腹腔间隔室综合征动物模型的构建特点

背景:腹腔间隔室综合征导致多器官功能损害的具体机制尚不十分清楚,为深入研究其发病机制及病理生理过程,需要合适的动物模型。目的:就腹腔间隔室综合征动物模型的制备过程中可能遇到的相关问题进行讨论,包括制备模型的标准、方法、动物的选择及监测腹压的方式。方法:由第一作者检索PubMed数据及CNKI数据库1990/2011有关腹腔间隔室综合征及腹腔高压及相关动物模型方面的文献。结果与结论:一个成功的腹腔间隔室综合征动物模型最好能保持腹腔压力的稳定,并能持续一定的时间,同时尽可能少的影响实验结果。所以无论选择腹腔灌注气体还是灌注液体模型的测量腹腔内压并维持压力的稳定是关键。腹腔灌注液体模型无法动态监测腹压,且压力波动较大,与之相比腹腔灌注气体模型测压较为方便,若使用电子供气系统动态监测则更为理想。生理模型是前瞻性的实验,但现有的生理模型有待改进。     

腹腔间隔室综合征动物模型的构建特点

背景：腹腔间隔室综合征导致多器官功能损害的具体机制尚不十分清楚,为深入研究其发病机制及病理生理过程,需要合适的动物模型。目的：就腹腔间隔室综合征动物模型的制备过程中可能遇到的相关问题进行讨论,包括制备模型的标准、方法、动物的选择及监测腹压的方式。方法：由第一作者检索PubMed数据及CNKI数据库1990/2011有关腹腔间隔室综合征及腹腔高压及相关动物模型方面的文献。结果与结论：一个成功的腹腔间隔室综合征动物模型最好能保持腹腔压力的稳定,并能持续一定的时间,同时尽可能少的影响实验结果。所以无论选择腹腔灌注气体还是灌注液体模型的测量腹腔内压并维持压力的稳定是关键。腹腔灌注液体模型无法动态监测腹压,且压力波动较大,与之相比腹腔灌注气体模型测压较为方便,若使用电子供气系统动态监测则更为理想。生理模型是前瞻性的实验,但现有的生理模型有待改进。     

Appearance of gas-containing gallstones on sonography and computed tomography

The diagnostic features of gas-containing gallstones on sonography and CT in 6 patients and the in vitro findings in 30 gas-containing gallstones are analyzed. On plain abdominal radiography, the stellate appearance of gas collections, though infrequent, is quite characteristic. On real-time sonography, gas-containing calculi can be observed to float within bile. Furthermore, larger gas collections within gallstones can be identified since they produce high-level echoes in the acoustic shadow of the stone, probably due to sound reverberation. These phenomena, although interesting, do not interfere with the high accuracy of sonography in the detection of gallstones. CT detects gallstones when their density differs from that of bile. Due to high-density resolution, even minute gas collections are displayed and can reveal gallstones with an isodense matrix. However, under routine abdominal scanning conditions (8 mm collimation), the gas collections often appear round or ovoid, because spatial resolution is inferior to that on plain radiography. This fact should be considered in the differential diagnosis of gas collections in the gallbladder region found on CT.     

Crisis Types of Abdominal Pain

When constant and widespread abdominal pain is not influenced by eating, defecating or passing gas, it is probably of central origin. An observer should recognize that there is little likelihood of an abdominal lesion in frequent episodes of severe abdominal pain which terminate spontaneously and in which the abdominal wall is soft. A hysterical element is sometimes observed in this syndrome. A carefully elicited history is helpful in diagnosis.     

肝门静脉积气的超声表现及临床意义

目的探讨肝门静脉积气的超声表现及临床意义.方法回顾性分析我科4年来超声发现肝门静脉积气的5例患者,分析肝门静脉积气的超声特点及其对临床治疗和预后的影响.结果 5例门静脉积气的患者均由超声首先发现,其共同的超声表现为门静脉内随血液流动的气泡样或点状强回声以及肝实质内边界不清的条片状强回声区.5例患者的原发病分别为腹腔脓肿、坏死性小肠结肠炎、肝移植手术和闭合性腹部外伤,根据原发病的不同,其中3例门静脉积气患者进行了手术治疗并痊愈,另2例经保守治疗后出院.结论多种病因可导致肝门静脉积气,超声诊断具有早期、敏感、特异的特点.肝门静脉积气的临床处理根据原发病的不同而不同.     

Mycotic abdominal aneurysm: report of a case with emphasis on the presence of gas echoes

Mycotic abdominal aneurysm is a relatively rare disease and its sonographic (US) findings have rarely been reported. We present a case of mycotic aneurysm of the common iliac artery in which the initial US showed a slightly wall-thickened abdominal aorta with gas echoes in the wall, a second US 6 days later showed a rapid increase in aortic size, and an emergent surgical intervention showed a mycotic aneurysm. This interesting observation suggested that the presence of gas echoes is a useful US finding indicating the beginning of a mycotic aneurysm and, when encountering this US finding, that emergent treatment should be considered to prevent delay in patient management. Received: 25 September 2000/Accepted: 18 October 2000     

新式剖宫产术480例临床分析

目的：探讨新式剖宫产的优缺点。方法：分析480例新式剖宫产术中，术后情况，术后放置节育环的随访情况。以及再次手术病例的观察，并与同期196例子宫下段部宫产比较，观察手术时间，术中出血量，术后肛门排气时间，放环随访时子宫,位置宫腔深度；及再次手术时腹腔粘连情况，结果：新式剖宫产手术时间短，胎儿娩出快，术后恢复快，但术后腹腔粘连较多，两组比较有显性差异。结论：新式剖宫产近期效果好，但远期腹腔粘连较多，值得探讨，以便进一步改进。     

Pneumatosis cystoides intestinalis and intramural intestinal gas

Gas in the bowel wall is an unusual but important finding on an abdominal radiograph. The so-called “benign form,” pneumatosis cystoides intestinalis, may be asymptomatic or may cause a variety of symptoms and can result in a bowel obstruction or a sterile pneumoperitoneum. On the other hand, intramural intestinal gas may represent severe underlying disease such as necrotizing enterocolitis or mesenteric vascular occlusion. This finding should be sought when examining abdominal radiographs. A thorough appreciation of the clinical significance of this unusual entity is necessary to make timely therapeutic decisions.     

Comparison of computed tomography and ultrasound in the evaluation of abdominal neuroblastoma

A retrospective review of 15 cases of abdominal neuroblastoma was undertaken to determine the efficacy of ultrasound (US) in the evaluation of this disorder. Thirteen of the 15 cases were studied with both US and computed tomography (CT). It was found that US was accurate in all but two cases, where shadowing from bowel gas and dense tumor calcifications prevented accurate delineation of residual tumors. The CT scans were degraded by artifacts from surgical clips in three cases and by patient motion in one. A nonopacified loop of bowel was mistaken for tumor by CT in one case. We conclude that although both CT and US should be done initially, US alone is adequate in most cases for follow-up of abdominal neuroblastoma. When excessive bowel gas is encountered, or dense tumor calcifications are known to be present, CT is the modality of choice.     

Sonography of pneumatosis cystoides intestinalis

Pneumatosis cystoides intestinalis (PCI) is a relatively rare benign condition, and its sonographic findings have rarely been reported. We report on four cases of PCI in which sonography showed multiple immobile linear or spotty high echoes in the thickened colonic wall. These sonographic findings were more clearly visualized by using high-frequency probes and helped in establishing the diagnosis. In addition, color Doppler sonography confirmed the absence of portal gas and helped rule out fulminant PCI. When encountering patients with abundant abdominal gas, the possibility of PCI should be considered and the colonic wall and the portal vein should be meticulously observed by high-frequency probe and color Doppler sonography to prevent a delay in the diagnosis and to improve patient management.     

超声药物透入配合早期康复锻炼对腹部手术后病人肠功能恢复的影响

[目的]观察腹部手术后超声药物透入配合早期康复锻炼对肠功能恢复的影响。[方法]将120例腹部手术病人随机分为两组,治疗组采用超声药物透入配合早期康复锻炼,对照组给予早期康复锻炼,观察两组肛门排气时间及腹胀情况。[结果]治疗组术后肛门排气时间、腹胀发生率与对照组比较差异有统计学意义（P〈0.01）。[结论]腹部手术后病人采用超声药物透入配合早期康复锻炼,肛门排气时间提前,腹胀发生率降低。     

腹部手术后胃瘫的诊断与治疗

目的 总结腹部手术后胃瘫的临床诊治经验。方法 对腹部手术后并发胃瘫的63例患者临床资料进行回顾性分析。结果 术后胃瘫的临床表现主要为腹胀、呕吐，无明显腹痛，大多数患者排气正常。消化道X线钡餐造影示胃蠕动差，胃镜检查吻合口通畅。63例经胃肠减压、营养支持、维持水电解质代谢平衡以及应用促进胃肠蠕动的药物及中西医结合等非手术治疗均缓解。结论 手术后胃瘫的诊断主要依据临床表现；胃镜检查有其重要价值；排除机械性梗阻后，采取非手术治疗，可取得满意疗效。     

Imaging of complications associated with port access of abdominal laparoscopic surgery

Advanced techniques and equipment in laparoscopic surgery offer advantages over open surgery, expanding the application of this minimally invasive procedure to a wide range of abdominal operations that used to be performed as an open procedure. Laparoscopic surgery is performed in the closed abdominal cavity in which the space is limited. To create a working space in the abdominal cavity, an artificial pneumoperitoneum is established and multiple ports are placed for the introduction of various laparoscopic instruments. Unlike open surgery in which the incision is made just above the target organ, laparoscopic access is made away from the area of dissection, with the instruments triangulated around the target organ within the abdomen. This fundamental difference in approach between the open and laparoscopic procedures may lead to peculiar postoperative complications after laparoscopic surgery, which may be present away from the target organ or in the abdominal wall, and be easily missed on postoperative imaging studies. These complications include port-related direct organ injuries, such as abdominal organ or vascular injury; abdominal wall complications related to laparoscopic port insertion such as vascular injury, infection, and hernia; abdominal wall complications related to specimen removal, such as port site tumor seeding and endometriosis; and complications related to gas insufflation. The radiologist plays an important role in the diagnosis of complications after laparoscopic surgery, and therefore should be familiar with the features of such complications on imaging scans in the era of laparoscopic surgeries.     

Portal Venous Gas on Point-of-Care Ultrasound in a Case of Cecal Ischemia

BackgroundPortal venous gas has mainly been studied in pediatrics and seen in cases of necrotizing enterocolitis. It is a rare finding in adults and is typically associated with underlying intestinal ischemia or other malignant intra-abdominal pathology. Portal venous gas is seen more readily on ultrasound compared to radiographs in both pediatric and adult patients. Findings include lucencies extending to the periphery of the liver, echogenic bubbles flowing centrifugally throughout the portal venous system, and bidirectional spikes interrupting the monophasic portal venous waveform on spectral analysis.Case ReportWe present a case of a 36-year-old female who presented with abdominal pain. She had findings consistent with portal venous gas on point-of-care ultrasound, prompting computed tomography of her abdomen and surgical consultation. She was ultimately found to have cecal ischemia from cecal volvulus, had surgical resection and anastomosis, and was able to be discharged from the hospital following recovery.Why Should an Emergency Physician Be Aware of This?With the ever-increasing use of point-of-care ultrasound, emergency physicians should be aware of the findings consistent with portal venous gas as well as its implications. Emergency physicians should know portal venous gas is associated with intestinal ischemia and other malignant pathologies and should prompt more advanced imaging or surgical consultation when observed. Emergency physicians should also understand the distinctions between portal venous gas and pneumobilia found on point-of-care ultrasound, given that portal venous gas is typically a malignant finding and pneumobilia is most frequently benign.     

Carbon dioxide embolism during laparoscopy: a case report.

A 28-year-old female with a diagnosis of multiparity was scheduled for laparoscopic tubal ligation. The patient had an unremarkable medical history, except that she had been a pack-a-day smoker for the past 10 years and had experienced a recent upper respiratory infection. General anesthesia was accomplished without incident, and insufflation of the abdomen with carbon dioxide (CO2) gas was begun. During insufflation the end tidal carbon dioxide (ETCO2) level dropped dramatically, ECG changes were noted, and vital signs deteriorated with the subsequent development of cardiac arrest. The patient was successfully resuscitated, fully awake, and extubated approximately 1 hour after the incident. A CO2 embolus caused by CO2 insufflation was suspected. In laparoscopic procedures, the use of CO2 gas is an efficient and inexpensive means of improving visualization of the abdominal cavity. The effect of CO2 insufflation on the patient should be given special consideration in these cases. Although serious complications associated with the use of CO2 gas are rare, such procedures must not be viewed with complacency. A protocol for the management of emergency situations should be developed and reviewed.     

Hangekobokuto (Banxia-houpo-tang), a Kampo Medicine that Treats Functional Dyspepsia

Although abdominal bloating is one of the most bothersome symptoms experienced by patients with functional dyspepsia (FD), therapeutic drugs to relieve abdominal bloating have not been established. We investigated the Kampo (Chinese herbal) medicine, Hangekobokuto (Banxia-houpo-tang, HKT) for patients with FD from the standpoint of bowel gas retention. The bowel gas volume calculated from a plain abdominal radiogram (gas volume score, GVS) in FD patients was significantly higher than that in healthy subjects. Two week administration of HKT in the FD patients showed a significant decrease of GVS. Furthermore, gastrointestinal symptoms, especially symptoms of abdominal pain, indigestion and constipation, all of which are closely related to abdominal bloating, improved significantly in FD patients after the administration of HKT. These results suggest that HKT improves abdominal bloating accompanied by the reduction of bowel gas in FD patients.     

Portal Venous Gas on Computed Tomography Imaging in Patients with Decompression Sickness

Background

It has been reported that portal venous gas is rarely found on computed tomography (CT) imaging in patients with decompression sickness (DCS). However, we propose that this is not true because we have encountered several patients with DCS who presented with portal venous gas on CT before hyperbaric oxygen therapy (HBOT). Here, we review our charts and present these patients’ characteristics.

Cases

We treated 37 patients with DCS from April 2007 to September 2011. Nine of these 37 patients underwent CT (thoracic, abdominal, or both) on admission because of dyspnea and other reasons. In four of nine patients, portal venous gas was incidentally found on CT. All patients were male, and three of them were SCUBA (self-contained underwater breathing apparatus) divers. Most of the patients did not have abdominal complaints. Three of four patients presented with gas in other abdominal areas (e.g., mesentery or inferior vena cava). HBOT (United States Navy Treatment Table 6) was performed in all patients, and abdominal CT performed after HBOT in three of four patients revealed the complete disappearance of portal venous gas and other venous gases. One patient died, and the remaining patients survived without any complications.

Conclusions

Most patients with DCS do not require CT examination before HBOT. However, if all patients with DCS undergo abdominal CT, the presence of portal venous gas in these patients may no longer be a rare finding. Although routine CT is not required for patients with DCS, it might be helpful for diagnosis.     

西甲硅油对便秘型肠易激综合征患者肠道气体的影响——附28例报告

目的：探讨西甲硅油对便秘型肠易激综合征（IBS）患者肠道气体的影响。方法：根据罗马Ⅲ诊断标准选取便秘型IBS患者28例,予以口服西甲硅油3 ml,3次/日,治疗2周。患者在服药前、后分别摄立位腹部X线平片,用图像处理软件计算气体容积积分 （GVS）,比较治疗前后GVS值的变化,同时对便秘型IBS患者的腹痛、腹胀症状进行评分并比较。结果：治疗后便秘型IBS患者的GVS为（0.05±0.01）,治疗前相应为（0.08±0.02）;治疗后腹痛症状评分为（0.9±0.5）分,治疗前相应为（2.2±0.6）分;治疗后腹胀症状评分为（0.9±0.6）分,治疗前相应为（2.0±0.8）分。治疗后便秘型IBS患者的GVS、腹痛症状评分、腹胀症状评分比治疗前明显下降（均为P＜0.05）。结论：西甲硅油能减少便秘型IBS患者的肠道气体,有效缓解腹痛、腹胀症状,且安全、有效。     

Computed tomographic findings in bowel ischemia

Computed tomography (CT) has been used in the evaluation of 11 patients with ischemic bowel lesions before confirmation of the disease with surgery or autopsy. The CT abnormalities were thickened bowel wall (10 patients) with post-contrast enhancement (9 patients), dilated fluid-filled bowel (9 patients), intramural low attenuation zones (5 patients), intramural gas (8 patients), and focal or diffuse free intraperitoneal fluid (5 patients). The diagnosis of bowel ischemia should be considered when performing CT in patients with abdominal pain of unknown etiology.     

穴位针刺治疗妇科腹部手术后患者腹胀的疗效观察

目的观察穴位针刺治疗妇科腹部手术后患者腹胀的效果。方法将250例行妇科腹部手术的患者．按手术的先后次序随机分为实验组和对照组,每组各125例。两组患者均按术后常规治疗和护理,实验组在此基础上给予穴位针刺。比较两组患者肛门排气时间和腹胀发生情况。结果实验组患者肛门排气时间为（14．3±5．5）h,对照组（30．5±3．5）h;实验组患者发生腹胀25例（20．0％）,对照组105例（84．O％）,两组比较,均P〈0．05,差异具有统计学意义。结论穴位针刺疗法可明显减轻妇科腹部手术患者腹胀,促进肛门排气。