Elevation of the head of bed reduces splanchnic blood flow in patients with intra-abdominal hypertension.

BACKGROUND: Elevation of the head of bed (HOB) increases intra-abdominal pressure (IAP), but the effect of body position on abdominal splanchnic perfusion is not clear. The current study aimed to evaluate the effect of body position on the superior mesenteric artery (SMA) and the celiac artery (CA) blood flow by Doppler ultrasound in mechanically ventilated patients with intra-abdominal hypertension (IAH). METHODS: This prospective cohort study included 53 mechanically ventilated patients with IAH. IAP, hemodynamic variables, and Doppler parameters of the SMA and CA were measured in the supine position. The measurements were repeated after the HOB angle was raised to 15° for 5 min and similarly at HOB angles of 30° and 45°. Finally, the patient was returned to the supine and these variables were re-measured. RESULTS: The median (interquartile range, IQR) superior mesenteric artery blood flow (SMABF) decreased from 269 (244-322) to 204 (183-234) mL/min and the median (IQR) celiac artery blood flow (CABF) from 424 (368-483) to 376 (332-472) mL/min (both p<0.0001) while median (IQR) IAP increased from 14(13-16) to 16(14-18) mmHg (p<0.0001) when the HOB angle was changed from 0° to 15°. However, SMABF and CABF were maintained at similar levels from 15° to 30°, despite median (IQR) IAP increased to 17(15-18) mmHg (p = 0.0002). Elevation from 30° to 45° further reduced median (IQR) SMABF from 200(169-244) to 164(139-212) mL/min and CABF from 389(310-438) to 291(241-383) mL/min (both p<0.0001), Meanwhile, median (IQR) IAP increased to 19(18-21) mmHg (p<0.0001). CONCLUSIONS: In mechanically ventilated patients with IAH, progressive elevation of the HOB from a supine to semi-recumbent position was associated with a gradual reduction in splanchnic blood flow. However, the results indicate that splanchnic blood flow is not further reduced when the HOB is elevated from 15° to 30°.This study confirms the influence of head-up angle on blood flow of the splanchnic organs and may contribute to the selection of the optimal position in patients with abdominal hypertension.

A straw entering the abdominal cavity through the female reproductive tract: a case report.

In this article, an unusual case of a 27-year-old woman, who presented with abdominal pain for the previous 2 days, is presented. Ultrasonography revealed a perforated uterus and a straw in the abdominal cavity. A foreign body in the abdominal cavity was diagnosed and removed by laparoscopic surgery, and antibiotics were administered. The patient reported no discomfort during follow-up for 1 month. This report highlights the rare case of a foreign body crossing the uterus into the abdominal cavity. The only possible action was immediate surgery to remove the foreign body from the abdominal cavity.

Atypical Metastases in the Abdomen and Pelvis From Biochemically Recurrent Prostate Cancer: 11C-Choline PET/CT With Multimodality Correlation.

PET with targeted radiotracers has become integral to mapping the location and burden of recurrent disease in patients with biochemical recurrence (BCR) of prostate cancer (PCa). PET with 11C-choline is part of the National Comprehensive Cancer Network and European Association of Urology guidelines for evaluation of BCR. With advances in PET technology, increasing use of targeted radiotracers, and improved survival of patients with BCR because of novel therapeutics, atypical sites of metastases are being increasingly encountered, challenging the conventional view that prostate cancer rarely metastasizes beyond bones or lymph nodes. The purpose of this article is to describe such atypical metastases in the abdomen and pelvis on 11C-choline PET (including metastases to the liver, pancreas, genital tract, urinary tract, peritoneum, abdominal wall, and perineural spread) and to present multimodality imaging features and relevant imaging pitfalls. Given atypical metastases' inconsistent relationship with the serum PSA level and the nonspecific presenting symptoms, atypical metastases are often first detected on imaging. Awareness of their imaging features is important because their detection affects clinical management, patient counseling, prognosis, and clinical trial eligibility. Such awareness is particularly critical because the role of radiologists in the imaging and management of BCR will continue to increase given the expanding regulatory approvals of other targeted and theranostic radiotracers.

Image Quality Evaluation of a Digital Radiography System Made in Thailand.

BACKGROUND: The National Science and Technology Development Agency (NSTDA) in Thailand researched and prototyped digital radiography systems under the brand name BodiiRay aiming for sustainable development and affordability of medical imaging technology. The image restoration and enhancement were implemented for the systems. PURPOSE: The image quality of the systems was evaluated using images from phantoms and from healthy volunteers. METHODS: The survey phantom images from BodiiRay and other two commercial systems using the exposure settings for the chest, the abdomen, and the extremity were evaluated by three experience observers in terms of the high-contrast image resolution, the low-contrast image detectability, and the grayscale differentiation. The volunteer images of the chests, the abdomens, and the extremities from BodiiRay were evaluated by three specialized radiologists based on visual grading on 5-point scaled questionnaires for the anatomy visibility, the image quality satisfaction, and the diagnosis confidence in using the images. RESULTS: BodiiRay phantom results were similar to those from the commercial systems. The overall performance averaged across the exposure settings showed that BodiiRay was slightly better than Fujifilm FDR Go in the low-contrast detectability (p = 0.033) and in the grayscale differentiation (p = 0.004). It was also slightly better than Siemens YSIO Max in the high-contrast resolution (p = 0.018). The images of chest, pelvis, and hand phantoms illustrated comparable visual quality. For volunteer images, the percentage of the images scored ≥4 ranged from 61% to 99%, 23% to 92%, and 96% to 99% for the chest, abdomen, and extremity images, respectively. The average score ranged from 3.63 to 4.46, 3.18 to 4.21, and 4.41 to 4.51 for the chest, abdomen, and extremity images, respectively. CONCLUSION: The phantom image results showed the comparability of these systems. The clinical evaluation showed BodiiRay images provided sufficient image qualities for digital radiography of these body parts.

Wernicke-Korsakoff syndrome in a patient with tuberculous peritonitis.

Tuberculous peritonitis is an uncommon type of extrapulmonary tuberculosis and can be present in different and rare conditions. Wernicke-Korsakoff syndrome is a neuropsychiatric disorder due to thiamine deficiency which is caused by poor nutrition for any reason. The relationship between tuberculous peritonitis and the Wernicke-Korsakoff has not been declared yet. Therefore, we aim to report a case of tuberculous peritonitis which presented with Wernicke-Korsakoff syndrome.

Clinical Feasibility of High-Resolution Contrast-Enhanced Dynamic T1-Weighted Magnetic Resonance Imaging of the Upper Abdomen Using Compressed Sensing.

OBJECTIVE: The objective of this study was to evaluate the clinical feasibility of high-resolution contrast-enhanced dynamic T1-weighted imaging (T1WI) using compressed sensing (CS) in magnetic resonance imaging. METHODS: This study retrospectively included 35 patients who underwent dynamic T1WI using volumetric interpolated breath-hold examination (VIBE) with CS reconstruction (CS-VIBE) and 35 patients with conventional VIBE for comparison. Two observers assessed the liver and pancreas edges, hepatic artery, motion artifacts, and overall image quality. Quantitative analysis was performed by measuring signal intensity and image noise. RESULTS: The results showed that CS-VIBE achieved significantly better anatomic delineation of the liver and pancreas edges and hepatic artery clarity than VIBE (P < 0.001). There were no significant differences in motion artifacts in dynamic phases and overall image quality. The signal intensities and INs of CS-VIBE were higher than VIBE. CONCLUSIONS: High-resolution dynamic T1WI using CS provides better anatomic delineation with comparable or better overall image quality than conventional VIBE.

Ultrasound Findings and Laboratory Predictors of Early Mortality in Patients With Severe Yellow Fever.

OBJECTIVE. Yellow fever is a hemorrhagic disease caused by an arbovirus endemic in South America; outbreaks have occurred in recent years. The purpose of this study was to describe abdominal ultrasound findings in patients with severe yellow fever and correlate them with clinical and laboratory data. MATERIALS AND METHODS. A retrospective cohort study was performed between January and April 2018. The subjects were patients admitted to an ICU with polymerase chain reaction-confirmed yellow fever. Bedside sonography was performed within 48 hours of admission. Images were independently analyzed by two board-certified radiologists. Laboratory test samples were collected within 12 hours of image acquisition. Multivariable logistic regression analysis was performed to identify 30-day mortality predictors; p < .05 was considered statistically significant. RESULTS. Forty-six patients (40 [87%] men, six [13%] women; mean age, 47.5 ± 15.2 years) were evaluated with bedside sonography. Laboratory tests showed high serum levels of aspartate aminotransferase (5319 U/L), total bilirubin (6.2 mg/dL), and creati-nine (4.3 mg/dL). Twenty-six (56.5%) patients died within 30 days of admission (median time to death, 5 days [interquartile range, 2-9 days]). The most frequent ultrasound findings were gallbladder wall thickening (80.4%), increased renal cortex echogenicity (71.7%), increased liver parenchyma echogenicity (65.2%), perirenal fluid (52.2%), and ascites (30.4%). Increased renal echogenicity was associated with 30-day mortality (84.6% versus 55.0%; p = .046) and was an independent predictor of this outcome after multivariate analysis (odds ratio, 10.89; p = .048). CONCLUSION. Reproducible abdominal ultrasound findings in patients with severe yellow fever may be associated with severity of disease and prognosis among patients treated in the ICU.

Fetal body MRI and its application to fetal and neonatal treatment: an illustrative review.

This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging.

EXTERNAL PRINGLE MANEUVER IN LAPAROSCOPIC LIVER RESECTION: A SAFE, CHEAP AND REPRODUCIBLE WAY TO PERFORM IT.

BACKGROUND: Tourniquet for right hepatectomy tightened and secured with forceps (arrow). Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique. AIM: Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube. METHODS: From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps. RESULTS: The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients. CONCLUSIONS: The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.

Time Requirement and Feasibility of a Systematic Quality Peer Review of Reporting in Radiology.

OBJECTIVE: To estimate the human resources required for a retrospective quality review of different percentages of all routine diagnostic procedures in the Department of Radiology at Bern University Hospital, Switzerland. MATERIALS AND METHODS: Three board-certified radiologists retrospectively evaluated the quality of the radiological reports of a total of 150 examinations (5 different examination types: abdominal CT, chest CT, mammography, conventional X-ray images and abdominal MRI). Each report was assigned a RADPEER score of 1 to 3 (score 1: concur with previous interpretation; score 2: discrepancy in interpretation/not ordinarily expected to be made; score 3: discrepancy in interpretation/should be made most of the time). The time (in seconds, s) required for each review was documented and compared. A sensitivity analysis was conducted to calculate the total workload for reviewing different percentages of the total annual reporting volume of the clinic. RESULTS: Among the total of 450 reviews analyzed, 91.1 % (410/450) were assigned a score of 1 and 8.9 % (40/450) were assigned scores of 2 or 3. The average time (in seconds) required for a peer review was 60.4 s (min. 5 s, max. 245 s). The reviewer with the greatest clinical experience needed significantly less time for reviewing the reports than the two reviewers with less clinical expertise (p < 0.05). Average review times were longer for discrepant ratings with a score of 2 or 3 (p < 0.05). The total time requirement calculated for reviewing all 5 types of examination for one year would be more than 1200 working hours. CONCLUSION: A retrospective peer review of reports of radiological examinations using the RADPEER system requires considerable human resources. However, to improve quality, it seems feasible to peer review at least a portion of the total yearly reporting volume. KEY POINTS: · A systematic retrospective assessment of the content of radiological reports using the RADPEER system involves high personnel costs.. · The retrospective assessment of all reports of a clinic or practice seems unrealistic due to the lack of highly specialized personnel.. · At least part of all reports should be reviewed with the aim of improving the quality of reports.. CITATION FORMAT: · Maurer MH, Brönnimann M, Schroeder C et al. Time Requirement and Feasibility of a Systematic Quality Peer Review of Reporting in Radiology. Fortschr Röntgenstr 2021; 193: 160 - 167.

Gliding performance is affected by cranial movement of abdominal organs.

Swimming is an extremely popular sport around the world. The streamlined body position is a crucial and foundational position for swimmers. Since the density of lungs is low, the center of buoyancy is always on the cranial side and the center of gravity is always on the caudal side. It has been reported that the greater the distance between the centers of buoyancy and gravity, the swimmer's legs will sink more. This is disadvantageous to swimming performance. However, the way to reduce the distance between the centers of buoyancy and gravity is yet to be elucidated. Here we show that swimmers with high gliding performance exhibit different abdominal cavity shapes in the streamlined body position, which causes cranial movement of the abdominal organs. This movement can reduce the distance between the centers of buoyancy and gravity, prevent the legs from sinking, and have a positive effect on gliding performance.

Leiomyomatosis peritonealis disseminata: Three case reports.

RATIONALE: Leiomyomatosis peritonealis disseminata (LPD) is a rare benign lesion primarily consisting of smooth muscle cells, which mostly affects premenopausal females. Here, we reported 3 females with LPD (age, 40-48 years) admitted for pelvic masses. PATIENT CONCERNS: All 3 LPD cases received laparoscopic uterine fibroid morcellation at 3, 8, and 14 years ago, respectively. Two cases were admitted for pelvic masses. One case was admitted for recurrent fibroids with pollakiuria. DIAGNOSES: LPD was considered in 2 cases preoperation according to imaging examination, and one of them received ultrasound-guided biopsy of the lesion in the right lobe of the liver. One case was considered as recurrent fibroids preoperation. After surgery, all cases were pathologically diagnosed as LPD consisting of benign smooth muscle cells. INTERVENTIONS: A total abdominal hysterectomy, salpingo-oophorectomy, and debulking was performed for all 3 cases. Intraoperative exploration revealed that the fibroids distributed in the mesentery (3 cases), broad ligament (1 case), omentum (1 case), liver (1 case), and rectus abdominis (1 case). OUTCOMES: No recurrence was found during postoperative following-up (5-12 months). LESIONS: Preoperative diagnosis of LPD is presented as a challenge due to unspecific clinical manifestations. Its diagnosis mainly depends on histopathologic evaluation. Surgery still is the primary treatment for LPD. For patients without reproductive desire, total abdominal hysterectomy, salpingo-oophorectomy, and debulking can be performed, and the affected tissue should be removed as much as possible based on the risk assessment.

Tumor desmoide intraabdominal y enfermedad inflamatoria intestinal crónica. Un escenario poco común / No disponible

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