Increase In Abdominal Pressure Research Articles

A computational analysis of the effect of supporting organs on predicted vesical pressure in stress urinary incontinence.

Stress urinary incontinence (SUI) or urine leakage from urethra occurs due to an increase in abdominal pressure resulting from stress like a cough or jumping height. SUI is more frequent among post-menopausal women. In the absence of bladder contraction, vesical pressure exceeds urethral pressure leading to urine leakage. The main aim of this study is to utilize fluid-structure interaction techniques to model bladder and urethra computationally under an external pressure like sneezing. Both models have been developed with linear elastic properties for the bladder wall while the patient model has also been simulated utilizing the Mooney-Rivlin solid model. The results show a good agreement between the clinical data and the predicted values of the computational models, specifically the pressure at the center of the bladder. There is 1.3% difference between the predicted vesical pressure and the vesical pressure obtained from urodynamic tests. It can be concluded that the accuracy of the predicted pressure in the center of the bladder is significantly higher for the simulation assuming nonlinear material property (hyperelastic) for the bladder in comparison to the accuracy of the linear elastic model. The model is beneficial for exploring treatment solutions for SUI disorder. Graphical abstract 3D processing of bladder deformation during abdominal pressure of a the physiological model and b the pathological model (starting from left to right and up to down, consecutively).

CROSSFIT TRAINING-RELATED SPONTANEOUS DIAPHRAGMATIC RUPTURE: A CASE REPORT

SESSION TITLE: Cardiovascular Cases SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/22/2019 3:45 PM - 4:45 PM INTRODUCTION: Spontaneous diaphragmatic rupture (DR) is extremely rare. Less than 50 cases have been reported. Spontaneous DR is a loss of the continuous solution of the diaphragm that can lead to the introduction of the abdominal viscera into the pleural cavity, it results from a variety of conditions, such as vigorous exercise, parturition, coughing, all this status conditioning an increase intraabdominal pressure without evidence of any trauma. CrossFit training is a form of exercise that incorporates rapid and successive high-intensity ballistic movements, recognized as one of the fastest growing modes of high-intensity functional training. The studies reported controversial evidence of the higher risk of injuries in the people training CrossFit. To our knowledge, there has been no reported cases in which the spontaneous rupture of the diaphragm was associated with CrossFit training. CASE PRESENTATION: A 28-year-old man visited the physician office (PO) reporting pain in the thoracic and epigastric area. The patient's complaints started 1 day before visiting the PO during CrossFit Training while he was weightlifting. He reported that he felt a stabbing pain in his thoracic and epigastric area that had become progressively worsened. On admission, the patient's vital signs were stable. Abdominal ultrasound revealed no abnormal signs. Chest radiograph showed an elevated left diaphragm. He was sent home but returned to the PO the following day with worsened pain. A CT scan was obtained and spontaneous diaphragmatic rupture with passage of peritoneal structures of the abdominal cavity was diagnosed. He immediately underwent primary repair of the diaphragm and relocation of the stomach and bowel was performed. After 7 days from the onset, he was discharged without any sequelae. DISCUSSION: Approximately 1% of DRs are reported to occur spontaneously. In this case spontaneous DR was caused by a sudden increase in abdominal pressure resulting in a pressure gradient across the diaphragm, such as heavy physical effort and sudden twisting movements. Although some cases of spontaneous DR followed by strenuous sport activities were reported in the medical literature, there has been no previous report of a case of spontaneous DR after CrossFit. As a result, increased abdominal pressure contributed to the rupture of the diaphragm. We believe that this is how our patient was injured. Spontaneous DR should be suspected if there is an abnormal diaphragmatic elevation in a patient who presents with sudden epigastric area pain after a static sport activity, such as CrossFit training. CONCLUSIONS: Spontaneous DR associated with physical exercise is a rare entity, however it should be suspected since it requires timely management to avoid complications. Since CrossFit training is a relatively new high intensity sport, further investigations must evaluate the safety and the risks of practicing this sport. Reference #1: Vilaro MF, Montano LG, Monroig HG, Rodriguez AD, Fernandez R, Rosario MG-D. CHRONIC COUGH CAUSING AN UNEXPECTED COMPLICATION. CHEST. 2018 Oct 1;154(4):1070A. Reference #2: Yang YM, Yang HB, Park JS, Kim H, Lee SW, Kim JH. Spontaneous diaphragmatic rupture complicated with perforation of the stomach during Pilates. Am J Emerg Med. 2010 Feb;28(2):259.e1-259.e3. Reference #3: Claudino JG, Gabbett TJ, Bourgeois F, Souza H de S, Miranda RC, Mezêncio B, et al. CrossFit Overview: Systematic Review and Meta-analysis. Sports Med - Open. 2018 Feb 26;4(1):11. DISCLOSURES: No relevant relationships by Daniel Arturo Herbert Anaya, source=Web Response No relevant relationships by José Antonio Meade Aguilar, source=Web Response No relevant relationships by Carlos Romero, source=Web Response

Ultrasound Probe Pressure on the Maternal Abdominal Wall and the Effect on Fetal Middle Cerebral Artery Doppler Indices.

Background and Objectives: Doppler ultrasound of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation, and other perinatal outcomes. The adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies. The aim of this study was to evaluate the effect of increased pressure exerted on the maternal abdominal wall during routine ultrasound on the middle cerebral artery (MCA), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). Materials and Methods: A prospective study was conducted, in which we included 40 pregnant women between 24 + 0 and 41 + 3 gestational weeks (GW), with singleton pregnancies, without any associated pathologies, undergoing routine US examination. We recorded the flow velocity waveforms in the MCA, and we measured the RI, PI, PSV, and the applied pressure on to the maternal abdominal wall—needed for a proper evaluation of MCA. We then repeated the same measurements at two different higher pressure levels, at the same time having a proper image of the targeted vessel. Results: We found significant differences for the PI and RI levels with an increase in abdominal pressure (median PI 1.46, 1.58, and 1.92, respectively; median RI 0.74, 0.78, and 0.85, respectively; p < 0.05), for both PI and RI. At the same time, we found no significant differences for PSV in the studied group in relationship with increase in abdominal pressure (median PSV 39.56, 40.10, and 39.70, respectively; p > 0.05). Conclusions: The applied abdominal pressure by the examiner’s hand, during routine US scan in pregnancy, can modify the MCA parameters of blood flow resistance (PI and RI) when measured by Doppler US, thus influencing the diagnostic accuracy in a series of pregnancy associated pathologies, such as chronic fetal distress (CFD) or intrauterine growth restriction (IUGR).

In vivo molecular engineering of the urethra for treatment of stress incontinence using novel biomimetic proteoglycans.

Stress urinary incontinence (SUI), a serious condition which affects ~56% of postmenopausal women, is the involuntary leakage of urine through urethra during physical activity that causes an increase in abdominal pressure. SUI is associated with a decrease in compliance and volume of urethral tissue, likely due to a reduced proteoglycan: collagen ratio in the extracellular matrix and collagen disorganization. Here, we investigated the use of biomimetic proteoglycans (BPGs) to molecularly engineer urethral tissue of New Zealand White rabbits to examine biocompatibility in vivo. BPG concentrations of 50 mg/mL (n = 6, 1 week) and 200 mg/mL (n = 6, 1 week and n = 6, 6 weeks) dissolved in 1× phosphate-buffered saline (PBS) were injected transurethrally using a 9 French cystoscope, and were compared to PBS-injected controls (n = 3, 1 week) and non-injected controls (n = 2, 1 week). Urethral compression pressure measurements confirm BPG injections did not modify normal urethral pressure, as intended. Histological assessment demonstrated biological tolerance of BPGs in urethra and no inflammatory response was detected after 1 and 6 weeks compared to non-injected controls. Confocal imaging of fluorescently-labeled BPG injected urethral specimens demonstrated the integration of BPGs into the interstitial connective tissue and confirmed they were still present after 6 weeks. A general decrease of collagen density was exhibited near injection sites which may be due to increased hydration induced by BPGs. Injection of BPGs is a novel approach that demonstrates potential as molecular treatment for SUI and may be able to reverse some of the degenerative tissue changes of individuals affected by this condition. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: 00B: 000-000, 2019. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2409-2418, 2019.

Sneeze and pop: a ruptured varicocele; analysis of literature, guided by a well-documented case-report

BackgroundAn acute scrotal hematoma, secondary to a spontaneous rupture of a varicocele is still a rare presentation in daily practice. However, multiple case reports have been reported. Sudden increase in abdominal pressure, resulting to an increased venous pressure can lead to a rupture of the varicocele. Literature search shows that due to uncertainty of the diagnosis, explorative surgery is often performed, sometimes resulting in unnecessary orchiectomies. The objective of this study was to determine classical clinical presentation of patients with a spontaneous rupture of a varicocele, determine the diagnostic procedure, and give an insight in the follow-up.Case presentationWe present a case of a 24-year old male with acute scrotal swelling after sneezing. Subsequently, we carried out a systematic literature search to identify all eligible studies to determine classic clinical presentation of spontaneous ruptures of a varicocele.ConclusionThe literature search shows that clinical presentation of idiopathic spontaneous scrotal hematomas is similar to testicular torsion, epididymo-orchitis, malignancy, or (incarcerated) inguinal hernia making differential diagnosis difficult. Especially when there has been increased abdominal pressure or strenuous activity preceding the symptoms, and the swelling is left sided, it should be included in the differential diagnosis for patient with acute inguinoscrotal swelling. Colour Doppler-Ultrasonography is recommended to distinguish between other causes of acute scrotum. The hematoma is usual self-limiting, justifying conservative treatment. Early surgical intervention is indicated with signs of ischaemia due to obstruction, infection of the hematoma, or uncertain diagnosis (i.e. malignancy). However, physicians should be cautious with direct exploration, as it led to unnecessary orchiectomy in 25% of patients. The hematoma can increase in size up to 3 months post-event, and it can take up to 15 months to completely resolve.

Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients.

Changes in the body position of patients receiving mechanical ventilation in intensive care unit are frequent. Contrary to healthy humans, little data has explored the physiological impact of position on respiratory mechanics. The objective of present paper is to review the available data on the effect of changing body position on respiratory mechanics in ICU patients receiving mechanical ventilation. Supine position (lying flat) or lateral position do not seem beneficial for critically ill patients in terms of respiratory mechanics. The sitting position (with thorax angulation >30° from the horizontal plane) is associated with improvement of functional residual capacity (FRC), oxygenation and reduction of work of breathing. There is a critical angle of inclination in the seated position above which the increase in abdominal pressure contributes to increase chest wall elastance and offset the increase in FRC. The impact of prone position on respiratory mechanics is complex, but the increase in chest wall elastance is a central mechanism. To sum up, both sitting and prone positions provides beneficial impact on respiratory mechanics of mechanically ventilated patients as compared to supine position.

Anesthesia Management and Recovery after Laparoscopic Colorectal Surgery

Open abdominal procedures are associated with high levels of postoperative surgical stress that can impede recovery of physiological functions. Trauma resulting from aggressive manipulation of organs, and especially the intestine, can increase postoperative complications and result in delay in normal recovery. In an attempt to minimize complications and overall duration of hospital stay, fast track strategies, called “early recovery after surgery” (ERAS) protocols, have been adopted. Laparoscopic surgery has recently been identified as a major component of rapid recovery. One of the key differences between the open and the laparoscopic approach is the use of pneumoperitoneum for organ exposure during laparoscopy. Prolonged increase in abdominal pressure in addition to patient positioning can have a profound effect on hemodynamic parameters such as central venous pressure (CVP), cardiac output and intracranial pressure. Modifications in fluid administration, the choice of anesthetic agent and the depth of neuromuscular blockade are indicated to accommodate to the conditions imposed by pneumoperitoneum. Postoperatively, laparoscopic surgery is usually associated with less aggressive analgesia management. Based on ERAS protocols, patients are encouraged to initiate early oral feeding and to resume physical activity as soon as possible after abdominal surgery. While laparoscopic abdominal surgery is associated with reduced needs for pain medication, there appear to be no significant differences in early enteral feeding and mobilization between laparoscopic procedures and open surgery. When all factors are taken into consideration, however, laparoscopic colorectal surgery is associated with significant reduction in the duration of the total hospital stay, and is therefore recommended whenever feasible.

Does intraoperative success predict outcome in the treatment of urethral sphincter insufficiency with bulking agent?

Sphincter insufficiency is mostly associated with neurogenic and some structural abnormalities in the pediatric population. As a mini-invasive treatment, urethral bulking agents have been used to treat this problem. The aim was to evaluate if technical success, defined as intraoperative increase in abdominal leak point pressure (ALPP), predicts the outcome of the treatment of sphincter insufficiency with urethral bulking agent. We reviewed all children treated first time with dextranomer/hyaluronic acid (Dx/HA) copolymer (Deflux) for urethral sphincter insufficiency and who intraoperatively had ALPPs measured during 2004-2014. Patient characteristics, change in urinary continence and the duration of the possible response were evaluated in neurogenic and non-neurogenic cases. The median age of the patients was 7.8 years (range 4.1-14.5) at initial treatment and median volume of Dx/HA instilled was 3.5mL (IQR 2-5). Twelve patients had neurogenic disease and 15 had non-neurogenic disease. Median ALPPs before and after the injections were 19 cmH2O (IQR 14-28) and 70 cmH2O (IQR 48-80), p<0.001. Increases in ALPPs were similar in both patient groups (p=0.661) and in 17 patients with any response and 10 patients with no response (p=0.267). In patients with any response the median duration of the response was only 0.8 years (IQR 0.09-2.0). During a median follow-up of 4.9 years (range 1.7-11.8), 15 patients received one to three repeat injections and eight patients went through sling or bladder neck operation (Summary table). During repeat injections, the preoperative ALPPs had returned to the original levels. Currently, 20% are continent or almost continent with one or more Dx/HA injections. In half of the patients with neurogenic bladder, compliance or volume deteriorated slightly in follow-up. Five out of 15 patients who reached puberty become continent spontaneously after failed bladder neck injection. Intraoperative ALPPs increased significantly in most patients during the procedure. However, only 52% of the patients experienced more than 1 month of success after the procedure, and even in those the effect lasted mostly under a year. With one to four injections one-fifth seem to have had a good long-term result. Although the long-term success rate is limited, bulking agent injection allowed the patients with spontaneous voiding to continue it and the injection did not prevent future treatments. Intraoperative increased ALPP does not predict a good long-term outcome after Dx/HA injection. At the end, only a fifth of our patients had good result with one or more Dx/HA injections. A change in bladder behavior is possible after treatment.

Laparoscopy and anesthesia: A clinical review

Laparoscopy has evolved since as early as 1950 to the present state of being the standard approach for most common surgical procedures. It has gained popularity in clinical practice in view of better cosmetics, lesser postoperative pain, shorter hospitalization, and faster recovery. However, the creation of pneumoperitoneum with laparoscopy is associated with various pathophysiological changes, especially involving the cardiovascular and respiratory systems. Electronic databases were searched to obtain the relevant literature with keywords related to laparoscopy from 1985 to 2016. Ninety-three papers were reviewed. Bibliographies were cross-checked and relevant literature was included. The pneumoperitoneum associated with laparoscopy is found to cause a decrease in cardiac output with an increase in pulmonary and systemic vascular resistance. These changes are mainly due to the increase in abdominal pressure which causes elevation of diaphragm with compression of small and big blood vessels. In the lungs, it causes a decrease in functional residual capacity with impaired pulmonary ventilation and perfusion. Increase in intra-abdominal pressure also perils the splanchnic circulation with a decrease in blood flow to the major abdominal organs. Preoperative assessment requires special attention, especially in high-risk patients. General anesthesia with controlled ventilation has proven to the ideal technique. Various pharmacological agents are used with varying success to attenuate the hemodynamic responses to laparoscopy. This article discusses the various consequences of laparoscopy as well as strategies to counteract them. It is essential for the anesthesiologists to have a good understanding of these changes and intervene at appropriate levels in terms of optimization in the preoperative period and management of hemodynamic changes in the perioperative period for a good surgical and patient outcome.

Hemorrhagic Valsalva Retinopathy in a Pregnant Woman

Valsalva retinopathy is caused by a sudden increase in intra-thoracic or abdominal pressure, following forced expiration, with mouth and nose closed (Valsalva maneuver). We report a case of Valsalva retinopathy in a pregnant woman. A 36 years old patient, pregnant at 24 weeks of amenorrhea, who consulted for sudden visual acuity decrease of the left eye, evolving since 24 hours after Valsalva maneuvers to calm down her panic and control her breathing. The refraction has demonstrated a decrease of visual acuity in the left eye to “can see a hand moving”, while the visual acuity remained normal in the right eye. Spontaneous evolution was marked by a fast and progressive reduction of hemorrhage and progressive recovery of vision in the left eye. Valsava retinopathy was first described in 1972 by Thomas Duane. Physical activity is usually found before it occurs. Many situations are usually associated to this occurrence among which: pregnancy, vomiting, weightlifting or trauma. Regression of this hemorrhage without sequelae is usual. But sometimes, we need a Nd:Yag laser treatment or surgery to evacuate the blood.

The Effects of a Modified High-carbohydrate High-fat Diet on Metabolic Syndrome Parameters in Male Rats.

Metabolic syndrome is a cluster of metabolic abnormalities including central obesity, hyperglycemia, hypertension, and dyslipidemia. A previous study has established that high-carbohydrate high-fat diet (HCHF) can induce MetS in rats. In this study, we modified components of the diet so that it resembled the diet of Southeast Asians. This study aimed to determine the effects of this modified HCHF diet on metabolic parameters in rats. Male Wistar rats (n=14) were randomised into two groups. The normal group was given standard rat chow. The MetS group was given the HCHF diet, comprises of fructose, sweetened condensed milk, ghee, Hubble Mendel and Wakeman salt mixture, and powdered rat food. The diet regimen was assigned for a period of 16 weeks. Metabolic syndrome parameters (abdominal circumference, blood glucose, blood pressure, and lipid profile) were measured at week 0, 8, 12, and 16 of the study. The measurement of whole body composition (fat mass, lean mass, and percentage of fat) was performed using dual-energy X-ray absorptiometry at week 0, 8, and 16. Our results indicated that the components of MetS were partially developed after 8 weeks of HCHF diet. Systolic blood pressure, triglyceride, low density lipoprotein cholesterol, fat content, and percentage of fat was significantly higher in the HCHF group compared to normal group (p<0.05). After 12 weeks of HCHF diet, the rats showed significant increases in abdominal circumference, blood pressure, glucose intolerance, and dyslipidemia compared to normal control (p<0.05). In conclusion, MetS is successfully established in male rats induced by the modified HCHF diet after 12 weeks.

What adds Valsalva maneuver to hemostasis after Trendelenburg's positioning during thyroid surgery?

Bleeding after thyroidectomy is life-threatening. The aim of the study was to evaluate whether controlling of further bleeding with Valsalva maneuver following Trendelenburg's positioning has an impact on hemostasis. This prospective study included 68 consecutive patients undergoing thyroidectomy. Study protocol consisted of performing manual intra-abdominal pressure increase and Valsalva maneuver to check hemostasis and treating any bleeding point identified, after Trendelenburg's positioning. All identified bleeding points and treatments were recorded. Total number of bleeding points identified in Trendelenburg's tilt was 49, while it was 41 when using Valsalva maneuver. Abdominal pressure increase, carried out before Valsalva maneuver, identified 14 bleeding points, which was less than bleeding after Trendelenburg's positioning and Valsalva maneuver (P<0.05). All bleeding points, except 1 for Trendelenburg's positioning and 1 for Valsalva maneuver, were minor (<2 mm). Only 4.4% bleeding vessels required ties or stitching. Valsalva maneuver helps to detect any further bleeding following Trendelenburg's positioning.

Detrusor pressures in urodynamic studies during voiding in women.

To investigate detrusor pressure during voiding in women using urodynamic studies (UDS). The study group comprised 57 women with non-neurogenic lower urinary tract symptoms. All patients underwent UDS between January 2010 and December 2014. UDS included filling cystometry, pressure flow study (PFS), uroflowmetry for the maximum flow rate (Qmax) and mean flow rate, and postvoid residuals. Existence of voluntary detrusor contraction was defined as a continuous and smooth increase in detrusor pressure (Pdet) after the instruction to micturate in the PFS. The bladder contractility index (BCI) was calculated as Pdet at Qmax + 5×Qmax. Statistical analyses were performed using the Mann-Whitney U test and p < 0.05 was considered statistically significant. The PFS showed that 23 patients had detrusor contraction (Pdet+ group) and 34 patients had no detrusor contraction (Pdet- group) during voiding. There were no significant differences in urodynamic parameters between the Pdet+ and Pdet- groups except in Pdet at Qmax and BCI. In the Pdet- group, 21 patients showed an increase in abdominal pressure during voiding (Pabd+ group), while the other 13 patients did not (Pabd- group). There were no differences in any of the urodynamic parameters between the Pabd+ and Pabd- groups. Based on UDS, an increase in detrusor or abdominal pressure may not be necessary in micturition in women. The present study suggests that relaxation of pelvic floor muscles including normal urethral function are important for micturition in women.

AB303. SPR-30 Neurotrophin dysregulation after dual injury childbirth model is corrected via electrical stimulation of the pudendal nerve in a rat model

ObjectiveStress urinary incontinence (SUI), the leakage of urine due to an increase in abdominal pressure, affects 30% of women over the age of 40. Childbirth is the primary risk factor for SUI since the child’s head passing through the birth canal can injure the EUS and the nerve that innervates it, the pudendal nerve (PN). Animal models with combined EUS [vaginal distension (VD)] and PN crush (PNC) injuries have shown that the nerve does not recover as well as with PNC alone and the animals have delayed return of function. Typically after a nerve injury, the neuron upregulates neurotrophin factors [i.e., brain derived neurotrophin factor (BDNF)] and their receptors [i.e., tyrosine kinase B (Trk B) and p75], and Schwann cells also upregulate neurotrophin factors [i.e., glial derived neurotrophin factor (GDNF) and NT4] as part of the regeneration process. The impaired nerve regeneration in the dual injury model was shown to be due to a dysregulation of BDNF in the PN motoneuron, so any potential treatment would need to upregulate BDNF. Electrical stimulation (ES) has been shown to upregulate BDNF and Trk B in neurons and GDNF in Schwann cells. Our previous work has shown daily and 4 times per week stimulation for 2 weeks accelerates functional recovery after PNC + VD. The aim of the study was to determine if daily stimulation causes an upregulation of neurotrophin factor and their receptors in motoneurons of the PN after injury. We hypothesize that the accelerated recovery from ES is mediated by an upregulation of BDNF and NT4 and their receptor Trk B, as well as GFRα1, the receptor of GDNF.MethodsAnimals were divided into five groups: Sham PNC, PNC, PNC + VD, PNC + VD with sham stimulation (SS) or PNC + VD + ES. ES (20 Hz, 0.3 mA, 0.1 ms) was conducted daily for 1 or 2 weeks after injury, when the spinal cord was harvested from L4–S3. The spinal cord was sectioned and Onuf’s nucleus, the motoneuron nucleus for the PN, was harvested via laser capture microscopy. RNA was then isolated and preamplified before running PCR and compared to GAPDH expression. A one way Anova was used to determine statistically significant differences between groups.ResultsOne week after PNC + VD, BDNF was not upregulated as previously shown. Neither were p75 or GFRα1, as expected. NT4 was not downregulated after PNC + VD, as expected. P75 was significantly increased in the PNC + VD + ES group compared to the PNC + VD group 2 weeks after injury. BDNF was also upregulated 2 weeks after PNC + VD + ES compared to PNC + VD.ConclusionsP75, NT4 and GFRα1 expression data suggest that PNC + VD causes dysregulation of other regenerative proteins other than BDNF. BDNF was upregulated 2 weeks after PNC + VD with ES. Future research will be designed to investigate the mechanism of this effect.Funding Source(s)VA Merit A1262-R and the RR&D Service of the VA

AB312. SPR-39 The use of support vector machine in the prediction of stress urinary incontinence

ObjectiveStress urinary incontinence (SUI) is the involuntary leakage of urine due to an increase in abdominal pressure and it affects 30% of women over the age of 40. One of the primary risk factor is childbirth. The baby’s weight, head size and maternal age are just some of the variables clinicians can use to predict if women will develop SUI. Additional, previous family history of SUI is another predictor for development suggesting a genetic role in development of SUI. A new method used to create predictive models is a support vector machine (SVM) use in the field of cancer biology. The purpose of the study was to determine if a SVM algorithm could construct a model that can improve the performance of predicting SUI compared with previous methods.MethodsData was obtained from the Pelvic Floor Disorder Network Childbirth and Pelvic symptoms Study (CAPS). Only information from the Urinary Incontinence and general data forms were used (e.g., maternal age, baby weight, head circumferences). We compared our models efficiency to a previously published model. Based on the data, we employ SVM algorithm to construct a model for predicting SUI. The basic idea of SVM is to find an optimal hyper-plane which can separate the data of one class from another class. In our study, we first divided the preprocessed data into two subsets, one is training data set, and the other one is testing data set. The testing data set was utilized to train an optimal model, that is, to find an optimal hyper-plane. The testing data set was employed to test the performance of the trained model. In order to obtain stable performance, we use 10 folds cross validation to train the model and to test its performance.ResultsAn optimal hyper-plane was determined. The results indicate the accuracy of prediction is around 70 percent, which is a little better than that of previous methods at 69 percent.ConclusionsThe proposed method in this study can predict SUI. Further investigation is needed to determine if limitation of risk factors from the model can improve its performance.Funding Source(s)None

Inhaled Beta Agonist Bronchodilator Does Not Affect Trans-diaphragmatic Pressure Gradient but Decreases Lower Esophageal Sphincter Retention Pressure in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD)

BackgroundChronic obstructive pulmonary disease (COPD) patients have a high incidence of gastroesophageal reflux disease (GERD) whose pathophysiology seems to be linked to an increased trans-diaphragmatic pressure gradient and not to a defective esophagogastric barrier. Inhaled beta agonist bronchodilators are a common therapy used by patients with COPD. This drug knowingly not only leads to a decrease in the lower esophageal sphincter (LES) resting pressure, favoring GERD, but also may improve ventilatory parameters, therefore preventing GERD. AimsThis study aims to evaluate the effect of inhaled beta agonist bronchodilators on the trans-diaphragmatic pressure gradient and the esophagogastric barrier. MethodsWe studied 21 patients (mean age 67 years, 57 % males) with COPD and GERD. All patients underwent high-resolution manometry and esophageal pH monitoring. Abdominal and thoracic pressure, trans-diaphragmatic pressure gradient (abdominal–thoracic pressure), and the LES retention pressure (LES basal pressure–transdiaphragmatic gradient) were measured before and 5 min after inhaling beta agonist bronchodilators. ResultsThe administration of inhaled beta agonist bronchodilators leads to the following: (a) a simultaneous increase in abdominal and thoracic pressure not affecting the trans-diaphragmatic pressure gradient and (b) a decrease in the LES resting pressure with a reduction of the LES retention pressure. ConclusionIn conclusion, inhaled beta agonist bronchodilators not only increase the thoracic pressure but also lead to an increased abdominal pressure favoring GERD by affecting the esophagogastric barrier.

One Time Surgery in Contemporary Diseases of the Abdominal Wall and Pelvis in the Elderly

Introduction: The diseases most frequently found in the elderly are E.I. (inguinal hernia)* and BPH. (Prostatic hypertrophy non-neoplastic)*. The latter causes an effect on the abdominal wall to the increase in abdominal pressure from cervical-urethral obstruction, leading to the onset of the inguinal hernia pathology due to abdominal pressure which is higher, the greater as the residual bladder urine. The purpose of the study is to provide information on the surgical strategy and on timing in the presence of the simultaneous two diseases.

English

INTRODUCTION: Abdominal trauma continues to account for a large number of trauma related injuries and deaths. Motor vehicle accidents, accidental fall are leading causes of blunt and penetrating trauma to abdomen. Blunt abdominal trauma is one of the leading preventable causes of the unnatural death in developed and developing countries. Blunt trauma is particularly deceptive as the clinical manifestations of the injury may be delayed for hours or days even though internal damage is serious and sometimes lethal. In open cases of abdominal trauma the clinical manifestations, diagnosis and management will be easier but closed cases of abdominal trauma offers a great challenge to the treating surgeon. Injuries to the abdominal viscera, caused by blunt trauma, are particularly common in civilian life. The blunt trauma differs from penetrating trauma, as the different organs are characteristically injured by compression from blunt straining. The solid organs such as spleen, liver, kidney, pancreas, etc., are the most vulnerable, while the hollow viscera like stomach, intestines and bladder are less likely to be involved. The outstanding features of injury to solid organ are the haemorrhage and shock, while in hollow visceral injury shock follows with the development of peritonitis. The aim of this study is to analyse the incidence of hollow viscus perforation and solid organ injuries and find out the morbidity and mortality in blunt abdominal trauma. AIM OF THE STUDY: 1. To evaluate the age and sex incidence of the involved patient population. 2. To evaluate the different organ systems involved in various modes of presentations as a primary tool in early diagnosis. 3. To find a possible treatment protocol cases of blunt trauma to the abdomen following road traffic accident. MATERIALS AND METHODS: 162 cases of blunt trauma following road traffic accidents admitted in all the surgical units at Thanjavur Medical College Hospital during the period of September 2016 to September 2017 The cases were selected with accurate history of trauma including the mode of injury, the time elapsed since injury till admission and history of primary resusitation documented carefully. Based on a careful history and meticulous physical examination combined with adjunctive investigations, a decision to operate or to manage conservatively was taken. Baseline laboratory parameters like blood urea, blood sugar, serum electrolytes and blood grouping was done in all cases. Plain x-ray abdomen in an erect posture was taken for all stable patients. Other investigations appropriately taken for associated injuries. Ultra sonogram and CT scan abdomen was not done as a routine diagnostic investigation, however few cases were subjected to the same in view of special circumstances. A performa of each case including the case, sex, mode of injury, and an accurate history suggesting the mode of injury was compiled. Personal history of previous trauma or surgeries and alcohol or drug intoxication was specifically sought for. Plain skiagram of the abdomen and four quadrant aspiration was done in all the cases. 17 All the patients were resusitated with ringer lactate solution and blood before surgical intervention. All the patients were manadatorily maintained on nasogastric suction, intravenous fluid replacement and broad spectrum antibiotics. Selected cases were catheterised. Post operative complications were specifically sought for and treated appropriately. DISCUSSION: In our study of blunt injury abdomen, caused due to road traffic accidents, 162 cases were admitted in thanjavur medical college and hospital from september 2016 to september 2017. Males accounted for 103 patients [45%]. Vijay malhotra et al also reported similar sex incidence in the landmark 1998 study. The proportionate majority of males could account for the male preponderance involved in road traffic accidents, also to a certain exten by their aggressive behaviour. Solid organ injuries like liver and spleen injuries due to direct compressive forces resulting from collision. Bowel injuries might have been contributed by deceleration shear stess and sudden increase in abdominal pressure. 49 cases [30.2%] were hemodynamically unstable at presentation and required aggressive reusitation. The connectialt and suffolk show a 44% shock incidence at presentation. 20 cases died among 162 cases, in which peritonitis waas the cause of death in 15 cases and 5 patients died due to hypovolemic shock, this is due to late presentation after which they have treated in mofsul hospitals and was referred to TMCH. Physical examination revealed abdominal bruises in 62 cases, abdominal pain and distension in 70 cases. Guarding found in all cases. Rigidity was noticed in 20 patients. Davis et al reported abdominal pain in 75% of the patienst, rigidity and rebound tenderness in 25%.

Stress distribution and deformation of uterosacral ligament and cardinal ligament under different working conditions simulated by the finite element model

To establish the finite element model of uterosacral ligament (USL) and cardinal ligament (CL) and analyze the stress distribution and deformation with USL and CL under different working conditions. Patients with stage Ⅲ-Ⅳ pelvic organ prolapse (POP) and healthy female volunteers were selected for research subject, and divided into anterior uterus group and posterior uterus group. Two POP patients and two volunteers were selectd into the anterior uterus group and posterior uterine group respectively. Pelvic MRI scan was performed in two groups. Based on the original MRI data sets, the finite element model of USL and CL was constructed by using the software such as the Mimics, and the stress distribution and deformation of USL and CL were simulated. Under the premise of the elastic modulus fixed and three different working conditions such as 60 cmH2O, 99 cmH2O and 168 cmH2O (1 cmH2O=0.098 kPa) with abdominal pressure generated by maximum Valsalva maneuver, according to the present conditions and the simulation, the trend was analyzed: the stress and deformation of the uterus, anterior vaginal wall, USL and CL in two groups were mainly distributed in the middle and lower part of the anterior vaginal wall or the ligament and the cervix-vagina junction, the maximum stress and the maximum displacement were mainly concentrated in the lower region of the anterior vaginal wall. With increasing of abdominal pressure generated by the maximum Valsalva maneuver, the maximum stress values of the POP patient in anterior uterus group under three different working conditions were: 0.027 9, 0.046 0, 0.078 0 MPa, and the maximum displacement values were: 9.145 5, 15.090 0, 25.607 0 mm. The maximum stress values of the volunteer in anterior uterus group under three different working conditions were: 0.012 6, 0.020 8, 0.035 3 MPa, and the maximum displacement values were: 1.816 7, 2.997 5, 5.086 7 mm. The maximum stress values of the POP patient in posterior uterine group under three different conditions were: 0.069 4, 0.114 6, 0.194 5 MPa, and the maximum displacement values were: 11.658 0, 19.236 0, 32.643 0 mm. The maximum stress values of the volunteer in posterior uterus group under three different working conditions were: 0.009 1, 0.015 1, 0.025 6 MPa, and the maximum displacement values were: 2.581 6, 4.259 6, 7.228 4 mm. The maximum stress values and the maximum displacement values were all increased with increasing of abdominal pressure in the two groups. The maximum stress values and the maximum displacement values of the POP patients were greater than those of volunteers. Under different working conditions, the maximum stress values and maximum displacement values of the posterior uterus POP patient were all greater than those of the anterior uterus POP patient. The finite element model of USL and CL is completely based on the MRI technology and the model is real and reliable. The increase of abdominal pressure will produce a larger stress and deformation of USL and CL, which is one of the reasons causing the injury of the ligament.

The potential participation of abdominal pressure in preeclampsia

Preeclampsia is a major cause of maternal and perinatal mortality and morbidity. Regardless of susceptibility or predisposing conditions and risk factors, the degree of increase in abdominal pressure is directly related to the severity of preeclampsia, particularly in women with hydatidiform mole. When increased abdominal pressure is normalized by delivery, preeclampsia is cured. Recent genetic studies highlighted two leading risk factors for preeclampsia: chronic renal disease and T235 homozygosity for the AGT gene. Thus, while there is increased abdominal pressure in pregnancy, an imbalanced renin angiotensin system and renal injuries lead to a vicious cycle of increasing abdominal pressure and further renal injuries. A hypothesis for the potential participation of pressure in preeclampsia is described and the amelioration of preeclampsia through postural intervention and the possible therapeutic effect of angiotensin[1–7] is suggested.