Abdominal and thoracoabdominal aortic aneurysm

Most abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms (TAAA) are asymptomatic and are found on physical exam or incidentally during radiological studies for other indications. These aneurysms are repaired primarily because their risk of rupture increases geometrically as the size exceeds 5 cm. The potential morbidity of intraoperative visceral and spinal ischemia involved with TAAA repair may be reduced with various adjunctive maneuvers.     

Abdominal aortic aneurysm in the elderly

AIM: Complication-free abdominal aortic aneurysm is often asymptomatic and its diagnosis is therefore frequently coincidental. Abdominal aortic aneurysm (AAA) is often suddenly manifested during the rupture stage, resulting in the patient's death. The importance of early diagnosis is therefore clear, enabling optimal monitoring and correct management. EXPERIMENTAL DESIGN AND SUBJECTS: This retrospective study evaluated the incidence of AAA in 1304 over-65-year-olds in care. The authors examined the presence of AAA-related symptoms, risk factors and the concomitance of other pathologies. RESULTS: Four subjects were diagnosed with AAA, equivalent to 0.3% of the total population. All were male, smokers, with multidistrict atherosclerosis in association with other pathologies. CONCLUSIONS: The incidence of AAA in the population of over-65-year-olds examined was lower than that reported in the literature. This discrepancy was due to the fact that the abdominal aorta is not usually examined in clinical practice. However, the high mortality rate of AAA during rupture prompted the authors to evaluate this disorder in high-risk patients.     

Abdominal aortic aneurysm: course of morbimortality of elective surgery in 20 years

A kinetic model of bisubstrate reaction catalyzed by baker's yeast transketolase is proposed. The model considers individual stages of substrates reversible primary binding. The model corresponds to the observed kinetics of product accumulation within a wide range of initial substrate concentrations. Kinetic parameters for the best simulation of the experimental data are defined. The equilibrium constants of the primary binding of both the initial and produced ketose and also the initial aldose were unequivocally determined by varying the initial substrate concentrations. The dissociation constants of the primary enzyme-substrate complex for the initial ketose (xylulose 5-phosphate) and the reaction product (sedoheptulose 7-phosphate) were found to differ by more than by two orders of magnitude. The result is discussed in the context of the hypothesis of flip-flop functioning of the transketolase active sites.     

Abdominal aortic aneurysm 18 years after apparent resolution of an umbilical catheter-associated aortic thrombosis

A young man was found to have an abdominal aortic aneurysm 18 years after the apparent resolution of an umbilical artery catheter-associated aortic thrombosis. This report underlines the need for long-term follow-up studies of infants with catheter-related vascular thrombosis.     

Abdominal aortic aneurysm repair with arterial branch reconstruction: utility of the temporary bypass technique

A 6-year prospective study of 80 abdominoplasties is reported. Type and incidence of complications are presented with particular attention toward the incidence of fluid collection following abdominoplasty, such as seroma and hematoma. Ultrasound was performed in 56 patients (70%), with normal findings in 27 patients (48%). Accurate diagnosis of fluid collection in 29 patients (51.8%), seroma in 24 (42.8%), and hematoma in 5 (9%) was confirmed with the aid of ultrasound. The advantage of early radiological diagnosis alerted the surgeon for positive findings of fluid collection areas in the abdominal wall, which resulted in close observation and early intervention whenever indicated. Ultrasound of the abdominal wall following abdominoplasty provides a noninvasive, accurate, and low-cost method of diagnosing fluid collection in the abdominal wall. This method, if performed routinely postabdominoplasty, will aid the surgeon in managing potential complications such as wound-healing problems, infection, and patient discomfort.     

Abdominal tuberculosis

Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality.     

Abdominal trauma--a review

A new laparoscopic instrument is available to remove hair from an ovarian dermoid cyst. It is constructed of Teflon, and is 35 cm in length and 9 mm in diameter. The distal 6 cm of the instrument tapers form 9 to 6 mm, and has longitudinal and transverse grooves. When the tapered part is rotated in the mat of hair, the hair attaches firmly to it and can be brought out easily.     

Abdominal compartment syndrome

PURPOSE: Two cases of abdominal compartment syndrome are described and the pathophysiology associated with it is reviewed. CLINICAL FEATURES: The first patient was a 46-yr-old man who sustained extensive blunt abdominal injuries following a fall. The second was a 54-yr-old man involved in a motor vehicle accident with blunt abdominal trauma. In both cases, the patients developed an extremely tense abdomen, increasing peak inspiratory pressures, hypercarbia and oliguria. Both demonstrated improvement in cardiac performance and ventilatory variables following an emergency decompressive celiotomy. CONCLUSION: Abdominal compartment syndrome results in impairment of organ function secondary to increased intraabdominal pressure. These patients require emergency decompressive celiotomy to relieve the symptoms. However, the incidence of intractable asystole and hypotension during this procedure is high and vigilance must be maintained during the release of the increased intraabdominal pressure.     

Abdominal compartment syndrome

The ACS is a clinical entity that develops from progressive, acute increases in IAP and affects multiple organ systems in a graded fashion because of differential susceptibilities. The gut is the organ most sensitive to IAH, and it develops evidence of end-organ damage before the development of the classic renal, pulmonary, and cardiovascular signs. Intracranial derangements with ACS are now well described. Treatment involves expedient decompression of the abdomen, without which the syndrome of end-organ damage and reduced oxygen delivery may lead to the development of multiple organ failure and, ultimately, death. Multiple trauma, massive hemorrhage, or protracted operation with massive volume resuscitation are the situations in which the ACS is most frequently encountered. Knowledge of the ACS, however, is also essential for the management of critically ill pediatric patients (especially those with AWD) and in understanding the limitations of laparoscopy. The role of IAH in the pathogenesis of NEC, central obesity co-morbidities, and pre-eclampsia/eclampsia remains to be fully studied.     

Abdominal cystic lymphangioma

Fifteen cases of primary urothelial carcinomas of the ureter are reported (14 transitional cell carcinoma and 1 mixed transitional cell carcinoma and squamous cell carcinoma). There was a clear male predominance (11/4); the peak incidence was in the sixth decade. Most tumors originated from the distal third of the ureter. Multicentricity and high recurrence rate after partial ureterectomy were noted. The clinical signs were hematuria and flank pain. Urine cytology and IVU were diagnostic in a limited number of cases. Retrograde pyelography was very helpful. CT showed to be the image modality of choice for diagnosis and preoperative staging.     

Abdominal desmoid tumor

Two cases of desmoid tumor of the abdominal wall are reported, together with some considerations and a review of the literature; desmoid tumor is an unusual neoplasm which affects women in prevalence. This is an histologically benign neoplasm with no metastatic capacity; however it is highly invasive in the site where it arose, so its treatment can become very difficult. The treatment is by surgical excision that must be as wide as possible, in order to obviate the great incidence of recurrence. The role of radiotherapy, hormone and chemotherapy has not been completely assessed so far.     

Cerebral aneurysm associated with persistent primitive olfactory artery aneurysm

Persistent primitive olfactory artery is a rare vascular anomaly but has a clinical importance because of its high association with cerebral aneurysm. We describe a patient with bilateral persistent primitive olfactory arteries associated with an unruptured saccular aneurysm on the left persistent primitive olfactory artery. Seven reported cases with this anomalous artery including ours are reviewed and classified into two variants. This anomalous artery arises from the terminal portion of the internal carotid artery and courses anteromedially along the ipsilateral olfactory tract and makes a hair-pin curve posterior to the olfactory bulb, becoming the distal anterior cerebral artery (variant 1) or the ethmoidal artery (variant 2). Out of 7 reported cases, 4 cases are associated with saccular aneurysms. The aneurysm in variant 1 is located on the hair-pin curve at which an apparent arterial branch is sometimes absent. Two patients suffer from anosmia. Persistent primitive olfactory artery should be kept in mind because of its high association with intracranial saccular aneurysms and unique clinical presentation.     

Abdominal wall hematoma]

We describe three case reports of hematomas in the abdominal wall muscles and discuss etiology, diagnostic findings and treatment. Abdominal wall hematomas are uncommon, and the condition is often misdiagnosed. One of our patients was laparotomised owing to suspected appendicitis, and one patient presented a tuberculous abscess that may have been an infected hematoma. Ultrasonographic examination or CT gives the correct diagnose. Conservative management is the treatment of choice unless bleeding is severe or the course is complicated by infection.     

Abdominal pain during pregnancy

In evaluating the pregnant patient with abdominal pain, the physician is presented with a wide range of diagnostic possibilities, including disorders that can occur in nonpregnant individuals and disorders that are unique to pregnancy. The development of modern laboratory testing methods and diagnostic imaging techniques has led to a decline in the morbidity and mortality from many of these disorders. With an understanding of the physiologic changes occurring during pregnancy, a careful history and physical examination, and judicious use of laboratory tests and imaging studies, the physician should be able to determine the cause of the patient's pain in the great majority of cases and, in the words of Babler, avoid "the mortality of delay."