RESUMO
BACKGROUND & AIMS: In patients with functional gut disorders, abdominal distension has been associated with descent of the diaphragm and protrusion of the anterior abdominal wall. We investigated mechanisms of abdominal distension in these patients. METHODS: We performed a prospective study of 45 patients (42 women, 24-71 years old) with functional intestinal disorders (27 with irritable bowel syndrome with constipation, 15 with functional bloating, and 3 with irritable bowel syndrome with alternating bowel habits) and discrete episodes of visible abdominal distension. Subjects were assessed by abdominothoracic computed tomography (n = 39) and electromyography (EMG) of the abdominothoracic wall (n = 32) during basal conditions (without abdominal distension) and during episodes of severe abdominal distension. Fifteen patients received a median of 2 sessions (range, 1-3 sessions) of EMG-guided, respiratory-targeted biofeedback treatment; 11 received 1 control session before treatment. RESULTS: Episodes of abdominal distension were associated with diaphragm contraction (19% ± 3% increase in EMG score and 12 ± 2 mm descent; P < .001 vs basal values) and intercostal contraction (14% ± 3% increase in EMG scores and 6 ± 1 mm increase in thoracic antero-posterior diameter; P < .001 vs basal values). They were also associated with increases in lung volume (501 ± 93 mL; P < .001 vs basal value) and anterior abdominal wall protrusion (32 ± 3 mm increase in girth; P < .001 vs basal). Biofeedback treatment, but not control sessions, reduced the activity of the intercostal muscles (by 19% ± 2%) and the diaphragm (by 18% ± 4%), activated the internal oblique muscles (by 52% ± 13%), and reduced girth (by 25 ± 3 mm) (P ≤ .009 vs pretreatment for all). CONCLUSIONS: In patients with functional gut disorders, abdominal distension is a behavioral response that involves activity of the abdominothoracic wall. This distension can be reduced with EMG-guided, respiratory-targeted biofeedback therapy.
Assuntos
Parede Abdominal/fisiopatologia , Biorretroalimentação Psicológica/métodos , Síndrome do Intestino Irritável/reabilitação , Parede Torácica/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Constipação Intestinal/etiologia , Constipação Intestinal/reabilitação , Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Diarreia/etiologia , Diarreia/reabilitação , Eletromiografia/métodos , Feminino , Gastroenteropatias/reabilitação , Humanos , Síndrome do Intestino Irritável/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Adulto JovemAssuntos
Fasciite Necrosante/cirurgia , Transplante de Pele , Retalhos Cirúrgicos , Parede Torácica/microbiologia , Antibacterianos/uso terapêutico , Candida albicans/isolamento & purificação , Terapia Combinada , Desbridamento , Fasciite Necrosante/microbiologia , Evolução Fatal , Humanos , Oxigenoterapia Hiperbárica , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Radiografia , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia , Resultado do TratamentoRESUMO
We report the case of a 25-year-old African-American man presenting to the Henry Ford Hospital emergency department with acute dyspnea secondary to a pneumothorax resulting from a migratory acupuncture needle. The patient received acupuncture treatment approximately 5 years prior to this presentation for treatment of posttraumatic chronic right shoulder pain. Chest radiography revealed retained needles in his right shoulder girdle and a needle overlying the thoracic cage with an attendant pneumothorax. Catheter aspiration for simple pneumothorax provided immediate symptomatic relief. Video-assisted thoracoscopy was then used to remove the migratory acupuncture needle from the chest wall. The patient recovered without complication and was discharged to home.