Search

Introduction Umbilicus is an important surface landmark on the anterior abdominal wall in addition to its aesthetic and psychological effect. Objectives The objective of the study is to determine the position of umbilicus in Iraqi adults to provide a guide for the neoumbilicus in abdominoplasty. Subjects and Methods This is an observational study performed on 100 volunteers with no abdominal wall abnormality. Measurements included weight, height, body mass index (BMI), distance from xiphoid to umbilicus, distance from xiphoid process to pubic symphysis, distance from xiphoid process to both anterior superior iliac spine (ASIS), distance from pubic symphysis to umbilicus and from pubic symphysis to xiphisternum, distance of umbilicus to both ASIS, and distance of umbilicus to interspinous line and to inter-anterior hypochondrium line. Results The study included 100 volunteers, with 50% male and 50% female whose age ranges between 18 to 60 years. The results were a follows: distance from xiphoid process to umbilicus and distance from xiphoid process to pubic symphysis were 18.03 ± 3.25 cm and 32.21 ± 4.64 cm, respectively; distances from xiphoid process to right ASIS and left ASIS were 25.95 ± 5.72 cm and 25.84 ± 6.02 cm, respectively; distance from pubic symphysis to umbilicus was 17.66 ± 3.12 cm; distance of umbilicus to interspinous line was 9.25 ± 1.84 cm. The distance from umbilicus to inter anterior hypochondrium line was 9.905 ± 2.19 cm. Conclusion These measurements can determine the neoumbilicus position, reduce practical mistakes, and improve postsurgical outcomes.

ltrasonography is the most popular modality used for clinical applications to detect abnormalities related to abdominal organs such as the liver, kidneys, uterus and other organs. In the context of organ recognition, image processing techniques are needed to improve image quality without eliminating important information contained in it. The purpose of this study was to identify prominent features of organs found in regional 3 (left liver lobe), 6 (left kidney and spleen) and 8 (bladder and prostate) from the abdomen using the gray level co-assurance matrix (GLCM) method. with features that are used, among others: contrast, correlation, energy and homogenity in the direction 0°, 45°, 90° and 135°. The results obtained show that each organ has a GLCM value that varies between one organ and another organ, namely regional Hypochondrium Dexta for left liver lobe organ, contrast 〖5.1473 x10〗^(-4)-〖1 x10〗^(-3), corrlation 0.9786-0.9890, energy 0.9073-0.9754 and homognity 0.9995 - 0.9997. Lumbaris Sinistra Regional for left ginjla organ, contrast 〖3.8526 x10〗^(-4)- 〖6.2959 x10〗^(-4), corrlation 0.9737 - 0.9862, energy 0.9737 - 0.9862 and homognity 0.9997-0.9998 while spleen, contrast 〖6.0350 x10〗^(-4) - 9.3762 x 〖10〗^(-4), corrlation 0.9640-0.9812, energy 0.9493-0.9816 and homognity 0.9995 - 0.9997. Regional Hipogastrum in bladder organs, contrast 4.0614〖 x10〗^(-4)- 9.9296 〖x10〗^(-4), corrlation 0.9770 - 0.9890, energy 0.9085 - 0.9884 and homognity 0.9995 - 0.9998 for prostate organs, contrast 3.0383 〖x10〗^(-4)-3.1532 〖x10〗^(-4), corrlation 0.9727 - 0.9738, energy 0.9877 - 0.9885 and homognity 0.9998. The range values represent the organs studied. The results of the research obtained indicate that the features of GLCM can be used to identify organs in regions 3, 6 and 8.

Highlights • This is a borderline tumor with indolent biological behavior. • There are still multiple poorly understood factors that can dictate its malignant transformation and prognosis. • Here, a rare tumor whose age and survival are tangent the literature reports describe. • There is a need for a long and rigorous segment to identify possible long-term metastases., Introduction Frantz’s Tumor or Solid Pseudopapillary Neoplasm (SPN) is rare with a solid-cystic pattern, and most common in young women. Presentation of case This study based on guidelines for case reports (SCARE) reports a case of SPN in a teenager aged 13 years at the diagnosis time, attended at a teaching public hospital in Brazil, which evolved into liver metastases. Clinical, laboratory, therapeutic and imaging data were collected from the physical chart and analyzed in light of current publications on the topic. The first consultation occurred in January 2012, where weight loss, fever, vomiting, left-sided hypochondrium and epigastric pain were reported. Imaging exams evidenced an expansive heterogeneous process in the pancreatic tail; however, laboratory exams and tumor markers did not present alteration in relation to reference values. In March of 2012, she underwent caudal body pancreatectomy, splenectomy, segmental colectomy and colo-coloanastomosis as a function of the intraoperative findings. After 63 months, right-sided hepatectomy was performed to resect metastases. Currently, she is undergoing outpatient monitoring, without complaint or alterations in imaging and laboratory exams, totaling 100 months of global survival. Discussion This is an interesting case report of a rare tumor, in so far as without any adjuvant chemotherapies, an 8-year long survival time could be achieved in this particular type of tumor despite initially large tumor expansion and later liver metastases. Conclusion Additional epidemiological studies, molecular and clinical trials are required to increase knowledge on SPN.

Egyptian medical scholars kept detailed notes chronicling the conditions encountered and describing the methods of abdominal examination that were based on studies of basic anatomy and embalming practices. Centuries later, in his Book of Prognostics, the Greek physician Hippocrates (ca. 400 bc) discussed the prognostic signifi cance of various types of abdominal fi ndings: The state of the hypochondrium is best when it is free from pain, soft, and of equal size on the right side and the left. But if infl amed, or painful, or distended; or when the right and left sides are of disproportionate sizes; all of these appearances are to be dreaded. A swelling in the hypochondrium, that is hard and painful, is very bad…. Such swellings at the commencement of disease prognosticate speedy death. Such swellings as are soft, free from pain, and yield to the fi nger, occasion more protracted crises, and are less dangerous than others. 2 Along with the basic methods of clinical evaluation known since antiquity, the modern surgeon has an armamentarium of sophisticated diagnostic studies that aid in the detection, diagnosis, and appropriate treatment of these frequently overlapping clinical entities. The primary goals in the management of patients with abdominal pain and/or an abdominal mass are (1) to establish a differential diagnosis through obtaining a clinical history, (2) to refi ne that differential diagnosis with a physical examination and appropriate studies, and (3) to determine the role of operative intervention in the treatment or refi nement of the working diagnosis.

Introduction: Acute abdomen is a very common problem in emergency department. Aims and Objectives: This study aims to find out the clinical and epidemiology profile of acute abdominal pain among patients attending emergency department of Santosh Medical College Ghaziabad. Materials and Methods: A tertiary care hospital based, cross-sectional study was conducted from January 2018- April 2019 2018, among patients presenting with acute abdominal pain to Santosh Medical College Ghaziabad, India. Data was entered on a standard data collection sheet after obtaining a written informed consent. Results: Out of 1200 patients admitted via the Emergency Department at the Hospital, 200 (16.6%) were admitted with atraumatic acute abdominal pain. Out of 200, 120(60%) were due to Surgical causes and 80 due to non-surgical causes. Most consistent symptom and sign were pain abdomen and abdominal tenderness respectively. Acute cholecystitis was the most common etiology of acute abdominal pain (35.8% cases), followed by, Renal Stones (30.5%), Acute Appendicitis (17.5%) and Intestinal Obstruction (16.67%) respectively. Conclusion: About 16.60% of all emergency admissions were due to acute abdominal pain and about 60.0% of all atraumatic acute abdominal pain was due to surgical cause. Acute cholecystitis was the most common cause of surgical abdominal pain. Keywords: Acute abdominal pain (AAP), Right hypochondrium (RHC), Epigastrium, Hypochondrium.

Chronic ectopic pregnancy is a variant of ectopic pregnancy presenting as chronic lower abdominal pain, menstrual irregularity and pelvic mass. Often, chronic ectopic may pose diagnostic conundrum due to unusual presentations. We are presenting an unusual case of chronic ectopic with negative urine pregnancy test, who presented with pain in right hypochondrium. The patient had bilateral adnexal mass with omental deposit on imaging masquerading adnexal malignancy, leading to decision for surgical management. Intraoperatively blood clots were present in supramesocolic compartment along with bilateral adnexal masses. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with clots evacuation was done and postoperatively, patient had complete relief of her symptoms. Final histopathology came out as ectopic gestation. Culminating point is to keep ectopic pregnancy as differential in all reproductive age group women presenting with pain in abdomen regardless of other symptom particularly with pelvic mass.

Se presenta el caso de un paciente de 57 años con cuadro clínico de dolor a nivel del hipocondrio y fosa ilíaca derecha. Se realizó estudios de imagen como ecografía y tomografía donde se evidenció proceso ocupativo retroperitoneal de gran tamaño con infiltración del riñón; por medio de la biopsia que llegó al diagnóstico de un linfoma no hodgkin difuso de células B grandes. El linfoma no hodgkin es una neoplasia que afecta al sistema linfático, representa el 4% de todos los cánceres y ocupa el séptimo lugar entre todas las neoplasias.

Background Laparoscopic liver resection has been increasingly utilized due to its less invasiveness approach compared with open surgery,1-3 but often creates challenges. Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) portends a poorer prognosis and often precludes patients from potential liver resection.4-6 We herein report a case of laparoscopic hepatectomy and thrombectomy in a patient with HCC and BDTT. Methods CT, ERCP, and POCS showed a 40-mm tumor located in the right lobe with BDTT. A five 12-mm trocar was inserted at the umbilicus for laparoscope, the epigastrium, both sides of the hypochondrium, and right lateral region. Moreover, a 5-mm trocar was inserted at left hypochondrium. After cholecystectomy, hepatoduodenal ligament was encircled using the tourniquet through 5-mm trocar site. The right portal vein was transected by stapler following transection of the right hepatic artery. After ICG staining (0.5 mg/body i.v.),7 hepatic parenchymal transection was performed using clamp-crashing technique. Moreover, CUSA also was used near Glissonian sheath. BDTT was removed from the right BD. Moreover, the cholangioscopy confirmed no BDTT remnants. The resection stump was then sutured. Finally, the right hepatic vein was divided with a stapler. A drainage tube was placed in the right subphrenic space. Operation time was 496 min, and blood loss was 91 ml. The patient was discharged without complications on postoperative day 11. Pathological diagnosis showed moderately differentiated HCC, tumor size 40 × 45 mm with negative surgical margins. Conclusions Pure laparoscopic resection for HCC with BDTT is a radical, yet feasible procedure.

Technological advances in imaging have provided an early diagnosis of benign and malignant liver tumors. Thus, it was possible to detect liver lesions more easily, cystic, or solid. Although most cystic lesions require medical follow-up, solid lesions need to be better evaluated...

Background: The gall bladder stones (GBS) are common disease related to diet habit, obesity, hematological diseases, diabetes mellitus and receiving total parenteral nutrition. GBS is a rare cause of hospitalization of pediatric patients, but have been increasingly diagnosed in recent years due to widespread use of ultrasonography. The aim of this case report study is to determine the clinical presentation, risk factors, valuable diagnostic procedures and outcome of laparoscopic management of cholelithiasis in children. Case report: Our case is a 9 years-old boy with empyemic gallbladder complaining of attacks of colicky epigastric pain associated with recurrent vomiting. On abdominal palpation, there is positive sign of deep tenderness at hypochondrium area and positive murphy sign. He has central obesity with BMI 29.9, skin folds more than 3.5 cm and waist circumference more than 90 cm. He has History of high cholesterol and fatty diet and fast food habit, prolonged intake of vitamin D and positive family history. While, no other associated risk factors was detected in our patient. All laboratory investigations was within normal ranges even for his lipid profile. Although, empyema was present, no leukocytosis was detected. Abdominal ultrasound showed the gall bladder wall is slightly thick surrounded by pericholycystic fluid, solitary gall bladder stone of 3 cm size and normal CBD. While, post-operative histopathological examination revealed thick wall gallbladder with multiple tiny stones of cholesterol type. The patient was treated with laparoscopic cholecystectomy with promising outcome and no complications. Conclusion: Pediatric surgeons should consider cholecystolithiasis as from differential diagnosis of abdominal pain associated with vomiting in children. Empyema of gallbladder should be considered once murphy sign is positive in such child patients. Child obesity, fatty diet, vitamin D deficiency and family history are possible risk factors. Ultrasonography is the mainstay of diagnosis. Laparoscopic cholecystectomy is the appropriate management for symptomatic cholelithiasis in children.

La fibrosis quística constituye una enfermedad autosómica recesiva producida por una alteración del brazo largo del cromosoma 7 (7q31.2). Al respecto se presenta el caso de un paciente de género femenino de 10 años, que acude a una institución de salud del segundo nivel de atención, por presentar dolor abdominal dolor abdominal tipo cólico que inicia en epigastrio y se irradia a hipocondrio bilateral; la misma que presenta diagnóstico de fibrosis quística con tres años de evolución; cuyos valores de amilasa y lipasa permitieron establecer diagnóstico presuntivo de pancreatitis, complicación que no resulta frecuente en pacientes pediátricos. El cuadro clínico permitió observar particularidades que le hacen inusual para ese grupo etario, al observarse complicaciones respiratorias y al desarrollo de pancreatitis. Los protocolos de manejo de la enfermedad, seguidos en las instituciones médicas involucradas, estuvieron acorde con los estándares establecidos a nivel nacional e internacional.

Highlights • The spontaneous perforation of the biliary tract is an extremely rare cause of peritonitis. • We present a case of spontaneous perforation of the biliary tract in a patient with a history of 4 previous ERCP, a current diagnosis of choledocholithiasis and a probable cholangitis. • This is the first case of spontaneous perforation of the biliary tract treated with ultrasound-guided drainage and ERCP successfully reported in México., Introduction The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1982, to date only around 70 cases have been reported. Here we present a case of spontaneous perforation of the biliary tract, in a patient with choledocholithiasis, which was treated with ultrasound-guided drainage and ERCP. Case report A 51-year-old male was admitted to the emergency room for 15-day evolution jaundice, localized pain in the right flank and hypochondrium of 3 days. He had a history of cholecystectomy 15 years ago and 4 episodes of cholangitis, the last one in 2015. A magnetic resonance imaging (MRI) was performed, that showed evidence of choledocholithiasis, in addition to a possible biliary leakage. The patient was treated with ultrasound-guided drainage and ERCP successfully. Discussion Spontaneous perforation of the biliary tract is a disease entity in which wall of the extrahepatic or intrahepatic duct is perforated without any traumatic or iatrogenic injury. The clinical presentation varies from nonspecific abdominal pain to biliary peritonitis, in most of the cases forming bilomas. Universal management involves decompression of the biliary tree and repair of the leak site. Conclusion The spontaneous perforation of the biliary tract is a disease that represents a diagnostic challenge. The treatment in the patients with SPBT is not well established and has to be individualized for each case, depending on the history of the patient, the site of perforation, the time of evolution, the suspicion of infection, and the patient status.

Introduction This article examines the variations and anomalies of gallbladder. This study is highly useful for surgical purposes where there is always a lot of variations seen, to prevent misdiagnosis and to aid in evaluation of differential diagnostic possibilities. Methods Ultrasonography was used to perform this study. Result This study demonstrates wide array of variants including anomalies in location, number and configuration. The present study shows that there is double gallbladder found in 1%, kinking of posterior wall of gallbladder in 15%, Phrygian cap deformity in 7%, curved gallbladder found in 1%, intrahepatic gallbladder observed in 9%, transverse gallbladder detected in 7% and the gallbladder is located under the left lobe of liver in 2% of the cases. Normal location in right Hypochondrium is seen in 81 subjects. Discussion The present study shows various anomalies of gallbladder that can be diagnosed prior to the surgery, so as to avoid misdiagnosis that could cause any fatality.

Les hernies internes sont une cause rare d'occlusion intestinale aiguë. La hernie à travers le ligament falciforme est une forme exceptionnelle dont le diagnostic est souvent fait en peropératoire. La tomodensitométrie abdominale, pratiquée en urgence, peut aider au diagnostic en préopératoire et permet de guider l'attitude thérapeutique. Aussi, nous a-t-il paru opportun de rapporter ce cas colligé dans le service de chirurgie viscérale A du CHU Hassan II de Fès. Nous rapportons l'observation d'un patient âgé de 48 ans, sans antécédent particulier, admis aux urgences avec un tableau d'occlusion évoluant depuis 4 jours. La radiographie d'abdomen sans préparation objectivait de multiples niveaux hydro-aériques de type grêlique dont certains se projetaient en regard de l'air hépatique, ainsi que la présence d'une anse intestinale plate en continuité avec un segment intestinal distendu. La tomodensitométrie abdominale n'a pas été réalisée vu une fonction rénale qui était altérée. Le patient était alors opéré en urgence après mise en condition et le diagnostic d'une hernie interne du ligament falciforme était fait en peropératoire. La hernie interne à travers le ligament falciforme est une cause rare d'occlusion intestinale aiguë de l'adulte dans notre pratique quotidienne. Le diagnostic est le plus souvent fait en peropératoire. Il faut savoir y penser devant le jeune âge, l'absence d'antécédents de chirurgie abdominale ou de processus infectieux intra péritonéal et la présence de niveaux hydro-aériques dans l'hypocondre droit.

Introduction : Malignant pheochromocytomas are rare tumors which carry a poor prognosis and their clinical presentation is variable. Malignancy is defined by the presence of local invasion and/or metastases. In this report, we describe three cases of large malignant pheochromocytomas. Cases Presentation : The three cases have presented abdominal masses. Two patients complained of hypochondrium pain, and the third one was asymptomatic. One of the patients experienced sweating for 2 years, while the two others had no symptoms suggesting the hyper secretion of catecholamines. Urinalysis revealed elevation of daily urinary excretion of catecholamine metabolites in two cases and the computed tomography (CT) revealed large adrenal masses in the three cases. The malignancy was confirmed by the presence of multiple liver, lung and bone metastases. Surgery was performed in one case, but the tumor resection was impossible because the mass was adherent to great vessels. Calcitonin, intact parathormone (PTH) and calcium were normal in the 3 cases, which ruled out multiple endocrine neoplasia syndrome type 2. Otherwise, there was no sign suggesting phacomatosis. Two patients died before starting therapy, while in the third case the treatment considered was surgery and chemotherapy regimen of cyclophosphamide, dacarbazine and vincristine (CVD). Follow-up, showed a progression of tumor size with no significant improvement of metastatic disease. Conclusion : Malignant pheochromocytomas are particularly rare and aggressive tumors. Despite advances in diagnosis and treatment of malignant pheochromocytomas, their management is still a real dilemma, especially in our context because of the lack of diagnostic tools such as genetic analysis and the cost of therapy.

Aim Within the Kampo medical system, there exists a system specific to Japan of abdominal diagnosis called abdominal palpation, or Fukushin, which is used to obtain a holistic picture, called an abdominal pattern, of the physical indications in the abdominal area. In order to educate students in this system, we have devised and continued to develop a Fukushin simulator, incorporating various improvements as appropriate. The present study describes some recent additions to the model with the aim of increasing its applicability across a broad range of abdominal patterns. Methods The simulator is modeled on the abdomen of a healthy adult man, from which we took a mold using flexible silicon resin. To increase the resistance in some areas, we used urethane foam mixed with silicon rubber or attached parts consisting of silicon rubber; to reduce the resistance to pressure in other areas, we used urethane foam in small quantities. Results By such adjustments, we were able to reproduce patterns seen frequently in abdominal palpation, that is, stuffiness and rigidity below the heart, rectus muscle tension, fullness in the chest and hypochondrium, and lower abdominal fullness, each marked by localized increases in resistance to touch; and lower abdominal numbness, marked by a localized reduction in resistance to touch. Conclusion It is expected that the simulator will make an important contribution not only to medical education but also to the standardization of abdominal diagnosis.

Diaphragmatic hernias are defined as a transposition of abdominal organs into the thoracic cavity through a defect in the phrenic muscle. They can be classified as congenital, acquired, or post traumatic. The Bochdalek hernia is congenital, it is produced by an alteration in the embryological development of the diaphragm, causing a zone of anatomical weakness that allows the protrusion of intraabdominal organs into the thoracic cavity. The prevalence of the Bochdalek hernia is 1 in 2,200 births and is located on the left side 80%-90% of the time, only 5%-10% remain undetectable during childhood. Less than 100 cases have been reported in adults. In Honduras there have been few cases reported in pediatrics, and none in adults. We present the case of a 38-year-old patient that seeks at the Hospital Escuela Universitario in Tegucigalpa, Honduras, due to abdominal pain located in the left iliac fosse that irradiates to the right flank and hypochondrium over the past two months, accompanied by dyspnea and paroxistic episodes of cough. At thoracic auscultation wheezing was found with predominance in the left lung, with hypoventilation and the presence of intestinal sounds. A thoracoabdominal tomography with contrast was performed, finding the presence of a diaphragmatic hernia occupying the whole left hemithorax, including the spleen, colon and stomach. The data is corroborated by a diagnostic laparoscopy, but because the organs could not be reduced to the abdominal cavity a laparotomy was performed. The findings correspond to the organs that are commonly herniated in the left Bochdalek hernia. After the laparotomy the patient had a satisfying progress, with subsequent hospital discharge. It is important to have a timely diagnosis and adequate treatment for this type of hernia to prevent complications that could compromise the life of the patient.

When splenectomy is performed, autotransplantation is the only method to preserve splenic function. The most frequently used technique for splenic autotransplantation in humans is the implantation of multiple sections of the splenic parenchyma into pouches created in the greater omentum. However, this technique of autotransplantation is associated with complications. For this reason, a technique in which only one 35-g slice of spleen is transplanted into the greater omentum but positioned within the native hypochondrium can be considered safe and useful for patients. Experimental studies continue to add valuable information to the ongoing research in the field of autotransplantation, providing a baseline for future studies in humans and adding arguments in favor of autotransplantation when the spleen cannot be preserved.

Chinese herbal medicinals that rectify or regulate the qi movement (sometimes referred to as “qi mechanism” or “qi dynamic”) as the main role and treat qi stagnation or qi counterflow syndrome are called “Herbs That Rectify Qi” or “Herbs That Move Qi.” Herbs that rectify qi are mainly indicated for the treatment of distending pain in the stomach cavity and abdomen, belching and acid swallowing, nausea and vomiting, diarrhea or constipation caused by qi stagnation in the spleen and stomach; distending pain in the hypochondrium, depression and discomfort, hernia pain; distending pain in the breast, and menstrual irregularities caused by constraint and stagnation of the liver qi; chest oppression and pain, cough and panting caused by obstruction, and stagnation of the lung qi.

Objective To investigate the characteristics of traditional Chinese medicine (TCM) syndromes and their elements in patients with post hepatitic cirrhosis by analyzing the relationships between signs and symptoms and biochemical parameters. Methods A total of 440 patients with hepatitis B cirrhosis treated in Shanghai Public Health Center and Shuguang Hospital, Longhua Hospital and Central Hospital of Putuo District Affiliated to Shanghai University of Traditional Chinese Medicine during January 2002 to January 2006 were enrolled in this study. Signs and symptoms and biochemical information of patients were collected by using a self-designed questionnaire regarding the four examinations of TCM. Signs and symptoms were firstly analyzed to find the frequency of occurrence. Then, the patients were divided into two groups according to non-existent or existent sign and symptom and the correlations between the signs and symptoms which occurred most frequently and their biochemical parameters were analyzed. Results Sixteen symptoms which occurred most frequently were fatigue, colored urine, liver palms, opaque complexion, string-like pulse, weakness at waist and knees, dry month and bitter taste in the mouth, profuse dreaminess and poor sleepiness, heaviness of limbs, abdominal distention, yellow eyes, fine pulse, impetuosity and susceptibility to rage, splenomegaly, poor appetite, and distension and fullness in the chest and hypochondrium. A previous study on syndrome differentiation of 900 patients with post hepatitic cirrhosis showed 4 syndrome patterns: internal accumulation of dampness-heat, liver-kidney yin deficiency, internal accumulation of blood stasis-heat, and liver depression and spleen deficiency. Further analysis showed that internal accumulation of dampness-heat syndrome was characterized by obvious hepatic inflammation, poor synthesis function and more ascites. Liver-kidney yin deficiency syndrome was characterized by low-level hepatic inflammation, poor synthesis function and more ascites. Internal accumulation of blood stasis-heat syndrome was characterized by low-level hepatic inflammation, poorer synthesis function, ascites and splenomegalia, and liver depression and spleen deficiency syndrome was characterized by slight hepatic inflammation, synthesis function injury, decreased internal portal vein diameter and less ascites. Conclusion Different syndrome patterns have different pathological features, showing the complexity and polymorphism of syndrome construction.

Aloplasty of postoperative hypochondrium hernia stomach (PHHS), using modified polypropilene mesh, but this is accompanied by a fairly high frequency of postoperative complications from the postoperative wound. In our view, the use of a nanomodified polypropylene mesh modified by carbon nanotubes and an antiseptic of polyhexamethleneguanidine chloride the results of operative treatment of PHHS. Aim – to improve the results of postoperative hypochondrium hernia stomach using modified polypropylene mesh. Object and methods. The analysis of operations treatment of 146 patients with PHHS of has been performed. Depending on the type of mesh used during operations treatment, patients were divided into 2 groups. In 73 (50%) of Group I patients using modified polypropilene mesh. In the 2nd group, 73 (50%) patients using classic polypropylene mesh. Results and discussion. Statistically significant results were obtained in patients of Group I compared to Group II: seroma was in 11 (15.5±1.2%) in Group II compared to 4 (5.5±0.4%) in Group I (p0.05). Chronic pain in the abdominal wall in 6 – 8 months after surgery was observed in 3 (5.6±0.6)% patients in group II and in 1 (1.9±0.4%) group I (p>0.05), recurrences of hernia were found in 3 (5.6±0.6%) patients of group II, in group I – in 1 (1.9±0.4)% (p

Calculi may form at any level in the urinary tract but mostly arises in the kidney (nephrolithiasis). People suffering from renal calculi entirely depend on the surgery although it is expensive, on the one hand, and may have complications, on the other hand. Hence, there is a need for alternative medicine (Homeopathy), as it avoids surgical intervention, complication, as well as cost-effectiveness. In Homeopathy, the basis of therapy is vital rather than a physiological one, i.e., the vital force must be stimulated to cure the patient, and that only other drug therapy is palliative or suppressive. The aim of the study is to know the efficacy of individualized homeopathic remedy in the dissolution or expulsion of calculus. A 23-year-old male patient came to the outpatient department, presented with pain in the right side of the lumbar region and hypochondrium for 4–5 days with difficulty in urination. Ultrasonography (USG) of the kidney, ureter, urinary bladder revealed two calculi in the right kidney, one at the upper pole (8 mm) and another one at lower pole (12 mm) calyx. Individualized homeopathic medicine Tuberculinum was prescribed in centesimal scale. USG revealed no calculus in the kidney, and serum urea and creatinine levels were found within normal limit. Therefore, it is concluded that constitutional medicine helped the patient in subsiding the pain, dissolution or expulsion of stone, and return of the natural state of the patient.

Background: Gall stone disease is a chronic recurrent disease of hepatobiliary system characterised by formation of gall stones due to impaired metabolism of bile acids, cholesterol and bilirubin. The prevalence of cholelithiasis is variable and has been reported as 2-29% in India with differences in interstate and interregions. The objective of the present study was mainly focuses on the total clinical study with surgical management and their outcome. Methods: A prospective study for a period of one year was done after approval from ethical committee. The socio-demographic factors, clinical history, physical examination, laboratory investigations with ultrasound abdomen were done in all the cases. Surgical repair by Laparoscopic and open cholecystectomy was done. Results: Females were more predominant with male: female ratio of 1:1.97. Mean age of study population was 34.12±6.2 years and was more common during 5 th decade of life. Pain in the hypochondrium was most common sign. Mixed stones were most common and mostly observed in cases of mixed diet. Laparoscopic cholecystectomy was most commonly performed with zero conversion rate. Wound infection was the most common post-operative complication in both the types of repair. Conclusions: To conclude, from the present study females were more commonly affected by cholelithiasis than males with a ratio of 1:1.97. Females are more prone during fertile age and reasons are multifactorial due to hormones, parity and hormonal contraceptives. Gall stone disease is more common during fourth and fifth decade of life in both males and females. Mixed diet (non-vegetarian) is associated with increased risk of developing gall stones than vegetarian diet.

Background: Omental torsion is usually diagnosed intraoperatively and resected. Recent literature supports conservative management after diagnosis of omental torsion using radiological imaging. We present the experience of a single institution. Methods: Retrospective review of clinical, laboratory, radiological and operative data were collected from patient case notes. Results: Six patients were identified as cases of omental torsion between January 2003 and May 2005. Abdominal ultrasound was performed in all patients. The abnormality was described in two patients as vaguely defined focal hyperdense mass-like lesion in the hypochondrium and right iliac fossa. In another two patients, localized small fluid collections were noted. The remaining two studies were reported as normal. Computed tomography scan of the abdomen performed in five patients accurately identified the abnormality as an ill-defined, relatively hyperdense fatty mass with a typical whorled appearance centred on engorged blood vessels. Four patients underwent surgery and two were successfully managed conservatively. Conclusion: Awareness and careful evaluation of clinical and laboratory findings, coupled with ultrasound and/or computed tomography studies of the abdomen, can make a reliable diagnosis of omental torsion, affording the option of conservative management in some cases.

The objective of this study was to explore the fetal development of the stomach, its morphology and relationship with neighboring structures. The study is carried out in 2003 using 160 human embryos and fetuses (81 males and 79 females) aged between 9 and 40 weeks of gestation. None of the cases had any external pathology or anomaly. Its topographical localization and relationship with surrounding structures were revealed with anatomical dissections. Width and height of the stomach, lengths of the greater and lesser curvatures, the angle between horizontal and vertical axes of the stomach and types of stomach were established. During the fetal life stomach was most commonly located above the transverse axis passing through the umbilicus, in left and right hypochondrium (81%). There were significant differences among trimester groups with respect to the localization of the stomach in the quadrants (P0.001). There were no significant sex differences in parameters. After the second trimester, the height of the stomach increased more than the width of the stomach and anterior abdominal height. The angle of stomach decreased from 100 degrees to 50 degrees throughout the fetal period. During the fetal period, wide angles stomach was more common in the first(f) and second trimesters while acute-angled stomach was more common in the third trimester and term fetuses. Diagnosis and treatment of fetal anomalies and pathologies of the stomach requires knowledge of fetal anatomy of the stomach. Data acquired in this study are believed to contribute to the studies of obstetrics, perinatology, forensic medicine and fetal pathology on fetal development of the stomach, and diagnosis and treatment of its anomalies, pathologies, and variations.

Abdominal wall bleeding in the port-site insertion placed during laparoscopic bariatric surgery is often difficult to control. From January 2005 to August 2011, 226 patients underwent bariatric surgery at our institutions. Seventeen patients (7.5%) presented port-site bleeding that could not be controlled with electrocautery and Foley's catheter (24 F) was used for bleeding inhibition. Of the 17 patients, there were 12 females (70.6%) and five males (29.4%) with a mean age of 38.35 years. Mean body mass index (BMI) was 44.2. Most of bleeding port-sites were located in hypochondrium and were 12-mm size. After the catheter removal (median 36 h), bleeding did not recur in any case. There were no other complications related to the port-side bleeding and the Foley catheter placement. Hospital stay was not prolonged due to the use of the Foley catheter. Port-site bleeding in bariatric surgery is a frequent complication. In up to 7.5% of the cases, the haemorrhage cannot be controlled with electrocautery. Compression with Foley catheter balloon is a safe and efficient method to stop bleeding.

The patient was a 58-year-old man with a tobacco habit of 20 cigarettes/day, ischemic cardiomyopathy and chronic obstructive pulmonary disease. He came to the Emergency Department due to the sudden appearance of a mass in the right abdomen after a fit of coughing. He was admitted with BP 125/75 mmHg and 102 bpm, and we observed a large mass in the right flank and hypochondrium during physical examination. The lab work showed hemoglobin 13.3 mg/dL and hematocrit 37.29%. A simple abdominal radiograph showed no alterations. Meanwhile, computed tomography of the abdomen with intravenous contrast revealed a large hematoma of the right rectus abdominis muscle sheath measuring 20 cm 14cm 70 cm with signs of active bleeding (Figs. 1 and 2). c i r e s p . 2 0 1 4 ; 9 2 ( 7 ) : e 3 9

A 48-yr-old female presented with a 1-yr history of pain in the hypochondrium and epigastrium. All routine investigations and computed tomography (CT) of the abdomen were done. CT findings revealed a well-defined cystic mass in the right ovary, and ascitis with features suggestive of secondaries over the omentum and peritoneal surface. The serum CA125 was 1255 U/mL (normal range 0-35 U/mL), which was indicative of ovarian malignancy. An exploratory laparotomy was performed. Histopathological examination of organs revealed the presence of granuloma. The patient was advised to undergo antitubercular treatment (ATT) and follow-up every month. After 1 mo of ATT, the CA125 level came down to 42 U/mL, which was near normal. As tuberculosis requires only a conservative management, we suggest that in cases of abdominopelvic mass with or without ascitis, high serum CA125 should always raise a suspicion of tuberculosis and a laparoscopy combined with peritoneal biopsy should be performed to confirm the diagnosis. This will prevent unnecessary laparotomies. Moreover, serum CA125 can be used to monitor the response of disease to antitubercular treatment.

The Zulinqi acupuncture point (GB.41), on the dorsal surface of the foot, is reported traditionally to be effective for treating disorders that occur along the course of the Gall bladder channel. The authors describe its beneficial use in five, widely differing indications and give supporting case histories. The indications discussed are: metatarsal fracture, bruised finger, headache, pain in the hypochondrium, and abdominal Herpes zoster. Its use in these cases is shown to illustrate four important principles of treatment: select lower points for upper diseases, use points on the right for symptoms on the left and vice versa, restrict needling to few but effective points, and apply one point to many purposes.

Sympathetic denervation has fallen into disfavour for operations. Dorso-perivertebral, paravertebral or retroperitoneal approaches are only of historic importance. The oblique retroperitoneal approach is popular because it provides good visibility, at the expense of a long skin incision. A videoscopic procedure has now been developed for lumbar sympathectomy. A transverse skin incision of 3–4 cm is made in the hypochondrium, lateral to the rectus sheath. The abdominal muscles are split along their fibres. The transversalis fascia is opened and the peritoneum is carefully peeled back. A trocar is then introduced laterally from the skin incision, and under visual control the sympathetic trunk is exposed. After identifying the ganglia, L2 and L3 are coagulated together with the part of the sympathetic trunk that joins them. The suction drainage is not required nor are balloons to develop the operation field, which is not insufflated. Patients undergo rehabilitation much more easily because of reduced wound pain and they leave hospital quickly. The method only requires basic videoscopy instruments.

We report a case of minimally invasive nephrectomy of a kidney transplanted into the abdominal cavity in a child. A 15-year-old girl underwent transplantation with a cadaveric donor kidney due to congenital pyelonephritis, vesicoureteral reflux, and secondary bladder atrophy. The transplant was complicated by hyperacute rejection, cytomegalovirus infection, and anastomotic stenosis of the Bricker neobladder. After recurrent urinary tract infections, the patient was reintroduced to hemodialysis in 2010. After pneumo-peritoneum, we placed 2 10-mm trocars in the hypochondrium and left side and 2 5-mm in the left iliac fossa and right upper quadrant. The transplanted kidney was skeletonized, the artery and vein were cut to the end-to-side anastomoses to the juxta-renal aorta and cava using an automatic 35-mm, stapler, and the ureter was dissected and closed with clips. Via a Pfannestiel minilaparotomy we extracted the allograft. The patient was discharged on the third postoperative day. After 4 months of follow-up, she is alive an on dialysis. Laparoscopic nephrectomy of a kidney transplanted into the abdominal cavity is feasible and safe in centers with skilled minimally invasive techniques.

Background: Breast reshaping after massive weight loss represents a challenging procedure because of severe hypoplasia and tissue ptosis. Standard mastopexytechniquesareofteninadequatetorestoreapleasantprofileandvolume. The authors present their experience with the anterior intercostal artery perforator flap in breast autologous augmentation and remodeling. Methods: Fifteen bariatric patients (30 breasts) affected by severe breast ptosis and tissue laxity in the upper abdominal wall underwent superior pedicle mastopexy with anterior intercostal artery perforator flap autologous augmentation. The flap was harvested including soft tissues above and below the inframammary fold, extending cranially 5 to 6 cm above the fold and inferiorly over the costal cage and hypochondrium. The flap was completely islanded on intercostal perforators originating from the fifth to seventh intercostal spaces. It was cranially advanced and sutured to the pectoralis major fascia. The medial and lateral borders were sutured together to shape an “autologous implant.” Results: All of the flaps were transferred successfully. The donor site was always closed primarily and upper abdominal laxity corrected. All of the breasts presented soft at palpation, with no clinical signs of flap necrosis early or late postoperatively. At 1-year follow-up, the breasts maintained good shape and projection. Conclusions: The anterior intercostal artery perforator flap proved to be a reliable option in bariatric mastopexy. The technique canbeperformed easily andallowstheharvestingofalargeamountoftissuewithawiderangeofmotion, providing adequate breast volume and projection without the need for implant placement. (Plast. Reconstr. Surg. 130: 917, 2012.)

A 68-year-old man with type 2 diabetes mellitus, hypertension and history of laryngeal cancer surgery with tracheostomy was operated on in 1993 and right chest rib chondrosarcoma surgery was performed in 1997. The patient presented with fever and acute right sided hypochondrium pain. Lung examination showed decreased breath sounds over the right posterior of the lower chest. Blood examination revealed elevation of inflammatory markers. Chest radiography showed right inferior lung lobe …

We report a case of 70 yr old woman with history of mass per abdomen since 5 months, which was insidious in onset and gradually progressed to present size. It was not associated with fever, haematuria, but gives history of loss of weight and loss of appetite. She was emaciated, poorly nourished with no significant past history. On examination she had mass per abdomen occupying Right lumbar, hypochondrium, umbilical, Right iliac fossa and hypogastrium abutting the anterior abdominal wall. No free fluid, no organomegaly. No evidence of swellings in other part of body, and no supraclavicular lymphadenopathy.

To find out whether the increase in the number of children admitted with injuries from mountain bicycle handlebars is attributed to recent changes in the design of children's bicycles.Retrospective study.Teaching general hospital, Israel.76 children who presented with abdominal injuries caused by bicycle handlebars.In 12 of the 76 children, there was an imprint of the handlebar edge on the hypochondrium. The most common injuries were isolated ruptures of spleen or liver, (14 and 11 patients, respectively). Five of the 25 patients were operated on and the rest treated conservatively.Children with an imprint or bruise made by the handlebar edge on the abdominal wall, or who give a clear history of injuries by a bicycle handlebar should be treated with great care. BMX handlebars are relatively high (for young riders) and wide; they also turn freely and are therefore in direct line with the upper abdomen. Prohibiting the use of bicycles with unpadded handlebars may prevent some of these intra-abdominal injuries.

A 76-year-old man affected by autosomal-dominant polycystic kidney disease was admitted for a 2-year history of purulent leakage from a cutaneous orifice present in the right hypochondrium. The patient was submitted to a percutaneous aspiration of a big symptomatic cyst in the right liver about 3 years earlier in another hospital. Shortly, an orifice with purulent leakage appeared in his hypochondrium. Two years later, the patient came under our observation. Computed tomography scan showed a polycystic liver with a fistula from a hepatic cyst to the skin. A laparoscopic approach was chosen to dissect the fistulous tract from its liver bed and then a cutaneous incision was performed to resect the en-block fistulous tract and skin containing the cutaneous orifice. Cystocutaneous fistula, as in our patient, is not reported yet; the laparoscopic approach allows treatment in the presence of a fistula and, as in our case, of hepatic cysts.

OBJECTIVE: The few investigations about pressure pain threshold in corporeal surface areas and children age showed no correlation between these parameters in all areas. In this research the existence of correlation between age and pressure pain threshold in seventeen areas of the corporeal surface of children was investigated. METHODS: A descriptive research was made with one hundred children from the Clinical Hospital of the Federal University of Minas Gerais. The selection of patients was made by directed search. There were forty five boys and fifty five girls with ages varying between 5.3 and 15.8 years old, and a mean (-/+ standard deviation) of 9.6 (-/+ 2.7) years old. The seventeen corporeal areas studied were regions of the trapezium, deltoid and supraspinal muscles, nine areas of the abdomen and the median part of the tibias. The pressure of 0.5 kg/cm(2)/s was made using a mechanical algometer. The pressure values that were recorded in the equipment when the children started to complain about the pain, by verbal communication, were considered as pressure pain thresholds. RESULTS: Positive correlations with significant statistic values were found between pressure pain threshold and age in every area investigated: trapezium, r = 0.36; deltoid, r = 0.34; supraspinal, r=0.42; hypochondrium, r=0.41; epigastrium, r=0.41; flank, r = 0.48; periumbilical, r = 0,40; iliac fossa, r = 0.49; hypogastrium, r = 0.45 and tibia, r = 0,29. CONCLUSIONS: Since correlations between age and pressure pain threshold were found in all areas studied, the age of a patient must be taken into consideration during clinical investigations and pain evaluations in children and adolescents. The younger the patient, the lower the pain thresholds.

A 66-year-old man developed sudden perineal discomfort and fever with painful anal, penile, and scrotal oedema during treatment with steroids for severe thrombocytopenia of unclear origin (whether auto immune thrombocytopenia or myelodysplastic syndrome). An anal fi stula was observed and CT scan showed emphysematous gangrene of the perineum and scrotum, with testicles suspended in this emphysematous space (fi gure A, B). Gas gangrene had also aff ected the soft tissues below the skin, causing stretching of abdominal wall up to the hypochondrium area (fi gure C, D), as also shown by three-dimensional CT scans (fi gure E, F). Subsequently, thrombocytopenia resolved com pletely and steroids were stopped. The patient was diagnosed with Fournier’s gangrene—a lifethreatening necrotising fasciitis caused by a perineal abscess with infection of the anal fi stula. The patient was successfully treated with fl uid replacement, broadspectrum antibiotics, and debridement of necrotic tissue, followed by reconstructive surgery. Published Online March 14, 2014 http://dx.doi.org/10.1016/ S0140-6736(13)61098-3

[⇓][1] ![Figure][2] In this engaging book, the Irish writer Brian Dillon looks at the topic of hypochondria. The subject is an elusive one, because the concept of hypochondria has changed greatly over the centuries. The word hypochondrium was used by Hippocrates to refer to the regions

A ?Y-year old wonxm presenkd in December 1YY5 with a Z-month hidory of :I poor appetik. post prandial bloa[ing and a dull back ache. Examination revcalcd a render mass in the left side of the abdomen. Compuwd tomogmphy (CT) of the abdomen demonsmired a large rcwopcrimncnl I,I;ILS cstcnding up into the lefr hypochondrium and displacing [he left kidney anteriorly (Fig. I ). The I~XISS was of predommantly low attenuation. enhanced following intravenous contrast medium and contn~ned la-go draining veins. A preliminary diagwsia of a rutroperironcal liposarcw~~;~ was w ggestcd and the patient vu\ referred IO the sucoma unit ilt the Royal Marsdcn Hospital. A I-I G Tru-cut needle biopsy USI\ perfom~ed under ulhxsound guidance. Hiskllogy showed fragments of turnour. containing multiple cells. The cells had a _eranular eosinophilic cymplasm and many showed multiple small cytoplasmic clear vncuolc~. Scatwed uniwcuolar cells were also apparent. The ;~ppear;mce\ were of a fatty tumour wth no evidence of malignancy. A provisional diagnovs of ;I h~hemomn wa\ made and excision ;Idviscd. At Iapnrotomy thcrc wah 3 large lumour of brown fat. with lnrgc veins draining mm the mescmcry. The tumour was excised without complication. although post-operatively the pariem sustained an acute bleed which wab trenrrd conservatively. The resected specimen was ;I large encnpsulakd tun~our (20 x I3 x 4 cm), wth ;1 smooth extemid hurface. On sectioning. it appeared lobular with a ligh[ brown discolor;~tion (Fig. 2). Hiskology revealed ;I dtffcrenriarcd fatry tumour consisting of multiwcuolated cells with granuklr eosinophilic cytoplasm and bland centwl nuclei (Fig. 3). Uniwcuolnr Ibmlr and cells indistinguishable from mature lipocyka were prcscnl. There \Y;I\ no ntypia or lipoblnst\. The appearances were of it hihemoma.

No presente trabalho é relatado um caso de paciente portadora de fístula bílio-brônquica (FBB) secundária a coledocolitíase tratada no Hospital da Universidade de Mogi das Cruzes e é feita uma revisão da literatura pertinente ao assunto. Tratava-se de uma paciente, 35 anos, feminino, parda, cujo quadro clínico inicial era dor em hipocôndrio direito, de caráter contínuo, acompanhada de icterícia do tipo obstrutivo e bilioptise que atingia até um litro em 24 horas. O diagnóstico foi confirmado por radiografia simples de abdome e ultra-sonografia abdominal. O tratamento consistiu em laparotomia, colecistectomia, coledocotomia com retirada de dois cálculos, drenagem de vias biliares, colangiografia intra-operatória e liberação da cápsula hepática da cúpula frênica direita. A evolução pós-operatória foi satisfatória, com regressão da bilioptise no pós-operatório imediato. Houve regressão progressiva da icterícia em torno do sétimo dia do pós-operatório. A paciente foi estudada com broncografia após 24 meses que mostrou não haver alterações anatômicas dos brônquios basilares direitos pela inundação biliar. A paciente encontra-se no sétimo ano de seguimento sem evidência da doença.In the present case report is presented a patient with bilio-bronchial fistula secondary to choledocholithiasis surgically treated at the University of Mogi das Cruzes Hospital. It is a 35-year-old female patient which initial clinical features were continuous hypochondrium pain, accompanied by obstructive jaundice and bilioptysis that reached one liter in a period of 24 hours. The diagnosis was confirmed by X-ray exams and by abdominal ultrasonography. The treatment consisted in laparotomy, cholecistectomy, choledochotomy and extraction of two stones from biliary tract, drainage of biliary tree, intraoperative cholangiography and separation of the hepatic capsule from the right diaphragmatic cupula. At the postoperative follow-up was observed a total regression of the bilioptysis and disappearance of the jaundice after the seventh postoperative day. The patient was submitted to bronchography that did not reveal anatomical changes on the right lowers bronchi by biliary flood. The patient is on the seventh postoperative year without any evidence of the disease.

WILMS TUMOR (nephroblastoma) in adults is rare. Only 3% of Wilms tumors are reported in adults. Most adult patients are diagnosed unexpectedly following nephrectomy for presumed renal cell carcinoma. We present a 40 yr old female patient who came with complaints of lump and pain in left lumbar and hypochondrium region. After examination and workup, provisionally diagnosed as renal cell carcinoma of left kidney. Radical nephrectomy was done and histopathology revealed Wilms tumor.

The anterior abdominal wall is divided, for descriptive purposes, into nine regions by two horizontal and two vertical planes. The horizontal planes are the transpyloric (midway between the suprasternal notch and the crest of the pubis) and transtubercular (through the tubercles of the iliac crests). The vertical planes are the right and left lateral planes, which pass through the midinguinal points to reach the region of the epigastric, umbilical and suprapubic, and laterally on each side, the hypochondrium, lumbar (lateral) and iliac regions (Figure 1).

a Present affiliation: Division of Hematology/Oncology, Wake Forest University, WinstonSalem, North Carolina. Reprints or correspondence: Dr. Madhuri Yalamanchili, 105-09 Crowne Chase Dr., WinstonSalem, NC 27104 (madhuriyalamanchili@yahoo.com). Clinical Infectious Diseases 2002; 35:763–4 2002 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2002/3506-0019$15.00 Figure 1. Soft-tissue mass on the right hypochondrium. The size of the mass shown here is smaller than the size that was noted at the time of original presentation, because this photograph was obtained after biopsy. Figure 2. CT scan of the cranium showing localized soft-tissue swelling of the scalp and a lytic lesion of the skull.