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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.

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.

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.

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.

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

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 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.

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.

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.

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.

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.

Background Without timely diagnosis, acute primary abdominal compartment syndrome (ACS) is a potentially fatal syndrome and often goes unrecognized until severe symptoms appear. Early diagnosis may significantly improve the prognosis of these patients. Case presentation We present the case of a 54-year-old man, successfully treated for acute myeloid leukemia with cytosine arabinoside, admitted to the intensive care unit with severe shock, refractory to standard therapy with antibiotics, fluid resuscitation, and vasopressors. Early diagnosis of acute primary abdominal syndrome was made based on an intra-abdominal pressure of 20 mm Hg (3 kPa) with new onset organ failure, after which decompressive laparotomy was performed. Stool cultures grew Clostridium difficile. Despite abdominal decompression, the abdominal compartment syndrome persisted with the development of toxic megacolon and a total colectomy was performed with favorable evolution. Methods A systematic review of published case reports was performed describing a primary ACS due to C. difficile toxic megacolon. A PubMed database search was performed with the following search terms, single or in combination: 'clostridium difficile', 'toxic megacolon', 'abdominal compartment syndrome', and 'CDI'. The latest search was performed for March 2019; only case reports after 1998 were included. Results We found a total of 19 case reports with C. difficile toxic megacolon (including the present case). The male/female ratio was 12/7, and there were 3 children. The mean age was 48.7 ± 23.5 years. The reason for admission was sepsis in 6, trauma in 2, postoperative in 4, enterocolitis in 5, pregnancy in 1 and abdominal complaints after topical antibiotics in 1. Three patients did not develop diarrhea. Five patients presented with diarrhea on average 5.8 ± 5.1 (median 4, 1-14) days prior to hospital admission while 7 patients developed diarrhea on average after 10 ± 19.6 (median 3, 0-54) days during admission. The intra-abdominal pressure (measured in 6 patients, including ours) was 29.2 ± 11 (20-50) mm Hg (3-7 kPa). Treatment consisted of (a combination of) vancomycin (orally or via rectal enemas), metronidazole (orally or intravenously), and surgical intervention (with decompressive laparotomy). Three patients died (15.8%). Conclusions Monitoring of intra-abdominal pressure allows early detection of abdominal compartment syndrome and is warranted in patients with C. difficile infection and/or toxic megacolon. Early decompression can lead to improved outcomes in patients with severe shock and organ failure.

Background Pneumoperitoneum is defined as the existence of extraluminal air in the abdominal cavity. In 80–90% of cases is due to perforation of a hollow organ. However, in 10–15% of cases, it is nonsurgical pneumoperitoneum. Objective The case of a patient undergoing mechanical ventilation, developing abdominal compartment syndrome tension pneumoperitoneum is reported. Clinical case Female, 75 years old asking for advise due to flu of long term duration. Given her respiratory instability, admission to the Intensive Care Unit is decided. It is then intubated and mechanically ventilated. Chest X-ray revealed a large pneumoperitoneum but no pneumothorax neither mediastinum, and due to the suspicion of viscera perforation with clinical instability secondary to intra-abdominal hypertension box, emergency surgery was decided. Conclusions When discarded medical history as a cause of pneumoperitoneum, it is considered that ventilation is the most common cause. Benign idiopathic or nonsurgical pneumoperitoneum, can be treated conservatively if the patient agrees. But if intraabdominal hypertension prevails, it can result in severe respiratory and haemodynamic deterioration, sometimes requiring abdominal decompression to immediately get lower abdominal pressure and thus improve haemodynamic function.

ResumenAntecedentesEl neumoperitoneo se define como la existencia de aire extraluminal en la cavidad abdominal. En el 80-90% de las ocasiones se debe a la perforación de una víscera hueca. No obstante, en un 10-15% de los casos se trata de neumoperitoneos no quirúrgicos.ObjetivoPresentamos el caso de una paciente sometida a ventilación mecánica que desarrolla un síndrome compartimental abdominal por neumoperitoneo a tensión.Caso clínicoPaciente mujer de 75años que consulta por síndrome gripal de días de evolución. Dada su inestabilidad respiratoria se decide su ingreso en la unidad de cuidados intensivos y se procede a su intubación orotraqueal con conexión a ventilación mecánica. En la radiografía de tórax se observa un gran neumoperitoneo sin neumotórax ni neumomediastino, por lo que, con la sospecha de perforación de víscera hueca y ante la inestabilidad clínica secundaria al cuadro de hipertensión intraabdominal, se decide su intervención quirúrgica urgente.ConclusionesCuando se descartan antecedentes médicos como causa de neumoperitoneo, se considera que la ventilación es la causa más frecuente.El neumoperitoneo benigno, idiopático o no quirúrgico, puede tratarse de forma conservadora si la clínica del paciente lo permite. Pero si existe un cuadro de hipertensión intraabdominal, puede producirse un grave deterioro hemodinámico y respiratorio que en ocasiones obliga a la descompresión abdominal de forma inmediata para conseguir disminuir la presión intraabdominal y, por tanto, mejorar la función hemodinámica del paciente.AbstractBackgroundPneumoperitoneum is defined as the existence of extraluminal air in the abdominal cavity. In 80-90% of cases is due to perforation of a hollow organ. However, in 10-15% of cases, it is nonsurgical pneumoperitoneum.ObjectiveThe case of a patient undergoing mechanical ventilation, developing abdominal compartment syndrome tension pneumoperitoneum is reported.Clinical caseFemale, 75 years old asking for advise due to flu of long term duration. Given her respiratory instability, admission to the Intensive Care Unit is decided. It is then intubated and mechanically ventilated. Chest x-ray revealed a large pneumoperitoneum but no pneumotorax neither mediastinum; and due to the suspicion of viscera perforation with clinical instability secondary to intra-abdominal hypertension box, emergency surgery was decided.ConclusionsWhen discarded medical history as a cause of pneumoperitoneum, it is considered that ventilation is the most common cause.Benign idiopathic or nonsurgical pneumoperitoneum, can be be treated conservatively if the patient agrees. But if intraabdominal hipertension prevails, it can result in severe respiratory and hemodynamic deterioration, sometimes requiring abdominal decompression to immediately get lower abdominal pressure and thus improve hemodynamic function.

Purpose We developed a new technique, sutureless mesh fixation, using 2-octyl cyanoacrylate (Dermabond®, a surgical tissue adhesive) for incisional hernia repair. The objective of this article is to introduce the new technique and to examine whether the technique provides sufficient resistance to abdominal pressure.

Summary Rectal prolapse has been attributed to conditions generating tenesmus or increasing abdominal pressure in both horses and donkeys. This report presents the case of a 7-year-old gelded donkey that sustained a type IV rectal prolapse secondary to a long-standing cystic calculus after several episodes of intermittent mucosal prolapse. Rectal prolapse was addressed first on an emergency basis by colorectostomy. After medical stabilisation, pain and straining management with repeated epidural drug administrations, a laparoscopic-assisted cystotomy was performed one week later to remove the calculus. The donkey was discharged and resumed his normal life at pasture.

Abdominal compartment syndrome with increased abdominal pressure resulted in multi-organ dysfunctions can be lethal in children. The open abdomen procedure intentionally leaves the abdominal cavity open in patients with severe abdominal sepsis and abdominal compartment syndrome by temporarily relieving the abdominal pressure. We reported our experience of open abdomen procedure in successfully treating a 4-year old boy with abdominal compartment syndrome caused by severe fungal peritonitis and sepsis after gastric perforation.

Urethral pressure reflectometry (UPR) has proven highly reproducible in women with pelvic organ prolapse. We hypothesized that urethral parameters would decrease after anterior colporrhaphy. A prospective, observational study where women with anterior vaginal wall prolapse ≥stage II were assessed before and after anterior colporrhaphy. Assessments consisted of prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining (at a standardized abdominal pressure of 50 cmH2O, PO-Abd 50), standardized stress tests with 300 ml saline, and answering the International Consultation on Incontinence – Urinary incontinence short form. Stress urinary incontinence (SUI) was defined as a positive stress test and a questionnaire with symptoms of SUI and a bother score > 1. Sample size was 30, power was 100% and the level of significance was 5%. We analyzed data with paired t-tests or non-parametric Wilcoxon signed rank tests; p-values

Colonoscopy outcome is limited by endoscope looping, which leads to patient discomfort, prolonged procedure, and increased sedation requirement. Traditional manual abdominal pressure is imprecise and manually intensive. A hands-free abdominal compression device (ACD) may improve colonoscopy outcome. We aimed to assess the effect of a novel ACD on colonoscopy outcomes compared to manual pressure.This was a prospective single-blinded study of patients undergoing outpatient colonoscopy. The ACD (N-Doe Pillow™) was applied on 50 consecutive patients. Endoscopists were blinded to device usage. Control cases using manual pressure were randomly selected in a 2:1 manner. Primary outcome was cecal intubation time. Secondary outcomes included sedation requirement and complications. Subgroup analyses evaluated ACD effect on endoscopists with different experiences and patients at higher risk of difficult colonoscopy. Fisher's exact and Student's t-tests were performed for univariate analyses. Multivariate analysis was performed using generalized linear regression.Fifty patients undergoing colonoscopy with ACD assistance were compared to 100 matched controls. Mean cecal intubation time was significantly reduced in the ACD group compared to controls (6.38 minutes versus 11.8 minutes, P .0001). Multivariate analysis showed that ACD use was independently associated with reduction in cecal intubation time (β-coeff: -4.11, P = .007). Subgroup analyses revealed a trend toward increased improvement in cecal intubation time among junior endoscopists and obese patients.A novel, hands-free ACD significantly decreased cecal intubation time in this prospective, single-blinded, match-controlled study. A trend toward more improvement was seen among junior faculty, suggesting an application for trainees and/or endoscopists with smaller case volumes.

WOS: 000423437800003, PubMed ID: 29142831, Background: Bleeding after thyroidectomy is life-threatening. The aim of the study was to evaluate whether controlling of further bleeding with Valsalva maneuver following Trendelenburg's positioning has an impact on hemostasis. Methods: This prospective study included 68 consecutive patients undergoing thyroidectomy. Study protocol consisted of performing manual intra-abdominal pressure increase and Valsalva maneuver to check hemostasis and treating any bleeding point identified, after Trendelenburg's positioning. All identified bleeding points and treatments were recorded. Results: Total number of bleeding points identified in Trendelenburg's tilt was 49, while it was 41 when using Valsalva maneuver. Abdominal pressure increase, carried out before Valsalva maneuver, identified 14 bleeding points, which was less than bleeding after Trendelenburg's positioning and Valsalva maneuver (P

Venous incompetence in the lower extremity is a common clinical problem. Basic understanding of venous anatomy, pathophysiologic mechanisms of venous reflux is essential for choosing the appropriate treatment strategy. The complex interplay of venous pressure, abdominal pressure, venous valvular function and gravitational force determine the venous incompetence. This review is intended to provide a succinct review of the pathophysiology of venous incompetence and the current role of imaging in its management.

No abstract available. Article truncated after 150 words. A 29 year old woman with history of a Whipple procedure for pancreatic cancer and nonalcoholic steatohepatitis cirrhosis presented with a massive upper gastrointestinal bleeding (UGIB) likely from esophageal varices and developed hemorrhagic shock. Emergent upper endoscopy could not be performed due to hemodynamic instability. Therefore, a Minnesota Tube was placed emergently for balloon tamponade of the bleeding. A transjugular intrahepatic portosystemic shunt was also placed emergently to decrease bleeding by reducing portal pressure. By this time, the patient had received 4 liters of normal saline, 14 units of packed red blood cells, 6 units of platelets, and 4 units of fresh frozen plasma. The Minnesota tube did control the bleeding somewhat, however, there was continued bloody drainage from the stomach port of the Minnesota tube. The patient’s abdomen became remarkably distended and was dull to percussion throughout. A CT scan of the abdomen and pelvis revealed severe dilatation of ...

The aim of our study was to compare air-charged and water-filled catheters simultaneously in the measurement of the intravesical, abdominal and detrusor pressure during urodynamic investigations.Consecutive women with lower urinary tract symptoms, referred for urodynamics were prospectively studied. Readings of intravesical pressure (p(ves)), abdominal pressure (p(abd)) and detrusor pressure (p(det)), recorded by both the air-charged and water-filled catheters, were displayed simultaneously and compared at the end of filling, on standing, on sitting prior to voiding and at the maximum involuntary detrusor contraction. The signals (pressures) recorded by both types of catheter were compared using the Bland-Altman plot and paired samples t test.Twenty women with a mean age of 49 (range 36-72) were recruited. One patient with normal urodynamics was excluded in view of the poor quality trace. At each of the four comparison points, the air-charged catheters consistently produced higher mean pressures than the water-filled catheters. There were wide variations in the difference between the readings produced by the two types of catheter.Pressures measured using air-charged catheters are not comparable with water-filled catheters and are therefore not interchangeable. Caution must be used when comparing urodynamic parameters using air-charged and water-filled catheters.

Urodynamic investigations can provide an explanation for lower urinary tract symptoms, such as incontinence. A careful history and examination should be performed prior to urodynamic testing. Some urodynamic investigations are non-invasive, such as flow studies, while the majority used in the diagnosis of urinary symptoms are invasive, involving urethral catheterization and placement of an abdominal pressure catheter. Bladder and abdominal pressures are measured during filling and voiding. Urodynamic equipment calculates detrusor pressure by subtracting abdominal from bladder pressure (pves − pabd=pdet). Urodynamics should be performed in accordance with standards published by the International Continence Society. Terminology used for lower urinary tract symptoms should also comply with International Continence Society standards. There is little morbidity associated with urodynamics, apart from a low risk of urinary tract infection and occasional discomfort. However as they are invasive, all clinicians referring patients for urodynamics should appreciate their use and application for clinical management.

Aim: The purpose of the study is to verify the hypothesis that there is a correlation between the degrees of myorelaxation obtained by neuromuscular blockage during general anesthesia with changes in IAP values. Material and methods: The present study was carried out in surgery department, during September 2016 - October 2016. The plot consisted of 9 patients who undergone surgeries in the extra-abdominal area: 2 total thyroidectomies, 3 subtotal thyroidectomies, 3 simple mastectomy and one axilo-femoral bypass. Results: By comparing the results obtained in the nine cases, it was observed a statistically insignificant increase of intraabdominal pressure at train of four ratio values of 0, 1 or 2, intraabdominal pressure instead showed statistically significant variations in train of four ratio values of 3 or 4, observed especially at the reversal of anesthesia and patient waking up. Conclusions: Train of four ratio is an accurate indicator of the degree of neuromuscular blockage. Train of four ratio values of 0-2 changed statistically insignificant the intra-abdominal pressure. Increase train of four ratio over 3 led to sudden increases in intra-abdominal pressure.

Purpose The impact of a capnoperitoneum on the known blood pressure (BP) difference of the upper and lower limb was studied in piglets. Methods Eleven German Landrace piglets (body weight, 4.3-7.4 kg; mean body weight, 6.2 kg) were studied. Arterial lines were placed in the right carotid and right femoral artery for pressure monitoring. Intraabdominal pressure levels were increased in steps of 6 mm Hg up to 24 mm Hg. Results We found that elevated intraabdominal pressures up to 24 mm Hg did not change the preexisting systolic BP difference between the carotid and femoral arteries. Systolic femoral artery pressure constantly remained 5% higher than its carotid counterpart. In addition, mean and diastolic values were not affected. Conclusions Arterial BP measurements recorded at the legs of piglets when abdominal pressure is increased by up to 24 mm Hg can be used for intraoperative assessment of systemic arterial BP.

Objective: To assess the amount of abdominal pressure generated by the Non-pneumatic Anti-Shock Garment (NASG), a first-aid counter pressure device for obstetric hemorrhage, and to evaluate if body mass index (BMI) and ap- plier strength, affect pressure. Study Design: A pilot study convenience sample of 20 non-pregnant volunteers underwent external abdominal pressure monitoring with NASG placement. Mean pressure and the effects of BMI and applier strength were examined. Results: The mean external abdominal pressure significantly increased from 1.0 mmHg at baseline to 67 mmHg on NASG application, returning to 1.0 mmHg upon removal (p=0.005). Greater mean pressure was exerted by a strong applier ver- sus a weak applier, irrespective of BMI (p

Summary Organ donor shortage for infant liver transplant recipients has lead to an increase in splitting and living donation. For cases in which even transplantation of the left lateral graft (Couinaud’s segments II + III) results in a ‘‘large for size situation’’ with an estimated graft body weight ratio (GBWR) of >4%, monosegmental liver transplantation was developed. This, however, bears complications because of greater parenchymal surface and suboptimal vascular flow. We exclusively use the left lateral graft from living donors or split grafts. Temporary abdominal closure is attempted in cases of increased pressure. We report of 41 pediatric transplants in 38 children £10 kg. Within this group, there were 23 cases with a GBWR of ‡4, and 15 cases with a GBWR

Zusammenfassung Infektionsversuche an Rindern mit dem Herpesvirus suis Typ 1 ergaben, das die Verbreitung des Virus im Tierkorper und das hieraus resultierende klinische Bild durch die Eintrittspforte des Virus bestimmt wird. So fand sich das Virus nach der Exposition des Respirationstraktes (intranasale bzw. bronchiale Instillation; Aerosolinhalation) u.a. in nervalen Organen des Kopfes und im Ruckenmark bis in Hohe des 7. Halswirbels (kraniales Virusverteilungsmuster). Demgegenuber breitete sich das Virus nach Applikation auf die unverletzte Rektal- und Vaginalschleimhaut sowie nach subkutaner Injektion im Lendenbereich, aber auch nach oraler Verabfolgung, vorwiegend im kaudalen Korperbereich aus und drang im Ruckenmark nicht uber den 1. Brustwirbel kranial vor (kaudales Virusverteilungsmuster). Das dem kranialen Virusverteilungsmuster entsprechende klinische Bild zeichnete sich durch kurze Krankheitsdauer mit Unruhe, Juckreiz im Kopfbereich, Zuckungen der Kopf- und Halsmuskulatur, lokale Lahmungen im Kopfbereich und Pansentympanie aus. Bei den Tieren mit kaudalem Virusverteilungsmuster wurden neben einer langeren Krankheitsdauer schwach ausgepragter lokaler Juckreiz im kaudalen Korperbereich, Koliksymptome, Betatigung der Bauchpresse und Zuckungen der Bauchmuskulatur beobachtet. Trotz Applikation hoher Virusdosen fuhrte die Exposition der unverletzten auseren Haut (≥ 107 KID50), der Lidbindehaut (104,8 bzw 106 KID50) und der Vormagenschleimhaut (106,8 bzw. 107,0 KID50) nicht zur Infektion. Demgegenuber gelang die subkutane Infektion mit einer Virusdosis von 50 KID50. Es ergaben sich Hinweise darauf, das das Herpesvirus suis Typ 1 beim Rind an der Eintrittspforte ohne wesentliche lokale Vermehrung in periphere Nerven eindringt und in diesen wahrend der Inkubationszeit das zentrale Nervensystem (ZNS) erreicht. Seine zentrifugale Verbreitung im und uber das ZNS hinaus bedingt die klinische Symptomatik. Summary Pathogenesis and clinical picture of Aujesky's Disease in cattle after experimental infection by respiratory, alimentary and reproductive organs and by the skin Infection experiments in cattle with Herpesvirus suis Type 1 showed that spread of the virus in the body and the ensuing clinical picture are determined by the portal of entry of the virus. Thus when the virus was given via the respiratory tract (intranasal or intrabronchial instillation; aerosol inhalation) virus was found above all in the nervous tissue of the head and in the spinal cord to the level of the 7th cervical vertebra (cranial dispersion of virus). In contrast, after virus introduction to the undamaged rectal and vaginal mucosa and after subcutaneous injection in the lumbar region, but also after oral administration, virus was found mainly in the caudal regions of the body and did not penetrate the spinal cord more anteriorly than the first thoracic vertebra (caudal virus dispersion). Cranial virus dispersion resulted in a clinical picture characterized by a short illness with unrest, itching in the head region, spasms of the head and neck musculature, local paralysis in the head region and tympany of the rumen. In animals with caudal dispersion of the virus the period of illness was longer, there was mild local itching in the caudal regions, clinical signs of colic, activation of abdominal pressure and spasms of the abdominal muscles. Despite the use of large doses of virus, exposure of the undamaged skin to virus (≥ MID50), the eyelid (104,8 or 106 MID50) and the forestomach mucosa (106.8 or 107.0 MID50) infection did not take place. In comparison, subcutaneous injection of a dose of virus of 50 MID50 produced infection. It would appear that Herpesvirus suis Type 1 enters without significant local proliferation in the peripheral nerves and during the incubation period it reaches the CNS. Its centrifugal spread into and through the CNS results in the clinical picture. Resume Pathogenese et clinique de la maladie d'Aujeszky du bovin apres une infection experimentale par l'appareil respiratoire, le tube digestif, les organes genitaux et la peau Des essais d'infection sur des bovins avec le virus Herpes type 1 du porc ont montre que l'extension du virus dans l'organisme et que l'image clinique qui en resultait etaient determinees par l'endroit de la penetration du virus. Apres l'exposition de l'appareil respiratoire (instillation intranasale et bronchique; inhalation par aerosol), le virus se retrouvait entre autres dans les organes nerveux de la tete et de la moelle epiniere jusqu'a la hauteur de la 7e vertebre cervicale (type cranial de la repartition du virus). Apres une application par la muqueuse intacte du rectum et du vagin et apres une application orale, le virus s'est etendu par contre principalement dans la partie caudale du corps et n'a pas penetre cranialement dans la moelle epineilre au-dela de la lere vertebre dorsale (type caudal de la repartition du virus). Le type cranial de la repartition du virus a correspondu a une image clinique marquee par une maladie de breve duree avec une agitation, des demangeaisons dans la region de la tete, des crampes de la musculature de la tete et du cou, des paralysies locales au niveau de la tete et une tympanie de la panse. Chez les animaux avec un type caudal de la repartition du virus, on a observe a cote d'une duree plus longue de la maladie des demangeaisons locales peu etendues dans la partie caudale du corps, des symptomes de colique, une activation de pressions abdominales et des crampes de la musculature abdominale. Des applications de doses virales elevees par exposition externe sur la peau non blessee (≥ 107 KID50), sur la conjonctive de la paupiere (104,8 et 106 KID50) et sur la muqueuse des estomacs (106,8 et 107,0 KID50) n'ont pas provoque d'infection. L'infection sous-cutanee avec une dose virale de 50 KID50 a par contre reussi. Il en resulte que le virus Herpes porcin du type 1 penetre dans un endroit sans multiplication locale marquee dans les nerfs peripheriques et atteint par ces nerfs le systeme nerveux central pendant le temps d'incubation. Son extension centrifuge dans et par le systeme nerveux central determine la symptomatologie clinique. Resumen Sobre la patogenia y clinica de la enfermedad de Aujeszky en vacunos tras infeccion experimental a traves de los aparatos respiratorio, digestive y genital asi como por la piel Ensayos de infeccion en vacunos con el virus herpes suis tipo 1 revelaron que la difusion del virus en el organismo animal y el cuadro clinico de aqui resultante se verifican por la puerta de entrada del virus. Asi se hallo el virus tras la exposicion del tracto respiratorio (instilacion intranasal resp. bronquial; inhalacion de aerosoles), entre otros sitios, en los organos neurales de la cabeza y en la medula espinal hasta la altura de la 7a vertebra cervical (modelo de distribucion craneal del virus). Frente a esto se difundio el virus tras aplicacion sobre las mucosas rectal y vaginal, no lesionadas, asi como tras inyeccion subcutanea en la region lumbar, aunque tras la administracion oral, sobre todo en el tramo caudal del cuerpo y penetraba en la medula espinal en direction craneal sin llegar a rebasar la 1a vertebra toracica (modelo de distribucion caudal del virus). El cuadro clinico correspondiente al modelo de distribucion craneal del virus estaba caracterizado por una duracion breve de la enfermedad con agitacion, prurito en el ambito cefalico, contracciones de las musculaturas cefalica y cervical, paralisis locales en el ambito cefalico y timpanismo ruminal. En los animales con modelo de distribucion caudal de virus se observaron, al lado de una duracion mas larga de la enfermedad, prurito local de revelation debil en el ambito corporal caudal, sintomas de colico, actuation de la prensa abdominal y sacudidas musculares abdominales. A pesar de aplicar dosis elevadas de virus no conducia la exposicion de la piel externa intacta (≥ 107 KID50), de la conjuntiva palpebral (104,8 resp. 106 KID50) y de la mucosa preestomacal (106,8 resp. 107,0 KID50). Frente a esto se logro la infeccion subcutanea con una dosis de virus de 50 KID50. Hubo indicios de que el virus herpes suis tipo 1 penetra en los vacunos por la puerta de entrada, sin multiplicacion local esencial, en los nervios perifericos, alcanzando en ellos durante el periodo de incubacion el sistema nervioso central (SNC). Su difusion centrifuga en el SNC y mas alla del mismo condiciona la sintomatologia clinica.

JORDAN K., GROTHEY A., PELZ T., LAUTENSCHLAGER C., FRANKE U., SCHOBER C. & SCHMOLL H.-J. (2010) European Journal of Cancer Care19, 603–609 Impact of quality of life parameters and coping strategies on postchemotherapy nausea and vomiting To assess whether prechemotherapy quality of life (QoL) factors and certain coping strategies are associated with postchemotherapy nausea and vomiting (PCNV). A total of 43 chemotherapy-naive patients scheduled to receive anti-emetic prophylaxis were enrolled in this study. QoL parameters were measured by a modified EORTC Quality of Life Questionnaire (QLQ-30). In addition, questions regarding active or passive coping strategies were asked 1 day before chemotherapy. Prechemotherapy QoL factors, coping strategies as well as other patient, disease and treatment variables were compared between the groups of patients with or without PCNV. The univariate analysis identified four QoL parameters, ‘tiredness’, ‘impairment of daily life by pain’, ‘sensation of abdominal pressure and fullness’ and ‘impairment of social activities’ as associated with PCNV. No association was found between coping strategies and PCNV. In the multivariate analysis, the factors ‘impairment of social activities’ and ‘sensation of abdominal pressure and fullness’ remained significant. Specific pretreatment QoL parameters are associated with the risk to develop PCNV. Thus, in addition to other established risk factors for PCNV, patients should be screened for these QoL factors in order to improve the control of PCNV and facilitate the selection of appropriate, individualised anti-emetic prophylaxes.

Object The authors investigated and compared the in vitro characteristics of 2 CSF shunts, the Strata NSC and the Codman Hakim, and their corresponding antisiphon devices (ASDs). Methods Six new CSF shunts and the corresponding ASDs for each model were tested in an automated, computerized experimental setup based on pressure regulation. Opening pressure accuracy, resistance, sensitivity to abdominal pressure, antisiphon effect, and the influence of different ASD positions were determined. Results In general the shunts performed according to the manufacturers' specifications. However, at the lowest setting, the opening pressure of the Strata NSC was close to 0, and in the Codman Hakim shunt, it was higher than specified. The resistance in the Codman Hakim shunt (5.4 mm Hg/ml/min) was much higher than that in the Strata NSC (3.6 mm Hg/ml/min). Abdominal pressure affected opening pressure in both valves. Positioning the Strata ASD above or below the ventricular catheter tip resulted in higher and lower opening pressures, respectively, than when it was placed in line with the catheter. The positioning of the Codman Hakim ASD did not influence the opening pressure. Conclusions Both CSF shunts work properly, but at the lowest setting the opening pressure of the Strata NSC was near 0 and in the Codman Hakim it was twice the manufacturer's specifications. The resistance in the Strata NSC was below the normal physiological range, and in the Codman Hakim device it was in the lower range of normal. The ASD did not change the shunt characteristics in the lying position and therefore might not do so in children. If this is the case, then a shunt system with an integrated ASD could be implanted at the first shunt insertion, thus avoiding a second operation and the possibility of infection.

Objective: To describe a case of abdominal compartment syndrome in a dog with babesiosis. Case summary: A 9-year-old female Bull Terrier presented with complicated babesiosis. Additional findings including respiratory distress, abdominal distension, and a decrease in urine output associated with an elevated abdominal pressure (23.5–25 cmH2O) led to a further diagnosis of abdominal compartment syndrome. This case report describes the clinical course of both conditions through resolution. New information provided: Abdominal compartment syndrome is not well described in the veterinary literature, but clinicians should be aware of this potential complication in critically ill patients. The pathophysiology and veterinary literature of abdominal compartment syndrome are reviewed.

The increasing recognition of abdominal compartment syndrome's adverse effect on patient outcome has been coupled with our expanding knowledge of techniques of temporary abdominal closure. Temporary abdominal closure can be used prophylactically to prevent abdominal compartment syndrome developing and more commonly in the treatment of patients with progressing or advanced abdominal compartment syndrome. The preferred technique involves a negative suction dressing protecting the fascial and skin edges, collecting intraperitoneal fluid and reducing contamination. Attempts of early closure will facilitate recovery.

Background: Burn patients are at high risk for secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) due to capillary leak and large volume fluid resuscitation. Our objective was to examine the incidence the incidence of IAH and ACS and their relation to outcome in mechanically ventilated (MV) burn patients. Methods: This observational study included all MV burn patients admitted between April 2007 and December 2009. Various physiological parameters, intra-abdominal pressure (IAP) measurements and severity scoring indices were recorded on admission and/or each day in ICU. Transpulmonary thermodilution parameters were also obtained in 23 patients. The mean and maximum IAP during admission was calculated. The primary endpoint was ICU (burn unit) mortality. Results: Fifty-six patients were included. The average Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores were 43.4 (± 15.1) and 6.4 (± 3.4), respectively. The average total body surface area (TBSA) affected by burns was 24.9% (± 24.9), with 33 patients suffering inhalational injuries. Forty-four (78.6%) patients developed IAH and 16 (28.6%) suffered ACS. Patients with ACS had higher TBSAs burned (35.8 ± 30 vs. 20.6 ± 21.4%, P = 0.04) and higher cumulative fluid balances after 48 hours (13.6 ± 16L vs. 7.6 ± 4.1 L, P = 0.03). The TBSA burned correlated well with the mean IAP (R = 0.34, P = 0.01). Mortality was notably high (26.8%) and significantly higher in patients with IAH (34.1%, P = 0.014) and ACS (62.5%, P < 0.0001). Most patients received more fluids than calculated by the Parkland Consensus Formula while, interestingly, non-survivors received less. However, when patients with pure inhalation injury were excluded there were no differences. Non-surgical interventions (n = 24) were successful in removing body fluids and were related to a significant decrease in IAP, central venous pressure (CVP) and an improvement in oxygenation and urine output. Non-resolution of IAH was associated with a significantly worse outcome ( P < 0.0001). Conclusion: Based on our preliminary results we conclude that IAH and ACS have a relatively high incidence in MV burn patients compared to other groups of critically ill patients. The percentage of TBSA burned correlates with the mean IAP. The combination of high CLI, positive (daily and cumulative) fluid balance, high IAP, high EVLWI and low APP suggest a poor outcome. Non-surgical interventions appear to improve end-organ function. Non-resolution of IAH is related to a worse outcome.

Looping is a common occurrence during colonoscopy. Once a loop has occurred and the endoscopist has reduced it, abdominal pressure given by the technician will help the loop from re-forming. In this article, we discuss some of the common loops that are formed, the methods the endoscopist must employ to reduce the loop, and the type of abdominal pressure used by the technician to help prevent the loop from re-forming and, thus, help attain cecal intubation. Hand placement for abdominal pressure is discussed and illustrated to provide a visual guide for the technician.

Purpose: To investigate the significance of slowly rising abdominal pressure (SRAP), which is often observed in nonneurogenic children during bladder filling in video urodynamic studies (VUDSs). Methods: The records of patients who underwent VUDS from July 2011 to June 2013 were reviewed. SRAP was defined as a rising curve over 5 cm H2O from the baseline abdominal pressure during the filling phase in VUDS. Bladder descent was defined when the base of the bladder was below the upper line of the pubic symphysis. An open bladder neck was defined as the opening of the bladder neck during the filling phase. Results: Of the 488 patients, 285 were male patients. The mean age at VUDS was 3.7 years (range, 0.2–17.6 years). The VUDS findings were as follows: SRAP, 20.7% (101 of 488); descending bladder, 14.8% (72 of 488); and bladder neck opening, 4.3% (21 of 488). Of the 72 patients with a descending bladder, 84.7% had SRAP. A significant difference in the presence of SRAP was found between the descending bladder and the normal bladder (P

Both measured intraabdominal pressure (IAP) and calculated splanchnic perfusion pressure (SPP) have been advocated for use in operative management of gastroschisis. We directly compared these 2 clinical indices.Institutional review board-approved multi-institutional retrospective review from 3 centers with 112 subjects. Splanchnic perfusion pressure was recorded as mean arterial pressure-IAP. We compared the clinical utility of IAP and SPP using univariate and multivariate regression analyses.Calculated mean SPP was higher among neonates requiring silo placement compared to those without (39.0 +/- 1.9 vs 33.7 mm Hg, P.01). Measured IAP levels were similar between groups (11.5 +/- 1.1 vs 10.0 +/- 0.5, mm Hg, P.4). On a receiver operating characteristic curve, the inflection point for more than 90% specificity for silo placement was at an SPP of 44. In multivariate regression analysis adjusting for all factors below, SPP was independently associated with silo placement (odds ratio 1.2, 95% confidence interval 1.1-1.3, P.01), and IAP was not (odds ratio 1.2, 95% confidence interval1.0-1.5, P.1).These data suggest that SPP is a stronger predictor than IAP for the ability to achieve primary closure in the management of neonatal gastroschisis. We infer from these data that intraoperative SPP of more than 43 mm Hg may obviate the need for silo placement.

A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand and left elbow, a weight loss of about 4.5 kg, and occasional upper abdominal pressure. He had no nausea, vomiting, diarrhea, dyspnea, or dysuria.

This article gives an overview of the role of sliding hiatus hernia in gastro-oesophageal reflux disease (GORD). The crural diaphragm acts as an external sphincter of the anti-reflux barrier. Contractions of the crural diaphragm increase lower-oesophageal-sphincter (LOS) pressure during each inspiration and in situations of increased abdominal pressure, whereas these contractions are inhibited when gas and/or a bolus has to pass the gastro-oesophageal junction. A hiatus hernia is associated with GORD symptoms, increased oesophageal acid exposure, and oesophagitis and its severity. In patients with hiatus hernia, the incidence of reflux episodes is increased during periods with low LOS pressure, straining and swallowing. These findings underline the importance of the crural diaphragm, which, when surrounding the LOS, protects against gastro-oesophageal reflux.