全麻下空气灌肠治疗小儿急性肠套叠

为了提高小儿急性肠套叠复位的成功率，近年来我们试行在基础全麻下实施空气灌肠治疗小儿急生套叠１５例收到了良好效果，全部病例皆治愈。结果提示，全麻下空气灌肠治疗小儿急性肠套叠优于单纯空气灌肠     

Acute pancreatitis in a young girl with the Netherton syndrome

Acute pancreatitis is uncommon in children younger than 15 years. We present the first report on the association of acute pancreatitis with the Netherton syndrome. The Netherton syndrome is an inherited skin disease characterized by ichthyosiform erythroderma, a pathognomonic hair shaft defect (“bamboo hair”), and atopic features.A 14-year-old girl with symptoms and signs of severe acute pancreatitis was admitted to our department. A diagnostic workup could not reveal any common known cause of pancreatitis, and the cause of pancreatitis would most likely be considered idiopathic. However, based on recent reports regarding various pathophysiological mechanisms for both acute pancreatitis and the Netherton syndrome (eg, shearing the 5q locus for the respective gene-associated defects in SPINK1 and SPINK5), we speculate if a possible association may exist. Investigations on pancreatitis and the Netherton syndrome may disclose factors closely involved in the pathomechanisms of both. This notion may be of clinical importance as it adds to the number of potential life-threatening events to patients with the Netherton syndrome.     

Torsion of an ectopic liver in a young child

A large ectopic liver nodule connected to the greater omentum had undergone infarction and separation because of torsion of its connecting stalk and was the cause of acute abdominal pain and elevated liver enzymes in a young female child. At laparotomy for a suspected perforated appendicitis, a hemorrhagic peritoneal fluid was found, together with an intraperitoneal solid mass lying freely in the right iliac fossa. The definitive diagnosis was obtained by histopathology. This is the first known such reported case.     

Magnetic resonance imaging of the upper abdomen using a free-breathing T2-weighted turbo spin echo sequence with navigator triggered prospective acquisition correction

PURPOSE: To evaluate a free-breathing navigator triggered T2-weighted turbo spin-echo sequence with prospective acquisition correction (T2w-PACE-TSE) for MRI of the upper abdomen in comparison to a conventional T2-weighted TSE (T2w-CTSE), a single-shot TSE (T2w-HASTE), and a T1-weighted gradient-echo sequence (T1w-FLASH). MATERIALS AND METHODS: A total of 40 consecutive patients were examined at 1.5 T using free-breathing T2w-PACE-TSE, free-breathing T2w-CTSE, and breath-hold T2w-HASTE and T1w-FLASH acquisition. Images were evaluated qualitatively by three radiologists regarding motion artifacts, liver-spleen contrast, depiction of intrahepatic vessels, the pancreas and the adrenal glands, and overall image quality on a four-point scale. Quantitative analysis of the liver-spleen contrast was performed. RESULTS: Depiction and sharpness of intrahepatic vessels were rated significantly better (P < 0.01) using T2w-PACE-TSE compared to T2w-CTSE and T2w-HASTE sequences. Significantly higher contrast values were measured for T2w-PACE-TSE images compared to T2w-CTSE, T2w-HASTE, and T1w-FLASH images (P < 0.01). Mean examination time of the T2w-PACE-TSE was 7.91 minutes, acquisition time of the T2w-CTSE sequence was 4.52 minutes. CONCLUSION: Prospective acquisition correction is an efficient method for reducing respiratory movement artifacts in T2w-TSE imaging of the upper abdomen. Compared to T2w-CTSE and T2w-HASTE sequences recognition of anatomical details and contrast can be significantly improved.     

Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study

Background. To explore the attitudes of intensivists in theUK to intra-abdominal pressure (IAP) measurement and abdominalcompartment syndrome (ACS) and to determine current practice. Methods. A postal questionnaire study addressed to the leadclinician in the intensive care unit was sent to hospitals inthe UK with a general surgical service. Results. Completed questionnaires were received from 137 ofthe 207 hospitals surveyed (66.2% response rate). Only 1.5%of the respondents (n=2) had no prior knowledge of intra-abdominalhypertension and ACS. IAP had been measured on some occasionby 75.9% (n=104) of the respondents, always by the intravesicalroute. Among those intensive care units that measured IAP, in93.2% (n=97) it was only measured when there was a suspicionof the development of ACS; 3.8% of units (n=4) measured IAPon all patients who had undergone an emergency laparotomy, and2.9% (n=3) measured IAP only in those who had undergone emergencylaparotomy associated with massive fluid resuscitation. Therewas major disparity in the frequency of IAP measurement andwhen to recommend abdominal decompression. Conclusions. Despite widespread awareness of IAH and the ACS,many intensive care units never measure the IAP. When it ismeasured, the intravesical route is used exclusively. No consensusexists on optimal timing of measurement or when decompressivelaparotomy should be performed.      

Sonographic diagnosis of right segmental omental infarction

PURPOSE: The purpose of this study was to identify the characteristic features of omental infarction so that this entity can be differentiated from other acute conditions in the right lower quadrant of the abdomen. METHODS: A retrospective review was undertaken. We searched our hospital medical records and found 6 patients with the diagnosis of omental infarction in the last 3 years. Clinical, sonographic, and CT findings at the time of hospital admission and at follow-up were studied. RESULTS: In 5 of the 6 patients (83%) sonography demonstrated a moderately hyperechoic, noncompressible ovoid mass located in the omental fat between the umbilicus and the right colon corresponding to the point of maximal tenderness or to the site of a palpable lesion on physical examination. In 1 patient, sonography revealed no abnormalities. In all patients, the diagnosis of omental infarction was confirmed by CT. One patient underwent laparoscopy because of intractable pain; laparoscopy revealed a necrotic segment in the omentum, and pathologic analysis confirmed the original diagnosis. CONCLUSIONS: Omental infarction is a benign self-limited disease that can mimic acute abdomen. The diagnosis can be established preoperatively with sonography and CT, which may avoid unnecessary laparotomy.     

Para-aortal lymph nodes dissection in 20 cases of primary epithelial ovary carcinoma stage I (Figo): Influence on staging

In this study 20 cases of primary epithelial ovary carcinoma stage I (Figo) were presented.In 5 cases (25%) para-aortic lymph nodes were positive, because of which their stage changed into Stage III. This shows that for correct staging of ovary carcinoma stage I, extirpation of the para-aortal glands is obligatory. It was observed that tumors on the external surface of the ovary and tumor cells in the peritoneum fluid were not related to positive para-aortal glands. The para-aortic metastases were found in the tumors with a histologic grading according to Broders' classification III and IV.     

Unusual migration in abdomen of a wire for surgical localization of breast lesions

We report a case of migration of a surgical localization wire from the breast to the abdomen. A 41-year-old female underwent presurgical needle localization of a deep-sited left-sided breast lesion. Migration of the localization wire in the chest wall occurred during the procedure documented by imaging. Computed tomography (CT) examination showed no evidence of the wire in the left lower lung field, no peritoneal free fluid, active bleeding, or abnormalities of abdominal organ, but a metallic-density representing the localization wire was seen for a length of 13 cm from the right diaphragmatic crus to the right psoas muscle, close to the inferior vena cava. A following CT examination showed the wire partially outside the inferior vena cava and partially inside the right iliac vein. The wire was successfully taken out by an angiographic interventional procedure.     

Multiple Jejunal Diverticulitis with Perforation in a Patient with Systemic Lupus Erythematosus: Report of a Case

A 70-year-old man with systemic lupus erythematosus (SLE) was brought to our Emergency Department after the sudden onset of acute and severe abdominal pain. Physical examination revealed a tender and distended abdomen with guarding and rebound tenderness in the periumbilical region and the left upper quadrant. A plain abdominal X-ray taken with the patient upright showed air fluid levels with dilatation of several loops in the small bowel. As the examination could not rule out bowel ischemia, perforation, or obstruction, an emergency laparotomy was performed, which revealed multiple jejunal diverticulosis, one of which had perforated and adhered to the right colon, causing rotation. The diverticulosis segment was resected and an end-to-end anastomosis was done. The patient had an uneventful postoperative recovery without any complications. This is an unusual cause of peritonitis in a patient with SLE, and we could not find any evidence to suggest involvement of the underlying SLE in the jejunal diverticulosis and diverticulitis in this patient. Nevertheless, the involvement of SLE might be possible and further investigation is warranted.     

老年急腹症180例诊治

目的 探讨老年人急腹症的临床特点和手术治疗效果.方法 对四川省科学城医院1995-07/2005-07收治的180例老年人急腹症患者中126例实施手术治疗者的诊断、治疗进行回顾性分析.结果 180例老年人急腹症患者中,男88例,女92例,平均年龄72岁,最大80岁.急性阑尾炎60例,占33.3%;急性胆囊炎、胆石症48例,占26.5%;肠梗阻29例,占16.1%;溃疡病穿孔、出血21例,占11.7%;急性化脓性胆管炎4例,占2.2%;急性胰腺炎4例,占2.2%;腹部闭合伤8例;脾破裂3例;肠破裂2例;肝损伤1例.合并有高血压74例,占40.1%;冠状动脉粥样硬化性心脏病18例,占10%;糖尿病15例,占8.3%;慢性支气管炎17例,占9.1%;脑血管意外4例,占2.2%;其他52例.并存2种以上疾病的36例,占20%;心电图有异常发现的82例,占40.6%;有126例手术126例,其中痊愈89例,占70.6%,好转31例,占24.6%,术后出现并发症26例,占20.6%,其中肺部感染11例,占42.3%;,死亡6例,占4.1%,误诊26例,占11.1%.结论 老年急腹症患者病情复杂多变,缺乏典型症状和体征,容易误诊,合并症多,明确术前诊断,与内科协作处理合并症,选择合适的手术方法和麻醉方式,掌握好手术时机,从而减少老年急腹症患者的病死率和并发症.