Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain

We report on our experience with routine abdominal ultrasonography in 120 children (aged 3–15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. Conclusion The diagnostic value of abdominal ultra‐sonography in unselected children with recurrent abdominal pain is low. However, the direct visualization of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain. Received: 19 March 1996 / Accepted: 29 January 1997     

Abdominal distension after colonic lactulose fermentation recorded by a new extensometer

Colonic lactulose fermentation induces bloating, but whether it also causes abdominal distension is not known. The aim of this study was to assess the effect of colonic lactulose fermentation on abdominal girth using a new extensometer. We recorded abdominal girth in 24 healthy subjects by means of an extensometer that measures the phase shift of an ultrasound wave propagating in a tube encircling the abdomen. The recordings were continuously made for 3 h after the ingestion of 100 mL of tap water with (16 subjects) or without (eight subjects) 10 g of lactulose. Every 10 min, H2 in the breath was analysed and the intensity of bloating was recorded. Bloating was never reported after water ingestion, whereas it was reported by 10 subjects after lactulose ingestion (P = 0.002). The mean +/- SD changes in abdominal girth in comparison with resting conditions were statistically significant after lactulose ingestion (3 +/- 2.9 mm; P = 0.002) but not after water ingestion (-0.2 +/- 2.7 mm; P = 0.82). The area under the curve of the changes in abdominal girth after lactulose were significantly greater than after water ingestion (P = 0.03). In conclusion, colonic lactulose fermentation induces bloating and abdominal distension. The new extensometer is useful for continuously recording changes in abdominal girth.     

Advantages of using the midline incision right retroperitoneal approach for abdominal aortic aneurysm repair

This study was conducted to compare the midline incision right retroperitoneal approach for repairing abdominal aortic aneurysms (AAA) with the transperitoneal approach. The intra- and postoperative course of 15 patients who underwent AAA repair using the transperitoneal approach between 1987 and 1991 and another 15 patients who underwent AAA repair using the retroperitoneal approach between 1991 and 1994 were evaluated. The incidence of postoperative wound complications was also assessed. There was no operative or hospital death in either group. Although a significantly longer interval was required from the incision to the aortic clamp using the extraperitoneal method, there were no statistical differences in the aortic clamping time, total operation time, or blood loss between the two groups. On the other hand, there was a statistically significant improvement in bowel function and a significant reduction in the length of postoperative hospitalization following the extraperitoneal procedure. Furthermore, no wound complications such as those associated with the left flank incision developed after the extraperitoneal procedure. Thus, we recommend the midline incision right retroperitoneal approach for AAA as it does not involve muscle division and is associated with fewer complications.     

腹主动脉瘤动脉壁血管平滑肌细胞增殖及凋亡的研究

目的研究腹主动脉瘤 (abdominalaorticaneurysm ,AAA)在发病不同时期动脉壁平滑肌细胞 (smoothmusclecells,SMC)增殖与凋亡的改变。方法建立大鼠AAA模型 ,分别于术后 3d、1、2、3、4周切取腹主动脉 ,应用原位DNA片段末端标记 (TUNEL)和免疫组织化学方法检测腹主动脉壁中SMC凋亡和相关基因bcl 2、bax蛋白以及增殖细胞核抗原 (PCNA)、α 血管平滑肌肌动蛋白(α actin)的表达。结果TUNEL及PCNA表达高峰时段分别为术后 2～ 3周和 1周 ;术后 3d至 1周凋亡细胞少于PCNA阳性SMC ,2～ 4周多于PCNA阳性SMC且SMC数量明显减少 ;bcl 2与bax蛋白表达分别于术后 1、3周达到峰值 (P <0 0 1)。结论动脉壁SMC增殖和凋亡的失衡与AAA发病密切相关 ;bcl 2与bax基因参与了对AAA动脉壁中SMC凋亡的调控。     

真空敷料装置在暂时性关腹中的应用

目的 探讨一种新的暂时性关腹方法一真空敷料装置的临床应用。方法 用聚丙烯薄膜、手术巾、塑料黏贴膜和引流管等构建真空敷料装置。记录使用此装置患者的各种临床资料和并发症。结果 有13例患者共使用真空包扎15次进行暂时性关腹，其中5次（33．3％）是因为腹内压增高无法获得无张力的筋膜对合，4次（26．7％）是为了再次手术探查，2次（13．3％）是因为损伤控制，4次（26．7％）是上述多个因素的联合。7例（53．8％）患者最终完成腹壁全层对合关闭，5例（38．5％）患者无法直接对合腹壁缺损，最后行创面断层皮片植皮；3例（23．1％）患者出现腹腔内脓肿，无1例出现消化道瘘，无内脏脱出。1例（7．7％）在试图关腹之前死亡，与真空包扎无关。结论 真空包扎可使患者获得直接腹壁肌肉筋膜层关闭，并发症发生率低、易于掌握，是一种较好的暂时性关腹方法。     

32例腹部开放性损伤的救治体会

目的:探讨开放性腹部损伤的治疗方法。方法:回顾性分析1991年-1994年32例开放性腹部损伤患者的临床资料。结果:开腹探查26例,单纯缝合6例,阴性探查3例,二次手术2例,术后切口感染2例,感染性休克死亡1例,治愈31例,病死率为3.12%。结论:开放性腹部外伤,首先要根据临床表现及辅助检查判定内脏是否损伤,手术时机的掌握是治疗的关键。     

Percutaneous Transhepatic Cholangiodrainage as Rescue Therapy for Symptomatic Biliary Leakage Without Biliary Tract Dilation After Major Surgery

Symptomatic biliary leakage following major upper abdominal surgery is a severe complication resulting in increased morbidity and mortality. Treatment options usually include either endoscopic intervention or surgical revision. These options may be burdened by a high perioperative risk for the patient (e.g., patients with severe disease) or simply may not be possible (e.g., nonpreserved gastroduodenal passage). In the past, percutaneous transhepatic cholangiodrainage did only seem to be a viable option for patients with dilated bile ducts. Here, we present our experience in a consecutive series of patients with symptomatic biliary leakage following major upper abdominal surgery and without dilation of the biliary system that underwent percutaneous transhepatic cholangiodrainage. Percutaneous transhepatic cholangiodrainage was feasible in 15 of 18 patients (83.3%). The procedure was technically not possible in three patients (16.7%). In 10 of the 15 patients (66.6%) with feasible percutaneous transhepatic cholangiodrainage, biliary leakage was definitely controlled without the need for surgical revision. Depending on the experience with the interventional procedure, percutaneous transhepatic cholangiodrainage should be considered as an alternative for treatment of symptomatic biliary leakage instead of immediate reoperation. Presented at the Digestive Disease Week 2005 (DDW), Chicago, IL, May 14–19, 2005 (poster presentation).     

造影剂到达腹主动脉的峰值大小与患者因素的关系

目的探讨造影剂到达腹主动脉的峰值大小与患者因素之间的关系。方法108例患者以2.5ml/s注射欧乃派克(300mgI/ml)20ml,12s后采用testbolus技术在腹腔干水平同层动态扫描腹主动脉,用dynamic evaluation软件测得腹主动脉的峰值大小,采用单因素回归分析和多因素逐步回归分析法研究患者的性别、年龄、身高、体重、心率、血压、注射位点、达峰时间及是否有心脏病、糖尿病、或化疗史对造影剂到达腹主动脉峰值大小是否有影响及影响程度。结果造影剂到达腹主动脉峰值大小,在男性平均比女性低;其随年龄、身高、体重、达峰时间的增加而逐渐降低,注射位点在手背静脉其值平均比在肘部静脉低;其不受心率、血压、是否有心脏病、糖尿病或化疗史的影响。参考公式:峰值大小(HU)=383.8400-身高(cm)×1.0909-体重(kg)×0.6760 注射位点×16.7878-达峰时间(s)×1.6882。结论可根据患者的性别、年龄、身高、体重、注射位点和达峰时间来适当调整患者CT血管成像时造影剂用量。     

A Pelvic Ring Fracture Complicated by Acute Traumatic Obstructed Direct Inguinal Hernia

Abstract A young male motorcyclist presented to the Pelvic Unit with an open-book fracture of his pelvis and an acute obstructed direct inguinal hernia. He was managed operatively and made an excellent recovery. Traumatic abdominal wall hernias are rare. This is a unique combination of injuries that the trauma surgeon should be aware of.     

腹主动脉球囊阻断技术在骶骨肿瘤切除中的临床评价

[目的]探讨应用腹主动脉球囊阻断技术在行骶骨肿瘤切除术中的临床应用价值。[方法]对36例骶骨肿瘤患者切除过程中应用腹主动脉球囊阻断技术(腹主动脉球囊阻断组),复习既往32例骶骨肿瘤应用传统的术前血管栓塞技术切除肿瘤患者(对照组)的临床资料,比较2组手术时间、出血量、并发症发生率、平均住院时间、术后恢复时间及复发率。[结果]腹主动脉球囊阻断组手术时间为(149.19±73.81)min,术中出血量为(826.67±509.11)ml,有2例骶神经损伤,平均住院时间(26.05±7.08)d,术后恢复时间(34.61±8,22)d,半年复发率5.5%,1年复发率11%,2年复发率16%;对照组手术时间为(221.33±45.19)min,出血量为(1652±706.99)ml,有3例骶神经损伤,4例出现局部皮肤缺血性疼痛,1例出现性功能障碍。平均住院时间(37.93±7.63)d,术后恢复时间(46.03±9.67)d,半年复发率18%,1年复发率31%,2年复发率40.6%。两者比较有显著性差异(P<0.05)。[结论]在骶骨肿瘤过程中,采用腹主动脉球囊阻断技术,可以缩短手术时间,减少出血量及并发症,缩短住院天数,术后恢复快,降低了复发率。是一项具有实用价值的临床技术。