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Purpose: Describe the clinical features and management of this uncommon case of late-onset Capsular bag distension syndrome that occurred 33 years after cataract surgery. Observation: An 87-year-old male was referred to our clinic complaining of blurred and gradual, painless reduction in vision in his left eye over the past year. A complete ophthalmological examination, Ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT), and optical biometry were performed to confirm the diagnosis. A 25-gauge pars plana vitrectomy combined with posterior capsulotomy was performed. The aspirated fluid was sent for microbiological analyses. After surgery, the patient's visual acuity returned to previous values, and anterior chamber depth slightly deepened. Samples taken were negative for bacteria. Conclusions and Importance: Late-onset Capsular bag distension syndrome may occur up to 33 years following cataract surgery. A surgical approach offers the advantage of complete clearance of the turbid fluid, also removing the residual cortical material and enabling microbial and pathological testing.

This article explores Mexico’s overlooked importance in the Central American armed conflict, the limits of its influence, and its connection to the late Cold War. Mexico’s policy toward Central America attempted to prevent an American and Cuban military intervention in the area and avoid a Cold War confrontation along its southern border. Mexico attempted to build detente in the region and prevent a global escalation of tension between the great powers. Meanwhile, it sought to propose a “third way” for the revolutionary actors shaped after Mexico’s political system and history. Studying Mexico’s efforts to create detente-like arrangements can shed light on the efforts of peripheral actors and their projects to influence the international system despite the actions of hegemonic powers.

This article explores Mexico’s overlooked importance in the Central American armed conflict, the limits of its influence, and its connection to the late Cold War. Mexico’s policy toward Central America attempted to prevent an American and Cuban military intervention in the area and avoid a Cold War confrontation along its southern border. Mexico attempted to build detente in the region and prevent a global escalation of tension between the great powers. Meanwhile, it sought to propose a “third way” for the revolutionary actors shaped after Mexico’s political system and history. Studying Mexico’s efforts to create detente-like arrangements can shed light on the efforts of peripheral actors and their projects to influence the international system despite the actions of hegemonic powers. [ABSTRACT FROM AUTHOR]

Objective: The aim was to provide a more efcient and tolerable oral contrast agent for bowel distension with fewer side efects due to its pH-sensitive nature. Methods: Mixtures of uncoated powder and enteric-coated granule forms of locust bean and xanthan gum (LBXG, 1:1 ratio) were developed. Locust bean and xanthan gum and commercially available oral contrast agents were examined using 3-tesla MR and MDCT units to determine imaging characteristics. In addition, LBXG was tested in a rabbit by a 3-tesla MR system. Results: Enteric-coated LBXG had a minimum of 10 times water absorption and swelling in the intestinal environment (pH 4.5-7.4). The lactulose solution was hyperdense, and the other contrast agents (including LBXG) were isodense on CT images. Methylcellulose solutions showed clumping in all environments despite sufcient shaking, and this type of clumping was not observed in other solutions. All solutions were hypointense on T1-weighted images and hyperintense on T2-weighted MR images. Although the enteric-coated LBXG granules were homogeneously soluble in water and an alkaline environment, they did not dissolve and precipitated in the acidic bufer despite sufcient shaking. LBXG showed biphasic character on MR images of the rabbit. Conclusion: Enteric-coated LBXG granules may be an efective oral contrast agent for enterography examinations. Because of its target-specifc nature, it may provide fewer side efects and a higher diagnostic efciency/toleration capacity. It can be used for enterography exams and bowel cleansing before enterography, endoscopy, and/or surgery. [ABSTRACT FROM AUTHOR]

This research focused on the tanning of sheepskins (Ovis aries) using tannins extracted from mango kernels (Mangifera indica) to assess the potential of this byproduct. Tannin extractions were conducted using ethanol-water solutions at concentrations of 70%-30% and 50%-50%. Quantification was performed via the Folin-Ciocalteu method using gallic acid as a standard. The tanning ability on sheepskin was evaluated through the leather's physical properties. The highest concentration of gallic acid equivalents (GAE) was obtained from the ethanol-water extraction at 50%-50%, with an average concentration of 110,1 mg GAE/g. Subsequently, the tanning process was applied to sheepskin, and the physical-mechanical properties of the leather were determined. Tensile strength values obtained were 12,7 MPa for the 50%-50% ethanol-water concentration and 11,3 MPa for the 70%-30% ratio. Elongation percentages were 11,7 N and 17,7 N, tear resistance values were 41,9 N and 58,0 N, shrinkage temperatures were 61°C and 60°C, distension measurements were 13,2 mm and 10,6 mm, and breakage forces were 37,4 daN and 48,3 daN respectively. Ultimately, the tanned leathers with tannins met 5 out of 6 analyzed tests according to UNE-EN ISO standards. Hence, the tannin extract from mango kernels demonstrates potential as a substitute for chromium salts, thereby favoring both environmental sustainability and the production of quality leather from sheepskin. [ABSTRACT FROM AUTHOR]

• Abdominal massage was effective in reducing pain and abdominal circumference. • Abdominal massage was effective in increasing comfort in patients. • Abdominal massage and position change can be used as an alternative for relieving bloating after colonoscopy. Pain, abdominal distention, and anxiety are major risk factors encountered after colonoscopy. Complementary and alternative treatments, such as abdominal massage and position change, are used to reduce the associated risk factors. To determine the effect of position change and abdominal massage on anxiety, pain, and distension after colonoscopy. A randomized three-group experimental trial. This study was conducted with 123 patients who underwent colonoscopy at the endoscopy unit of a hospital located in western Turkey. Three groups were formed: two interventional (abdominal massage and position change) and one control, each including 41 patients. Data were gathered using a personal information form, pre- and post-colonoscopy measurement form, the Visual Analog Scale (VAS), and the Spielberger State-Trait Anxiety Inventory. Pain and comfort levels, abdominal circumference values, and vital signs of the patients were measured at four evaluation times. In the abdominal massage group, the VAS pain scores and abdominal circumference measurements decreased the most and the VAS comfort scores increased the most 15 min after the patients were taken to the recovery room (p <0.05). Furthermore, bowel sounds were heard, and bloating was relieved in all patients in both intervention groups 15 min after they were taken to the recovery room. Abdominal massage and position change can be considered effective interventions for relieving bloating and facilitating flatulence after colonoscopy. Moreover, abdominal massage can be a powerful method for reducing pain and abdominal circumference and increasing patient comfort. [ABSTRACT FROM AUTHOR]

Tannins are phenolic compounds of great economic and ecological interest, with various uses among which are natural tanning of skins, which help to minimize the environmental impact caused by the indiscriminate use of chromium. For this reason, in this research, it was proposed to extract, quantify and evaluate tanning effect of tannins on the skin of fish of the species cachama (Colossoma macropomum), extracted from the sap of the pseudostem of banana (Musa paradisiaca) in a state of senescence. For this, extractions were made with different concentrations of solvent Sap/Ethanol/Water varying its temperature (4 and 30 °C) with the purpose of finding the best ratio of solvents to optimize extraction of tannins. It was found that the optimal tannins extraction temperature of the pseudostem was at 4 °C with a ratio 1:1 Sap/Ethanol. The extract obtained was analyzed by a qualitative test to show the presence of condensed tannins in the pseudostem in a state of senescence. The quantification of tannins was performed by UV-Vis spectrophotometry analysis using Folin Ciocalteu method at a measurement of 280 nm, obtaining a maximum concentration of 12,27 g/L equivalent to gallic acid (EAG). The process of tanning in cachama fish skin (Colossoma macropomum) was performed, where physical-mechanical properties of the leather obtained were determined as tensile strength (26,3 MPa), elongation percentage (91,2 %), tear resistance (58,6 N), shrinkage temperature (62 °C), distension (13,72 mm) and breakage (53,16 daN), comparing the quality of tanning with vegetable tannin extracts of the pseudostem with industrial tanning with chromium (wet blue). It was found that the pseudostem extract can be a potential substitute to chromium salts, allowing tannery processes with similar properties and with less environmental impact. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciencia y Poder Aéreo is the property of Escuela de Postgrados de la Fuerza Aerea Colombiana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Supplemental Digital Content is Available in the Text. Bladder sensory neurons express T-type calcium channel Cav3.2, but not Cav3.1 or Cav3.3. Blocking Cav3.2 inhibits bladder afferent sensitivity and bladder pain responses to distension. The bladder wall is innervated by a complex network of afferent nerves that detect bladder stretch during filling. Sensory signals, generated in response to distension, are relayed to the spinal cord and brain to evoke physiological and painful sensations and regulate urine storage and voiding. Hyperexcitability of these sensory pathways is a key component in the development of chronic bladder hypersensitivity disorders including interstitial cystitis/bladder pain syndrome and overactive bladder syndrome. Despite this, the full array of ion channels that regulate bladder afferent responses to mechanical stimuli have yet to be determined. Here, we investigated the role of low-voltage-activated T-type calcium (CaV3) channels in regulating bladder afferent responses to distension. Using single-cell reverse-transcription polymerase chain reaction and immunofluorescence, we revealed ubiquitous expression of CaV3.2, but not CaV3.1 or CaV3.3, in individual bladder-innervating dorsal root ganglia neurons. Pharmacological inhibition of CaV3.2 with TTA-A2 and ABT-639, selective blockers of T-type calcium channels, dose-dependently attenuated ex-vivo bladder afferent responses to distension in the absence of changes to muscle compliance. Further evaluation revealed that CaV3.2 blockers significantly inhibited both low- and high-threshold afferents, decreasing peak responses to distension, and delayed activation thresholds, thereby attenuating bladder afferent responses to both physiological and noxious distension. Nocifensive visceromotor responses to noxious bladder distension in vivo were also significantly reduced by inhibition of CaV3 with TTA-A2. Together, these data provide evidence of a major role for CaV3.2 in regulating bladder afferent responses to bladder distension and nociceptive signalling to the spinal cord. [ABSTRACT FROM AUTHOR]

This study was conducted to examine the effect of progressive muscle relaxation on abdominal pain and distension in colonoscopy patients. A randomized controlled experimental design. The experimental group was informed about progressive muscle relaxation (PMR) and an audio recording was provided. After the colonoscopy, abdominal pain (Visual Analogue Scale (VAS) pain) and distension (VAS distension) scores were assessed, then PMR was applied for 30 minutes and pain scores were determined again. VAS pain and VAS distension scores of the control group were determined after colonoscopy and 30 minutes later. VAS abdominal pain and VAS distension scores were evaluated at the 2nd, 4th, 8th, 12th, 16th, and 24th hour after the procedure on all patients. The day after the colonoscopy, post-test data were collected. The pretest VAS pain and VAS distension mean scores were similar in the intervention and control groups (P >.05). The mean VAS pain and VAS distension scores decreased significantly in the intervention group post procedure (P <.05). PMR was determined to be effective in reducing abdominal pain and distension after colonoscopy. [ABSTRACT FROM AUTHOR]

Copyright of Diyala Journal of Medicine is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Acute intestinal obstruction is one of the commonest and potentially dangerous surgical emergencies with a high frequency of morbidity and mortality if managed inappropriately. Although the mortality is decreasing with a better understanding of pathophysiology, improvement in radiological diagnostic techniques, fluid and electrolyte correction, potent antimicrobials, surgical management, and improvement in anaesthesia. The present prospective study was conducted to find out various etiological factors of mechanical intestinal obstruction and to evaluate morbidity and mortality in adult patients. Material Methods: The present prospective observational study of 290 patients with adult intestinal obstruction was carried out from December 2016 to October 2018 in the Department of Surgery at a Tertiary Care Hospital. The study included a total of 290 patients out of which 218 underwent surgical management and 72 underwent management conservatively, hence aetiology of intestinal obstruction was studied in the operative patients. Results:The peak age incidence was seen between 31-60 years in small bowel obstruction. Abdominal pain 283(98%) and distension 278(96%) were the most common presenting complaints. Out of 290 patients 218 (75.17%) patients underwent a surgical procedure in whom the most common intraoperative findings were adhesions and bands seen in 84 cases (38.53%) which were post-operative. Malignancy was seen in 6 cases (9.17%) involving small bowel. Adhesiolysis was the most common procedure done in 94 cases, with 78 cases of postoperative adhesive intestinal obstruction. Surgical site infection was the most common complication 109(50%). Conclusion: Clinical, radiological, and operative findings put together can bring about the best and most accurate diagnosis of intestinal obstruction. Among the factors influencing mortality and morbidity are age, state of hydration, the viability of the bowel, aetiology of obstruction, site of obstruction, delay in diagnosis and surgical intervention and associated medical illness. [ABSTRACT FROM AUTHOR]

After briefly exposing the conceptual framework on peace and security, this article distinguishes between the concepts of doctrine and strategy, to review the development of both since the cold war. It is argued that the two main doctrines remain in force, the one based on deterrence and the so-called shared security. An examination of the evolution of strategies according to the main actors in Europe (USA, Russia, NATO, EU, UN and OSCE) shows that these depend both on their doctrinal matrix and on the relations between said actors. [ABSTRACT FROM AUTHOR]

Esophageal peristalsis consists of initial inhibition (relaxation) followed by excitation (contraction), both of which move sequentially in the aboral direction. Initial inhibition results in receptive relaxation and bolus-induced luminal distension, which allows propulsion by the contraction with minimal resistance to flow. Similar to the contraction wave, luminal distension has unique waveform characteristics in normal subjects; both are modulated by bolus volume, bolus viscosity, and posture, suggesting a possible cause-and-effect relationship between the two. Distension contraction plots in patients with dysphagia with normal bolus clearance [high-amplitude esophageal contractions (HAECs), esophagogastric junction outflow obstruction (EGJOO), and functional dysphagia (FD)] reveal two major findings: 1) unlike normal subjects, there is luminal occlusion distal to bolus during peristalsis in certain patients, i.e., with type 3 achalasia and nonobstructive dysphagia; and 2) bolus travels through a narrow lumen esophagus during peristalsis in patients with HAECs, EGJOO, and FD. Aforementioned findings indicate a relative dynamic obstruction to the bolus flow during peristalsis and reduced distensibility of esophageal wall in the bolus segment of the esophagus. We speculate that a normal or supernormal contraction wave pushing bolus against resistance is the mechanism of dysphagia sensation in significant number of patients. Representations of distension and contraction, combined with objective measures of flow timing and distensibility are complementary to the current scheme of classifying esophageal motility disorders based solely on the characteristics of contraction phase of peristalsis. Better understanding of the distensibility of the bolus-containing segment of the esophagus during peristalsis will lead to the development of novel medical and surgical therapies in the treatment of dysphagia in significant number of patients. [ABSTRACT FROM AUTHOR]

Background: Abdominal bloating and distension are prevalent gastrointestinal symptoms. Our aim was to design and validate a questionnaire to reliably measure the multiple symptom components of bloating and distension in the outpatient setting. Methods: A 45‐item questionnaire was developed after an extensive literature review. Face and content validity were established through expert review and a focus group. Validation was achieved by administering an identical questionnaire 1 week apart. Data were assessed using standard methods. Key results: Forty one patients returned both questionnaires (85% women; mean age = 44 years). Respondents reported a variety of diagnoses, including irritable bowel syndrome (63%), gastroesophageal reflux disease (54%), functional dyspepsia (27%), small intestinal bacterial overgrowth (22%), and gastroparesis (17%). Test‐retest reliability revealed excellent agreement (k ≥ 0.81) and substantial agreement (0.61 ≤ k < 0.81) for 29% and 43% of categorical questions, respectively. Alternate‐parallel form reliability was supported by association between responses for questions that evaluated missing school/work and questions that evaluated symptom impact on daily activities (p < 0.05). Patients who missed school/work due to bloating symptoms were more likely to report a severe impact on their ability to enjoy life (p < 0.05) and their overall well‐being (p < 0.01). Contingency analyses revealed an association between overall 7‐day symptom severity and impact on daily activities (p < 0.001), enjoying life (p < 0.001), and overall well‐being (p < 0.001). Conclusions and Inferences: This novel questionnaire demonstrated good validity and reliability in patients with symptoms of bloating and distension. The questionnaire was easy to use and score, making it a potentially useful tool for both research studies and clinical purposes. [ABSTRACT FROM AUTHOR]

Ultrahigh-frequency ultrasound (UHFUS) allows sharp visualization of human small muscular arteries. This may help in elucidating some aspects of the pathophysiology of arterial aging, such as the stiffness gradient between large and small conduit arteries and its consequences on the microcirculation, as well as vascular diseases affecting medium-sized arteries. However, UHFUS use is still limited, partly because of the lack of validated tools to quantify vascular structure and mechanical properties of small muscular arteries. In this validation study, scans of digital arteries were obtained with UHFUS (VevoMD, Visualsonics-Fujifilm, Toronto, ON, Canada), analyzed using Carotid Studio software (Quipu, Pisa, Italy) and compared with the manual measurement. Agreement between the two techniques on measures of diameter, distension and intima-media thickness (IMT) was evaluated using Bland-Altman analyses; inter- and intra-operator reproducibility was evaluated using coefficients of variation (CVs). Overall, no trend or significant bias was observed between Carotid Studio and manual analysis. All limits of agreement were acceptable. The intra-observer CV of diastolic diameter and IMT were 4.1% and 4.2%, respectively. The inter-observer CV for diastolic diameter and IMT were 7.3% and 5.4%, respectively. Intra- and inter-observer CVs for distension were higher (25.7% and 26.7%, respectively). These results suggest that the Carotid Studio software is a valid and reproducible tool to study UHFUS scans of digital arteries, with potential utility both in rare vascular diseases of medium-sized arteries and in the study of the pathophysiology of arterial aging in general. [ABSTRACT FROM AUTHOR]

For the past two decades, botulinum neurotoxin A (BoNT/A) has been described as a strong candidate in the treatment of pain. With the production of modified toxins and the potential new applications at the visceral level, there is a real need for tools allowing the assessment of these compounds. In this study, we evaluated the jejunal mesenteric afferent nerve assay to investigate BoNT/A effects on visceral nociception. This ex vivo model allowed the continuous recording of neuronal activity in response to various stimuli. BoNT/A was applied intraluminally during three successive distensions, and the jejunum was distended every 15 min for 3 h. Finally, samples were exposed to external capsaicin. BoNT/A intoxication was validated at the molecular level with the presence of cleaved synaptosomal-associated protein of 25 (SNAP25) in nerve terminals in the mucosa and musculosa layers 3 h after treatment. BoNT/A had a progressive inhibitory effect on multiunit discharge frequency induced by jejunal distension, with a significant decrease from 1 h after application without change in jejunal compliance. The capsaicin-induced discharge was also affected by the toxin. This assay allowed the description of an inhibitory effect of BoNT/A on afferent nerve activity in response to distension and capsaicin, suggesting BoNT/A could alleviate visceral nociception. [ABSTRACT FROM AUTHOR]

Abdominal bloating and distension are highly prevalent symptoms that can negatively impact quality of life and lead to medical consultation. Despite their prevalence, symptoms of bloating and distension pose a unique diagnostic and therapeutic challenge, as they are inherently nonspecific symptoms with a complex etiology, and no uniform diagnostic or treatment algorithm currently exists. Additionally, bloating is common among disorders of gut-brain interaction, which can be difficult to treat. This article offers a practical approach for evaluating and treating symptoms of bloating and distension through discussion of 5 common etiologies: diet, small intestinal bacterial overgrowth, constipation, visceral hypersensitivity, and abdomino-phrenic dyssynergia. An effective personalized evaluation and treatment plan can be established to address symptoms of bloating and distension through consideration of these etiologies in the context of the patient's individual characteristics and presentation. [ABSTRACT FROM AUTHOR]

Abstract Background The BladderScan Prime Plus (BPP; Verathon, Bothell, Washington) is an application‐specific, three‐dimensional ultrasound device used for human, point‐of‐care volumetry of the urinary bladder. Objective To estimate the BPP's accuracy, repeatability, and optimized settings for assessing urinary bladder volumes in dogs, a variable utilized in assessing micturition disorders. Animals Twenty‐four, client‐owned, healthy, male dogs presenting for routine examination. Methods Prospective examinations were conducted by an experienced ultrasonographer and a novice, selecting the BPP's “man” or “child” setting, and were compared to urine volume obtained by catheterization. Results Mean urine volume significantly varied by operator (P = .05), device setting (P 5.5 kg (n = 18/24), mean difference between BPP's “man” setting and catheterized measurements, regardless of operator, was not significant. Conclusions Although small magnitude interuser variability is present in BPP examinations, the device provides accurate, though imprecise quantification of bladder volume in canids weighing >5.5 kg.

The diagnosis of acute surgical conditions of abdomen is in many instances challenging and complex. In these circumstances, abdominal paracentesis becomes useful and carries immense value. Aim of the study is to evaluate the efficacy of abdominal paracentesis as a simple, bedside and accurate diagnostic tool for acute abdominal conditions. A total of 60 patients with acute abdomen admitted to Emergency Surgery department of Rajindra Hospital, Patiala were taken for study. Every patient, who fulfilled inclusion and exclusion criteria, underwent diagnostic peritoneal tap and followed by routine investigations and radiological investigations wherever needed. In present study we found, sensitivity of the abdominal paracentesis as an aid for diagnosing cause of acute abdomen was 89.65%, specificity was found to be 100%, PPV was 100%, NPV of 20% and accuracy of 90%. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this overview is to summarise the findings of meta-analyses of randomised controlled trials that compare conservative treatment options for frozen shoulder. Methods: The authors conducted an electronic literature search for meta-analyses published using PubMed, Web of Science and the Cochrane Library. Two researchers independently applied selection criteria and assessed quality of meta-analyses using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Short-, medium- and long-term outcomes were synthesised narratively. Results: A total of 319 studies were identified, of which 8 meta-analyses were eligible for inclusion. All included meta-analyses were judged to be low or critically low quality according to AMSTAR-2, however, their data synthesis and interpretation was considered valid. Physiotherapy, intra-articular and subacromial corticosteroid injection (CSI), and arthrographic distension/hydrodilatation with corticosteroid were reported with sufficient evidence. Intra-articular CSI and arthrographic distension/hydrodilatation with corticosteroid provide advantages over placebo in short-term pain relief, range of motion (ROM) and shoulder function, with improvements in ROM continuing into the medium and long term. Arthrographic distension/hydrodilatation with corticosteroid provides medium-term and long-term improvements in ROM over intra-articular CSI and physiotherapy. Proprioceptive neuromuscular facilitation provides advantages over conventional physiotherapy for pain improvement and external rotation in the short term. Conclusions: Arthrographic distension/hydrodilatation with corticosteroid provides superior pain relief in the short term and improvement in range of motion across all time frames for frozen shoulder when compared to CSI or physiotherapy. Level of evidence: Level IV [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound (EUS)-guided gallbladder (GB) drainage has recently emerged as a more feasible treatment than percutaneous transhepatic GB drainage for acute cholecystitis. In EUS-guided cholecystostomies in patients with distended GBs without pericholecystic inflammation or prominent wall thickening, a needle puncture with tract dilatation is often difficult. Guidewires may slip during the insertion of thin and flexible drainage catheters, which can also cause the body portion of the catheter to be unexpectedly situated and prolonged between the GB and intestines because the non-inflamed distended GB is fluctuant. Upon fluoroscopic examination during the procedure, the position of the abnormally coiled catheter may appear to be correct in patients with a distended stomach. We experienced such an adverse event with fatal bile peritonitis in a patient with GB distension suggestive of malignant bile duct stricture. Fatal bile peritonitis then occurred. Therefore, the endoscopist should confirm the indications for cholecystostomy and determine whether a distended GB is a secondary change or acute cholecystitis.

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by tissue eosinophilia and can affect any part of gastrointestinal (GI) tract from the esophagus to the rectum, although stomach and small intestine are sites most frequently involved. We hereby describe an unusual case of eosinophilic gastroenteritis affecting the stomach, small intestine, colon and rectum involving the mucosa and serosa. A twenty-oneyearold student presented with fever, diarrhea, ascites and right pleural effusion. Total leucocyte count was high with marked eosinophilia. Ascitic and pleural fluid were exudates with low adenosine deaminase (ADA) level and predominant eosinophils. Biopsy specimens of the stomach, duodenum, ileum, colon and rectum showed dense eosinophilic infiltration of lamina propria. Based on the constellation of clinical features and investigations, a diagnosis of EGE was made, and therapy with prednisone was started. Symptoms and peripheral eosinophilia rapidly resolved. It is thus imperative to diagnose this disease early and institute the necessary treatment. [ABSTRACT FROM AUTHOR]

Malignant rhabdoid tumor (MRT) is one of very aggressive neoplasm commonly seen in kidney. An 8 months old boy presented with fever, abdominal distension, multiple vomiting and reduced oral intake. CT Angiography revealed a hyper dense mass involving multiple segments of the liver and associated rupture. He had near normal Sr. AFP (Alpha-Feto protein) levels. An emergent laparotomy revealed a tumour arising from the left lobe of liver which had ruptured already and the surface was bleeding. There was a large haemoperitoneum. A left hemi-hepatectomy was done. Post operative course was turbulent. He never recovered enough to be given chemotherapy. Prognosis was explained, the parents took the child home against medical advice. He died at home a few weeks later. Histopathological examination (HPE) revealed to be malignant rhabdoid tumour of the liver.

[West J Emerg Med. 2014;15(4):354–355.]

For the past two decades, botulinum neurotoxin A (BoNT/A) has been described as a strong candidate in the treatment of pain. With the production of modified toxins and the potential new applications at the visceral level, there is a real need for tools allowing the assessment of these compounds. In this study, we evaluated the jejunal mesenteric afferent nerve assay to investigate BoNT/A effects on visceral nociception. This ex vivo model allowed the continuous recording of neuronal activity in response to various stimuli. BoNT/A was applied intraluminally during three successive distensions, and the jejunum was distended every 15 min for 3 h. Finally, samples were exposed to external capsaicin. BoNT/A intoxication was validated at the molecular level with the presence of cleaved synaptosomal-associated protein of 25 (SNAP25) in nerve terminals in the mucosa and musculosa layers 3 h after treatment. BoNT/A had a progressive inhibitory effect on multiunit discharge frequency induced by jejunal distension, with a significant decrease from 1 h after application without change in jejunal compliance. The capsaicin-induced discharge was also affected by the toxin. This assay allowed the description of an inhibitory effect of BoNT/A on afferent nerve activity in response to distension and capsaicin, suggesting BoNT/A could alleviate visceral nociception.

High-resolution esophageal manometry (HRM) in its current form assesses only the contraction phase of peristalsis. Degree of esophageal distension ahead of contraction is a surrogate of relaxation and can be measured from intraluminal esophageal impedance measurements. The characteristics of esophageal contractions, i.e., their amplitude, duration, velocity, and modulating factors, have been well studied. We studied the effect of bolus volume and viscosity and posture on swallow-induced distension and contraction and the temporal relationship between the two. HRM impedance recordings of 50 healthy subjects with no esophageal symptoms were analyzed. Eight to ten swallows of 5 and 10 mL of 0.5 N saline and a viscous bolus were recorded in the supine and Trendelenburg positions. Custom-built computer software generated the distension-contraction plots and numerical data of the amplitudes of distension (cross-sectional area) and contraction, and the temporal relationship between distension and peak contraction. The hallmarks of distension waveforms are that 1) distension peak, similarly to contraction, travels the esophagus in a peristaltic fashion, and the amplitude of distension increases from the proximal-to-distal direction; 2) the amplitude of distension is greater with 10 mL than with 5 mL and greater in Trendelenburg than in supine posture; and 3) bolus viscosity increases the amplitude of distension and alters the temporal relationship between distension and contraction waveforms. We describe the characteristics of esophageal distension during peristalsis and the relationship between distension and contraction in a relatively large cohort of normal subjects. These data can be used to compare differences between normal subjects and patients with various esophageal motility disorders in future studies. NEW & NOTEWORTHY We studied esophageal distension (surrogate of inhibition) ahead of contraction during peristalsis from intraluminal esophageal impedance measurements. Esophageal distension, similarly to contraction, travels the esophagus in a sequential manner, and the amplitude of esophageal distension increases from proximal to distal direction in the esophagus. Bolus volume, viscosity and posture have significant effects on the amplitude of distension and its temporal relationship with contraction. [ABSTRACT FROM AUTHOR]

It is well known that overload changes the mechanical properties of biological tissues and fasting changes the responsiveness of intestinal afferents. This study aimed to characterize the effect of overload on mechanosensitivity in mesenteric afferent nerves in normal and fasted Sprague–Dawley rats. Food was restricted for 7 days in the Fasting group. Jejunal whole afferent nerve firing was recorded during three distensions, i.e., ramp distension to 80 cmH2O luminal pressure (D1), sustained distension to 120 cmH2O for 2 min (D2), and again to 80 cmH2O (D3). Multiunit afferent recordings were separated into low-threshold (LT) and wide-dynamic-range (WDR) single-unit activity for D1 and D3. Intestinal deformation (strain), distension load (stress), and firing frequency of mesenteric afferent nerve bundles [spike rate increase ratio (SRIR)] were compared at 20 cmH2O and 40 cmH2O and maximum pressure levels among distensions and groups. SRIR and stress changes showed the same pattern in all distensions. The SRIR and stress were larger in the Fasting group compared to the Control group (P < 0.01). SRIR was lower in D3 compared to D1 in controls (P < 0.05) and fasting rats (P < 0.01). Total single units and LT were significantly lower in Fasting group than in Controls at D3. LT was significantly higher in D3 than in D1 in Controls. Furthermore, correlation was found between SRIR with stress (R = 0.653, P < 0.001). In conclusion, overload decreased afferent mechanosensitivity in a stress-dependent way and was most pronounced in fasting rats. Fasting shifts LT to WDR and high pressure shifts WDR to LT in response to mechanical stimulation. [ABSTRACT FROM AUTHOR]

Background: The BladderScan Prime Plus (BPP; Verathon, Bothell, Washington) is an application‐specific, three‐dimensional ultrasound device used for human, point‐of‐care volumetry of the urinary bladder. Objective: To estimate the BPP's accuracy, repeatability, and optimized settings for assessing urinary bladder volumes in dogs, a variable utilized in assessing micturition disorders. Animals Twenty‐four, client‐owned, healthy, male dogs presenting for routine examination. Methods: Prospective examinations were conducted by an experienced ultrasonographer and a novice, selecting the BPP's "man" or "child" setting, and were compared to urine volume obtained by catheterization. Results: Mean urine volume significantly varied by operator (P =.05), device setting (P <.001), and weight (P =.01); the "man" setting produced mean volumes nearer to catheterized volumes. The mean difference between BPP's "man" setting and catheterized volume was 0.88 mL, with maximal positive and negative disagreement of +23.2 mL to −55.3 mL (SD 19.0). Percent disagreement between BPP and catheterized volumes demonstrated a mean of −4.5%, with maximal positive and negative disagreement of +58.1% to −74.1% (SD 34.9). The experienced operator recorded volumes significantly (P =.05) higher than the novice, with difference in means of 3.2 mL. In dogs weighing >5.5 kg (n = 18/24), mean difference between BPP's "man" setting and catheterized measurements, regardless of operator, was not significant. Conclusions: Although small magnitude interuser variability is present in BPP examinations, the device provides accurate, though imprecise quantification of bladder volume in canids weighing >5.5 kg. [ABSTRACT FROM AUTHOR]

The heart is involved in the regulation of blood pressure and body fluid homeostasis. As a blood volume sensor and effector for the regulation of the volume and pressure homeostasis, the atria are the central regulator to secrete humoral messenger cardiac natriuretic hormones into the circulation. The primary action of the atria in response to the volume change in the body is to control the secretion of atrial natriuretic peptide (ANP), a member of the family of cardiac natriuretic hormones. Although all cardiac chambers are able to secrete ANP, the major source of the cardiac hormone is the atria until reactivation of the synthesis of the ventricles. In heart disease including hypertension and cardiac hypertrophy, ventricular ANP synthesis and plasma levels of ANP are increased. However, the roles of the atria for the ANP secretion are not well defined in hypertension or heart failure. Under the high concentration of plasma levels of ANP by compensatory and/or pathophysiological reactivation of the ventricular synthesis and release of ANP, with activation of the renin-angiotensin system and changes in the atrial distensibility, the roles of the atria should be reevaluated in the heart disease. The purpose of the present review is to address modulation of the atrial role in the regulation of ANP secretion and its significance in the pathological changes in hypertension and cardiac disease and to strengthen the importance of the role of the interstitial fluid dynamics of the atrial wall in the regulation of ANP secretion. [ABSTRACT FROM AUTHOR]

Purpose of review: The goal of this paper is to review categorically treatment options for the diverse mechanisms to which studies have shown underlie bloating and abdominal distension. Recent findings: While previous studies typically associate bloating and distension with a functional gastrointestinal disorder, in appropriate clinical settings, workup to look at diseases such as postural orthostatic hypotension, chronic intestinal pseudoobstruction, Ehlers-Danlos syndrome, and mast cell activation syndrome can further provide insight into to these patients. Summary: Bloating and distension are commonly presented to the gastroenterologist. The underlying mechanism can be ambiguous, and therefore, the treatment can be challenging. However, current treatment options that are available can be effective if used in the appropriate patient. Further research is desperately needed for the more elusive disease processes mentioned in this review that presents with bloating and distension. [ABSTRACT FROM AUTHOR]

Nowadays ultrasonography is a very important tool for intensive care physicians, the use of which is spreading more and more. However, it is not enough to acquire the technical skills to perform it, but also -and perhaps more importantly- we must know how to interpret the findings, for which an adequate knowledge of physiology or underlying pathophysiology is critical. Such is the case of understanding the mechanisms or forces involved in the distension and collapse of the inferior vena cava, in order to provide an adequate clinical application to the images we get when we analyze this variable

Bloating is one of the most common and troublesome problems in a large proportion of patients with gastrointestinal disorders but the mechanism is not completely understood. Several factors, including gas-producing intestinal microbiota, disturbed handling of intestinal gas, visceral hypersensitivity, abnormal viscero-somatic responses, fermentable diet, and psychological factors, have been suggested as mechanisms. For an assessment, thorough medical history-taking and physical examination are the first steps. On the other hand, organic disorders should always be considered first for a differential diagnosis. The therapeutic options available are considered challenging and still limited in clinical practice. The treatment strategy may include diet modification, pharmacologic approach, psychiatric approach, biofeedback, etc. Further studies will be needed to explore the variable mechanism of bloating and develop an efficient treatment.

Key points: The immediate increase in skeletal muscle blood flow following contraction is greater when the contracting muscle is below vs. above heart level. This has been attributed to muscle pump‐mediated venous emptying and subsequent widening of the arterial to venous pressure gradient, which can occur below but not above heart level.However, alternative explanations could include greater rapid onset vasodilatation and/or transmural pressure‐mediated mechanical distension of resistance vessels, but these remain unexplored.We demonstrate that active vasodilatation is not responsible for greater post‐contraction hyperaemia below the heart. Instead, an increased transmural pressure‐mediated mechanical distension of resistance vessels is a key mechanism responsible for this phenomenon.Our findings establish the importance of considering/accounting for local mechanical arteriolar distension effects when investigating exercise hyperaemia.They also inform the application of exercise for rehabilitative purposes and prompt investigation into whether arteriolar distension accompanying vasodilatation is reduced with diseases or ageing, thereby compromising exercising muscle perfusion. We tested the hypotheses that increased post‐contraction hyperaemia in higher (H; below heart) vs. lower (L; above heart) transmural pressure conditions is due to (1) greater active vasodilatation or (2) greater transmural pressure‐mediated arteriolar distension. Participants (n = 20, 12 male, 8 female; combined mean age 24.5 ± 2 years) performed a 2 s isometric handgrip contraction, where arm position was maintained within or changed between H and L during contraction, resulting in four starting–finishing arm position conditions (LL, HL, LH, HH). Post‐contraction forearm blood flow (echo and Doppler ultrasound) was higher with contraction release in H vs. L environments (P < 0.05). However, contraction initiated in H did not result in greater vasodilatation (forearm vascular conductance; FVC) than contraction initiated in L, regardless of contraction release condition (peak FVC: LL 217 ± 104 vs. HL 204 ± 92 ml min−1 (100 mmHg)−1, P = 0.313, LH 229 ± 8 vs. HH 225 ± 85 ml min−1 (100 mmHg)−1, P = 0.391; first post‐contraction cardiac cycle FVC: same comparisons, both P = 0.317). However, FVC of the first post‐contraction cardiac cycle was greater for contractions released in H vs. L regardless of pre‐contraction condition (LL 106 ± 67 vs. LH 152 ± 76 ml min−1 (100 mmHg)−1, P < 0.05; HL 80 ± 51 vs. HH 119 ± 58 ml min−1 (100 mmHg)−1, P < 0.05). These findings refute the hypothesis that greater hyperaemia following a single contraction in higher transmural pressure conditions is due to greater active vasodilatation. Instead, our findings reveal a key role for increased transmural pressure‐mediated mechanical distension of arterioles in creating a greater increase in vascular conductance for a given active vasodilatation following skeletal muscle contraction. Key points: The immediate increase in skeletal muscle blood flow following contraction is greater when the contracting muscle is below vs. above heart level. This has been attributed to muscle pump‐mediated venous emptying and subsequent widening of the arterial to venous pressure gradient, which can occur below but not above heart level.However, alternative explanations could include greater rapid onset vasodilatation and/or transmural pressure‐mediated mechanical distension of resistance vessels, but these remain unexplored.We demonstrate that active vasodilatation is not responsible for greater post‐contraction hyperaemia below the heart. Instead, an increased transmural pressure‐mediated mechanical distension of resistance vessels is a key mechanism responsible for this phenomenon.Our findings establish the importance of considering/accounting for local mechanical arteriolar distension effects when investigating exercise hyperaemia.They also inform the application of exercise for rehabilitative purposes and prompt investigation into whether arteriolar distension accompanying vasodilatation is reduced with diseases or ageing, thereby compromising exercising muscle perfusion. [ABSTRACT FROM AUTHOR]

Left heart distension during venoarterial extracorporeal membrane oxygenation (VA ECMO) often necessitates decompression to facilitate myocardial recovery and prevent life-threatening complications. The objectives of this study were to compare clinical outcomes between patients who did and did not undergo left atrial (LA) decompression, quantify decompression efficacy, and identify risk factors for development of left heart distension. This was a single-center retrospective case–control study. Pediatric VA ECMO patients who underwent LA decompression from June 2004 to March 2016 were identified, and a control cohort of VA ECMO patients who did not undergo LA decompression were matched based on diagnosis, extracorporeal cardiopulmonary resuscitation, and age. Among 194 VA ECMO cases, 21 (11%) underwent LA decompression. Compared to the control cohort, patients with decompression had longer hospital length of stay (60 ± 55 vs. 27 ± 23 days, p = 0.012), but similar in-hospital mortality (29% vs. 38%, p = 0.513). Decompression successfully decreased mean LA pressure (24 ± 11 to 14 ± 4 mmHg, p = 0.022) and LA:RA pressure gradient (10 ± 7 to 0 ± 1 mmHg, p = 0.011). No significant differences in early quantitative measures of cardiac function were observed between cases and controls to identify risk factors for left heart distension. Despite higher qualitative risk for impaired cardiac recovery, patients who underwent LA decompression had comparable outcomes to those who did not. Given that traditional quantitative measures of cardiac function are insufficient to predict development of eventual left heart distension, a combination of clinical history, radiographic findings, hemodynamic monitoring, and laboratory markers should be used during the evaluation and management of these patients. [ABSTRACT FROM AUTHOR]

Functional abdominal bloating and distension (FABD) are common gastrointestinal complaints, encountered on a daily basis by gastroenterologists and healthcare providers. Functional abdominal bloating is a subjective sensation that is commonly associated with an objective abdominal distension. FABD may be diagnosed as a single entity (the sole or cardinal complaint) or may overlap with other functional gastrointestinal disorders such as functional constipation, irritable bowel syndrome, and functional dyspepsia. The pathophysiology of FABD is not completely understood. Proposed underlying mechanisms include visceral hypersensitivity, behavioral induced abnormal abdominal wall-phrenic reflexes, the effect of poorly absorbed fermentable carbohydrates, and microbiome alterations. Management includes behavioral therapy, dietary interventions, microbiome modulation, and medical therapy. This review presents the current knowledge on the pathophysiology, evaluation, and management of FABD. [ABSTRACT FROM AUTHOR]