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Internal hemorrhoidal disease and non-surgical therapy Abstract. Haemorrhoids are a physiological part of the sphincter muscle which, under non-physiological conditions such as abdominal pressure, becomes enlarged and develops symptoms such as bleeding. The therapy consists of reducing the enlarged plexus. In addition to lifestyle adaptations, semi-invasive methods such as coagulation, rubber band ligations and, in more severe stages, surgical procedures such as the classic established methods (Milligan-Morgan, Ferguson, in selected cases Longo) can be considered.

Background: Stress urinary incontinence is an involuntary leaking of urine during physical activity, such as coughing, sneezing, laughing, or exercise that increases abdominal pressure. Stress urinaryincontinence has a wide variety of impacts on women's daily. Objectives: To assess the stress urinary incontinence among women before and after pelvic floor exercise, to assess the severity of stress urinary incontinence among women before and after pelvic floor exercise, to find out the association between stress urinary incontinence and severity with selected demographic variables. Methodology: A study will be conducted in the rural community area of the Wardha district. A total of 30 women will be selected as the study sample by using the non-probability purposive sampling technique as per the inclusion/exclusion criteria. An interventional evaluatory approach and time-series design will be used. In this study, the researcher will assess the stress urinary incontinence with the help of a structured questionnaire and again assess the severity of stress urinary incontinence with a grading scale after that pelvic floor exercise will be given to that woman after 2 weeks again researcher will assess the stress urinary incontinence and severity of the stress urinary incontinence with the grading scale. Outcome/results: The outcome will be the pelvic floor exercise or training (PFE) will minimize the incidence rate of stress urinary incontinence among women it also helps to increase the pelvic floor muscle strength.

AIMS To compare in vivo differences of two catheter systems for urodynamics to further discover their measurement properties. METHODS Side-by-side catheterization with two catheters for intravesical and abdominal pressure during full cystometry in 36 prospectively recruited patients with analysis of mean and absolute differences at urodynamic events and post hoc in-depth signal analysis comparing the full pressure traces of both systems. RESULTS The mean pressure differences at urodynamic events between air-filled and water-filled systems are small, however, with a large variation, without a systematic difference. The majority of the intersystem differences are significantly larger than 5 cmH2 O. Further analysis showed that urodynamic event pressure differences of both systems at the start of the test were carried forward throughout the remainder of the test without subsequent or additional tendency to differ. Post hoc whole test signal analysis with pressures equalized from the first sample shows high cross-correlation (>0.981) between the pressure signals per location (rectum and bladder) per test and almost zero-time shift (

Advances in multiparametric brain monitoring have allowed us to deepen our knowledge of the physiopathology of head injury and how it can be treated using the therapies available today. It is essential to understand and interpret a series of basic physiological and physiopathological principles that, on the one hand, provide an adequate metabolic environment to prevent worsening of the primary brain injury and favour its recovery, and on the other hand, allow therapeutic resources to be individually adapted to the specific needs of the patient. Based on these notions, this article presents a decalogue of the physiological objectives to be achieved in brain injury, together with a series of diagnostic and therapeutic recommendations for achieving these goals. We emphasise the importance of considering and analysing the physiological variables involved in the transport of oxygen to the brain, such as cardiac output and arterial oxygen content, together with their conditioning factors and possible alterations. Special attention is paid to the basic elements of physiological neuroprotection, and we describe the multiple causes of cerebral hypoxia, how to approach them, and how to correct them. We also examine the increase in intracranial pressure as a physiopathological element, focussing on the significance of thoracic and abdominal pressure in the interpretation of intracranial pressure. Treatment of intracranial pressure should be based on a step-wise model, the first stage of which should be based on a physiopathological reflection combined with information on the tomographic lesions rather than on rigid numerical values.

During pneumoperitoneum, intra-abdominal pressure (IAP) is usually kept at 12–14 mmHg. There is no clinical benefit in IAP increments if they do not increase intra-abdominal volume IAV. We aimed to estimate IAV (DIAV) and respiratory driving pressure changes (DP RS) in relation to changes in IAP (DIAP). We carried out a patient-level meta-analysis of 204 adult patients with available data on IAV and DP RS during pneumoperitoneum from three trials assessing the effect of IAP on postoperative recovery and airway pressure during laparoscopic surgery under general anesthesia. The primary endpoint was DIAV, and the secondary endpoint was DP RS. The endpoints’ response to DIAP was modeled using mixed multivariable Bayesian regression to estimate which mathematical function best fitted it. IAP values on the pressure–volume (PV) curve where the endpoint rate of change according to IAP decreased were identified. Abdomino-thoracic transmission (ATT) rate, that is, the rate DP RS change to DIAP was also estimated. The best-fitting function was sigmoid logistic and linear for IAV and DP RS response, respectively. Increments in IAV reached a plateau at 6.0 [95%CI 5.9–6.2] L. DIAV for each DIAP decreased at IAP ranging from 9.8 [95%CI 9.7–9.9] to 12.2 [12.0–12.3] mmHg. ATT rate was 0.65 [95%CI 0.62–0.68]. One mmHg of IAP raised DP RS 0.88 cmH 2O. During pneumoperitoneum, IAP has a nonlinear relationship with IAV and a linear one with DP RS. IAP should be set below the point where IAV gains diminish. NEW & NOTEWORTHY We found that intra-abdominal volume changes related to intra-abdominal pressure increase reached a plateau with diminishing gains in commonly used pneumoperitoneum pressure ranges. We also found a linear relationship between intra-abdominal pressure and respiratory driving pressure, a known marker of postoperative pulmonary complications.

Limited abdominal space in congenital diaphragmatic hernia (CDH) might result in abdominal compartment syndrome (ACS) and require delayed abdominal closure (DAC). This study reviewed outcomes in pediatric ACS/DAC after CDH repair. Medline/PubMed, Scopus, Web of Science, Ovid and Lilacs databases were reviewed. Data from studies published in English/Spanish/Portuguese between 1990–2020 was collected. Results are presented as descriptive statistics. Sixteen reports offered 118 children, 112 (94.9%) being neonates. There were six ACS (5.1%) and 112 DAC (94.9%). Regarding ACS, the diagnosis was made clinically (n = 4; 66.7%), using Doppler scans (n = 1; 16.7%) or bladder pressure measurement (n = 1; 16.7%). There was one (16.7%) lethal outcome. The rationale to perform DAC was not clearly stated, and measurement of abdominal pressure was not mentioned in all reports. Silo was the preferred approach in 36 children (32.1%), followed by skin closure only (n = 16; 14.3%), vacuum (n = 10; 8.9%), fascia patch and skin closure (n = 5; 4.5%), fascia patch and vacuum dressing (n = 1; 0.9%), fasciotomy (n = 1; 0.9%); with no DAC technique reported in 43 patients (38.4%). Complications after DAC were reported in nine children (8.1%). One DAC using vacuum dressing that was clinically diagnosed with ACS required silo placement. There were 19 (17%) lethal outcomes. ACS/DAC after CDH repair are reported more frequently in neonates (112/118; 94.9%). There is no clear rationale stated behind the decision to perform DAC, with the silo being the preferred approach. Criteria need to be worked for DAC in CDH with large herniated content and small volume abdomen to prevent ACS.

Objectives: This review aims to study the role of the abdominal wall in testicular migration process during the human fetal period. Materials and Methods: We performed a descriptive review of the literature about the role of the abdominal wall in testicular migration during the human fetal period. Results: The rise in intra-abdominal pressure is a supporting factor for testicular migration. This process has two phases: the abdominal and the inguinal-scrotal stages. The passage of the testis through the inguinal canal occurs very quickly between 21 and 25 WPC. Bilateral cryptorchidism in Prune Belly syndrome is explained by the impaired contraction of the muscles of the abdominal wall; mechanical obstruction due to bladder distention and structural alteration of the inguinal canal, which hampers the passage of the testis during the inguinoscrotal stage of testicular migration. Abdominal wall defects as gastroschisis and omphaloceles are associated with undescended testes in around 30 to 40% of the cases. Conclusions: Abdominal pressure wound is an auxiliary force in testicular migration. Patients with abdominal wall defects are associated with undescendend testis in more than 30% of the cases probably due to mechanical factors; the Prune Belly Syndrome has anatomical changes in the anterior abdominal wall that hinder the increase of intra-abdominal pressure which could be the cause of cryptorchidism in this syndrome.

Increased abdominal pressure is common in obese patients and predisposes them to gastroesophageal regurgitation (GER). To drain GER and prevent aspiration, nasogastric (NG) tubes are frequently inserted in obese patients undergoing general anesthesia. However, whether gastric drainage actually decreases the occurrence of GER remains to be elucidated. In this study, increased abdominal pressure was simulated with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning, while the retained NG tube was replaced by a pre-inserted esophageal multichannel intraluminal and pH (MII-pH) monitoring. Fifteen patients undergoing elective gynecologic laparoscopy were enrolled in this study. Thirteen patients (86%) developed GER while in the LPT position. With the high occurrence of GER, pre-inserted NG tubes under general anesthesia are not likely to be protective in obese patients.

Purpose: The purpose of this study is to measure the change in abdominal pressure depending on the speed of the horse riding training exercise equipment. Methods: 27 women with an average age of 21.5 years, height of 164.66 cm, weight 55.07 kg, and body mass index of 21.59 kg/m² were divided into 3 groups, 9 subjects in each group, of low, medium, and high-speed training groups. Each training group was given three times a week during 6 weeks using a horse riding equipment for 20 minutes a day. Abdominal pressure was measured using a stabilizer. Results: Each group trained at low, medium, and high speed showed an increase in abdominal pressure(p

Absztrakt: Bevezetés: Az óriás hasfali defektusok kezelése kihívást jelent a sebészek számára. CT-vizsgálattal meghatározható a sérvzsák és a hasüreg térfogata közötti arány, megállapítva a téraránytalanság mértékét, amely a műtét utáni hasűri nyomás mértékének kifejezője lehet. Célkitűzés: A posztoperatív óriás hasfali defektusok kivizsgálásában alkalmazott CT-vizsgálat jelentőségének alátámasztása, a rekonstrukciós módszer hatékonyságának elemzése a hasűrinyomás-méréssel. Módszer: Prospektív kutatást végzünk klinikánkon, vizsgálva az óriás hegsérvvel kezelt betegeinket, akiknél műtét előtt hasi CT-vizsgálat készül. A hasfal rekonstrukciója feszülésmentesen, retromuscularisan elhelyezett Prolene hálóval és sérvzsákból készített peritoneumlebenyekkel történik. Műtét alatt és műtét után hasűri nyomást mérünk, posztoperatívan 2, 4, 6 hónap után telefonon keresztül követjük betegeinket. Eredmények: Elért eredményeinket három eset kapcsán mutatjuk be. 1. eset: A 48 éves nőbetegnél óriás kiújult hegsérv, több társbetegség állt fenn. Testtömegindexe 43,6, a hasfali defektus átmérője 155 mm, a hegsérv térfogata 1536,63 cm3 volt. A műtét utáni 7. napon hazabocsátottuk. 2. eset: Az 51 éves férfi betegnél multilocularis óriás hegsérv keletkezett, testtömegindexe 26,85 volt. A két hasfali defektus átmérője 123 mm és 105 mm, térfogatuk együttes értéke 406,41 cm3 volt. A műtét utáni 5. napon a beteget elbocsátottuk. 3. eset: A 67 éves férfi beteg testtömegindexe 23,7, a hasfali defektus mérete 100 mm, térfogata 258,10 cm3 volt. A beteget a műtét utáni 4. napon elbocsátottuk. Következtetés: A preoperatív CT-vizsgálat adatai fontosak az alkalmazott műtéti technika megválasztásában. A sérvzsák és a háló együttes alkalmazása az óriás hegsérvek rekonstrukciójában olcsó és feszülésmentes műtéti technikát biztosít a fokozott rizikóval rendelkező betegek esetében. A technika rövid távú hatékonyságának elemzésére a húgyhólyagon keresztül mért hasűri nyomás a választandó módszer. Orv Hetil. 2020; 161(9): 347–353.

This study presents a comparison of the common Child Restraint Systems (CRS) which reduces the value of dynamic loads affecting the child's body during car accidents. The analyzed systems were: child seats, Combi Booster Seats, and straps&mdash, adjustable vehicle seat belts adapted to children's stature. The effectiveness of the analyzed devices was assessed on the basis of experimental tests carried out in the accredited laboratory approving the Child Restraint Systems. The tests were carried out in accordance with the new Regulation No. 129 UN/ECE. We examined whether the tested devices meet the guidelines of the new Regulations No. 129 despite approval in accordance with Regulation No. 44. Based on the research results, better safety parameters of some new solutions dedicated to children&rsquo, s safety could be observed. Almost all the selected CRS met requirements stated in Regulation No. 129. The only exception was for abdominal pressure in one of the tested devices. One of the most important parameters measured during crash tests is Head Injury Criterion (HIC). Head Resultant Acceleration in tested devices was 14.7%&ndash, 39.0% less than the limit determined in Regulation No. 129 whereas Chest Resultant Acceleration was 17.4%&ndash, 37.6% less. Abdominal pressure was 46.4%&ndash, 81.4% beneath the limit (apart from one case which did not meet the requirements). The HPC parameter (Head Performance Criterion) was 45.4&ndash, 74.5 % less. The final results show that there are still some possibilities for improving the safety of young vehicle passengers.

Introduction and hypothesis The article discusses three theories of stress urinary incontinence, the urethral hanging theory, Enhörning’s theory, and the integral theory. Methods The abdominal pressure transmission theory proposed by Enhörning is often misunderstood. It is regularly interpreted to mean that, in cases of stress urinary incontinence, the bladder neck descends outside the abdominal cavity, and treatment must involve elevating or repositioning the bladder neck. Results However, this actually contradicts the information provided in Enhörning’s original paper. The urethral hanging theory accepts the core of Enhörning’s theory and the integral theory rejects it. The three theories have different views on closure and opening of the bladder neck and on the pathophysiology of urethral funneling. Conclusion These differences are described and discussed.

Introduction Colonic high-resolution manometry (HRM) is a novel, not widely used diagnostic method used in the final workup of chronic constipation before surgery. Since its introduction, different motor patterns have been defined. However, it remains to be established whether these patterns are easily and reproducibly identified by different investigators. Methods The primary aim of this study was to determine agreement for motor pattern identification with HRM. To calculate the interobserver agreement (IOA), the Fleiss's kappa statistic for multiple observers was used. Seven participants analyzed 106 one-min time frames, derived from five measurements in healthy volunteers and five in patients with chronic constipation. The time frames were chosen to show a variety and combination of motor patterns consisting of short antegrade, short retrograde, cyclic anterograde, cyclic retrograde, long antegrade, long retrograde, slow retrograde motor pattern, high-amplitude propagating motor patterns, and pancolonic pressurizations. All of the measurements were performed with a solid-state colonic HRM catheter, comprising 40 pressure sensors spaced 2.5 cm apart. Results A median of 10.25 h (range 6-20) were required to analyze all time frames. High-amplitude propagating contractions achieved an almost perfect level of agreement (k = 0.91). Several motor patterns achieved substantial agreement; these included the short antegrade (k = 0.63), long antegrade (k = 0.68), cyclic retrograde (k = 0.70), slow retrograde motor pattern (k = 0.80), and abdominal pressure or movement artifacts (k = 0.67). Moderate agreement was found for short retrograde (k = 0.57), cyclic anterograde (k = 0.59), long retrograde motor patterns (k = 0.59) and simultaneous pressure waves (k = 0.59). Conclusion For the majority of motor patterns, the overall IOA for colonic manometry was substantial or high. This high level of agreement supports the use of colonic manometry application in clinical and research settings. Harmonization has the potential to improve agreement for long anterograde motor patterns with high amplitudes and for mixed direction patterns.

OBJECTIVES:. We describe seven proned patients with coronavirus disease 2019-related acute respiratory distress syndrome in whom a paradoxical decrease in driving pressure reversibly occurred during passive, volume-controlled ventilation when compressing the lower back by a sustained “dorsal push.” We offer a potential explanation for these unexpected observations and suggest the possible importance of eliciting this response for lung-protective ventilation of similar patients. DESIGN/SETTING:. Case series at a single teaching hospital affiliated with the University of Minnesota. Measurements were recorded from continuously monitored airway pressure and flow data. PATIENTS:. Nonconsecutive and nonrandomized sample of coronavirus disease 2019 acute respiratory distress syndrome patients who were already prone and paralyzed for optimized lung protective clinical management while inhaling pure oxygen. INTERVENTIONS:. Sustained, firm manual pressure applied over the lower back in all patients, followed by abdominal binding in a subset of these. MEASUREMENTS AND MAIN RESULTS:. Respiratory system driving pressure declined and respiratory system compliance improved in seven patients with the dorsal push maneuver. In a subset of four of these, abdominal binding sustained those improvements over >3 hours. CONCLUSIONS:. Sustained compressive force applied to the dorsum of the passive and prone patient with severe respiratory failure due to coronavirus disease pneumonia may elicit a paradoxical response characterized by improved compliance and for a given tidal volume, lower plateau, and driving pressures. Such findings, which suggest end-tidal overinflation within the aerated part of the diseased lung despite the already compressed anterior chest wall of prone positioning, complement and extend those observations recently described for the supine position in coronavirus disease 2019 acute respiratory distress syndrome.

Urethral prolapse is a very rare disease, which is most often found in prepubescent girls. It occurs in about one over 5000 girls in the context of a chronic cough or any situation that increases abdominal pressure. It is often associated with diagnostic confusion, which delays management. We report the case of a 6-year-old child brought in urgently by her parents for a minimal genital hemorrhage and presence of a mass protruding from the vulva. In the hypothesis of a urethral prolapse, a medical treatment (conservative) was prescribed. After two weeks, the mass decreased significantly in volume and disappeared completely after 2 months.

he standard treatment for patients with neuromuscular respiratory failure is non-invasive ventilation (NIV) as non-invasive ventilation support-setting (NVS). NVS is administered through a nasal or face mask and/or mouthpiece with the potential to cause nasal ulcers, discomfort, and/or aesthetic issues, resulting in poor compliance. We reported the observation of a 45-year-old woman with limb-girdle muscular dystrophy (LGMD), secondary to Dysferlin deficiency, who was on NVS since 2017 for nocturnal hypoventilation. In 2018, despite nocturnal ventilation, due to weight gain and daytime hypoventilation, a nasal mask was introduced. We initiated daytime intermittent abdominal pressure ventilation (IAPV) to mitigate cosmetic problems, improving in pO2 and decreasing in pCO2 versus baseline (52>84 mmHg, 46>33 mmHg respectively) at 6 (85 mmHg, 42 mmHg) and 18 months (93 mmHg, 38 mmHg), respectively. IAPV was effective, safe, and well-tolerated in our patients who did not tolerate standard daytime NVS with the known interface.

Noninvasive ventilation has become the initial treatment for symptomatic ventilatory pump failure but, when used at ventilatory support settings, can be an alternative to tracheostomy mechanical ventilation. The intermittent abdominal pressure ventilator, a corset with an internal air sack inflated by a ventilator, allows to increase tidal volumes through the raising of the diaphragm and its consequent passive descent. It has been used for daytime support for more than 70 yrs, but its knowledge among clinicians is scarce. A narrative review was performed by searching PubMed, Medline, and the Cochrane Database of Systematic Reviews using the terms "IAPV" or "pneumobelt." One hundred forty patients were cited using the intermittent abdominal pressure ventilator from 1946 until it went off the market in the 1970s, although many continued to use it. There was only one publication on its use from 2003 to 2017, but three publications from 2017 through 2021. It has been used for full diurnal ventilatory support by some patients for more than 50 yrs and has even been used throughout the labor of a mother with no ventilator-free breathing ability. The intermittent abdominal pressure ventilator is a ventilatory support alternative for patients with ventilatory pump failure. It can be effective and well tolerated and maintain quality of life without facial interfaces. More widespread application is warranted.

Enhörning’s abdominal pressure transmission theory (ET) is built on Pascal’s law of fluid pressures. A theory that rejects ET also rejects this basic physical law and cannot be considered scientifically sound. The integral theory (IT) of female stress urinary incontinence rejects ET. This issue is discussed from the viewpoint of the urethral hanging theory of female stress urinary incontinence (UHT).

Objectives: Few studies have described retrograde migration of the atrial catheter tip in ventriculoatrial shunt to treat adult hydrocephalus. Methods: We placed ventriculoatrial shunts in 25 selected adult patients with a previous complicated abdominal surgery or concurrent bowel disease and in patients with persistent symptoms after a ventriculoperitoneal, potentially due to conflicting internal abdominal pressure. Clinical and radiological follow-ups were performed at least 18 months postoperatively. Results: No mortality or early or late infection occurred in the series of patients. At the long-term clinical and radiological follow-up (mean 4.5 years), eight patients died due to causes unrelated to shunt surgery. All other patients were able to live independently but some experienced neurological decline related to their neurodegenerative disease. In five patients (20%), atrial catheter migration was detected on a control chest x-ray; in four patients, it was associated with worsening of their clinical condition. These patients underwent surgical substitution of the atrial catheter. The remaining asymptomatic patient was managed conservatively. Conclusions: The ventriculoatrial shunt was a safe, effective procedure for treating hydrocephalus in adult patients. Retrograde migration of the atrial catheter tip in symptomatic patients required surgical substitution of the atrial catheter. Keywords: Cardiac catheter, Complication, Endovascular procedure, Hydrocephalus, Migration, Normal-pressure, Shunt, Surgical procedure

Stress urinary incontinence (SUI) is the involuntary leakage of urine which occurs with sudden increase in abdominal pressure, such as during sneezing, coughing, or laughing. This is a common symptom in women, affecting more than 50% of women and a cause of substantial morbidity. Women and men do not commonly report this symptom to their physicians. This under-reporting may be one of the reasons for undertreatment. In fact, successful treatments exist which decrease or cure SUI, including pelvic floor muscle training and various surgeries but only a small fraction of those with SUI receive treatment.

To determine whether pressure readings measured with air-filled catheter (AFC) and water-filled catheter (WFC) systems are equivalent during cystometric assessment, especially in case of pressure measurements at Valsalva manoeuvres and coughs. Twenty-five subjects were recruited. The commercially available 7-Fr TDOC AFC, which simultaneously reads water and air pressures in the bladder and rectum, was used to compare filling and voiding data recordings. Data were compared using paired t-tests, Bland-Altman plots and linear correlation methods, respectively. Pressure readings measured by the two systems showed a good correlation at Valsalva manoeuvres [R2 = 0.988, 0.968 for vesical pressure (Pves) and abdominal pressure (Pabd), respectively] and at coughs (R2 = 0.972, 0.943 for Pves and Pabd, respectively). There was a statistically significant difference between the two different measurement modalities at coughs (p < 0.01), initial resting pressure (p < 0.01) and the maximum pressure at detrusor overactivity (p < 0.01). This indicated that the difference between the two measurement modalities during Valsalva manoeuvres could reach up to 5.2 cmH2O and 8.1 cmH2O in Pves and Pabd measurements, respectively. During coughs, the difference could reach up to 20 cmH2O and 19.5 cmH2O in Pves and Pabd measurements, respectively. Pressure recordings from AFC and WFC systems appear to be interchangeable for some urodynamics parameters such as Pves at Valsalva manoeuvres if the baseline pressure is compensated, but not for fast-changing pressure signals such as coughs. This has to be considered when pressures are being taken with the AFC.

Background: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized as aetiologies of organ failure and mortality among a wide variety of patient populations. Since the first global survey in 2007, several surveys have been conducted. However, it remains unclear to what extent health-care professionals in clinical practice are aware of the widely accepted definitions and recommendations proposed in the World Society of the Abdominal Compartment Syndrome (WSACS) guidelines and whether these recommendations are being applied clinically. Methods: We conducted an international cross-sectional survey to determine the impact of the 2013 WSACS IAH/ACS Consensus Definitions and Clinical Management Guidelines on IAH/ACS clinical awareness and management. We also aimed to compare the results to the findings of the global survey conducted in 2007. Results: The survey had 559 respondents with most respondents being physicians from Europe, and who worked in mixed intensive care units (87.3%; n = 448). The majority of respondents (73.2%) were aware of WSACS (the Abdominal Compartment Society), with a greater percentage being aware of the WSACS guidelines compared to the 2007 survey (60.2% vs. 28.4%). A considerable proportion of respondents (18%) never measure intra-abdominal pressure (IAP), with the most common reason for not measuring IAP being reliance on physical examination (39%; n = 38). Analysis of the 11 questions related to knowledge and clinical practice of IAH, ACS and WSACS consensus definitions showed an improvement from the first survey (42.7% of questions answered correctly in comparison to 48.0% in this survey, P = 0.0001). The responses to how physicians managed IAH and ACS were different to the previous survey, with diuretics being used "usually" or "frequently" (49.2%), more than inotropes (38.6%), decompressive laparotomy (37.0%), paracentesis (36.5%), and fluids/blood products (24.2%). Most respondents would perform/request a decompressive laparotomy in cases of ACS. Polycompartment syndrome was something considered by 39% (n = 218) in their daily practice. Almost two thirds of respondents (63.5%; n = 355) thought that gastrointestinal injury should be added to the Sequential Organ Failure Assessment (SOFA) score. Conclusions: This survey shows an improvement in general awareness and knowledge regarding IAP, IAH and ACS, although the level of understanding and awareness of WSACS guidelines remains low. There appear to be some practice changes and greater awareness of the need to monitor abdominal pressures. Future initiatives should focus on education, identifying which patients should receive routine monitoring, and incorporation of IAH and ACS care into ICU bundles and protocols already in existence.

Aims Detrusor overactivity (DO) of the bladder is a finding on urodynamic studies (UDS) that often correlates with lower urinary tract symptoms and drives management. However, UDS interpretation remains nonstandardized. We sought to develop a mathematical model to reliably identify DO in UDS. Methods We utilized UDS archive files for studies performed at our institution between 2013 and 2019. Raw tracings of vesical pressure, abdominal pressure, detrusor pressure, infused volume, and all annotations during UDS were obtained. Patients less than 1 year old, studies with calibration issues, or those with significant artifacts were excluded. In the training set, five representative DO patterns were identified. Candidate Pdet signal segments were matched to representative DO patterns. Manifold learning and dynamic time warping algorithms were used. Five-fold cross validation (CV) was used to evaluate the performance. Results A total of 799 UDS studies were included. The median age was 9 years (range, 1-33). There were 1,742 DO events that did not overlap with annotated artifacts (cough, cry, valsalva, movements). The AUC of the training sets from the five-fold CV was 0.84 ± 0.01. The five-fold CV leads to an overall accuracy 81.35%, and sensitivity and specificity of detecting DO events are 76.92% and 81.41%, respectively, in the testing set. Conclusions Our predictive model using machine learning algorithms provides promising performance to facilitate automated identification of DO in UDS. This would allow for standardization and potentially more reliable UDS interpretation. Signal processing and machine learning interpretation of the other components of UDS are forthcoming.

Aim This study aims to evaluate the intracorporeal pressures immediately after the insertion of the catheters for urodynamic testing with a water‐filled urodynamic pressure transducer system to determine the relevance of the International Continence Society (ICS) zeroing principles. Methods Here, a retrospective analysis of a random series of urodynamic recordings is performed. The initial pressures, immediately after the insertion of the catheters, have been compared with the pressures after some milliliters of filling and flushing away of the gel, used with insertion, and/or the mucus and debris from the inserted catheters. Differences of initially recorded intravesical and intrarectal pressures from those after flushing and filling are analyzed and associated with the ICS standard practice of zeroing. Results Statistically and clinically significant differences between the initial pressures and the pressures after filling and flushing are observed, with nonphysiological initial pressures in 62% of the studies. Some filling (20 ml or more in the bladder) and flushing of the pressure channels resulted in the registration of physiological pressures and synchronous response from both lines on abdominal pressure increases. Conclusions The pressure signal quality of a water‐filled urodynamic system immediately after catheter insertion is low with inaccurately displayed pressure values, but it changes to normal after flushing the pressure channels and some filling. Rezeroing of the intracorporeal pressures immediately after catheter insertion for cystometry is the inappropriate correction procedure that misleadingly modifies the false initial pressures, resulting in ongoing unrealistic urodynamic study pressures.

Intubated ventilator-dependent patients with high-level spinal cord injury can be managed without tracheostomy tubes provided that they have sufficient cognition to cooperate and that any required surgical procedures are completed and they are medically stable. Intubation for a month or more than extubation to continuous noninvasive ventilatory support (NVS) can be safer long term than resort to tracheotomy. Noninvasive ventilation (NIV) is not conventionally being used for ventilatory support. Noninvasive interfaces include mouthpieces, nasal and oronasal interfaces, and intermittent abdominal pressure ventilators. NIV/NVS should never been used without consideration of mechanical insufflation-exsufflation for airway secretion clearance.

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was is it possible to identify predictive risk factors for the development of intra-abdominal hypertension (IAH) or abdominal compartment syndrome after cardiac surgery. Altogether 131 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A total of 755 patients were included, with the incidence of IAH between 26.9% and 83.3%. The limited evidence on IAH after cardiac surgery should be interpreted with caution. Obesity is a strong predictor of postoperative IAH, although not confined to a central pattern and body mass index is correlated with intra-abdominal pressure (IAP). Prolonged cardiopulmonary bypass and aortic cross-clamp time predisposed to IAH in 4 cohorts. IAH in cardiac surgery patients is associated with hepatic and renal impairment, and corresponding biochemical markers may be helpful in screening, although lacking specificity. In contrast to the development of IAH in other settings, the evidence for the role of fluid balance is poor. Accurate prediction of IAH remains elusive. Based on the available evidence, routine IAP measurement should be considered postoperatively in patients with obesity, particularly those with renal or hepatic impairment, prolonged cardiopulmonary bypass or operative time, requiring vasopressor support, to prevent the deleterious effects of IAH.

Background and Aims The renal arterial resistive index (RRI) reflects renal hemodynamics non-invasively using Doppler arterial waveforms. RRI is defined by factors such as age, sex, weight, height or mean arterial pressure. Intra-abdominal hypertension (IAH) is a common complication among post-surgical patients that can affect renal blood flow. We aimed to determine the relationship between intra-abdominal pressure (IAP) and RRI in a sample of incident kidney transplant patients (KTs). Method Single-center prospective cohort of deceased-donor KTs. Anesthesia, surgical technique and immunosuppression induction therapy was the same in all cases. IAP monitoring was performed according to WSACS guidelines using the urinary bladder technique (UnoMeter Abdo-Pressure kit). IAP values were registered every 8h during the first 72h after surgery or until reoperation. Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Doppler ultrasonography was performed 24h after surgery. RRI was calculated using the following formula: (peak systolic velocity – end-diastolic velocity)/peak systolic velocity. The study was approved by the local ethics committee and written informed consent was obtained in all cases. Results 137 patients were enrolled. Table 1 summarizes relevant patient and hemodynamic variables. Stepwise multivariate linear regression analysis was used to examine independent predictors of RRI in this sample, including all variables in Table 1. Age (β=0.005, std.error=0.001, P Conclusion Increased IAP in the first 24h after surgery is common in KTs and is correlated with higher RRI, which is associated with increased risk of graft loss and death.

Background The shape and cross-sectional area (CSA) of internal jugular vein (IJV) are easily affected by external factors. That causes venous collapsibility. We tried to distend IJV by increasing the pressure on patients' abdomen in order to improve the success rate of internal jugular vein catheterization (IJVC). Materials and methods Patients undergoing IJVC were randomly allocated to two groups: Group 1 and Group 2. For patients in Group 1, the pressure on abdomen was increased by placing a 3000 ml bag of normal saline (NS). No special treatment was arranged for patients in Group 2. Transverse images of right IJV were captured at the outer edge which was parallel to the cricoid by ultrasonography. CSA, circumference (CF), transverse diameter (TD) and anteroposterior diameter (APD) of right IJV were measured and compared. All patients underwent ultrasound-guided short-axis puncturing. The success rates of one-off puncturing in two groups were recorded and compared. Results The results under ultrasonography assessments show that CF, CSA, APD and success rate of puncturing in Group 1 were significantly higher than that of Group 2 (P 0.05). There was no significant difference in complications between two groups (P > 0.05). Conclusion Pressure on the abdomen could significantly increase CSA of IJV. That helps improving the success rate of one-off puncturing.

This study presents a comparison of the common Child Restraint Systems (CRS) which reduces the value of dynamic loads affecting the child’s body during car accidents. The analyzed systems were: child seats, booster seats, and straps—adjustable vehicle seat belts adapted to children’s stature. The effectiveness of the analyzed devices was assessed on the basis of experimental tests carried out in the accredited laboratory approving the Child Restraint Systems. The tests were carried out in accordance with the new Regulation No. 129 UN/ECE. The authors examined whether the tested devices meet the guidelines of the new Regulations No. 129 despite approval in accordance with Regulation No. 44. Based on the research results, better safety parameters of some new solutions dedicated to children’s safety could be observed. Almost all the selected CRS met requirements stated in Regulation No. 129. The only exception was for abdominal pressure in one of the tested devices. Head Resultant Acceleration in tested devices was 14.7–39.0% less than the limit determined in Regulation No. 129 whereas Chest Resultant Acceleration was 17.4–37.6% less. Abdominal pressure was 46.4–81.4% beneath the limit (apart from one case which did not meet the requirements). The HPC parameter (Head Performance Criterion) was 45.4–74.5% less. The final results show that there are still some possibilities for improving the safety of young vehicle passengers.

Introduction: Many different approaches for the repair of a perineal hernia (PH) after abdomino-perineal rectum amputation (APR) have been described throughout the years. Literature shows us that the use of a mesh had the best results with relatively low rates of recurrence compared to primary suture. Yet there is still no consensus on the best technique for fixation of the mesh in the perineal cavity. Methods: We want to introduce an addition to the surgical repair technique, using laparoscopic glue to ensure a solid fixation of the mesh. This is to prevent small bowel from sliding into the perineal area due to the high abdominal pressure when standing and to avoid the difficulties and risks of laparoscopical suturing in this area. Results: This use of glue for fixation of the mesh has been successful in the three cases described, with no recurrence after one-year follow-up. Conclusion: A recurrent PH can be prevented by a solid fixation of the mesh using the technique of a glued mesh repair. This technique shows to be easy, fast and without recurrence.

Intra-abdominal hypertension (IAH) is common in critically ill patients. Diagnosis is based on measurement of intra-abdominal pressure, most commonly via the bladder. Modern imaging techniques with plain radiographs, computed tomography and magnetic resonance can help establish the diagnosis and also guide treatment. In 2013 the Abdominal Compartment Society (WSACS) published updated consensus definitions and recommendations for management of IAH and abdominal compartment syndrome (ACS). This review will give a concise overview of the important role radiographic imaging plays within these management guidelines.

Background This study examined the feasibility of transabdominal intestinal ultrasonography in evaluating acute gastrointestinal injury (AGI). Methods A total of 116 patients were included. Intestinal ultrasonography was conducted daily within 1 week after admission to the intensive care unit. Ultrasonography indicators including intestinal diameter, changes in the intestinal folds, thickness of the intestinal wall, stratification of the intestinal wall, and intestinal peristalsis (movement of the intestinal contents) were observed to determine the acute gastrointestinal injury ultrasonography (AGIUS) score. The gastrointestinal and urinary tract sonography ultrasound (GUTS) protocol score was also calculated. During the first week of the study, the gastrointestinal failure (GIF) score was determined daily. The correlations between transabdominal intestinal scores (AGIUS and GUTS) and the GIF score were analyzed to clarify the feasibility of evaluating AGI through observation of the intestine. The utility of intestinal ultrasonography indicators in predicting feeding intolerance was investigated to improve the ability of clinicians to manage AGI. Results A total of 751 ultrasonic examinations were performed with 511 images (68%) considered to be of “good quality.” AGIUS and GUTS scores differed significantly between AGI patients (GIF score 0–2) and non-AGI patients (GIF score 3–4) (p r = 0.54, p r = 0.66, p 10/min) have increased risk for feeding intolerance (16/83 vs. 25/33, p Conclusions The transabdominal intestinal ultrasonography represents an effective means for assessing gastrointestinal injury in critically ill patients. Intestinal ultrasonography indicators, especially the degree of intestinal peristalsis, may be used to predict feeding intolerance. Trial registration ClinicalTrial.gov, NCT03589248. Registered 04 July 2018—retrospectively registered.

To determine intraabdominal pressure (IAP) in women during CrossFit and to determine whether parity, age, or CrossFit experience affects IAP during CrossFit exercises, we evaluated 10 women: 5 experienced and active CrossFitters and 5 who were not regularly engaged in CrossFit. A Laborie urodynamics abdominal pressure probe with the Goby wireless system measured IAP during 10 repetitions of 13 different CrossFit exercises. Women had a mean age of 36 years. A significant difference was found between mean peak IAP of the 5 parous vs the 5 nulliparous women (P = 0.009). Experience with CrossFit did not affect mean peak IAP achieved with exercise. In some exercises, there was a significant change in IAP as participants progressed through repetitions (P = 0.003 for back squats and 0.04 for sit-ups). Participants achieved IAP values that were markedly higher than those previously published.

Breathing dysfunction is the most frequently meeting complication during intraoperative period in morbid obese patients. Using positive end expirative pressure (PEEP) is one of the most important point during mechanical ventilation. For support of adequate minute ventilation it‘s recommended use PEEP 8 cm. H 2 O. The aim of the study is to find the optimal level of PEEP in morbid obese during bariatric surgery. Materials and methods . In our study we included 30 patients. In 10 patients we did not use PEEP. 12 patients were ventilated wis PEEP 5 cm. H 2 O. and among 8 patients we have using PEEP 8 cm. H 2 O. during operation we have controlling blood gases, mechanical parameters of breathing, abdominal pressure and have calculating abdominal perfusion pressure. Conclusion . Using PEEP 8 cm H 2 O and higher in morbid obese reduce abdominal perfusion pressure but do not influence on blood gases.

Aims This study aimed to identify signs and symptoms which show differences between men with detrusor underactivity (DU) compared to those with both DU and bladder outlet obstruction (BOO). Methods One thousand six hundred and twelve urodynamic tests on male patients were analyzed retrospectively. Signs and symptoms which showed a statistically significant difference between patients with DU alone and patients with both DU+BOO were identified. Results In the DU only group, considering only patients without a history of bladder outlet surgery, the number of daytime micturitions was lower, maximum voided volume on the bladder diary was higher, and slow stream was reported less often, whereas urinary tract infections were reported more often than for DU+BOO males. The average urine flow rate and abdominal pressure at maximum flow were greater in the DU males, compared to the DU+BOO males. Conclusions These data suggest that by combining symptoms, medical history and signs, that could be measured without the need for invasive urodynamics, it may be possible to identify men with DU in a non-invasive way. By doing so, men with DU could be separated from men with both DU+BOO, with sufficient specificity to allow the use of any new non-surgical treatment modalities, such as new and effective medical therapy.

A functional review of 156 patients with a median hernia of anterior abdominal wall. The data series are included in the algorithm of multifunctional surgical treatment of medial hernias. The greatest number of matches with the algorithm (53,1%) was found when using the five-factor functional analysis. Among the four-factor diagnostic options in choosing a reliable method of hernioplasty combined proved sharing criteria for intra-abdominal pressure, electrofasciomyographya taking into account the size and location of medial hernia defects (41,3%).

Introduction Though surgical drainage is used as a safety measure, it's not without complications. Migration of various drains has been described, but very little literature refers to the migration of peritoneal drain. Presentation of case A 55-year male underwent anterior Gastro-Jejunostomy for inoperable metastatic carcinoma of the Gastric Pylorus. We found the peritoneal drain missing on the third post-operative day. On further evaluation, we found it to have migrated into the peritoneal cavity. We opened the operative wound for a partial length and retrieved the drain. Discussion We did research to find why drain migrates and searched literature on migration of peritoneal drains. The possible etiologies for drain migration are (1) Drain hasn't been fixed properly (2) Cutting through of suture material (3) Relatively low abdominal pressure (4) Pressure over the drain by patient's body weight when he lies on the same side as drain. Conclusion Every use of drain should be weighed for its needs and risks. Proper precautions during drain placement avoid unnecessary complications, morbidity and prolonged hospital stay.

Aims The standard sensor for abdominal pressure (Pabd) measurement in urodynamics (UD) is a rectal sensor. In patients where the rectum is not available due to prior surgery or when external anal sphincter (EAS) tone is poor, rectal sensor may slip, making Pabd recording unreliable. Vaginal Pabd measurement and wireless vaginal sensors have been tried. We present our preliminary series of a novel nasogastric tube (NG) sensor for Pabd measurement. Methods We identified patients undergoing UD with a NG Pabd sensor from a prospectively maintained UD database of a tertiary care urological center between July 2013 and December 2016. Results Out of 1325 urodynamic procedures done, 46 (3.5%) were performed using NG Pabd sensor. The median (IQR) age was 44 (12) years. Indications for UD in these patients were neurogenic bladder in 22 (47.8%), urinary retention in 17 (37%), post-meningomyelocele repair in four (8.7%), traumatic paraplegia in two (4.3%), and cervical myelopathy in one (2.2%). The indications for NG Pabd sensor were lax EAS tone (40; 86.9%), post-abdominoperineal resection (2; 4.3%), and painful thrombosed hemorrhoids (4; 8.7%). It was possible to make definitive urodynamic diagnosis in all patients using NG Pabd sensor. Initial calibration and NG Pabd excursions throughout the study were similar to that of rectal Pabd sensor. There were no problems with NG tube tolerance. Conclusion Use of nasogastric sensor is feasible, accurate, cost-effective, and viable alternative for Pabd measurement in patients with poor anal tone or absent rectum due to postoperative status.

Introduction This study was designed to identity risk factors for parastomal hernia occurring after abdominoperineal resection for rectal cancer. Methods The study group was comprised of 158 patients with rectal cancer who underwent abdominoperineal resection in our department from January 1990 through December 2014. Twelve variables were studied as risk factors for parastomal hernia. Results Parastomal hernia developed in 27 patients, including 19 patients who underwent colostomy creation via an intraperitoneal route and 8 patients who underwent colostomy creation via an extraperitoneal route. On univariate analysis, a BMI ≥25 kg/m2 was significantly related to the development of parastomal hernia (P = 0. 018), and an ASA physical status ≥2 was slightly but not significantly related to parastomal hernia (P = 0. 076). Multivariate analysis showed that a BMI ≥25 kg/m2 was an independent risk factor (odds ratio = 2.9698; P = 0. 016). Conclusion Patients with a BMI ≥25 kg/m2 should be instructed about lifestyle modifications to control preoperative bodyweight and to reduce abdominal pressure.

Summary Aims Nomograms based on Valentini-Besson-Nelson (VBN) model implying only 3 measurements (filling bladder volume, maximum flow-rate [Q max ] and detrusor pressure at Q max ) were recently developed to evaluate detrusor contractility ( k ) and urethral obstruction ( U ) in women. As their algebraic fitting leads to fast evaluations (Excel ® software), our aims were applications to populations of non-neurologic women without and with bladder outlet obstruction (BOO). Methods The software was applied to measurements obtained during pressure flow studies. Hidden hypothesis of nomograms were no significant contribution of abdominal pressure between onset of flow and Q max and standard nervous excitations until Q max . Studied populations were 202 women without symptom suggestive of obstruction and 125 women with proven anatomical urethral obstruction who underwent urodynamic study. Results For non-obstructed women, a good agreement was found between the values of k and U obtained using nomograms or a complete VBN analysis of the recorded curves. Whatever the obstructive status, there was a good correlation between the value of k and U . Evolution with ageing was similar with higher values of k and U in the BOO group. Curves k (age) and U (age) gave coefficients allowing an age adjustment. The high k value in the detrusor overactive (DO) group was consistent with a similar effect to that of BOO on the detrusor. Conclusion Evaluation of detrusor contractility ( k ) and urethral obstruction ( U ) can be obtained from the point of Q max during pressure-flow study. Evolution with ageing is similar with (higher values) or without BOO. DO also induces an increased detrusor contractility. Level of evidence 4.

Introduction: Elevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%. Aim: The aim of this study was to observe if a link between increased intraabdominal pressure and modification in renal function exists (NGAL, creatinine clearance). Material and Method: The study enrolled 30 critically ill patients admitted in the Intensive Care Unit of SCJU Tîrgu Mures between November 2015 and August 2016. The study enrolled adult, hemodynamically stable patients admitted in intensive critical care - defined by a normal blood pressure maintained without any vasopressor or inotropic support, invasive monitoring using PICCO device and abdominal pressure monitoring. Results: The patients were divided into two groups based on the intraabdominal pressure values: normal intraabdominal pressure group= 52 values and increased intraabdominal group= 35 values. We compared the groups in the light of NGAL values, 24 hours diuresis, GFR and creatinine clearance. The groups are significantly different when compared in the light of NGAL values and GFR values. We obtained a statistically significant correlation between NGAL value and 24 hour diuresis. No other significant correlations were encountered between the studied items. Conclusions: NGAL values are increased in patients with high intraabdominal pressure which may suggest its utility as a cut off marker for patients with increased intraabdominal pressure. There is a significant decreased GFR in patient with elevated intraabdominal pressure, observation which can help in early detection of renal injury in patients due to high intraabdominal pressure. No correlation was found between creatinine clearance and increased intraabdominal pressure.

Highlights • We present a rare case of a congenital splenic cyst that corresponds to less than 10% of non-parasitic splenic cyst. • We describe our laparoscopic approach management of a partial splenectomy • We review the literature on the different treatment options for NPSC based on recurrence and success rates., Non-parasitic splenic cysts (NPSC) are a rare condition that makes difficult to know their true incidence and represent 10% of all benign splenic cysts, they can be either congenital with the presence of epithelial lining that originate from invagination of the capsular mesothelial lining or post-traumatic with absence of epithelial lining. We present our management of a splenic congenital cyst in a pediatric patient. A 10-year-old female patient presented to the clinic complaining with a 3-week abdominal pain at the left upper quadrant. An ultrasound showed an enlarged spleen with a thinned walled cystic image on the lower pole of 5 cm. An abdominal CT confirmed the presence of a splenic cyst at the lower pole of the spleen of 5 cm in diameter. Three-port laparoscopic partial splenectomy was done isolating and dividing the lower splenic artery and vein and the lower pole of the spleen with a vessel sealing device. Management of a non-parasitic splenic cyst is controversial: cystectomy, fenestration, percutaneous drainage and sclerotherapy have been previously described, most of them aiming to preserve spleen function and avoiding overwhelming post-splenectomy infection. Partial splenectomy seems the most effective one in terms of preserving spleen function and avoiding recurrence.

The aim of this study was to evaluate the correlation between serum and tissue level of the Neutrophil gelatinase-associated lipocalin (NGAL), a peptide that seems to be predict the postoperative evolution of patients with high abdominal pressure. From 30 consecutive patients hospitalized in the Intensive Care Unit, we have randomly selected five cases that undergo abdominal surgical interventions, received postoperative mechanical ventilation and abdominal pressure was monitorized for at least 48 hours. In all of these cases, the plasmatic level of NGAL was measured using the Elisa method and immunohistochemical (IHC) stains with the anti-NGAL biomarker were performed in the surgically removed tissues. All of the five patients were overweight, showed high serum level of NGAL (over 950 ng/ml) and died with postoperative or septic shock. The NGAL serum level was not correlated with the abdominal pressure. No IHC positivity was observed in the examined tissues, except NGAL positivity for intravascular neutrophils. In conclusion, the postoperative high serum NGAL level may indicate unfavorable evolution. NGAL seems to be syntesized by the circulating neutrophils and its preoperative tissue expression does not reflect the serum value.

ABDOPRE is a device that reduces the abdominal pressure of intensive care patients with intraabdominal hypertension. The controlled reduction following a time protocol is consequence of the application of an external negative pressure inside a vacuum bell affixed to the patient’s abdomen. Originally developed in 2007, ABDOPRE was tested in four intensive care patients with intrabdominal pressures (12 to 15 mmHg). In three of these patients a reduction of 5 mmHg, 3 mmHg and 2 mmHg was accomplished. Afterwards, a new, cheaper, smaller and lighter version of ABDOPRE was developed using an ARDUINO UNO board for the control system and an ARUINO UNO SHIELD for the electrical interface. This version has an optimized Software and includes two bell sizes of 14 and 24 L respectively.