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Intra-abdominal pressure

Mark D Darocki, Anthony J Medak
A spontaneous diaphragmatic hernia (SDH) occurs when intra-abdominal contents extend into the thoracic cavity through a defect in the diaphragm after a sudden increase in intra-abdominal pressure. SDH is one of the rarest surgical emergencies with less than 30 reported cases in the literature.1,2 In our case a 94-year-old female presented to the emergency department in respiratory distress with unilateral breath sounds and was diagnosed with a SDH. The only treatment option for a SDH is surgical.3,11 However, nasogastric tube decompression of the gastrointestinal tract and supplemental oxygen can be used to alleviate symptoms until definitive operative management is performed...
August 2018: Clinical practice and cases in emergency medicine
Mostafa S Abbas, Khaled S Mohamed, Osama A Ibraheim, Ahmed M Taha, Tameem M Ibraheem, Bashir A Fadel, Abdelraheem Elawamy, Ahmed M Abbas
BACKGROUND: Blood loss and perioperative blood transfusion requirements affect the long-term survival after liver resection for malignant tumours. Terlipressin is a synthetic vasopressin analogue with relative specificity for the splanchnic circulation where it causes vasoconstriction with subsequent reduction of blood loss during abdominal surgeries. We tried to examine the impact of terlipressin on blood loss and blood transfusion needs during liver resection. METHODS: In this randomised, double-blind placebo-controlled trial 84 patients scheduled for major liver resections were randomly assigned to receive either terlipressin at the onset of surgery as an initial bolus dose of (1 mg over 30 minutes) followed by a continuous infusion of 2 μg/kg/h throughout the procedure (Terlipressin group) or the same volume and rate of 0...
August 5, 2018: Acta Anaesthesiologica Scandinavica
Mariana F Lima, Luiz Antonio Mondadori, Aline Y Chibana, Daniel B Gilio, Eduardo Henrique Giroud Joaquim, Frederic Michard
Hemodynamic and depth of anesthesia (DOA) monitoring are used in many high-risk surgical patients without well-defined indications and objectives. We implemented monitoring guidelines to rationalize hemodynamic and anesthesia management during major cancer surgery. In early 2014, we developed guidelines with specific targets (Mean arterial pressure > 65 mmHg, stroke volume variation < 12%, cardiac index > 2.5 l min-1  m-2 , central venous oxygen saturation > 70%, 40 < bispectral index < 60) for open abdominal cancer surgeries > 2 h...
August 3, 2018: Journal of Clinical Monitoring and Computing
Lucia Comuzzi, Mariana B de Abreu, Gabriel C Motta-Ribeiro, Renata T Okuro, Thiago Barboza, Niedja Carvalho, Umberto Lucangelo, Alysson R Carvalho, Walter A Zin
Background: Laparoscopic surgery with pneumoperitoneum increases respiratory system elastance due to the augmented intra-abdominal pressure. We aim to evaluate to which extent positive end-expiratory pressure (PEEP) is able to counteract abdominal hypertension preventing progressive lung collapse and how rib cage elastance influences PEEP effect. Methods: Forty-four Wistar rats were mechanically ventilated and randomly assigned into three groups: control (CTRL), pneumoperitoneum (PPT) and pneumoperitoneum with restricted rib cage (PPT-RC)...
2018: Frontiers in Physiology
Lana Van Damme, Jan J De Waele
BACKGROUND: Decompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney function and outcome...
July 25, 2018: Critical Care: the Official Journal of the Critical Care Forum
Luiz Carlos Von Bahten, Paulo Afonso Lopes Lange, Renan Fernando Ferreira Alves, Herick Muniz Nequer Soares, Thiago Magalhães de Souza, Aline Cadena Von Bahten
OBJECTIVE: to assess the physicians' knowledge regarding intra-abdominal hypertension and abdominal compartment syndrome and to compare it with the established literature. METHODS: we conducted a descriptive, observational, cross-sectional, quantitative study. We interviewed 38 physicians through a self-administered questionnaire composed of objective questions. We carried out the study in a tertiary reference university hospital, located in Curitiba, Paraná. RESULTS: the mean age of the participants was 28 years, 60...
July 19, 2018: Revista do Colégio Brasileiro de Cirurgiões
Fernando A M Herbella, Francisco Schlottmann, Marco G Patti
The pathophysiology of gastroesophageal reflux disease is complex and linked to an intricate valve mechanism at the level of the esophagogastric junction that must counteract a trans-diaphragmatic pressure gradient, which is constantly forcing gastric contents upwards. Surgical antireflux therapy is usually aimed towards reinforcement of this valve mechanism. The valve mechanism is made up by the intra-abdominal length of the esophagus; the diaphragmatic sphincter, the angle of His, and the lower esophageal sphincter: all these elements must be restored with an antireflux procedure...
July 23, 2018: Updates in Surgery
Hussam Al-Diery, Anthony Phillips, Nicholas Evennett, Sanjay Pandanaboyana, Michael Gilham, John A Windsor
Nonocclusive mesenteric ischemia (NOMI) is a condition that can encompass ischemia, inflammation, and infarction of the intestinal wall. In contrast to most patients with acute mesenteric ischemia, NOMI is distinguished by patent arteries and veins. The clinical presentation of NOMI is often insidious and nonspecific, resulting in a delayed diagnosis. Patients most at risk are those with severe acute and critical disease, including major surgery and trauma. Nonocclusive mesenteric ischemia is part of a spectrum, from mild, asymptomatic, and an unexpected finding on CT scanning, through to those exhibiting abdominal distension and peritonitis...
January 1, 2018: Journal of Intensive Care Medicine
McKayla J Riggs, Naikeya H Coston, Nicholas R Teneyuque, Erin A Keyser
Subconjunctival hemorrhages are common in trauma and with increased intra-abdominal pressure. Despite the sustained pressure endured while pushing, they are rarely observed postpartum and can be an indicator of underlying ophthalmic disease. We present a case of a postpartum patient who developed bilateral subconjunctival hemorrhages with a retro-orbital hematoma. The patient is a 29-year-old gravida-1-para-0 at 41 weeks gestation who underwent an uncomplicated induction and delivery. She developed diplopia and orbital pain postpartum...
July 12, 2018: Military Medicine
Toko Shinkai, Kentaro Ono, Kouji Masumoto, Yasuhisa Urita, Chikashi Gotoh
BACKGROUND: Nonoperative management (NOM) has been established as the standard treatment for isolated blunt organ injury in hemodynamically stable pediatric patients. Although delayed splenic rupture or bleeding is a rare complication in NOM, it is an issue that many pediatric surgeons are greatly concerned about. We herein report a rare pediatric case concerning the mechanisms involved in delayed splenic rupture after NOM. CASE PRESENTATION: A 9-year-old boy with severe abdominal pain was transferred to our hospital...
July 11, 2018: Surgical Case Reports
Javier Hernán Dorado, Matías Accoce, Gustavo Plotnikow
The respiratory system mechanics depend on the characteristics of the lung and chest wall and their interaction. In patients with acute respiratory distress syndrome under mechanical ventilation, the monitoring of airway plateau pressure is fundamental given its prognostic value and its capacity to assess pulmonary stress. However, its validity can be affected by changes in mechanical characteristics of the chest wall, and it provides no data to correctly titrate positive end-expiratory pressure by restoring lung volume...
April 2018: Revista Brasileira de Terapia Intensiva
Supradip Ghosh, Rajvinder Singh, Sonali Ghosh, Aayush Chawla
Abdominal compartment syndrome (ACS) is an uncommon complication of dengue haemorrhagic fever (DHF), described so far only in association with fluid refractory shock and high-volume resuscitation. We describe an unusual case of ACS in a patient of DHF where raised intra-abdominal pressure was due to spontaneous rectus sheath haematoma causing external compression. Early recognition of the haematoma, constant vigilance and timely decision for surgical intervention could salvage the patient with complete recovery of organ function...
July 10, 2018: BMJ Case Reports
Andrew W Kirkpatrick, Federico Coccolini, Luca Ansaloni, Derek J Roberts, Matti Tolonen, Jessica L McKee, Ari Leppaniemi, Peter Faris, Christopher J Doig, Fausto Catena, Timothy Fabian, Craig N Jenne, Osvaldo Chiara, Paul Kubes, Braden Manns, Yoram Kluger, Gustavo P Fraga, Bruno M Pereira, Jose J Diaz, Michael Sugrue, Ernest E Moore, Jianan Ren, Chad G Ball, Raul Coimbra, Zsolt J Balogh, Fikri M Abu-Zidan, Elijah Dixon, Walter Biffl, Anthony MacLean, Ian Ball, John Drover, Paul B McBeth, Juan G Posadas-Calleja, Neil G Parry, Salomone Di Saverio, Carlos A Ordonez, Jimmy Xiao, Massimo Sartelli
Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. Principles of treatment include early antibiotic administration and operative source control. A further therapeutic option may be open abdomen (OA) management with active negative peritoneal pressure therapy (ANPPT) to remove inflammatory ascites and ameliorate the systemic damage from SCIAS...
2018: World Journal of Emergency Surgery: WJES
Dushyant Iyer, Leanne Hunt, Steven A Frost, Anders Aneman
BACKGROUND: Elevated intra-abdominal pressure (IAP) is a common occurrence in mechanically ventilated patients in the intensive care unit (ICU). This study was undertaken to determine the relationship between IAP, pulmonary compliance and the duration of mechanical ventilation. METHODS: A prospective study of 220 consecutively enrolled mechanically ventilated patients admitted to a mixed surgical-medical ICU in a tertiary referral hospital. The IAP was measured at least twice daily, benchmarked against consensus guidelines...
July 5, 2018: Acta Anaesthesiologica Scandinavica
Daan J L van Twist, Peter W de Leeuw, Abraham A Kroon
Fibromuscular dysplasia is a heterogeneous group of systemic, noninflammatory, and nonatherosclerotic diseases of the vascular wall. It is the second-most common abnormality of the renal artery. Although hypertension is the most common presenting symptom, other symptoms, such as pulsatile tinnitus, stroke, chest pain, or abdominal discomfort, may result from other affected vascular beds. Revascularization of the renal artery appears to be effective at lowering blood pressure in many patients with renal artery fibromuscular dysplasia...
July 3, 2018: Hypertension Research: Official Journal of the Japanese Society of Hypertension
Robert Zymliński, Jan Biegus, Mateusz Sokolski, Ewa A Jankowska, Waldemar Banasiak, Piotr Ponikowski
No abstract text is available yet for this article.
June 29, 2018: Polish Archives of Internal Medicine
Ary Serpa Neto, Lieuwe D Bos, Pedro P Z A Campos, Sabrine N T Hemmes, Thomas Bluth, Carolyn S Calfee, Marion Ferner, Andreas Güldner, Markus W Hollmann, Inmaculada India, Thomas Kiss, Rita Laufenberg-Feldmann, Juraj Sprung, Demet Sulemanji, Carmen Unzueta, Marcos F Vidal Melo, Toby N Weingarten, Anita M Tuip-de Boer, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J Schultz
BACKGROUND: Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE: To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING: Operating rooms of six hospitals in Europe and USA...
June 27, 2018: European Journal of Anaesthesiology
Myeongjin Choi, Pratistha Tamrakar, Patricia F Schuck, Julie L Proctor, Ashley Moore, Katrina Asbury, Gary Fiskum, Turhan Coksaygan, Alan S Cross
BACKGROUND: Injured warfighters air evacuated to tertiary medical care facilities are subjected to many stresses that may promote the development of sepsis. In this study, we tested the hypothesis that exposure to "in-flight" hypobaria and/or hyperoxia within 24 hours after onset of intra-abdominal infection in rats accelerates the development and/or severity of sepsis and neurologic injury in survivors. METHODS: Sprague-Dawley rats underwent cecal ligation/puncture (CLP) or sham procedures...
July 2018: Journal of Trauma and Acute Care Surgery
Shaobo Yang, Kuiran Dong, Shan Zheng
RATIONALE: Takayasu arteritis (TA) is a chronic granulomatous inflammation affecting the aorta and its main branches. The clinical symptoms are mainly due to arterial claudication and end-organ ischaemia. Abdominal pain is an uncommon manifestation of TA. PATIENT CONCERNS: We present a rare case of TA in a 13-year-old boy who first presented with abdominal pain. An emergency aortic stent implantation and aneurysm embolization were performed, and the intra-operative diagnosis was aortic pseudoaneurysm...
June 2018: Medicine (Baltimore)
Kota Tayashiki, Hiroaki Kanehisa, Naokazu Miyamoto
Tayashiki, K, Kanehisa, H, and Miyamoto, N. Does intra-abdominal pressure have a causal effect on muscle strength of hip and knee joints? J Strength Cond Res XX(X): 000-000, 2018-It remains unclear whether intra-abdominal pressure (IAP) has a causal effect on lower-limb muscle strength. This study aimed to clarify whether or not changes in IAP, induced by changing breathing state, influence muscle strength of hip and knee extensor and flexor. Eighteen healthy males (age: 22.0 ± 2.2 years, height: 1.71 ± 0...
June 25, 2018: Journal of Strength and Conditioning Research
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