Objective To approach the clinical values of computer tomography (CT) examination technique and imaging features in abdominal cavity parenchymal organs injury. Methods One hundred and fifty-nine patients with abdominal cavity parenchymal organs injury were examined by CT of plain scan and (or) contrast enhancement, the enhancement included arterial phase, parenchymal phase and the kidney scanning delay phase, the results of CT scanning were compared. Results Ninty-eight cases among 159 patients were diagnosed as the abdominal cavity parenchymal organs injury by the CT, the diagnosis accordance rate was 98.1% (156/159) by operation and follow-up, 22 cases were simple viscus damage or back bone and pelvic fracture, 39 cases were negative, the examination positive rate was 75.5% (120/159). Conclusion The CT can display the parenchymal organ traumatic condition, subcapsule hematoma, retroperitoneal hematoma, seroperitoneum and injured grade. It is the first selective examination to use CT scanning in abdominal cavity parenchymal organ damage, and it has important clinic values to use correct scanning techniques in abdominal injury examination.
ObjectiveTo investigate the feasibility of laparoscopy in the diagnosis and treatment of acute abdomen. MethodsThe clinical data of 81 patients with acute abdomen treated in our hospital from January 2012 to December 2013 were retrospectively analyzed. ResultsOf the 81 patients with acute abdomen, there were 38 cases of acute appendicitis, 15 cases of gastric perforation, 10 cases of duodenal ulcer perforation, 10 cases of acute cholecystitis, 1 case of mesenteric artery embolism, 2 cases of internal hernias, 2 cases of ileocecal tumor, 2 cases of sigmoid colon rupture, 1 case of intestinal adhesion. The 81 cases were treated by laparoscopy, including 79 cases (97.5%) were clearly diagnosed; 73 cases were succeeded by laparoscopy, and 8 cases converted to laparotomy. The operation time were 35-191 minutes, with an average of 76 minutes; the intraoperative blood loss were 20-130 mL, with an average of 43 mL; the postoperative hospital stay were 3-13 days, with an average of 5.6 days. Seventy-six patients received followed-up for 2-24 months, and the median time were 14 months, no special complications occurred during follow-up period, but 1 case of ileocecal tumor suffered from lung metastases in 12 months after operation. ConclusionsLaparoscopy can be used in the preferred way of diagnosis and treatment of acute abdomen.
Laparoscopy has become a commonly used approach to diagnosis and treatment of acute abdomen, and it has good diagnostic value and therapeutic effect in selective cases. It should be practiced by experienced surgeons in laparoscopic surgery and emergency abdominal surgery. Hemodynamic instability, severe abdominal distension, fecal peritonitis, and tumor perforation are contraindications to laparoscopy. In recent years, more and more acute abdominal diseases can be successfully treated by laparoscopy. Randomized controlled trials have proved the laparoscopic treatment in acute appendicitis, acute cholecystitis, peptic ulcer perforation, acute gynecological diseases was comparable to open surgery, and had advantages of fewer complications and faster postoperative recovery. The utilization of laparoscopy in other diseases such as blunt and penetrating abdominal trauma, small intestinal obstruction, and diverticulitis with perforation remains controversial, and needs more randomized controlled trials to investigate the feasibility of laparoscopic surgery.
The pediatric cadaver impact experiments were reconstructed using the validated finite element(FE) models of the 3-year-old and 6-year-old children. The effect of parameters, such as hammer size, material parameters and thorax anatomical structure characteristics, on the impact mechanical responses of 3-year-old and 6-year-old pediatric thorax was discussed by designing reasonable finite element simulation experiments. The research results showed that the variation of thorax contact peak force for 3-year-old group was far larger than that of 6-year-old group when the child was impacted by hammers with different size, which meant that 3-year-old child was more sensitive to hammer size. The mechanical properties of thoracic organs had little influence on the thorax injury because of the small difference between 3-year-old and 6-year-old child in this research. During the impact, rib deformation led to different impact location and deformation of internal organs because the 3-year-old and 6-year-old children had different geometrical anatomical structures, such as different size of internal organs. Therefore, the injury of internal organs in the two groups was obviously different. It is of great significance to develop children finite element models with high biofidelity according to its real anatomical structures.
ObjectiveTo investigate the correlation between tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), phospholipase A2 (PLA2) and myocardial cell function disorders in severe chest-abdominal injury patients. MethodsEighty-two subjects with severe chest-abdominal injury were collected from January 2009 to June 2012, of whom the trauma index were all above or equal to 17 points. As the rescue and treatment were in progress, the patients were examined for their creatine kinase-MB (CK-MB), cardiac troponin T (cTnT), TNF-α, IL-6, and PLA2 for correlation analysis. Another 82 subjects undergoing physical examination during the same time were chosen as the controls, who were again divided into myocardial cell function control group with 46 subjects and injury factors control group with 36 subjects. ResultsFor the myocardial cell function control group, CK-MB was (8.13±3.64) U/L, and cTnT was (26.71±11.58) pg/mL; for the injury group, those two indexes were respectively (158.74±31.59) U/L and (496.25±58.46) pg/mL. For the injury factors control group, TNF-α was (1.28±0.59) ng/mL, IL-6 was (63.93±41.49) ng/mL, and PLA2 was (7.47±5.27) ng/mL; for the injury group, those three indexes were respectively (36.41±18.09) ng/mL, (393.83±143.86) ng/mL, and (41.35±14.26) ng/mL. For severer chest-abdominal injury patients, all correlation factors between CK-MB and TNF-α, IL-6, PLA2 were above 0.911, and the factors between cTnT and TNF-α, IL-6, PLA2 were all above 0.912, and all correlations were positive. ConclusionTNF-α, IL-6 and PLA2 all participate in the process of acute myocardial cell function disorders in severe chest-abdominal injury patients. Early intervention of TNF-α, IL-6, and PLA2 may reduce myocardial cell damage, and improve patients' survival rate.
ObjectiveTo explore the value of gadobutrol enhanced magnetic resonance angiography (MRA) in abdominal artery angiography.MethodsThe patients were prospectively included for gadobutrol enhanced MRA examination from December 2014 to December 2015. The image quality was assessed by two radiologists. The subjective score and signal intensity were measured for the large and medium arteries, and the subjective score for the small artery was recorded. The Kappa consistency analysis was used to assess the two radiologists’ subjective score.ResultsAll 112 patients were enrolled in this study, 96 of whom were included for the physical examination, 16 of whom were included for the liver tumors. No adverse reactions were found in these patients. The MRA images of 2 patients were affected by the severe respiratory artifact. The MRA images of the other 110 cases were clear and could well show the origins, shapes of large and medium arteries and small arteries. The subjective scores were 21.22±1.93 and 6.24±1.33 of the large and medium arteries and small arteries, respectively. The values of signal noise ratio and contrast signal noise ratio of the large and medium arteries were 1 093.27±331.71 and 897.27±333.29, respectively. The Kappa values of the two radiologists’ subjective score were 0.782 and 0.772 for the large and medium arteries and small arteries, respectively.ConclusionsGadobutrol enhanced MRA can clearly display large and medium arteries, and can also display some small arteries. It has a good application value in abdominal artery angiography.
Objective To summarize the research progress of magnetic resonance quantitative technique in the iron overload of the abdominal parenchyma organ. Methods By reviewing the related literatures domesticly and abroad, the present status and progress of abdominal magnetic resonance quantitative technique and other examinations in the study of iron overload were analyzed. Results MRI multi-sequence examination technique had changed the research model of iron overload in different organs, and had important clinical significance in imaging diagnosis of abdominal parenchyma organ damage. so far, many techniques of MRI had been used in detection of iron overload, which included signal intensity measurements(including signal intensity ratio and signal intensity difference of positive and negative phases), T2/R2 measurements, T2*/R2* measurements, Dixon and its derivatization, ultrashort echo time technique and susceptibility weighted imaging (including conventional susceptibility weighted imaging and quantitative magnetic sensitive imaging). Conclusion Magnetic resonance quantitative examination technique is expected to be the first choice for detection of hepatic iron overload, and can improve the early detection rate of iron overload pancreatic damage.
China has entered an aging society. Elderly patients with acute abdomen have complex clinical manifestations and often have more complications. For elderly acute abdomen, the results of abdominal physical examination and laboratory testing often can not reflect the patient’s condition. The differential diagnosis of diseases should be emphasized in clinical diagnosis and treatment. The treatment of acute abdomen in the elderly not only needs standardized analgesic treatment, but also pays attention to the evaluation of the disease, and adopts multidisciplinary cooperation to formulate appropriate treatment plans.
ObjectiveTo evaluate the value of spiral CT in diagnosing ischemic bowel changes in systemic lupus erythematosus (SLE) patients presenting with acute abdominal pain. MethodsThe clinical data and spiral CT imaging files of 23 SLE patients presenting with acute abdominal pain were retrospectively reviewed. Sixteen had contrastenhanced spiral CT scanning of the abdomen, the rest had plain CT study. Observation emphasis was placed on the changes of bowel wall (wall thickness, enhancement pattern, lumen size) and mesentery (mesenteric edema, engorgement of mesenteric vessels and their abnormal arrangement pattern). Other abnormal findings (e.g. fluid accumulation, changes of abdominal solid organs, lymphadenopathy) were also observed. ResultsNineteen patients had intestinal wall thickening (19/23, 82.6%), with the “target sign” in 12 patients (12/16, 75.0%); Bowel lumen dilatation was present in 16 patients (16/23, 69.6%). Mesenteric swelling with increased density of adipose tissue was noticed in 21 patients (21/23, 91.3%); 18 patients had engorgement of mesenteric vessels (18/23, 78.3%), with comb like arrangement in 4 patients (4/16, 25.0%). Other abnormal findings included ascites, hydrothorax, hydropericardium, hepatosplenomegaly and so on. ConclusionThe most common CT findings in SLE patients presenting with acute abdominal pain are the signs associated with ischemic bowel disease. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.
Objective To summarize the experience of diagnosis and treatment of acute abdominal pain caused by hepatic hydatid. Methods The preoperative diagnosis, the surgical methods and the curative effect after operation of 297 patients with acute abdominal pain caused by hepatic hydatid who were treated in our hospital from 1960 to 2004 were analyzed. Results The healing rate was 95.96% (285/297 cases), and the death rate was 4.04% (12 /297 cases). Six out of 12 cases of death were caused by diffusive biliary peritonitis and allergic shock attributable to the rapture of hydatid into abdominal cavity. Two patients died of malnutrition caused by the spreading of Echinococcus and the correspondingly repeated operations. Another 4 patients with giant hydatid containing 7 000-12 000 ml fluid, died of hepatic insufficiency caused by the postoperative infection in the cyst. Conclusion The acute abdominal pain caused by hepatic hydatid should be treated mainly through emergency operation and the necessary antianaphylaxis, anti-infection and antishock therapies should also be used at the same time.