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Giant congenital melanocytic nevus (GCMN) is a rare birthmark disorder that reportedly affects 1 in 20,000–500,000 live births. Here, we present a case of GCMN in a 1-day-old newborn that covered the entire abdomen, reaching the thigh and chest, and laterally toward the backward aspect of the trunk to involve the entire back and buttocks. We discuss the diagnostic and treatment approach.

PURPOSE: To develop a quantitative DCE MRI technique enabling entire-abdomen coverage, free-breathing acquisition, 1-second temporal resolution, and T(1)-based quantification of contrast agent concentration and kinetic modeling for the characterization of pancreatic ductal adenocarcinoma (PDAC). METHODS: Segmented FLASH readouts following saturation-recovery preparation with randomized 3D Cartesian undersampling was used for incoherent data acquisition. MR Multitasking was used to reconstruct 6-dimensional images with 3 spatial dimensions, 1 T(1) recovery dimension for dynamic T(1) quantification, 1 respiratory dimension to resolve respiratory motion, and 1 DCE time dimension to capture the contrast kinetics. Sixteen healthy subjects and 14 patients with pathologically confirmed PDAC were recruited for the in vivo studies, and kinetic parameters v(p), K(trans), v(e), and K(ep) were evaluated for each subject. Intersession repeatability of Multitasking DCE was assessed in 8 repeat healthy subjects. One-way unbalanced analysis of variance (ANOVA) was performed between control and patient groups. RESULTS: In vivo studies demonstrated that v(p), K(trans), and K(ep) of PDAC were significantly lower compared with nontumoral regions in the patient group (P = .002,.003, .004, respectively) and normal pancreas in the control group (P = .011

Objective The main difficulty in laparoscopic or robot-assisted surgery is the narrow visual field, restricted by the endoscope's access port. This restriction is coupled with the difficulty of handling the instruments, which is due not only to the access port but also to the loss of depth of field and perspective due to the lack of natural lighting. In this article, we describe a global vision system and report on our initial experience in a porcine model. Material and methods The global vision system consists of a series of intraabdominal devices, which increase the visual field and help recover perspective through the simulation of natural shadows. These devices are a series of high-definition cameras and LED lights, which are inserted and fixed to the wall using magnets. The system's efficacy was assessed in a varicocelectomy and nephrectomy. Results The various intraabdominal cameras offer a greater number of intuitive points of view of the surgical field compared with the conventional telescope and appear to provide a similar view as that in open surgery. Areas previously inaccessible to the standard telescope can now be reached. The additional light sources create shadows that increase the perspective of the surgical field. Conclusion This system appears to increase the possibilities for laparoscopic or robot-assisted surgery because it offers an instant view of almost the entire abdomen, enabling more complex procedures, which currently require an open pathway.

Once thought to only be of use in elective general surgery specialties, minimally invasive surgery is gaining popularity in the fields of emergency general surgery and trauma. In this chapter we explore the uses of minimally invasive techniques in trauma surgery. Since its acceptance by general surgeons in the 1990s, laparoscopy has become the gold standard in several arenas. Its adoption in trauma patients, however, has been slow to gain traction. Major concerns surrounding laparoscopy in trauma address the increased expenses of laparoscopy, ineffectiveness at visualizing the entire abdomen, increased length of time in the operating room, and missed injuries.

Mantophasmatodea (Heelwalkers), described in 2002, is the most recently discovered insect order. Additionally, with only 21 species described to date, it is also among the smallest insect orders known. Mantophasmatodea are 1–4 cm long, secondarily wingless predators. They inhabit bushes, herbs, shrubs, or hide within grass tussocks in open semi-arid landscapes of sub-Saharan Africa. Adult males and females use percussive signals to communicate with one another, mainly for mate localization, recognition of male vs female, and potentially also for species recognition. Females drum their entire abdomen onto the substrate, producing single pulses spaced at regular intervals. Males use a special drumming organ located on their subgenital plate to generate groups of pulses (pulse trains), also repeated at regular intervals. Although most of the species investigated thus far occur in allopatry and have limited dispersal abilities, male vibrational signals are still surprisingly distinct from each other at an interspecific level, and most species can be distinguished by the structure of the male signal. Behavioral experiments additionally suggest that some information about species identity is encoded in male and female vibratory signals. However, the signals are probably mainly used for the localization of a potential mate within the structurally complex vegetation that the heelwalkers inhabit. Moreover, Mantophasmatodea possess very sensitive scolopidial organs to detect substrate vibrations—the well-developed subgenual organ complex within the tibia of all legs is probably most sensitive to the species-specific communication signals. Despite their recent discovery, comparatively little is known about their biology, behavior, and diversity.

Purpose Perfusion zones of the deep inferior epigastric perforator (DIEP) flap aid surgeons in estimating approximate tissue territory with reliable perfusion. Since the Hartrampf perfusion zone was developed, it has been modified continuously; however controversies remain regarding whether the recent perfusion models can satisfy current anatomical and clinical evidence. We conducted a comprehensive review of previous studies to synthesize relevant knowledge and critically reappraise current perfusion models. Methods All anatomical and clinical studies that investigated perfusion of DIEP flaps were searched, yielding 21 studies suitable for review. A meta-analysis was conducted when sufficient data were provided. Results The perforators had unpredictable subcutaneous courses and were preferentially directed laterally. The medial and lateral perforators showed different characteristics in terms of branching pattern, orientation, and linking vessels between them. Ex-vivo perfusion findings suggested that medial perforators favored Hartrampf zone II rather than zone III and perfused the entire abdomen frequently, whereas the lateral perforators favored zone III and their perfusion territories were limited primarily to the hemi-abdomen. In the meta-analysis based on the clinical perfusion studies, zone III had significantly higher perfusion than zone II (P = 0.04) and these tendencies remained in both medial and lateral perforator-based flaps. Conclusions Considerable discrepancies were found between findings of ex-vivo and clinical perfusion studies. A thorough review of existing knowledge based on the perforasome concept explained these discrepancies satisfactorily and revealed unsolved issues of the current perfusion models. Flap perfusion clearly varies widely individually; however, this review will help with surgical planning and decision making. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:98-108, 2018.

Introduction The aim of this study was to evaluate the feasibility of dedicated motility assessment software for quantitative evaluation of basic gastric motility and to validate it using manual measurements. Methods Ten patients (5 males/5 females, mean 41 years) out of a previous series of small bowel MR-enterography examinations with well visible stomachs were included in this Institutional Reviews Board approved, retrospective study. MRI (1.5-T, Siemens Sonata) was performed after standardised oral preparation (3% aqueous mannitol over 1 h). Coronal 2DtrueFISP (TR 283.8/TE 1.89/FOV400/10 mm slice) motility acquisitions covering the entire abdomen were performed in apnoea. For each patient, image analysis for assessment of gastric motility was performed both manually and using the dedicated software either the proximal (n = 5) or in the distal (n = 5) gastric corpus. The main quantitative endpoints (amplitude, frequency) describing gastric motility were compared using (paired) Student's t-Test. Results All motility curves qualitatively matched each other (10/10). No significant differences (P > 0.05) were found for amplitudes (mean: 18.17 mm manual; 17.78 mm software), contraction frequencies (5.1/min; 4.7/min) and mean lumen diameters (34.12 mm; 33.13 mm), respectively. Mean duration for a single measurement was significantly (P

Ultrasound (US) has gained its place as the preferred first-line imaging modality in the child’s abdomen. Especially in infants US has advantages – the small amount of tissue and fat creating restrictions to CT and MRI allows for application of high-resolution (especially linear) transducers, offering excellent imaging capabilities; in addition, US is applicable at the bedside and can be performed without sedation. As radiation protection has become a key issue for imaging children, exploiting US to the utmost using all its possibilities and applying modern methods that have significantly widened US potential is an indispensable and increasingly important approach. This review illustrates standard US techniques, basic and new applications throughout the entire abdomen and its different organ systems, trying to point out the enormous potential of US in different clinical scenarios, focusing on gastrointestinal and urogenital issues. Future perspectives provided by new modalities such as contrast-enhanced a...

Intraoperative grid pattern markings have been used in the performance of liposuction. Grid pattern markings include series of longitudinal and transverse lines to delineate various anatomical boundaries and landmarks, including the midline, lateral line, and medial line. The markings are superimposed on the customary preoperative markings and divide broad or circumferential body surfaces into smaller subunits for liposuction. Grid pattern markings are applied to areas such as the anterior thighs, medial thighs, entire abdomen, flanks, back, arms, buttocks, calves, and ankles; they are not applied to smaller, less curved areas. Eighty-two consecutive patients underwent lipoplasty in 562 areas of the body. The revision rate for postliposuction contour irregularities was 4.0 percent (nine of 224 areas) where grid pattern markings were used; one area had an indentation type of contour irregularity and required autologous fat grafting. The revision rate was 1.5 percent (five of 328 areas) where grid pattern markings were not used; two areas in one patient had indentation-type contour irregularities and required autologous fat grafting. All remaining areas requiring revision had protuberant-type contour irregularities and responded to additional liposuction only. The use of grid pattern markings is associated with a low incidence of serious contour-related complications.

A two-point Dixon technique using a novel phase-correction algorithm and commercially available dual-echo fast gradient-echo pulse sequence is presented. The phase-correction algorithm determines the directional rather than phase distribution of signals due to field inhomogeneities. Specifically, a region-growing scheme uses precalculated spatial gradients of the signal phase to guide the growth sequence, so there is no need to manually select the seeds or use an empirical angular threshold. Further, the determination of the signal direction of a given pixel is based on both the amplitude and phase of the surrounding pixels, the direction of which has already been determined. The advantages of this algorithm include its easy implementation, computational efficiency, and robustness in the presence of pixels with large phase uncertainty. The feasibility and usefulness of the technique are demonstrated in vivo with artifact-free water and fat images of an entire abdomen in a single breath-hold.

Summary Abdominal pain in pregnancy poses a diagnostic and management challenge to the attending physician. Many causes are specific to pregnancy, but conditions affecting the non-pregnant woman can also complicate pregnancy. Identifying the cause is influenced by the anatomical and physiological changes of pregnancy. When diagnosis and symptom control fail after 6–8 h a multidisciplinary approach should be considered. The safety and the possibility of a systematic cross-sectional evaluation of the entire abdomen have been important reasons for the use of magnetic resonance imaging in pregnancy with intractable pain. Laparoscopic surgery when appropriate is now proving to be as safe as open surgery in pregnancy. Updating knowledge and assessment skills is essential in the management of abdominal pain in obstetric triage settings.

In Japan, the measurement of abdominal circumference is commonly used in diagnosis of visceral fat accumulation. It is also recommended that visceral fat at the umbilical level be measured using CT scans. If CT is used to measure the visceral fat area, we do not have to consider the possibility of measurement error due to subcutaneous fat. However, it is unknown whether the visceral fat area measurement by CT reflects the visceral fat volume of the entire abdomen.We examined the correlation between the visceral fat area at the umbilical level and the visceral fat volume of the entire abdomen using CT images taken from the diaphragm to the pubic bone.The results showed that there was a very high correlation between the visceral fat area and the visceral fat volume. The correlation was not affected by gender differences, old age or whether visceral fat was accumulated or not.Therefore, we concluded that it is possible to estimate the visceral fat volume of the entire abdomen by measuring the visceral fat area at the umbilical level.

We report a method of fast adipose tissue (FAT) assessment to characterize the quantity, and distribution of abdominal adipose tissue. Whole-volume coverage of the abdomen was obtained using 31 contiguous transverse T(1)-weighted images from 16 obese females. A radiologist manually traced all adipose tissue volumes in the images, while a physiologist used an automated method to measure adipose tissue in a single image at the level of the umbilicus. Automated analysis of the umbilicus-level image was significantly correlated with values obtained by manual analysis of the entire abdomen (p < 0. 001). There was good agreement between the automated umbilicus-level image method and the manual whole abdomen method for subcutaneous adipose tissue (r(2) = 0.958), visceral adipose tissue (r(2) = 0. 753), and total adipose tissue (r(2) = 0.941). The automated method required 6 min vs 2 h for the manual method.

CT has become the primary imaging modality for evaluation of possible appendicitis. About 20 % of patients taken to surgery for appendicitis without CT have had a normal appendix removed. CT has demonstrated overall accuracy of between 93 % and 98 %. Alternative diagnoses are seen in 34–80 % of patients without appendicitis but who were suspected of having appendicitis. For evaluation of appendicitis different techniques have been successful, including the use of no contrast, use of oral and intravenous contrast, and use of rectally administered contrast. Scanning of the entire abdomen and pelvis and scanning of an area limited to the right lower quadrant are also options. Ultrasonography has been shown to have a role in pediatric patients. If ultrasonography is positive, CT is not necessary. If ultrasonography is negative, CT should follow.

An extremely rare case of primary liposarcoma of the greater omentum is reported. A 51-year-old man was seen at the hospital because of abdominal distention. As a result of close examinations, the patient was diagnosed as having an intraabdominal tumor and was operated on. Upon laparotomy, a large volume of ascites was noted. The tumor was mainly present in the greater omentum, but a large number of small tumors with the diameters of 1 to 2cm were confirmed in the entire abdomen. The tumors were extirpated as possible as we could. The histopathological diagnosis was well differentiated liposarcoma partly with myxoid change. The prognosis was poor. The patient experienced recurrence four months after the operation and died after unsuccessful chemotherapy.

A case of giant (32 Kg) malignant fibrous histiocytoma (MFH) arising from the uterus and occupying the entire abdomen and the pelvis is reported. The patient had debulking surgery, followed by combination chemotherapy, but died 7 months after diagnosis.

Ziel der Arbeit: Es soll analysiert werden, inwieweit die Unterschiede zwischen den Organlagen des mathematischen Phantoms und den anatomischen Verhaltnissen des Menschen zu Fehlschatzungen der Organdosen und der effektiven Dosis fuhren konnen. Methodik: Fur die CT-Untersuchungen des Thorax, des Oberbauches, des Pankreas, des Beckens und des gesamten Abdomens wurden die Organdosen sowohl unter alleiniger Berucksichtigung der Organlagen des mathematischen Phantoms als auch unter genauerer Berucksichtigung der anatomischen Verhaltnisse des Menschen bestimmt. Ergebnisse: Beim Phantom liegen das Abdomen bei der CT-Untersuchung des Thorax und der gesamte Darm bei der CT-Untersuchung des Oberbauches sowie des Pankreas vollstandig auserhalb des Scanvolumens, wahrend der gesamte Darm bei der CT-Untersuchung des Beckens direkt exponiert wird. Bei Berucksichtigung der anatomischen Verhaltnisse des Menschen kann es zu Anderungen der berechneten Organdosen mit einem Faktor uber 15 und der effektiven Dosen mit einem Faktor unter 1,5 kommen. Schlusfolgerungen: Die Unterschiede zwischen den Organlagen des Phantoms und den anatomischen Verhaltnissen des Menschen konnen zu erheblicher Fehlschatzung der Dosen bestimmter Organe fuhren. Dagegen ist die effektive Dosis realistisch. Die Dosisabschatzung mittels mathematischer Phantome ist somit eine leistungsfahige Methode zur Abschatzung des radiogenen Gesamtrisikos. Purpose: To analyse how far dose calculations for the CT examination of the thorax and abdomen can lead to faulty estimations of organ doses and effective dose due to differences in the topographic anatomy between mathematical phantom and man. Methods: For the CT examination of the thorax, upper abdomen, pancreas, pelvis and the entire abdomen, organ doses were calculated with conversion factors, first with regard to the topographic relation within the phantom, then with additional regard to the real anatomy of the man. Results: In the phantom, the abdomen lies outside the scan volume in case of CT-examination of the thorax and the whole intestine outside the scan volume in case of CT-examination of the upper abdomen and the pancreas, whereas the entire intestine is directly exposed in case of CT-examination of the pelvis. Dependent on whether dose calculations take real anatomy into account, doses of special organs can differ by a factor greater than 15. The calculated effective doses differ by a factor less than 1.5. Conclusions: Calculations of organ doses for the CT examination of the thorax and abdomen can lead to considerable errors due to different topographic relations between phantom and man. In contrast, the calculated effective dose is realistic. Hence, dose calculations with the help of mathematical phantom is an efficient method to estimate the total radiogenic risk.

A 10-year-old female presented with a palpable mass occupying the entire abdomen. Computerized tomography scan showed a large expansive lesion measuring 22 cm × 20 cm × 13 cm. The mass was resected and the diagnosis of leiomyoma was made from immunehistochemical findings. Mesenteric leiomyoma is an uncommon tumor among gastrointestinal stromal tumors.

Immersive virtual environments use a stereoscopic head-mounted display and data glove to create high fidelity virtual experiences in which users can interact with three-dimensional models and perceive relationships at their true scale. This stands in stark contrast to traditional PACS-based infrastructure in which images are viewed as stacks of two-dimensional slices, or, at best, disembodied renderings. Although there has substantial innovation in immersive virtual environments for entertainment and consumer media, these technologies have not been widely applied in clinical applications. Here, we consider potential applications of immersive virtual environments for ventral hernia patients with abdominal computed tomography imaging data. Nearly a half million ventral hernias occur in the United States each year, and hernia repair is the most commonly performed general surgery operation worldwide. A significant problem in these conditions is communicating the urgency, degree of severity, and impact of a hernia (and potential repair) on patient quality of life. Hernias are defined by ruptures in the abdominal wall (i.e., the absence of healthy tissues) rather than a growth (e.g., cancer); therefore, understanding a hernia necessitates understanding the entire abdomen. Our environment allows surgeons and patients to view body scans at scale and interact with these virtual models using a data glove. This visualization and interaction allows users to perceive the relationship between physical structures and medical imaging data. The system provides close integration of PACS-based CT data with immersive virtual environments and creates opportunities to study and optimize interfaces for patient communication, operative planning, and medical education.

Minimally invasive procedures are of growing importance in modern surgery. Navigation and orientation are major issues during these interventions as conventional endoscopes only cover a limited field of view. We propose the application of a Time-of-Flight (ToF) satellite camera at the zenith of the pneumoperitoneum to survey the operation situs. Due to its limited field of view we propose a fusion of different 3-D views to reconstruct the situs using photometric and geometric information provided by the ToF sensor. We were able to reconstruct the entire abdomen with a mean absolute mesh-to-mesh error of less than 5 mm compared to CT ground truth data, at a frame rate of 3 Hz. The framework was evaluated on real data from a miniature ToF camera in an open surgery pig study and for quantitative evaluation with a realistic human phantom. With the proposed approach to operation situs reconstruction we improve the surgeons’ orientation and navigation and therefore increase safety and speed up surgical interventions.

Accurately detecting and segmenting ovarian cancer metastases can have potentially great clinical impact on diagnosis and treatment. The routine machine learning strategies to locate ovarian tumors work poorly because the tumors spread randomly to the entire abdomen. We propose a tumor sensitive matching flow (TSMF) to identify metastasis-caused shape variance between patient organs and atlas. TSMF juxtaposes the role of feature computation/classification, and TSMF vectors highlight tumor regions while dampening all other areas. Therefore, metastases can be accurately located by choosing areas with large TSMF vectors, and segmented by exploiting the level set algorithm on these regions. The proposed algorithm was validated on contrast-enhanced CT data from 11 patients with 26 metastases. 84.6% of metastases were successfully detected, and false positive per patient was 1.2. The volume overlap of the segmented metastases was 63±5.6%, the Dice coefficient was 77±4.2%, and the average surface distance was 3.9±0.95mm.

We present the case of an 8-year-old child with diffuse lipomatosis simultaneously involving the intra-peritoneum, retro-peritoneum and abdominal wall. To the best of our knowledge, this is the first case of diffuse lipomatosis with simultaneous multi-focal involvement of the entire abdomen.

Magnetic resonance imaging (MRI) has been increasingly studied as a diagnostic tool for the evaluation of the colon. Without the use of intralu-minal colonic distension methods or following colonic distension with the use of either positive or negative luminal contrast medium (MR colonogra-phy), cross-sectional images can be acquired of the entire abdomen. Subsequent evaluation of the complete colonic wall can be executed using multipla-nar reformations of the source data set with optional three dimensional (3D) rendering, in the case of a MR colonography data set. Although most investigators primarily focused on the ability of detecting colorectal polyps and masses using MR colonogra-phy, a wide spectrum of colorectal disorders can be evaluated by utilizing MRI to examine the colon.

This is the first clinical case report of a thoracic invasive thymoma metastatic to the ovary with disease noted in the entire abdomen including the pelvis 5 1/2 years after initial diagnosis. The involved areas of metastases include the distal ileum, peritoneal and serosal surfaces (including the surface of the distal colon, bladder, and pelvis), and the surface of the right ovary. The patient survived 13 years after her initial diagnosis and 7 1/2 years after discovery of her metastases. Thymomas are rare tumors but comprise the most common primary tumor of the anterior mediastinum. Extrathoracic metastases of malignant thymomas are also rare, and the literature reports that the most common sites for metastases are the liver, lung, lymph nodes, and bone. Extrathoracic disease is associated with a poor prognosis. The average time of survival after the diagnosis of metastases is 1.5 years.

Laparoscopy, and particularly robotically assisted laparoscopy, continues to advance rapidly, thus changing the practice of urology. The changes in the practice of pediatric urology, while slower, have also altered the surgical approach to various conditions of the genitourinary tract in children. While open procedure typically require a thorough working knowledge of smaller areas, the laparoscopic surgeon must have a thorough working knowledge of the entire abdomen and pelvis as they are in full view for all cases. In this chapter, we aim to provide the reader with the anatomic perspective associated with our new paradigm in surgical care.

Multidetector row CT (MDCT) has become an imaging technique of choice to study routinely the small bowel. Thin collimation and fast scanning allow coverage of the entire abdomen within a single suspended respiration phase allowing the use of multiple enhancement phases after intravenous contrast administration. MDCT of the small bowel can identify and stage most of the common diseases of the small bowel. MDCT is changing the paradigm for diagnosing small bowel disease by becoming the first diagnostic line for almost all small bowel diseases. MDCT has the needed sensitivity and specificity, the availability, and the safety for a front-line diagnostic method.

Laparoscopic exploration followed by possible appendectomy is a safe and straightforward approach to the management of appendicitis. Because of the ability to visualize the entire abdomen at operation, it has improved diagnostic utility over open appendectomy and may therefore be advantageous for patients in whom the diagnosis is unclear. A significant percentage of this group can also avoid operative intervention beyond exploration. If the exploration is positive for appendicitis, proceeding to laparoscopic appendectomy has been shown to reduce postoperative hospital stay and decrease the time until a patient resumes normal diet and activity following surgery. Despite the reduction in wound infection with laparoscopic appendectomy, it has been associated with longer operative times and potentially higher rates of intra-abdominal abscess formation. The remaining complications from laparoscopic appendectomy are related to surgical error or diagnostic delay and can be minimized with careful technique and ear ly intervention.

Giant solitary nonparasitic cysts of the liver are rarely encountered in children, and establishing a preoperative diagnosis is usually difficult, especially when the cyst occupies the entire abdomen. We report herein the case of an 8-year-old girl found to have a giant congenital solitary cyst of the liver masquerading as an ovarian cyst.

The presence of a pelvic spleen is an exceedingly rare occurrence. Correct diagnosis, which is essential for appropriate management, can be suggested by sonographic evaluation and confirmed with the use of computed tomography. The case presented here demonstrates the necessity of examination of the entire abdomen by sonography when a pelvic mass of unknown etiology is encountered.

Computed tomography (CT) represents the preferred imaging modality for imaging the large bowel when virtual endoscopic reconstructions are desired. Using the spiral acquisition technique, it has become possible to scan the entire abdomen within a single breathhold, however, slice thicknesses of 5 mm or more are necessary should the breathhold not last longer than 30-40 s. With the advent of multislice CT, contiguous 1-mm slices can be obtained through the entire abdomen while even shortening the breathhold to 25-30 s. The improved speed and spatial resolution of multislice CT results in remarkably sharp virtual reconstructions allowing detection of polyps with sizes less than 3 mm. The disadvantages must still be considered including a dataset consisting of up to 800 images representing a new challenge for postprocessing hard- and software.

Gastrointestinal (GI) tract examination with computed tomography (CT) is currently performed by slice-based visual inspection despite the volumetric nature of the problem. The entire abdomen may now be continuously scanned within a single breath-hold with spiral CT. The GI tract can be computationally extracted from spiral CT images, the lumen explicitly unraveled onto a plane, and colonoscopy virtually simulated via fly-through display. A semi-automatic approach was developed for fly-through and unraveling in vivo. Automation of this approach was investigated in numerical simulation. The techniques are promising for colon cancer screening.

Giant hydronephrosis, NephrectomyGiant hydronephrosis, the collection of more than 1liter of fluid within the renal pelvi-calyceal system,is uncommon in adults. When it exists the kidneyand renal pelvis can extend across the midline andmay occupy the entire abdomen resulting in severalsymptoms or may still remain asymptomatic.

Although the majority of impalpable undescended testes lie in an intracanalicular location, a significant number are also found to be intraabdominal. The expected location of intraabdominal testes is a line joining the renal hilum and the internal inguinal ring. We describe a case of an adult patient in whom impalpable undescended testes were located in a retrovesical location. This case highlights the importance of performing a thorough inspection of the entire abdomen and pelvis if the impalpable testis is not found in an expected location.

The authors report a giant hepatocellular carcinoma (HCC) with a diameter over 30 cm and weight over 10 kg that was resected completely. A 62-year-old man was admitted because of continuous abdominal uplift. A computed tomography scan demonstrated that the entire abdomen was filled with a giant tumor containing both cystic and solid components with a size of 29 cm x 22 cm. The huge tumor was successfully resected without any complication, such as massive hemorrhage or visceral injuries. The size and weight of the tumor were 35 cm x 30 cm x 15 cm and 10 050 g, respectively. Pathological examination showed that the tumor was a well-differentiated HCC, and alpha-fetoprotein was positive. Postoperative syndrome, characterized by hypovolemic shock, diarrhea and urine retention, was observed and induced by abdominal decompression. This syndrome was resolved with expectant treatment. The patient was still alive without recurrence after a 27-mo follow-up.

The use of laparoscopy in general surgery has expanded to aid in the diagnosis of various intraabdominal conditions. A new application of the laparoscope is described to explore the abdominal cavity for potential gangrenous bowel after reduction of an incarcerated inguinal hernia. Hernioscopy allows for a good view of the entire abdomen including inspection of the colon for serosal changes of carcinoma. Exploration via this technique is accomplished without additional skin incisions or fascial disruptions and with no increased morbidity, when performed during the inguinal herniorrhaphy.

Both ‘perchers’ (Libellula saturata) and ‘fliers’ (Anax junius and Aeshna multicolor) remained active in the field in sunshine at air temperatures from at least 24 °C to 36 °C. The percher basked at low air temperatures and regulated exogenous heat input by postural adjustments. It markedly reduced flight activity at high air temperatures but flew nearly continuously at intermediate temperatures. In direct sunlight, the abdomen of L. saturata heated faster than the thorax, but this percher exhibited little or no capacity to transfer heat between abdomen and thorax. In contrast, the fliers gave no evidence of behavioural thermoregulation, but both showed impressive capacities for heat transfer from thorax to abdomen. When heated exogenously on the thorax the temperature of the entire abdomen of both fliers increased uniformly, but with endogenous heat production during pre-flight warm-up there was only a slight temperature increase near the anterior portion of the abdomen. Removal of abdominal air sacs or immobilizing the abdomen with wax to prevent all abdominal pumping did not significantly alter the capacity to transfer heat from thorax to abdomen. Ligation of the heart anywhere along the length of the abdomen abolished heat transfer. Given sufficient exogenous heat input, fliers that can regulate their thoracic temperature by transferring the excess heat to the abdomen died in about 2 min due to overheating when the heart was occluded. Under our experimental conditions the fliers appeared to thermoregulate exclusively via a control of blood circulation.

During the past five years, 21 patients with Stage III nodular malignant lymphoreticular tumors (MLT) have undergone total central lymphatic (TCL) irradiation. The irradiation must include the entire abdomen and Waldeyer's ring in addition to the usual regions encompassed by total nodal irradiation. A threshold dose of 2500–3000 rad in 20–45 days is received m each target volume. Every patient has been rendered free of all evidence of disease. One patient developed local recurrence and three had marginal recurrences; they are now free of disease 6–56 months after additional irradiation. Five patients have developed visceral dissemination and are receiving chemotherapy. All patients are alive (6–60 months, median 24 months). A prospective randomized trial has been established to compare TCL irradiation to the most favorable combination chemotherapy for patients with Stage III nodular MLT.

To identify patients at high risk for the development of enteric injury, an analysis was made of 212 women who received extensive pelvic and abdominal radiotherapy at the University of Minnesota from 1970 through 1981. One hundred one patients with cervical carcinomas received 8,000 to 8,500 rads to point A, 6,000 rads to point B, and 4,500 to 5,075 rads to the periaortic lymph nodes. One hundred eleven women with ovarian cancers received 2,000 rads to the entire abdomen, followed by an additional 2,975 to 3,000 rads to the pelvis. The overall complication rate was 6.6% (14/212). The only patients who sustained chronic radiation morbidity had thin physiques. The maximum likelihood multiple logistic model was utilized to predict the probability of enteric injury as a function of thin physique, previous operations, and hypertension for individual patients. The usefulness of predictive models is discussed, and possible reasons for the susceptibility of thin women to ionizing radiation are explored.

Total central lymphatic irradiation (2500-3000 rads in 3 to 6 weeks) including the entire abdomen, the supradiaphragmatic nodal areas, and Waldeyer's ring is being investigated as a potentially curative approach to patients with Stage III disease. Twenty-two patients have been treated (24-month minimum observation). All evidence of disease has disappeared in every patient. Three patients have developed local recurrence; 2 of them received 2000 rads or less. Three patients had marginal recurrences, and 5 developed generalized disease involving viscera. Fourteen patients (64%) are alive and free of any evidence of disease from 24-90 months (median, 54 months). Absolute survival is 82% (18/22).

Presentation of Case A forty-two-year-old gravida 2, para 2, was admitted to the hospital because of abdominal pain. Two days previously she experienced the onset of crampy pain over the left iliac crest. It varied in intensity and was accompanied by a sensation that a bowel movement might afford relief. An enema yielded a moderate amount of soft stool but did not relieve the pain. The pain increased in intensity and was present over the entire abdomen, especially the lower portion. On the day before entry there was bilateral shoulder pain, especially with deep respirations or coughing. The patient was . . .

SARCOMA of the stomach is seldom encountered, if one may judge by the reports in the literature. Approximately 200 cases have been reported and they seem to be of more frequent occurrence than individual experience would lead one to infer. In the Berlin Pathological Institute, for instance, there is but one example of sarcoma of the stomach in the 840 specimens. In this discussion I have excluded lymphosarcoma, which is a fairly frequent finding. Frazier, in 1914, quotes Bruch as being the first to record a case of sarcoma of the stomach, in 1847. Virchow, in 1864, referred to three cases. Baldy, in 1893, reported the case of a patient who came to him complaining of a mass in the abdomen, which was accompanied by progressive weakness and loss of weight. Physical examination disclosed a large irregular mass filling the entire abdomen from the symphysis to the ensiform cartilage. A small hard mass, the size of a walnut, was found in the umbilicus. There had been no gastro-intestinal symptoms. Operation disc...

Unsuspected abnormalities are occasionally detected during real-time ultrasound examinations. To determine the frequency of these findings during standard, routine real-time abdominal survey, the records of 500 consecutive examinations were reviewed. We found that a significant number of important occult abnormalities were detected. The influence of the abdominal survey on clinical management and improved radiologic consultation is discussed.

Phenol and trichloroacetic acid (TCA) are used for cosmetic face peeling. Deaths associated with phenol have been ascribed to the cardiotoxicity. Our purpose has been to study and compare the cardiovascular responses to these two agents in a rat model. Fifteen rats underwent abdominal epilation. Two to six days later a surface area comparable to the human face (16 cm2) was delineated on the abdomen. Baker's phenol or 50% TCA was applied to this area. Cardiac rate and rhythm and arterial pressure were monitored. Once stable, the same agent was applied to the entire abdomen for further study. TCA has been shown to be a safer agent than phenol in this rat model. Assuming that this model simulates the human response, monitoring would appear to be indicated during full-face Baker's phenol peeling.

Two models of antishock trousers were studied for the effect of their inflation on the pulmonary function of 20 healthy men. Vital capacity was measured for each model at pressures at 0, 30, 60, and 100 mm Hg. The antishock suit with the abdominal compartment extending over the entire abdomen decreased the vital capacity 13.8% with inflation to a pressure of 100 mm Hg. The antishock suit with a smaller abdominal compartment, considered the standard model, decreased vital capacity only 5% at the same pressure.