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Ginekologia Polska 2022Morcellation is an integral part of laparoscopic procedures related to uterine fibroids, which consist of the mechanical fragmentation of the tumor and its extraction...
OBJECTIVES
Morcellation is an integral part of laparoscopic procedures related to uterine fibroids, which consist of the mechanical fragmentation of the tumor and its extraction outside the abdominal cavity. To avoid the risk of tissue dissemination, special extraction systems have been developed, which allow morcellation of the specimen under visual control and its removal without contact with the abdominal organs. The aim of the paper is to compare the two systems for laparoscopic morcellation.
MATERIAL AND METHODS
The study included 33 premenopausal women with symptomatic leiomyomas or adenomyosis, who were qualified for laparoscopic surgery with contained power morcellation. Patients were allocated alternately to a different tissue extraction system's group. According to the study protocol, selected operative parameters were prospectively recorded. Finally, an assessment of bag use was performed. The data was statistically analyzed.
RESULTS
There were significant differences between the two tested systems in terms of introducing and positioning the bag, its removal from the peritoneal cavity, as well as optic trocar insertion and establishing the pseudo-peritoneum.
CONCLUSIONS
Despite the minor design differences and some ergonomic aspects, both presented systems proved to be safe and feasible tools for laparoscopic contained morcellation. This technique both reduces the risk of tissue dissemination and preserves the advantages of minimal invasiveness.
Topics: Humans; Female; Uterine Neoplasms; Uterine Myomectomy; Morcellation; Leiomyoma; Laparoscopy; Hysterectomy; Peritoneum
PubMed: 35315008
DOI: 10.5603/GP.a2022.0001 -
Asian Journal of Surgery Dec 2022
Topics: Humans; Fibromatosis, Aggressive; Neoplasm Recurrence, Local; Abdominal Cavity
PubMed: 35750612
DOI: 10.1016/j.asjsur.2022.06.026 -
Acta Veterinaria Scandinavica Feb 2020Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations...
BACKGROUND
Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations have not been described previously in canine patients and neither has the use of immunohistochemistry to determine their origin, i.e. vascular versus lymphatic.
CASE PRESENTATION
An 8-year-old neutered female Cocker spaniel was referred for pollakiuria, dysuria and a painful abdomen. Computed tomography scanning of the abdomen showed a fluid filled structure adjacent to the urinary bladder. During surgical exploration, a thin walled cystic structure with sero-haemorrhagic fluid was found, extending from the retroperitoneal space into the abdomen. The mass was excised and submitted for histopathology, revealing a cystic mass lined by a fibrovascular capsule within the retroperitoneal/mesenteric adipose tissue. The inner surface of the cyst was lined by a single layer of bland, flattened spindle cells. Intramural blood vessels were well differentiated, with perivascular haemorrhage. On recurrence 11 months later, the mass was excised for the second time and a PleuralPort (Norfolk Animal products) was placed. Fifteen months after initial presentation, progression occurred with haemorrhagic fluid in the cystic space, pleural- and abdominal cavities and the owners opted for euthanasia. Histopathology and positive immunohistochemistry for lymphatic markers lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1) and prospero homeobox protein-1 (PROX-1) confirmed a lymphatic vascular origin of the cystic structure.
CONCLUSIONS
To our experience, a definitive diagnosis of retroperitoneal cystic malformation of lymphatic origin could be done only by combining the clinical presentation, advanced imaging, histopathology and LYVE-1 and PROX-1 immunohistochemistry. This is the first report of a vascular malformation in a dog where immunohistochemistry was used to make a final diagnosis. A lymphatic malformation, even if rare, should be added on the list of the differential diagnosis in a patient with a retroperitoneal cystic structure containing serohaemorrhagic fluid. Results of this case report can aid in diagnosis of future cases, however, further studies on therapy and management are needed to provide additional information about optimal treatment of these patients.
Topics: Animals; Dog Diseases; Dogs; Euthanasia, Animal; Female; Neoplasm Recurrence, Local; Retroperitoneal Neoplasms; Retroperitoneal Space; Tomography, X-Ray Computed
PubMed: 32007092
DOI: 10.1186/s13028-020-0506-9 -
Medicine Aug 2023Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal tumor that typically develops in lymph nodes; it is clinically uncommon and has only occasionally been...
RATIONALE
Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal tumor that typically develops in lymph nodes; it is clinically uncommon and has only occasionally been documented in cases of soft tissue, liver and spleen, and retroperitoneum; it is also extremely uncommon to develop in the stomach.
PATIENT CONCERNS
A 64-year-old woman who discovered a lump in her left upper abdomen 6 months prior and was taken to the hospital due to excruciating abdominal pain.
DIAGNOSIS
An abdominal computed tomography scan showed a soft tissue mass around the cardia. The immunohistochemical and postoperative histopathology results were compatible with FDCS.
INTERVENTIONS
The patient underwent "radical total gastrectomy and esophagojejunostomy" (Roux-Y anastomosis).
OUTCOMES
The patient recovered well 2 months after surgery.
LESSONS
We report a case of FDCS occurring in the stomach and abdominal cavity, which was unique in terms of clinical location, clinical presentation, and imaging signs. This case report aims to enhance clinicians' understanding and diagnosis of FDCS in the stomach and abdominal cavity and reduce the rate of clinical misdiagnosis.
Topics: Humans; Female; Middle Aged; Dendritic Cell Sarcoma, Follicular; Stomach; Abdomen; Abdominal Cavity; Gastrectomy
PubMed: 37543831
DOI: 10.1097/MD.0000000000034289 -
Scientific Reports May 2022Early recognition of elevated intraabdominal pressure (IAP) in critically ill patients is essential, since it can result in abdominal compartment syndrome, which is a...
Early recognition of elevated intraabdominal pressure (IAP) in critically ill patients is essential, since it can result in abdominal compartment syndrome, which is a life-threatening condition. The measurement of intravesical pressure is currently considered the gold standard for IAP assessment. Alternative methods have been proposed, where IAP assessment is based on measuring abdominal wall tension, which reflects the pressure in the abdominal cavity. The aim of this study was to evaluate the feasibility of using patch-like transcutaneous sensors to estimate changes in IAP, which could facilitate the monitoring of IAP in clinical practice. This study was performed with 30 patients during early postoperative care. All patients still had an indwelling urinary catheter postoperatively. Four wearable sensors were attached to the outer surface of the abdominal region to detect the changes in abdominal wall tension. Additionally, surface EMG was used to monitor the activity of the abdominal muscles. The thickness of the subcutaneous tissue was measured with ultrasound. Patients performed 4 cycles of the Valsalva manoeuvre, with a resting period in between (the minimal resting period was 30 s, with a prolongation as necessary to ensure that the fluid level in the measuring system had equilibrated). The IAP was estimated with intravesical pressure measurements during all resting periods and all Valsalva manoeuvres, while the sensors continuously measured changes in abdominal wall tension. The association between the subcutaneous thickness and tension changes on the surface and the intraabdominal pressure was statistically significant, but a large part of the variability was explained by individual patient factors. As a consequence, the predictions of IAP using transcutaneous sensors were not biased, but they were quite variable. The specificity of detecting intraabdominal pressure of 20 mmHg and above is 88%, with an NPV of 96%, while its sensitivity and PPV are currently far lower. There are inherent limitations of the chosen preliminary study design that directly caused the low sensitivity of our method as well as the poor agreement with the gold standard method; in spite of that, we have shown that these sensors have the potential to be used to monitor intraabdominal pressure. We are planning a study that would more closely resemble the intended clinical use and expect it to show more consistent results with a far smaller error.
Topics: Abdomen; Abdominal Cavity; Abdominal Muscles; Abdominal Wall; Humans; Intra-Abdominal Hypertension; Reproducibility of Results
PubMed: 35585106
DOI: 10.1038/s41598-022-12388-x -
Circulation Research Aug 2021
Topics: Humans; Kidney Diseases; Peritoneum; Renal Dialysis; Vascular Remodeling
PubMed: 34410821
DOI: 10.1161/CIRCRESAHA.121.319785 -
Asian Journal of Surgery Nov 2022
Topics: Abdominal Cavity; Echinococcosis; Humans
PubMed: 35643904
DOI: 10.1016/j.asjsur.2022.05.074 -
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 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2020The incidence of abdominal wall hematomas increased after the introduction of anticoagulant and antiplatelet drugs in clinical practice. These patients are usually old,...
BACKGROUND
The incidence of abdominal wall hematomas increased after the introduction of anticoagulant and antiplatelet drugs in clinical practice. These patients are usually old, and they have more than one comorbidity. Most spontaneous hematomas tend to limit itself and conservative treatment with close follow up is usually enough, but surgery is an option that should be decided critically. Unnecessary surgical interventions could worsen the situation. The present study aims to analyze the results of patients under anticoagulant/antiplatelet treatment and with spontaneous abdominal wall hematomas from surgeons' perspective.
METHODS
This is a retrospective study that the medical records of 43 patients who were under anticoagulant/antiplatelet therapy and consulted our general surgery clinic because of the spontaneous abdomen and abdominal wall hematoma between January-2016 and September-2018 were reviewed.
RESULTS
The findings showed that most of the cases were presented with abdominal pain. Thirty of these patients were female (69.7%). The mean age was 69.32 years. More than half of the patients (58.1%) were referred from the emergency department. All of the cases were under anticoagulant and antiplatelet treatment for several reasons. With presenting signs and symptoms and after evaluation of laboratory tests, computed tomography was performed to 30 patients (69.7%) as an initial test. USG and MRI were the other methods used. The most common diagnosis was rectus sheath hematoma (n=16; 37.2%) and followed by intestinal and colon wall, lumbar, psoas, pelvic and retroperitoneal hematoma in decreasing order. Among 43 patients, 39 patients (90.6%) followed with conservative treatment and two patients were treated with transcatheter arterial embolization. Two patients (4.6%) were died on day 1 and 11 after diagnosis. No surgery needed for all patients.
CONCLUSION
Early recognition, hospitalization of risky patients, close follow-up of hemodynamic parameters, patients' response to conservative treatment and minimal invasive methods are key points. Conservative care is the choice of treatment, but surgery must always keep in mind in hemodynamic unstable patients.
Topics: Abdominal Cavity; Aged; Anticoagulants; Female; Hematoma; Humans; Male; Platelet Aggregation Inhibitors; Retrospective Studies; Surgeons
PubMed: 31942735
DOI: 10.14744/tjtes.2019.32485 -
Journal of Medicine and Life Jan 2024Primary segmental omental torsion (PSOT) is a very rare cause of acute abdominal pain, and it may often imitate the clinical picture of acute appendicitis. In instances...
Primary segmental omental torsion (PSOT) is a very rare cause of acute abdominal pain, and it may often imitate the clinical picture of acute appendicitis. In instances of acute abdominal pain without anorexia, nausea, and vomiting, omental torsion should be included in the differential diagnosis. Any misdiagnosis may lead to major complications such as intraabdominal abscesses and adhesions. A 63-year-old overweight man with a body mass index (BMI) of 41 Kg/m presented to the emergency department on a remote island with acute abdominal pain. His medical history included type 2 diabetes mellitus managed with insulin, essential hypertension, osteoarthritis, and no previous abdominal operations. He reported a sharp pain originating in the epigastrium and the right hypochondrium that started five days prior. Physical examination revealed rebound tenderness and guarding across the abdomen with a positive McBurney sign. However, the patient did not report vomiting and was not nauseous. Vital signs were as follows: blood pressure 116/56 mmHg, heart rate 98 beats/min, respiratory rate 19 breaths/min, and a temperature of 38.2 C. Laboratory results showed a white blood cell count of 10.6, neutrophils of 8.11, C-reactive protein (CRP) 74 mg/l, haemoglobin11.6 g/dl, and hematocrit 36.9%. Due to the absence of a radiographer at the hospital during that period, no imaging investigations were conducted. Diagnostic laparoscopy demonstrated diffused hemoperitoneum and necrotic mass at the site of the hepatic flexure. Initially suspected to be an advanced colon cancer, the decision was made to proceed with open surgery. The necrotic segment of the omentum was found at the right superior point of attachment of the omentum to the hepatic flexure. Consequently, the necrotic segment of the omentum was resected. A thorough investigation of the abdominal cavity did not detect any other abnormalities or pathologies. The patient recovered uneventfully and was transferred to the surgical ward. Torsion of the omentum is a very rare cause of acute abdominal pain. This case highlights the necessity of considering PSOT in the differential diagnosis of acute abdominal pain, especially in cases where symptoms are suggestive of appendicitis but diagnostic findings are negative.
Topics: Humans; Appendicitis; Omentum; Male; Middle Aged; Diagnosis, Differential; Torsion Abnormality; Abdominal Pain; Acute Disease
PubMed: 38737669
DOI: 10.25122/jml-2023-0429