilation, abdominal wall defect diameter and changes in bowel appearance. Correlation of these factors with the presence of mechanical intestinal complications at birth, named 'complex gastroschisis'.
RESULTS
Fifty-two patients (26%) had complex gastroschisis (CG), including ten vanishing gastroschisis. The presence of intra-abdominal bowel dilation at the second (T2) or third (T3) trimester ultrasound was predictive for CG, with odds ratios at 6.69 (95%CI 2.41-18.55) and 4.72 (95%CI 2.16-10.28), respectively, with a cut-off value at the last examination of >19 mm. A small abdominal wall defect diameter was also predictive for CG, with cut-off values of <9.2 mm at T2 and <12.5 mm at T3. Vanishing gastroschisis recorded earlier intra-abdominal bowel dilation diagnosis, associated with a small wall defect and no extra-abdominal dilation.
CONCLUSION
Intra-abdominal bowel dilation and a small abdominal wall defect diameter accurately predict CG and could be a first sign of vanishing gastroschisis when they occur early. © 2016 John Wiley & Sons, Ltd.
Topics: Abdomen; Adult; Dilatation, Pathologic; Female; Fetal Development; Gastroschisis; Humans; Infant, Newborn; Intestines; Pregnancy; Pregnancy Outcome; Prognosis; Remission, Spontaneous; Retrospective Studies; Ultrasonography, Prenatal; Young Adult
PubMed: 27981591
DOI: 10.1002/pd.4984 -
Cureus Nov 2022Abdominal tuberculosis, a form of extrapulmonary tuberculosis is common in developing countries like India. Manifestations of abdominal tuberculosis are widely variable....
Abdominal tuberculosis, a form of extrapulmonary tuberculosis is common in developing countries like India. Manifestations of abdominal tuberculosis are widely variable. Its incidence is high among human immunodeficiency virus (HIV) infected patients in the adult population. Here, we report a 26-year-old male, initially treated in a private clinic for abdominal distention, loss of appetite, and loss of weight for one month. Magnetic resonance imaging (MRI) of the abdomen showed a large loculated fluid collection. Computed tomography (CT) of the chest showed signs of pulmonary tuberculosis. The patient was started on anti-tuberculosis therapy (ATT) and discharged. Ten days later, the patient presented to our hospital with foul-smelling pus discharging from the umbilicus and necrosis of the surrounding tissue. Abdominal examination revealed a tense, distended, and tender abdomen. The patient was referred for emergency laparotomy. The intraoperative findings showed features that were a combination of plastic fibrous type and encysted loculated type of peritoneal tuberculosis. The above-mentioned case describes a very uncommon presentation of abdominal tuberculosis. A high degree of suspicion is required for diagnosing such conditions, especially in immunocompromised individuals. The case report also highlights the difficulties in the diagnosis of abdominal tuberculosis.
PubMed: 36505153
DOI: 10.7759/cureus.31184