Abdominal Distension Research Articles

Combining clinical and radiological features improves prediction of bowel ischemia in patients with CT findings of pneumatosis intestinalis.

Pneumatosis intestinalis on CT presents a diagnostic dilemma, because it could reflect bowel ischemia or benign finding. To determine radiological and clinical features that can predict bowel ischemia in patients with pneumatosis intestinalis on CT. Patients with "pneumatosis" in abdominal CT reports performed between 1/1/2002 and 12/31/2018 were retrospectively included. Pneumatosis intestinalis was confirmed by review of images. Radiological features of pneumatosis, laboratory data, clinical signs and symptoms were collected. Pathologic pneumatosis intestinalis (PPI) was defined as presence of ischemic (viable or dead) bowel on surgery or death during admission or within 30 days of discharge due to ischemia. Univariate statistical analysis was used to identify features associated with PPI, followed by multivariate logistic regression models. A total of 313 consecutive patients with pneumatosis intestinalis (162 (52%) men, median age 67 years, IQR 55-78 years) were included. Pathologic pneumatosis intestinalis was present in 114/313 (36%) patients. Presence of arterial or venous thrombosis, porto-mesenteric gas, fat stranding, and location in the small bowel were significantly associated with PPI. A combined clinical and radiological model, which included age, WBC, creatinine, abdominal distention, rebound or guarding, shock, presence of porto-mesenteric gas and fat stranding showed an AUC of 0.85 for prediction of PPI, higher than models using clinical (AUC = 0.80, p = 0.005) or radiological factors (AUC = 0.80, p < 0.0001) alone. Improved prediction of pathological pneumatosis intestinalis can be achieved by a model incorporating both clinical and radiological features (AUC = 0.85)rather than by either clinical (AUC = 0.80) or radiological (AUC = 0.80) features alone.

Giant mesenteric cysts: Clinical insights and diagnostic challenges.

Giant mesenteric cysts are rare and their clinical presentation varies depending on their location and size and therefore varies widely in clinical manifestations. Many theories have attempted to explain the occurrence of these tumors but no precise cause has been found. However, surgical excision is the gold standard in the treatment of these tumors and there is no need for adjuvant radiotherapy or chemotherapy. We present three cases of male children with giant mesenteric cysts in different abdominal regions with different clinical manifestations, all of which had no abdominal pain but abdominal distension as the main complaint. Radiological investigations confirmed the presence of intra-abdominal cysts without precise localization, and surgical intervention was successful and these tumors were completely removed. While these conditions are rare and not frequently seen by surgeons, they should be considered as a differential diagnosis for intra-abdominal cysts, as this is important for the outcome of correct treatment. These tumors are often diagnosed during surgery and complete surgical excision is essential and the diagnosis is confirmed by histological analysis. The clinical findings of this study suggest that environmental factors are a possible cause of the development of these tumors, which requires further study to understand the pathophysiology of these tumors.

Colon Volvulus: Disease or Consequence?

Introduction: Sigmoid colon volvulus is produced by torsion on itself, which causes an obstruction and endangers the blood supply to the organ and represents a condition because of another underlying pathology, the highest prevalence is in men over 70 years of age. Objective: Presentation of a case. Method: A 73-year-old man with paranoid schizophrenia under treatment presented to the emergency department for acute constipation of 72 hours, with no evacuation and flatus. She refers to abdominal distension of 48 hours prior in a sudden and evolutionary way, continuous abdominal pain of a colic type and generalized oppressiveness. An emergency exploratory laparotomy was performed initially, with the finding of volvulus of the giant sigmoid colon not perforated, but with intestinal ischemia. Intestinal resection of the sigmoid colon and stoma is performed. Discussion: Strangulated colon volvulus makes it a surgical emergency due to intestinal necrosis, septic shock and death; the computed tomography study is the gold standard for confirming the diagnosis of colon volvulus, surgical treatment is definitive. Conclusion: Sigmoid colon volvulus is a consequence of another pathology (such as benign prostatic hypertrophy) and not a disease. Its initial treatment (endoscopically) will depend on the time of evolution, infrastructure, expertise and/or each case. But at the end of the day, management is urgent, priority to scheduled, with partial resection of the colon, stoma, and/or bowel reconnection.

Mechanism of Curcuma phaeocaulis Extracts on the Proliferation and Apoptosis of Gallbladder Cancer Cells via mTOR/p70S6K Signaling Pathway

Background Curcuma phaeocaulis (CP) is utilized as a Chinese herbal medicine to treat abdominal distension and other related ailments. Curcuma phaeocaulis extracts (CPE) are rich in active components and exhibit anti-tumor properties. Purpose Purpose: This work was to assess the impact of CPE on the proliferation, apoptosis, migration, and invasion of gallbladder cancer cells (GCC), aiming to investigate its potential underlying mechanisms of action. Methods CP was utilized as the raw material to prepare CPE volatile oil via drying and heating processes. Total phenolic content analysis was conducted, assessing its scavenging capacity against 2,2-diphenyl-1-picrylhydrazyl (DPPH•) and •OH free radicals, as well as its inhibitory effects on the growth of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Human GCC line GBC-SD was selected, cultured conventionally as a control, and treated with CP volatile oil at concentrations of 25 µg/mL (Low-CPE group), 50 µg/mL (Middle-CPE group), and 100 µg/mL (High-CPE group). Cell proliferation activity was evaluated using MTT assay, apoptosis rate was assessed via flow cytometry, migration, and invasion were measured using the Transwell chamber assay, and Western blot was performed to assess proteins in the mTOR/p70S6K signaling pathway. Results The total phenolic content in the volatile oil prepared from warm CPE was approximately 30.9 mg/g, consisting of over 20 active constituents. The warm CP volatile oil exhibited scavenging rates of 85.3% for DPPH• radicals and 91.5% for •OH radicals, with minimum inhibitory concentrations against S. aureus, E. coli, and P. aeruginosa at 4.0 mg/mL, 8.0 mg/mL, and 1.0 mg/mL, respectively. Relative to the Ctrl group, Low-CPE, Middle-CPE, and High-CPE groups demonstrated decreased cell proliferation activity, increased apoptosis rates, reduced cell migration and invasion, decreased phosphorylation levels of mTOR and p70S6K proteins ( p &lt; 0.05), exhibiting concentration-dependent characteristics. Conclusion The volatile oil derived from warm CPE exhibited robust anti-oxidant and anti-bacterial activities. The warm CP volatile oil effectively inhibited GCC proliferation, migration, and invasion by suppressing the activation of the mTOR/p70S6K signaling, while promoting apoptosis.

P0438 Altered Visceral Sensitivity in patients with Ulcerative Colitis in remission

Abstract Background Ulcerative colitis (UC) in remission is commonly associated with residual symptoms, despite adequate inflammatory control. Distinguishing between inflammatory and non-inflammatory causes is essential, in order to target therapy and avoid any unnecessary treatment escalation. Once mucosal inflammation has been excluded through endoscopic evaluation, high resolution anorectal manometry (HRAM) along with sensory testing could help symptom assessment. The aim on this study is to explore whether established physiologic diagnostic modalities such as HRAM could add value in investigation of patients with UC in remission. Methods Patients with confirmed UC in remission (after proper endoscopic assessment) were evaluated with Visceral Sensitivity Index (VSI, 15 items, ranging 0-75). They subsequently underwent HRAM with a solid-state catheter followed by the rectal sensory test by a gradual rectal distention according to the IAPWG Protocol, aiming to access rectal physiology and sensory perception. Results A total of 32 eligible adult patients (43% females, mean age 40,8 y.o.) were enrolled. Internal consistency for VSI was excellent (Cronbach’s alpha=0.933). Total mean VSI scores were 43.15 (26.11-60.19). An increased VSI score was reported in 12/37 (37.5%) of patients, whereas 20/32 (62.5%) of patients ranged low. Patients with increased total VSI scored significantly worse in bloating and abdominal distention, anxiety when going to new restaurants and worry, avoiding new foods, belief in a serious illness indication, a frightening abdominal discomfort and vigilance while no significant differences were found in mean rectal pressures and outcomes of balloon inflation (table 1). Conclusion Although a 37% of patients with UC in endoscopic remission score high in VSI, rectal pressures and perception as observed by the HRAM and ballon distention test are non-significant. VSI displays excellent consistency when evaluating patients with UC.

The safety, tolerability, pharmacokinetics and pharmacodynamics of an optimized dual GLP-1/GIP receptor agonist (BGM0504) in healthy volunteers: A dose-escalation Phase I study.

Previous experiments have demonstrated that BGM0504, a GLP-1R/GIPR dual agonist drug by molecular dynamics-guided optimization, had enhanced agonistic activity compared to tirzepatide. This study aims to investigate its safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) in Chinese healthy volunteers. A randomized, double-blind, placebo-controlled and dose-escalation Phase I study was conducted as follows: a single dose (2.5 mg) and once-weekly administration for 2 weeks to reach target doses (5, 10 and 15 mg) by titration. A total of 40 volunteers received at least one dose of BGM0504 or placebo. The PK profile of BGM0504 was investigated over a wide dose range and supported once-weekly administration. It was observed that Cmax and AUC of BGM0504 were linearly proportional to the dose from 2.5-15 mg. The change in body weight (%) from baseline in BGM0504 groups was greater than that in the placebo group, with -3.24%, -6.26%, -7.09% and - 8.30% in 2.5, 5, 10 and 15 mg groups, respectively, indicating a certain dose correlation. Meanwhile, the potential roles of BGM0504 in glycaemic control were also observed. The most frequent adverse events reported were gastrointestinal (vomiting, nausea, decreased appetite, diarrhoea and abdominal distension). BGM0504 was generally safe and well tolerated with favourable PK profile and potential role in weight loss was also confirmed. These findings support subsequent development of BGM0504 for type 2 diabetes mellitus (T2DM) and obesity.

N27 Impact of Anaesthetic Nurse Scheduling Patterns on Resuscitation Outcomes after Painless Gastrointestinal Endoscopy in Patients with Inflammatory Bowel Disease

Abstract Background Nurse anesthetists in the post-anesthetic care unit (PACU) of the Gastrointestinal Endoscopy Center monitor and manage complications following endoscopy procedures. We examined the impact of nurse anesthetist scheduling patterns on resuscitation efficiency of inflammatory bowel disease (IBD) patients in the anesthesia recovery room after painless gastrointestinal endoscopy. Methods This was a retrospective analysis of IBD patients who underwent resuscitation following painless gastrointestinal endoscopy at a large tertiary care IBD clinic. Two anesthetic nurse practitioner scheduling models were compared: In 2022 (before-reform, BR), the scheduling model consisted of three anesthetic nurse practitioners (N1, N2, N3) with a nurse-to-resuscitation bed ratio of 1.5:1. In 2023 (after-reform, AR), the scheduling template was adjusted to reduce one N2 anesthesia nurse (nurse-to-resuscitation bed ratio of 1:1). The number of consultations, length of stay, complications, anesthesia nurses' satisfaction and patient satisfaction were compared between BR and AR groups. Results 211 and 246 patients with IBD were resuscitated in the PACU after painless gastrointestinal endoscopy in 2022 and 2023, respectively. The median length of stay in the PACU decreased significantly from 27.30 min (25.10–28.98) before the reform to 22.30 min (20.20–24.70) after the reform (p&amp;lt;0.001). There was no significant difference in the occurrence of complications following the implementation of the reform (hypoxemia, hypotension, nausea and vomiting, abdominal distension, pain, coughing, hypersomnia) (p=0.354). The anesthesia nurse practitioners were more satisfied with the reformed scheduling pattern, which mirrored the improved satisfaction among IBD patients. Conclusion The reformed anesthesia nurse scheduling model yielded improved resuscitation efficiency, reduced costs, and improved satisfaction of nurse anesthetists and IBD patients. Further studies are required to validate these findings.

Very-Low-Absorbable Geraniol for the Treatment of Irritable Bowel Syndrome: A "Real-World" Open-Label Study on 1585 Patients.

The objective of this study was to evaluate the efficacy of a very-low-absorbable geraniol formulation, administered as a food supplement, in patients with irritable bowel syndrome (IBS) in a real-world setting in Italy. This open-label study was conducted in Italy on patients diagnosed with IBS and treated for 4 weeks with 240 mg/day of Palmarosa essential oil, absorbed on 960 mg of ginger root powder to obtain a very-low-absorbable geraniol formulation. Baseline characteristics, including demographic and symptoms were recorded using the IBS Severity Scoring System (IBS-SSS). After 28 ± 7 days, the patients were asked to complete the IBS-SSS questionnaire again. The primary objective was to confirm the effects of a very-low-absorbable geraniol formulation on self-reported symptoms of IBS and the quality of life of affected individuals. The secondary objective was to confirm the effect of the treatment on the different IBS subtypes. A total of 1585 patients were included in the study, with a mean age of 44.8 years and 56.4% women. Following the 4-week supplementation period, significant decreases were observed in the patients' IBS-SSS (-67.9%) and all the primary IBS symptoms, such as abdominal distention (-82.3%), unsatisfaction with bowel habits (-46.2%), and interference with quality of life (QoL) (-64.9%) (all p < 0.01). The patients' stool type improved significantly. Treatment was effective in all IBS subtypes. Treatment with very-low-adsorbable geraniol food supplement was associated with improvements in symptoms and bowel habits in all IBS subtypes in a real-world setting in Italy. These findings support the use of geraniol as an effective option for patients with IBS regardless of the disease subtype.

Exploring early postoperative core symptoms in Chinese patients with primary liver cancer: a cross-sectional and longitudinal network analysis.

Patients with primary liver cancer (PLC) experience a range of symptoms in the early postoperative period. Symptoms include cancer-related symptoms and adverse effects of treatment. Exploring the core symptoms and their dynamics in the early post-hepatectomy patients may help provide better symptom management programs. The purpose of this study was to identify the core symptoms in early post-hepatectomy patients and to explore the trajectory of their dynamics. During the period from March 2021 to September 2022, a total of 281 patients diagnosed with PLC and undergoing radical curative surgery were recruited from the hepatobiliary surgery departments of two hospitals in Eastern China, among whom 249 individuals (88.6%) agreed to participate in the study. A comprehensive symptom assessment was administered to the patients 1-2days after surgery (T1) and 1-2days before discharge (T2). Network analysis was used to identify core symptoms in early post-hepatectomy patients based on symptom severity. The network analysis identified the core symptoms of dry mouth, pain, abdominal distension, the lack of appetite, and nausea at T1. In contrast, at T2, the lack of appetite, pain, shortness of breath, and disturbed sleep were revealed. At the two early time points, while the results of the network structure test showed no statistically significant difference in the overall symptom network structure, there was a significant difference in the results for the core symptoms. Our study demonstrates the need to identify core symptoms in the early post-hepatectomy to improve symptom management in PLC patients. It is crucial to apply network analysis as an essential component of cancer care.

Pan-TRK positive uterine sarcoma in immunohistochemistry without neurotrophic tyrosine receptor kinase gene fusions: A case report.

The classification of uterine sarcomas is based on distinctive morphological and immunophenotypic characteristics, increasingly supported by molecular genetic diagnostics. Data on neurotrophic tyrosine receptor kinase (NTRK) gene fusion-positive uterine sarcoma, potentially aggressive and morphologically similar to fibrosarcoma, are limited due to its recent recognition. Pan-TRK immunohistochemistry (IHC) analysis serves as an effective screening tool with high sensitivity and specificity for NTRK-fusion malignancies. We report a case of a malignant mesenchymal tumor originating from the uterine cervix, which was pan-TRK IHC-positive but lacked NTRK gene fusions, accompanied by a brief literature review. A 55-year-old woman presented to the emergency department with abdominal pain and distension, exhibiting significant ascites and multiple solid pelvic masses. Pelvic examination revealed a tumor encompassing the uterine cervix, extending to the vagina and uterine corpus. A punch biopsy of the cervix indicated NTRK sarcoma with positive immunochemical pan-TRK stain. However, subsequent next generation sequencing revealed no NTRK gene fusion, leading to a diagnosis of poorly differentiated, advanced-stage sarcoma. The clinical significance of NTRK gene fusion lies in potential treatment with TRK inhibitors for positive sarcomas. Identifying such rare tumors is crucial due to the potential applicability of tropomyosin receptor kinase inhibitor treatment.

Appendicoileal knotting and Appendicoileal fistula in a-13-year-old child: rare complication of appendicitis: A case report

Introduction: Acute appendicitis is an inflammation of the appendix, which is the most common abdominal surgical emergency. If left untreated, appendicitis can rupture with abscess formation. Rarely, it can lead to fistula formation in other organs or form a knot and cause bowel obstruction. Both appendicitis knot and appendicoileal fistula occurrence in the same patient are rare complications of acute appendicitis. Case presentation: We present the first case of appendicoileal knot with appendicoileal fistula in a 13-year-old male patient who presented with abdominal distension of 3 days duration with failure to pass feces and flatus and crampy abdominal pain. Abdominal examination revealed a distended abdomen, visible bowel loops, and tenderness at the lower abdomen bilaterally. Multiple air-fluid levels were seen on an erect abdominal X-ray. With a diagnosis of small bowel obstruction, he underwent exploratory laparotomy. Intraoperative, the appendix was wrapped around a loop terminal ileum and its tip had fistulous communication with the ileum. For this appendectomy and ileal resections with end-to-end anastomosis were done. Conclusion: Appendicoileal knot and/or fistula formation should be expected as a cause for small bowel obstruction in patients with appendicitis. Laparotomy is the treatment modality for patients with bowel obstruction due to appendicitis.

Naso-intestinal versus gastric tube for enteral nutrition in patients undergoing mechanical ventilation: a systematic review and meta-analysis

BackgroundA systematic appraisal of the comparative efficacy and safety profiles of naso-intestinal tube versus gastric tube feeding in the context of enteral nutrition for mechanically ventilated (MV) patients is imperative. Such an evaluation is essential to inform clinical practice, ensuring that the chosen method of nutritional support is both optimal and safe for this patient population.MethodsWe executed an exhaustive search across PubMed et al. databases to identify randomized controlled trials (RCTs) that scrutinize the role of naso-intestinal and gastric tubes for mechanically ventilated (MV) patients up to May 30, 2024. The process of study selection, quality assessment, and data extraction was conducted independently by two researchers. RevMan 5.3 software was used for meta-analysis.ResultsOur meta-analysis included 8 RCTs, published between 1992 and 2018, encompassing a total of 676 MV patients. The results indicated that naso-intestinal tube feeding, compared to gastric tube feeding, was associated with a significant reduction in the incidence of ventilator-associated pneumonia (VAP) [Risk Ratio (RR) = 0.69, 95% confidence interval (CI) (0.52, 0.92)] and gastric retention (RR = 0.11, 95% CI (0.04, 0.28)). No statistically significant differences were observed in the incidence of aspiration (RR = 0.93, 95% CI (0.35, 2.50)) vomiting (RR = 0.70, 95% CI (0.23, 2.08)), abdominal distension (RR = 0.87, 95% CI (0.29, 2.63)), or diarrhea (RR = 1.10, 95% CI (0.77, 1.55)).ConclusionsThe current evidence indicates that naso-intestinal tube feeding is efficacious in lowering the incidence of VAP and gastric retention among MV patients, without a corresponding escalation in the risk of adverse events, including aspiration, vomiting, abdominal distension, and diarrhea. These insights significantly augment the existing corpus of knowledge pertaining to the optimization of enteral nutrition strategies for patients on mechanical ventilation.

Change in sleep, gastrointestinal symptoms, and mood states at high altitude (4500m) for 6 months.

This study aimed to investigate the alterations in sleep quality and sleep patterns among military personnel at altitudes ranging from 1500 to 4500m, as well as the associated factors influencing their sleep. This study employed a longitudinal prospective survey conducted over a period of six months, from November 2023 to June 2024. A total of 90 soldiers were recruited for participation. Initially, demographic data and sleep conditions were collected through a questionnaire administered to participants at an altitude of 1,500m. Subsequently, participants were monitored continuously to gather data over seven days at an altitude of 4,500m, specifically during the 7 days of the 6-month survey period), and the 1st month at an altitude of 4,500m (on the 1st month of the six-month survey period. Spearman's rank correlation was utilized to investigate the relationships among sleep quality, gastrointestinal symptoms, and mood states. The total score of the Pittsburgh Sleep Quality Index (PSQI) exhibited an increase, indicating impaired sleep quality among soldiers stationed at an altitude of 4,500m for durations 7 days, 1 month, 3 months, and 6 months. Notably, after 7 days of soldiers, there was a significant gradual in the number of military soldiers experiencing gastrointestinal symptoms, such as diarrhea, abdominal distention, and constipation, which subsequently stabilized with prolonged exposure to the altitude. Furthermore, a significant rise in the incidence of depression was observed after days of rapid exposure 4,500 above sea level, and the emotional state of military personnel tended to tend towards mild depression over the duration of time Correlation. Correlation analysis showed that the PSQI score was closely related to the Athens Insomnia Scale(AIS) total score, Epworth Sleepiness Scale(ESS) total score, Self-Rating Anxiety Scale(SAS) total score, Self-Rating Depression Scale(SDS) total score, difficulty in falling asleep, easy to wake up or wake up early at night, poor breathing and snoring (on the 1st month, the 3rd month and the 6th month at the altitude of 4500m respectively: rs = 0.868, 0.648, 0.483, 0.459, 0.472, 0.364, 0.613, 0.75; rs = 0.856, 0.521, 0.481, 0.354, 0.768, 0.720, 0.511, 0.535; rs = 0.756, 0.490, 0.496, 0.352, 0.708, 0.737, 0.424, 0.408, p < 0.01 or p < 0.05); Positively correlated with heart rate (at 4500m 7 days at altitude: rs = 0.233, p = 0.027), diarrhea (at 4500m 1-month at altitude: rs = 0.237) bloating and constipation (at 4500m 1 month and 3months respectively: rs = 0.472; rs = 0.364; rs = 0.341, 0.273, p < 0.05); and with age, sex, marital status, education were significantly positive correlation (rs = 0.463, 0.251, 0.255, 0.230, p < 0.05). The impaired sleep quality, gastrointestinal symptoms, and anxiety and depression in military personnel changed with the extension of the time of stationing at 4500m altitude, which was most prominent when stationed at high altitude for 7 days; the sleep quality of those stationed at high altitude had a close relationship with the gastrointestinal symptoms, the type of sleep(insomnia and drowsiness), and the heart rate, but it varied with the duration of the stationing at high altitude; our study provides new information for the prevention of sleep disturbance, gastrointestinal symptoms, and negative emotions in high-altitude military personnel.

Factors Associated with Clinically Significant Extrinsic Compression on Gastroduodenal Endoscopy.

Although clinicians frequently encounter incidentally detected gastroduodenal extrinsic compressive lesions (GDECLs) on upper gastrointestinal endoscopy (UGE), theoptimal management approach for GDECLs has not been fully established. This study aimed to stratify and identify important factors associated with clinically significant GDECLs that require regular follow-up or further treatment. Between June 2007 and December 2015, a total of 73 patients with suspected GDECLs on UGE at Kyung Hee University Hospital at Gangdong were identified and studied retrospectively. After the final diagnosis, patients were divided into the following two groups: clinically significant GDECLs, which requires regular follow-up or further treatment, and clinically non-significant GDECLs. Among 73 GDECLs, 23 (31.5%) lesions were classified as clinically significant GDECLs and 50 (68.5%) as clinically non-significant GDECLs. In multivariate analysis, clinical and endoscopic parameters that were independently associated with clinically significant GDECLs included older age (≥ 60years), large size (≥ 4cm) of extrinsic compression, previous history of intra-abdominal malignancy, and symptoms of abdominal distension (all p < 0.05). Several clinical and endoscopic parameters showed significant association with the identification of clinically significant GDECLs on endoscopy. These predictive factors might be useful in determining whether to perform further diagnostic work-up in patients with GDECLs.

Case of intractable beriberi treated with acupuncture of He's three-promotion needling method

The paper introduces one case of intractable beriberi treated with acupuncture of He's three-promotion needling method. The patient visited the hospital because of "repeated redness and swelling of the feet, combined with itching for over 2 years, aggravated in recent 2 days on the left foot". The chief complaints included redness and swelling of the left foot, with the normal walking disturbed, poor appetite, and abdominal distention after meal. The case was identified as beriberi (downward flowing of damp heat, and dysfunction of spleen in transportation due to deficiency). In treatment, using the fire needling technique of acupuncture, Bafeng (EX-LE10) on the left side were stimulated (warming-promotion method). The blood drops were squeezed in the local, if less bleeding was presented, the three-edge needle was used to prick the local area where the acupoint located (strong-promotion method). Afterward, the regular acupuncture was delivered at bilateral Yinlingquan (SP9), Zusanli (ST36) and Sanyinjiao (SP6), as well as Yanglingquan (GB34) and Xuanzhong (GB39) on the left side (mild-promotion method). The therapeutic regimen was adjusted flexibly according to the changes of the symptoms. After treated for 3 weeks, the symptoms disappeared.

MANAGEMENT OF HEPATIC ENCEPHALOPATHY WITH AYURVEDA - A CASE REPORT

Ayurveda is an Indian system of medicine that has been practised for thousands of years—Ayurveda medicines have been found to be effective in most chronic diseases like liver cirrhosis, hepatitis, and hepatic encephalopathy. A 58-year the male patient was admitted with complaints of irrelevant talk, abdominal distension, anorexia, drowsy, partially obeying verbal commands, yellowish discolouration of sclera, and bipedal oedema. The patient was managed with Ayurveda medicines. Hepatic encephalopathy (HE), the neuropsychiatric presentation of liver disease, is associated with high morbidity and mortality.

Association of Subcapsular Liver Hematoma With Preeclampsia, Eclampsia, or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome.

To describe the presentation, outcomes, and management strategies for cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. This was a case series of individuals with subcapsular liver hematoma managed at a single level IV center over a 10-year period, from 2013 to 2024. Presenting signs and symptoms, laboratory findings, time of onset, management strategies, acute perinatal and maternal outcomes, and long-term outcomes such as subsequent pregnancies were reviewed in the medical record and recorded. Data were summarized using descriptive statistics, with results reported as means, standard deviations, and ranges. Categorical variables were summarized as counts and percentages. There were 13 cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, and HELLP syndrome between 2013 and 2024. In 10 of the 13 pregnancies (76.9%), delivery was preterm. The most common presenting symptoms were epigastric or right upper quadrant pain (53.8%), followed by abdominal distention (38.5%). Diagnosis of subcapsular liver hematoma was made in the antepartum period for six patients and was made in the postpartum for seven patients. The diagnosis was confirmed in all cases by computed tomography. Conservative management with close hemodynamic monitoring and transfusion of blood and blood products was sufficient in 11 (84.6%) patients; two patients underwent surgical exploration. The mean duration of hospital stay was 10 days (range 2-21 days). Maternal complications included pleural effusions, acute kidney injury, and pulmonary edema. There were no maternal deaths. There were four stillbirths and no neonatal deaths. Four people had five subsequent pregnancies; delivery was preterm in all five pregnancies, two pregnancies were complicated by subsequent HELLP syndrome, and one patient developed recurrent subcapsular liver hematoma. Subcapsular liver hematoma is a rare complication of preeclampsia, eclampsia, and HELLP syndrome that is associated with substantial maternal and perinatal morbidities. Conservative management with hemodynamic monitoring and transfusion of blood and blood products was sufficient for management in the majority of cases. All subsequent pregnancies resulted in preterm births.

A Neonate Presenting With Large Abdominal Mass: A Rare Case of Congenital Leukemia.

Leukemia symptoms occurring in the first 4 weeks of infancy are known as congenital leukemia. We present a case of congenital leukemia in a full-term neonate manifesting at birth with a grossly distended abdomen due to a large abdominal mass. Ultrasonography of the abdomen showed a large abdominal mass originating from the liver. Congenital leukemia was suspected based on the very high total leukocyte counts and the presence of blast cells in the peripheral blood smear, which was confirmed by bone marrow aspiration. The bone marrow aspirate smear showed 42% blast cells. Due to overwhelming sepsis, the baby died at the neonatal intensive care unit on day 4 after birth. This report highlights the atypical presentations of congenital leukemia in the neonatal period.

Aortic body tumor with intracardiac metastasis in a dog.

A 9-y-old, spayed female, non-brachycephalic mixed-breed dog was presented with progressive abdominal distension and diarrhea of <24 h duration. An echocardiogram revealed nodular masses in the pericardium and myocardium, particularly near the auricles. Diagnostic and therapeutic pericardiocentesis failed to improve the dog's status, and the owner elected euthanasia. The autopsy revealed numerous nodules within the pericardium, heart base, and myocardium of the left and right ventricles. Histopathology revealed the presence of a neuroendocrine tumor, immunopositive for chromogranin A and negative for synaptophysin and calcitonin, supporting the diagnosis of aortic body tumor with intracardiac metastasis.

Utility of Abdominal Radiographs After Posterior Spinal Fusion for Neuromuscular Scoliosis.

Background/Objectives: Postoperative ileus, the temporary cessation of gastrointestinal motility leading to accumulation of fluid and gas in the bowel, is a common complication following posterior spine fusion (PSF) in patients with neuromuscular scoliosis (NMS). Abdominal radiographs (KUBs) are often ordered to differentiate between ileus and mechanical obstruction but expose patients to radiation, add cost, and may lead to unnecessary work up. The aim of this study was to determine how often KUBs led to a change in treatment after PSF in patients with NMS. Methods: A retrospective review was conducted of NMS patients with ≥2-year follow-up treated with PSF between January 2014 and December 2019 at a tertiary pediatric hospital. Results: Of the 133 patients (age 13.7, SD 2.6 years; preoperative curve magnitude 82.8, SD 23.0 degrees; follow-up 44.7, SD 15.4 months), 22.6% (30/133) underwent KUB imaging due to abdominal pain, distension, or delayed return of bowel function. In total, 93.3% (28/30) of the KUB imaging was consistent with ileus. One KUB study resulted in a gastroenterology consultation and bowel cleanout, and one raised concerns regarding possible pneumatosis of the colon, prompting a pediatric surgery consultation and exploratory laparotomy which was unremarkable. Conclusions: KUBs were performed in nearly 25% of NMS patients during the acute postoperative period, but rarely provided useful diagnostic information leading to changes in management. In the presence of postoperative abdominal distension, feeding intolerance, and delayed return of bowel function, we advocate for continuing conservative measures until bowel function returns, reserving abdominal radiographs for patients with a worsening exam despite bowel rest or additional causes for concern.