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Khirurgiia 2024To evaluate the efficacy of negative pressure therapy in patients with peritonitis.
OBJECTIVE
To evaluate the efficacy of negative pressure therapy in patients with peritonitis.
MATERIAL AND METHODS
The study included 127 patients with advanced secondary peritonitis between 2019 and 2022. All patients were divided into 2 groups. All ones underwent staged sanitation of the abdominal cavity. In the first group (=76), re-laparotomies were accompanied by skin suture only and passive abdominal drainage. The second group included patients (=51) with open abdominal cavity strategy and negative pressure therapy (vacuum-assisted laparostomy). We analyzed the number of surgeries, postoperative complications, duration of hospital-stay and mortality.
RESULTS
In the second group, there were significantly lower morbidity, mean number of surgeries and hospital-stay. In addition, incidence of fascial closure of abdominal cavity was higher and mortality rate was lower in the same group.
CONCLUSION
Vacuum-assisted laparostomy in patients with advanced peritonitis can reduce the number of secondary purulent complications and mortality, as well as increase the incidence of fascial closure of abdominal cavity. This approach reduces the number of surgical interventions and duration of in-hospital treatment.
Topics: Humans; Male; Female; Peritonitis; Middle Aged; Laparotomy; Postoperative Complications; Negative-Pressure Wound Therapy; Length of Stay; Aged; Abdominal Cavity; Adult; Treatment Outcome; Drainage
PubMed: 38785233
DOI: 10.17116/hirurgia20240517 -
Seminars in Cell & Developmental Biology Aug 2019The peritoneum is a large serous membrane with both epithelial and mesenchymal features, and is essential for maintaining an intra-abdominal homeostatic equilibrium. The... (Review)
Review
The peritoneum is a large serous membrane with both epithelial and mesenchymal features, and is essential for maintaining an intra-abdominal homeostatic equilibrium. The peritoneum plays a central role in the pathogenesis of a number of disorders. Pathological processes affecting the peritoneum such as inflammation and carcinomatosis can have serious clinical consequences, but the pathophysiology of these conditions is poorly understood. Understanding peritoneal embryology, anatomy and physiology is crucial to comprehend pathophysiological mechanisms and to devise a new focus for research. The vascular response to pathological processes appears to be of considerable importance, since the peritoneal vasculature plays a pivotal role in most associated diseases. Therefore, this review summarizes currently available literature with special emphasis on the development, anatomy and function of the peritoneal vasculature. Pathological processes are described to illustrate physiological and pathophysiological characteristics of the peritoneum.
Topics: Humans; Peritoneum
PubMed: 30253239
DOI: 10.1016/j.semcdb.2018.09.007 -
BioMed Research International 2021The National Science and Technology Development Agency (NSTDA) in Thailand researched and prototyped digital radiography systems under the brand name BodiiRay aiming for...
BACKGROUND
The National Science and Technology Development Agency (NSTDA) in Thailand researched and prototyped digital radiography systems under the brand name BodiiRay aiming for sustainable development and affordability of medical imaging technology. The image restoration and enhancement were implemented for the systems.
PURPOSE
The image quality of the systems was evaluated using images from phantoms and from healthy volunteers.
METHODS
The survey phantom images from BodiiRay and other two commercial systems using the exposure settings for the chest, the abdomen, and the extremity were evaluated by three experience observers in terms of the high-contrast image resolution, the low-contrast image detectability, and the grayscale differentiation. The volunteer images of the chests, the abdomens, and the extremities from BodiiRay were evaluated by three specialized radiologists based on visual grading on 5-point scaled questionnaires for the anatomy visibility, the image quality satisfaction, and the diagnosis confidence in using the images.
RESULTS
BodiiRay phantom results were similar to those from the commercial systems. The overall performance averaged across the exposure settings showed that BodiiRay was slightly better than Fujifilm FDR Go in the low-contrast detectability ( = 0.033) and in the grayscale differentiation ( = 0.004). It was also slightly better than Siemens YSIO Max in the high-contrast resolution ( = 0.018). The images of chest, pelvis, and hand phantoms illustrated comparable visual quality. For volunteer images, the percentage of the images scored ≥4 ranged from 61% to 99%, 23% to 92%, and 96% to 99% for the chest, abdomen, and extremity images, respectively. The average score ranged from 3.63 to 4.46, 3.18 to 4.21, and 4.41 to 4.51 for the chest, abdomen, and extremity images, respectively.
CONCLUSION
The phantom image results showed the comparability of these systems. The clinical evaluation showed BodiiRay images provided sufficient image qualities for digital radiography of these body parts.
Topics: Abdominal Cavity; Hand; Humans; Pelvis; Phantoms, Imaging; Radiographic Image Enhancement; Radiographic Image Interpretation, Computer-Assisted; Radiography, Thoracic; Thailand; Thorax
PubMed: 34869760
DOI: 10.1155/2021/3102673 -
Aesthetic Surgery Journal May 2023Abdominal high-definition liposuction has been practiced for many years. However, problems such as low-lying, "sad-looking" umbilici and lower abdominal "pooches" remain...
BACKGROUND
Abdominal high-definition liposuction has been practiced for many years. However, problems such as low-lying, "sad-looking" umbilici and lower abdominal "pooches" remain unresolved. Additionally, the waistline, as the pivotal point connecting the chest and hips, deserves more attention and improvement.
OBJECTIVES
The aim of this study was to use polydioxanone (PDO) threads after liposuction: (1) to improve the shape and position of the umbilicus permanently; (2) to tighten the lower abdomen permanently; and (3) to redefine "high-definition" liposuction.
METHODS
All patients underwent high-definition liposuction of the abdomen and waist. After liposuction, bidirectional, barbed PDO threads were placed in the upper central abdomen. The threads were pulled to cinch the upper abdominal skin and then tied. The resulting umbilicus elevation was measured for up to 12 months. Higher waistlines were also created to match higher-positioned umbilici.
RESULTS
Fifty-two female subjects were included. The range of umbilicus elevation at 12 months was 0.8 to 3.6 cm. Most umbilici were converted to vertical orientation, and lower abdomens became lengthened, flattened, and tightened. Moreover, the enhanced waistlines and body curves created better body proportions.
CONCLUSIONS
This technique results in permanent elevation and shape enhancement of both umbilicus and lower abdomen. In addition, because the umbilicus is raised, a higher waistline can be created without any discordance, making the lower limbs appear longer. Overall, the maneuvers contributed to the restoration/rejuvenation of the abdomen and created a better overall body shape and proportion.
Topics: Humans; Female; Umbilicus; Lipectomy; Polydioxanone; Abdomen; Abdominal Cavity; Abdominal Wall
PubMed: 35977112
DOI: 10.1093/asj/sjac232 -
Journal of Minimally Invasive Gynecology 2020To illustrate a technique of robotic vesicovaginal fistula repair in a patient with a previous history of pelvic radiation therapy and multiple abdominal surgeries.
STUDY OBJECTIVE
To illustrate a technique of robotic vesicovaginal fistula repair in a patient with a previous history of pelvic radiation therapy and multiple abdominal surgeries.
DESIGN
Stepwise demonstration of the technique with narrated video footage.
SETTING
This 59-year-old woman presented with vesicovaginal fistula. She had a history of rectosigmoidectomy followed by pelvic radiotherapy for stage III colon cancer 23 years earlier and subsequent robotic hysterectomy, bilateral salpingo-oophorectomy, and omentectomy with bilateral pelvic and para-aortic lymphadenectomy for stage II mixed cell endometrial carcinoma, which required surgical reintervention because of a pelvic hematoma and complete vaginal cuff dehiscence.
INTERVENTIONS
We performed a robotic approach to vesicovaginal fistula with several key steps to repair the fistula and maintain the integrity of the abdominopelvic structures: (1) careful bowel adhesiolysis involving multiple segments of the intestine to the abdominal and pelvic peritoneum; (2) cystotomy with vaginal probe guidance; (3) fistulectomy by monopolar scissors after ureteral orifice visualization; (4) dissection of the retropubic space of Retzius, relieving bladder tension; (5) transverse sutures to coapt the raw surfaces on the vaginal side and the bladder in 2 layers with minimal tension; and (6) transurethral instillation of methylene blue into the bladder.
CONCLUSIONS
Traditionally, patients with vesicovaginal fistula after pelvic radiation therapy and multiple abdominal surgeries are managed by laparotomy. This video demonstrates a feasible robotic approach to vesicovaginal fistula repair, with superior imaging affording 3-dimensional visualization and stabilization of instruments, allowing wrist-like movements.
Topics: Abdominal Cavity; Cystostomy; Female; Humans; Laparoscopy; Middle Aged; Pelvis; Peritoneum; Radiotherapy; Robotic Surgical Procedures; Ureter; Vesicovaginal Fistula
PubMed: 31352069
DOI: 10.1016/j.jmig.2019.07.015 -
Biomolecules Dec 2021Formation of peritoneal adhesions (PA) is one of the major complications following intra-abdominal surgery. It is primarily caused by activation of the mesothelial layer... (Review)
Review
Formation of peritoneal adhesions (PA) is one of the major complications following intra-abdominal surgery. It is primarily caused by activation of the mesothelial layer and underlying tissues in the peritoneal membrane resulting in the transition of mesothelial cells (MCs) and fibroblasts to a pro-fibrotic phenotype. Pro-fibrotic transition of MCs-mesothelial-to-mesenchymal transition (MMT), and fibroblasts activation to myofibroblasts are interconnected to changes in cellular metabolism and culminate in the deposition of extracellular matrix (ECM) in the form of fibrotic tissue between injured sides in the abdominal cavity. However, ECM is not only a mechanical scaffold of the newly synthetized tissue but reciprocally affects fibrosis development. Hyaluronan (HA), an important component of ECM, is a non-sulfated glycosaminoglycan consisting of N-acetyl-D-glucosamine (GlcNAc) and D-glucuronic acid (GlcUA) that can affect the majority of processes involved in PA formation. This review considers the role of endogenously produced HA in the context of different fibrosis-related pathologies and its overlap in the development of PA.
Topics: Epithelium; Fibroblasts; Hyaluronic Acid; Myofibroblasts; Peritoneum
PubMed: 35053193
DOI: 10.3390/biom12010045 -
Seminars in Nuclear Medicine Sep 2020The peritoneum is the largest and most complex serous membrane in the human body. The peritoneal membrane is composed of a layer of mesothelium supported by a thin layer... (Review)
Review
The peritoneum is the largest and most complex serous membrane in the human body. The peritoneal membrane is composed of a layer of mesothelium supported by a thin layer of connective tissue. The peritoneum is one continuous sheet, forming two layers and a potential space between them - the peritoneal cavity- which is subdivided into multiple communicating spaces containing small amount of serous fluid that facilitates frictionless movement of mobile intraabdominal viscera. Peritoneum also contributes to fluid exchange mechanism and plays a role in immune response. The peritoneum is subject to many neoplastic and non-neoplastic processes including infections, trauma, developmental and inflammatory processes. Different Nuclear Medicine imaging techniques can be used to diagnose peritoneal diseases, most of these techniques can be customized depending on the clinical scenario and expected findings. Peritoneal scintigraphy can detect abnormal peritoneal communication or compartmentalization. Several nuclear medicine techniques can help characterize intraperitoneal fluid collections and differentiate sterile from infected fluid. PET imaging plays an important role in imaging of different neoplastic and non-neoplastic peritoneal pathologies. Nuclear radiologists need to be familiar with peritoneal anatomy and pathology to interpret peritoneal findings in dedicated peritoneal nuclear medicine imaging studies, as part of more general nuclear medicine scans, or on CT or MRI component of hybrid imaging studies. The purpose of this article is to review the normal peritoneal anatomy, various pathologic processes involving the peritoneum, and different nuclear medicine and hybrid imaging techniques that can help detect, characterize, and follow up peritoneal pathology.
Topics: Humans; Nuclear Medicine; Peritoneum
PubMed: 32768005
DOI: 10.1053/j.semnuclmed.2020.04.005 -
Clinical Anatomy (New York, N.Y.) May 2024Preservation of Scarpa's fascia has improved clinical outcomes in abdominoplasty procedures and in other body contour surgeries. However, the physical properties of...
Preservation of Scarpa's fascia has improved clinical outcomes in abdominoplasty procedures and in other body contour surgeries. However, the physical properties of Scarpa's fascia have not yet been described, and grafts are still underexplored. Fresh surgical specimens from five female patients subjected to classical abdominoplasty were dissected and analyzed. A grid was drawn on the fascia surface, dividing it into equal upper and lower halves; four Scarpa's fascia samples (30 × 10 mm) were collected from each half, 40 mm apart. The thickness was measured with a caliper. A strain/stress universal testing machine was used for mechanical tests. Twenty-five samples were obtained (nine from the upper half, 16 from the lower). The average thickness was 0.56 ± 0.11 mm. The average values for stretch, stress, strain, and Young's Modulus were, respectively, 1.436, 4.198 MPa, 43.6%, and 23.14 MPa. The upper half showed significantly greater thickness and strain values (p = 0.020 and p = 0.048; Student's t-test). The physical and biomechanical properties of Scarpa's fascia can make it a donor area for fascial grafts as an alternative to fascia lata, as it is always available and has minimal donor-site morbidity. Further studies are needed to validate this statement. It seems advantageous to use the lower half of the abdomen instead of the upper part as a donor site.
Topics: Humans; Female; Abdominal Wall; Abdominoplasty; Adipose Tissue; Fascia Lata; Abdominal Cavity
PubMed: 37377018
DOI: 10.1002/ca.24087 -
Korean Journal of Radiology May 2023Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated... (Review)
Review
Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated when they occur. Delayed diagnosis and treatment are associated with increased morbidity and mortality; therefore, timely and accurate management is essential. Additionally, employing strategies to differentiate between major injuries requiring surgical intervention and minor injuries considered manageable via non-operative management is important. Bowel and mesenteric injuries are among the most frequently overlooked injuries on trauma abdominal computed tomography (CT), with up to 40% of confirmed surgical bowel and mesenteric injuries not reported prior to operative treatment. This high percentage of falsely negative preoperative diagnoses may be due to several factors, including the relative rarity of these injuries, subtle and non-specific appearances on CT, and limited awareness of the injuries among radiologists. To improve the awareness and diagnosis of bowel and mesenteric injuries, this article provides an overview of the injuries most often encountered, imaging evaluation, CT appearances, and diagnostic pearls and pitfalls. Enhanced diagnostic imaging awareness will improve the preoperative diagnostic yield, which will save time, money, and lives.
Topics: Humans; Wounds, Nonpenetrating; Abdominal Injuries; Intestines; Mesentery; Tomography, X-Ray Computed; Retrospective Studies
PubMed: 37133211
DOI: 10.3348/kjr.2022.0998 -
Journal of Leukocyte Biology Apr 2021The peritoneal cavity is a fluid filled space that holds most of the abdominal organs, including the omentum, a visceral adipose tissue that contains milky spots or... (Review)
Review
The peritoneal cavity is a fluid filled space that holds most of the abdominal organs, including the omentum, a visceral adipose tissue that contains milky spots or clusters of leukocytes that are organized similar to those in conventional lymphoid tissues. A unique assortment of leukocytes patrol the peritoneal cavity and migrate in and out of the milky spots, where they encounter Ags or pathogens from the peritoneal fluid and respond accordingly. The principal role of leukocytes in the peritoneal cavity is to preserve tissue homeostasis and secure tissue repair. However, when peritoneal homeostasis is disturbed by inflammation, infection, obesity, or tumor metastasis, specialized fibroblastic stromal cells and mesothelial cells in the omentum regulate the recruitment of peritoneal leukocytes and steer their activation in unique ways. In this review, the types of cells that reside in the peritoneal cavity, the role of the omentum in their maintenance and activation, and how these processes function in response to pathogens and malignancy will be discussed.
Topics: Adaptive Immunity; Animals; Humans; Immunity; Immunity, Innate; Omentum; Peritoneal Cavity
PubMed: 32881077
DOI: 10.1002/JLB.5MIR0720-271RR