Increase In Intra-abdominal Pressure Research Articles

Neglected cause of retinal detachment: a hospital-based case-control study on occupational heavy lifting as a risk factor

BackgroundHeavy lifting may lead to sudden increase in venous, intra-abdominal, and intraocular pressure which in turn may cause retinal detachment (RD). The epidemiological evidence for this association is still inconclusive. This study was carried out to investigate the relationship between occupational heavy lifting and RD.MethodsA case-control study was carried out on 151 RD cases and 113 controls free of RD attending the ophthalmology outpatient clinic at Ain Shams University. Personal, medical, and occupational data were collected using interview questionnaires in addition to conducting full ophthalmologic examination.ResultsThe mean age of study participants was 45.8 ± 9.1 years (46.8 ± 8.9, 44.4 ± 9.2 for RD cases and controls respectively). Statistically significant differences were found between cases and controls regarding years of working, occupational categories, frequency of occupational heavy lifting, non-work heavy lifting, history of head trauma, history of eye surgeries, and family history of RD. Multivariate logistic regression analysis showed that lifting (Odds ratio (OR) = 4.8, p < 0.0001), history of head trauma (OR = 3.3, p = 0.013), diabetes mellitus (DM) (OR = 4.96, p < 0.0001), and previous eye surgeries (OR = 3.5, p = 0.003) increased the risk of RD.ConclusionOccupational heavy lifting is associated with RD. Occupational categories, duration of lifting heavy objects during work and family history of RD had a significant effect on RD. An ergonomic approach should be adopted and practiced as it has a significant impact on reducing the risks of lifting and carrying heavy objects. The workplace’s design (including having appropriate mechanical aids available) is also of significant importance to reducing the risks. During the patient’s visit, ophthalmologists should consider and look for the occupational heavy lifting history as a potential risk factor of the patient’s symptoms.

Continuous fentanyl infusion reduces intra-abdominal pressure, postoperative pain and normalizes lungs’ mechanical changes in newborn with viscera-abdominal disproportion in early post-operative period

We aimed to study the influence of prolonged administration of fentanyl on postoperative pain, intra­ab­dominal pressure and mechanical lungs’ changes that may happen in neonates in early post­operative period. 30 newborns (in the period from January 2017 to May 2021) with gastroschisis were divided into two groups ac­cordingly to the method of analgesia (14 – morphine hydrochloride; 16 – prolonged infusion of fentanyl). Lungs’ mechanical characteristics, effectiveness of post­operative analgesia, abdominal wall relaxation was studied by monitoring of dynamic compliance (Cdyn), pressure and flow­volume loops, capnography. Apprising analgesia sta­tus, we measured hemodynamic, SаO2, blood level of cortizol, C­reactive protein (CRP), glucose, analyzed post­operative pain syndrome using visual analogue scales (VAS). Intra­abdominal pressure (IAP) was controlled by Cron. For statistic analysis we used Student’s t­test. In the group with morphine, thete was the increase of IAP by 11–12 cm H2O, being stable during some period of time, and also variable levels of pain according to VAS, the in­creasing of CRP from 0.8 ± 0.25 mg/dl by 5 mg/dl, cortisol by 674.4 nmol/l, and blood glucosae rate – 7.4 mmol/l. Periods with high traumatic effects and poor analgesia (morphine group) reasoned the increasing IAP, step by step dynamic compliance decreasing in 3.4 times, resistance increasing in 2.42 times and PIP rising till 22 cm H2O. Di­rect correlation between IAP increase and lungs’ mechanical changes took place. The study has demonstrated that prolonged administration of fentanyl prevented high increase of IAP, CRP, levels of glucose and cortizol and changes of VAS data, lungs’ mechanical characteristics.

Getting Ready for Continence Certification: Assessing and Managing Stress Incontinence.

Getting Ready for Continence Certification: Assessing and Managing Stress Incontinence.

Epiploic appendagitis in a Spiegel hernia: A case report and review of the literature.

IntroductionSpigelian hernia is a rare differential diagnosis of abdominal pain. It affects mainly women above the fifth decade of life, more on the left side than on the right side, usually with comorbidities that lead to an increase in intra-abdominal pressure, described as risk factors for the outbreak of ventral hernias. The content of a ventral hernia might be an epiploic appendix and lead to appendagitis.Presentation of caseThis article presents the case of an 82-year-old female patient who presented epiploic appendagitis in a Spigelian hernia.DiscussionSpigelian hernia is a rare type of ventral hernia, especially in association with an epiploic appendagitis. A literature search of this rare entity yielded three publications presenting epiploic appendagitis in a Spigelian hernia. The initial approach after the diagnosis should be adequate analgesia associated with surgical correction of the hernia. There is no gold standard treatment for the repair. European and American societies suggest that if there is no palpable nodule, laparoscopic repair is preferable, always using a mesh.ConclusionEpiploic appendagitis in a Spigelian hernia is a rare condition whose diagnosis is a big challenge. However, the correct diagnosis can lead to a shorter hospital stay, with less cost and avoid the use of unnecessary medications.

Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps.

Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. In this narrative review, we aim to provide a comprehensive overview of current insights into intra-abdominal pressure monitoring, intra-abdominal hypertension, and abdominal compartment syndrome. The focus of this review is on the pathophysiology, risk factors and outcome of intra-abdominal hypertension and abdominal compartment syndrome, and on therapeutic strategies, such as non-operative management, surgical decompression, and management of the open abdomen. Finally, future steps are discussed, including propositions of what a future guideline should focus on. Pathological intra-abdominal pressure is a continuum ranging from mild intra-abdominal pressure elevation without clinically significant adverse effects to substantial increase in intra-abdominal pressure with serious consequences to all organ systems. Intra-abdominal pressure monitoring should be performed in all patients at risk of intra-abdominal hypertension. Although continuous intra-abdominal pressure monitoring is feasible, this is currently not standard practice. There are a number of effective non-operative medical interventions that may be performed early in the patient's course to reduce intra-abdominal pressure and decrease the need for surgical decompression. Abdominal decompression can be life-saving when abdominal compartment syndrome is refractory to non-operative treatment and should be performed expeditiously. The objectives of open abdomen management are to prevent fistula and to achieve delayed fascial closure at the earliest possible time. There is still a lot to learn and change. The 2013 World Society of Abdominal Compartment Syndrome guidelines should be updated and multicentre studies should evaluate the effect of intra-abdominal hypertension treatment on patient outcome.

INTRACTABLE COUGH CAUSING SPONTANEOUS RECTUS SHEATH HEMATOMA

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cough is a physiologic mechanism that causes airways to be cleared of foreign materials and excess secretions. The violent expiration is associated with rapid contraction of the diaphragm and the abdominal wall muscles leading to an increase in intraabdominal pressures. Longstanding untreated cough can lead to spontaneous abdominal wall hematomas. (1) CASE PRESENTATION: A 65-year-old gentleman presented to the Emergency Room with right lower quadrant abdominal pain of one-week duration. He had no past medical history. He was noted to have a persistent intractable cough for one month. Prior to the onset of cough, he had one week of loss of taste and smell, nasal congestion, nasal discharge and postnasal drip. According to him, the cough was so bad that he felt like he was going to burst. Although his family insisted, he did not get the cough evaluated. His vital signs were stable. Physical examination showed ecchymosis, a small palpable mass and tenderness in the right lower quadrant. Lung exam was unremarkable. Lab work unremarkable with normal platelet count and coagulation profile. Computed Tomography (CT) of the abdomen/pelvis showed an intramuscular vascular mass of 9 cm within the right rectus abdominis suggestive of a hematoma which was managed conservatively. Of note, he was not on any anticoagulants. On 1 month follow-up, he had complete resolution of abdominal pain, ecchymosis, mass and tenderness in the right lower quadrant. However, he continued to have a persistent cough for which he was referred to pulmonology. He visited the pulmonary clinic after 5 months of referral. At that time, he had become dependent on over-the-counter (OTC) oral decongestants and antihistamines. He had no reflux symptoms, no allergies, was a lifetime nonsmoker, employed as a banker and had a Labrador for 11 years. CT chest showed normal lung parenchyma. Pulmonary function tests revealed features of mild obstructive lung disease. His OTC medications were stopped and he was given a course of oral prednisone along with fluticasone and azelastine nasal spray with dramatic improvement and complete resolution of cough. DISCUSSION: Sustained cough results in over contraction and overstretching of abdominal muscles with an increase in intra-abdominal pressures. (2) Vigorous coughing plausibly generates shear forces high enough to tear superior and inferior epigastric vessels along the posterior aspect of long rectus muscle which results in rectus sheath hematomas. Almost 29% of spontaneous rectus sheath hematomas are the result of sustained cough the risk of which increases with the use of anticoagulants. (3) While these hematomas are conservatively managed, patients should undergo a thorough evaluation and treatment of cough to prevent its recurrence. CONCLUSIONS: This case highlights the potential of sustained vigorous cough to cause abdominal wall hematomas even in the absence of anticoagulants. REFERENCE #1: 1. Fuller RW, Jackson DM. Physiology and treatment of cough. Thorax. 1990;45(6):425-430. doi:10.1136/thx.45.6.425 REFERENCE #2: 2. Kodama K, Takase Y, Yamamoto H, Noda T. Cough-induced internal oblique hematoma. J Emerg Trauma Shock. 2013;6(2):132-134. doi:10.4103/0974-2700.110789 REFERENCE #3: 3. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore). 2006;85(2):105-110. doi:10.1097/01.md.0000216818.13067.5a DISCLOSURES: No relevant relationships by Fady Jamous, source=Web Response No relevant relationships by Swaminathan Perinkulam Sathyanarayanan, source=Web Response

Intra-abdominal pressure monitoring in the management of patients with blunt injury abdomen: Prospective observational study

Background and Aim: Abdominal trauma can result in the increase of intra-abdominal pressure (IAP) for a variety of reasons including the accumulation of blood or free fluid in the peritoneal cavity, oedema of the intestinal wall, retroperitoneal hematoma or abdominal packing for haemorrhage control. The aim was to study the role of intra-abdominal pressure (IAP) monitoring in the management of patients with blunt injury abdomen. Material and Methods: Hospital based prospective observational study in 100 patients who presented to emergency medicine department later shifted to department of general surgery in Tertiary care Institute of India, over a period of 18 months. IAP was measured in emergency medicine department and ICU at presentation, that is, 0 hours, 3 hours, 6 hours, 12 hours, 24 hours, 48 hours, 72 hours and 96 hours. Parameters noted were blood pressure, pulse rate, respiratory rate, oxygen saturation (SpO2), urine output, blood urea, serum creatinine, IAP, time of presentation to hospital after injury, duration of ICU and hospital stay, need for ventilatory support, morbidity (new organsystem dysfunction) and mortality. Results: Correlation between IAP and vital parameters, renal parameters at 0, 3, 6, 24 and 72 hours were found statistically significant. Observation between IAP and vital parameters, renal parameters at 12 hours all parameters are significant except IAP has weak positive correlation with DBP and this was found statistically insignificant. Hospital stay decreased as IAP increases in surgically intervened group because IAP returned to normal after surgical decompression, but this finding was statistically significant only at 72 hours in our study. Conclusion: Before development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the potential candidates should be offered surgical decompression at proper time.

Влияние методов послеоперационного обезболивания на моторную функцию желудочно-кишечного тракта у детей с перитонитом, осложненным интраабдоминальной гипертензией

Актуальность. Метод послеоперационного обез­боливания может влиять на скорость восстановления моторной функции желудочно-кишечного тракта, уровень интраабдоминального давления (ИАД) и способствовать развитию интраабдоминальной гипертензии (ИАГ). Цель: исследовать влияние методов послеоперационного обезболивания на моторную функцию кишечника у детей с перитонитом, осложненным ИАГ. Материалы и методы. 115 детей, которым были проведены оперативные вмешательства по поводу аппендикулярного перитонита, рандомизированы на группы в зависимости от метода послеоперационного обезболивания: «Опиоиды» (n = 36, инфузия морфина), «Лидокаин» (n = 40, инфузия лидокаина), «ЭДА» (n = 39, эпидуральная аналгезия). В зависимости от уровня ИАД и наличия органной дисфункции дети каждой группы были разделены на подгруппы: «без ИАГ» (ИАД &lt; 10 мм рт.ст.), «ИАГ» (ИАД &gt; 10 мм рт.ст.) и «АКС» (абдоминальный компартмент-синдром, ИАГ с органной дисфункцией). Всем детям в послеоперационном периоде проводилось измерение уровня ИАД и оценка скорости восстановления моторной функции желудочно-кишечного тракта. Результаты. Во всех подгруппах группы «ЕДА» время до восстановления перистальтики и первых испражнений и объем остатка по назогастральному зонду были статистически значимо меньшими по сравнению с аналогичными показателями в подгруппах группы «Опиоиды» (Р &lt; 0,05). В подгруппах «ИАГ» и «АКС» группы «ЭДА» также было статистически значимо меньшим время до первых испражнений по сравнению с аналогичными показателями в подгруппах группы «Лидокаин» (Р &lt; 0,05). Статистически значимо меньшими были время до восстановления перистальтики и объем остатка по НГЗ во всех подгруппах группы «Лидокаин» по сравнению с аналогичными показателями группы «Опиоиды» (Р &lt; 0,05). Эпизоды повышения ИАД &gt;10 мм рт.ст. значительно чаще встречались у детей в группе «Опиоиды», чем в группах «Лидокаин» и «ЭДА» (Р &lt; 0,05). Количество эпизодов ИАД &gt; 10 мм рт.ст. имело прямую корреляцию с длительностью времени восстановления перистальтики, но сила такой корреляции была выше в группах «Опиоиды» (rs = 0,78; p = 0,001 и rs = 0,76; p = 0,01) и «Лидокаин» (rs = 0,58; p = 0,008 и rs = 0,95; p = 0,01), чем в группе «ЭДА» (rs = 0,39; p = 0,16 и rs = 0,46, p = 0,43). Выводы. ЭДА является оптимальным методом послеоперационного обезболивания у детей с перитонитом, осложненным ИАГ, который приводит к раннему восстановлению моторной функции ЖКТ и предотвращает дальнейший рост ИАД. Инфузия лидокаина может быть использована как альтернативный метод обезболивания. Системная опиоидная аналгезия оказывает негативное влияние на моторику желудочно-кишечного тракта.

Diagnosis of Intra-Abdominal Pressure in a Patient with Concomitant Injury as a Predictor of the Development of Acute Pancreatitis in the Post-traumatic Period: A Case Report

This article presents a clinical case of treatment of a patient with concomitant trauma. The increase in intra-abdominal pressure (IAP), as a predictor of the development of pancreatitis, was controlled by the developed method of radiation diagnostics. A method for assessing an increase in IAP, as a predictor of acute pancreatitis, is to quantify the volumetric blood flow in the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) by Doppler ultrasound.

Analysis of the Prevalence of Urinary Incontinence in Women Living in a Rural Commune

Introduction: Urinary incontinence (UI) is one of the most common chronic diseases in women. It is estimated that around 17%-60% of women of different ages are affected in Poland [1,2]. Urinary incontinence involves an involuntary leakage of urine from the urethra in conditions associated with an increase in intra-abdominal pressure, e.g., during coughing, exertion or sneezing, and affects women twice as often as men [3]. Research Aim: Analysis of the prevalence of urinary incontinence in women living in a rural commune. Materials and Methods: The group of research participants comprised 130 women, randomly selected and living in a rural commune in Wielkopolska Province. The respondents completed an anonymous survey containing 31 questions about urinary incontinence. The study was conducted at the patients’ houses, during appointments, and in a PHC nurse’s office. Results: The group of patients subjected to the study comprised 130 women of different ages. The most numerous group, 46.2% (n=60), consisted of women aged 30 to 60, 29.2% (n=38) were women over 60 years of age and 24.6% (n=32) were those under 30 years of age. From among the female population surveyed, urinary incontinence occurred in 50.7% (n=66), whereas 49.3% (n= 64) did not experience any UI. While analyzing the results regarding uncontrolled urinary incontinence, the researchers found that it had lasted for over 4 years in 22.3% (n = 29), from 3 to 4 years in 13.8% (n = 18), from 1 to 2 years in 10% (n = 13) and under a year in 4.6% (n = 6). The study showed a relationship between the occurrence of UI and selected variables such as age, BMI, and number of deliveries. Conclusions: • Urinary incontinence is common among the female population being studied, which confirms the thesis of a “silent epidemic”. • The factors predisposing to the occurrence of urinary incontinence among the women surveyed include age, BMI and the number of deliveries.

A prospective study of outcome in patients with intra-abdominal hypertension

Background: Intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intra-abdominal pressure (IAP) are well documented. It is known to affect almost all the system in the body, but mainly the renal, cardiovascular and pulmonary systems. The purpose of this study is to prospectively observe the outcome of IHP in patients admitted in ICU, acute surgical and emergency wards over three years and give our recommendations based on the outcome in such patients.Methods: We measured intravesical pressure using simple manometry to measure IAP.Results: We observed cardiac dysfunction in 16.30%, renal dysfunction in 10.86%, respiratory dysfunction in 21.74% and mortality of 15.2%. Significant mortality was associated with IAH grade II (55.6%) and grade III (100%).Conclusions: Due to the contribution towards mortality and common occurrence we suggest that intra-abdominal pressure be measured in ICU conditions.

Larétinopathie de Valsalva et le travail d’accouchement au CHU-IOTA

Valsal va retinopathy occurs when superficial retinal capillaries are disrupted due to intraocular hyperpressure following a sudden increase in intrathoracic or intra-abdominal pressure. One patient of 24 had a sudden drop in visual acuity in her left eye during labor. The yag laser hyaloidotomy allowed a complete resorption of the haemorrhage and a clear improvement of visual acuity. The closed glottis push technique or vasalva maneuver during labor seems to be a risk factor for pre-retinal haemorrhage.

Physiology of intra‐abdominal volume during pregnancy

A total of 580 pregnant and 50 puerperal women were included in this cross-sectional study to assess the physiological changes that allow women to adapt to a chronic increase in intra-abdominal pressure during pregnancy. The volume of the uterus, intra‐abdominal volume (IAV), visceral and subcutaneous fat was calculated. During pregnancy, the IAV increases up to 1.5 times. Changes in IAV until 24 weeks present a linear relationship (5.2%); thereafter, changes become exponential and, at 40 weeks, IAV increases by 61%. This fact is exclusively related to the progressive growth of the foetus and to the increase in uterine size. At term, the IAV reserve is exhausted, becoming equal the anteroposterior and transverse diameters of the abdomen. In conclusion, the adaptive capabilities of IAV related to the foetal growth are limited by the IAV reserve. The reserve capacity of the IAV and tensile properties of the abdominal wall can be estimated by the dynamics of the anteroposterior and transverse abdominal diameters. IMPACT STATEMENT What is already known on this subject? A causal relationship between intra-abdominal hypertension and the development of adverse obstetric and perinatal outcomes has been suggested. Nevertheless, the role of this condition as a leading cause of systemic dysfunction during pregnancy remains unrecognised and underestimated. What do the results of this study add? This study assesses the dynamics of IAV in uncomplicated singleton pregnancies. What are the implications of these findings for clinical practice and/or further research? The study of abdominal pressure indicators such as intra-abdominal volume and compliance will help to a better understand the aetiology, pathophysiology, prognosis and treatment strategies for pregnant women with intra-abdominal hypertension.

Maternal Diaphragmatic Hernia Correction During Pregnancy

Abstract Congenital diaphragmatic hernia consists of a defect in the embryonic development of the diaphragm that allows the passage of the abdominal viscera into the thoracic cavity, its diagnosis during pregnancy is quite rare. We present the case of a 31-year-old woman, with 23 weeks of gestation, who consulted for epigastric pain, nausea, and repetitive emetic episodes, without improvement with the medication provided. Due to the intense abdominal pain, a computed tomography of the abdomen and thorax was performed where the 28 mm defect was found at the left diaphragmatic level with protrusion of the gastric fundus to the thoracic cavity. She was taken to surgical management by laparoscopy with abdominal and thoracic approach, with a successful result and without maternal perinatal complications. Although the integrity of the diaphragmatic suture could be feared in relation to the increase in intraabdominal pressure due to uterine growth, the evolution of our patient and previous reports show that postoperative complications are not frequent. Successful vaginal delivery has even been described in some reports. Diaphragmatic hernias diagnosed during pregnancy are quite rare. We suggest that the optimal management of them during pregnancy is immediate surgical correction in case of persistent symptoms, more studies are needed to establish firm recommendations on the management of this pathology.

Role of intra-abdominal pressure monitoring in the management of patients with blunt injury abdomen

Background: Blunt injury abdomen is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. The aim was to study the role of intra-abdominal pressure (IAP) monitoring in the management of patients with blunt injury abdomen.Methods: Hospital based prospective observational study in 77 patients who presented to emergency medicine department with blunt injury abdomen for over a period of 22 months. Age ≥18 years, patients with acute blunt injury abdomen are included in study.Results: Our study population (77 patients) were a group of patients who presented with blunt injury to abdomen, out of which 66 were male (85.70%), 11 were female (14.30%). Most common age group involved in our study was 20-30 years, mean time of presentation to the hospital was 7.40 hours. SBP, DBP, SpO2 decreased significantly as IAP increases. P. R., R. R. increased significantly as IAP increases. U/O decreased significantly as IAP increases. Sr. Cr, B.U. increased significantly as IAP increases. Surgical abdominal decompression had helped in all operated patients to get statistically significant decrement of IAP during initial post-operative hours. 12 patients required ventilator support in surgically intervened group. Mean duration of hospital stay was 8.025 days. Mortality rate in our study was 3.9%.Conclusions: Before development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the potential candidates should be offered surgical decompression at proper time.

The assessment of the effect of different intraabdominal pressures used for laparoscopic cholecystectomy surgery on optic nerve sheath diameter: a prospective observational cohort study

Background/aimDuring laparoscopic cholecystectomy operations, increases in intraabdominal, intrathoracic, and intracranial pressures (ICP) can be seen after pneumoperitoneum created for surgical imaging. Orbital ultrasonography (USG), which has been developed in recent years, is a method that can evaluate the ICP by measuring the optic nerve sheath diameter (ONSD) from the eyeball.In our study, we aimed to evaluate whether different intraabdominal pressure values created during laparoscopic cholecystectomy operations correlate with ICP by measuring ONSD.Materials and methodsThe study included a total of 90 patients with American Society of Anesthesiologists (ASA) physical status classification I (ASA I) and II (ASA II) and ages from 18 to 65 years with laparoscopic cholecystectomy planned.After the patients were intubated, at the 5th min, bilateral ONSD measurements were performed. The same measurements were performed at the 15th and 30th min after CO2 insufflation and additionally 10 min after CO2 was released at the end of the operation. During intrabdominal CO2 insufflation, patients with 10 mmHg pressure applied comprised Group 1, patients with 12 mmHg pressure applied comprised Group 2, and patients with 14 mmHg pressure applied comprised Group 3.Results The study was completed with 89 patients, 51 female and 38 males. One patient was excluded from the study due to erroneous values. The variations in ONSD measured in the right-left eye before pneumoperitoneum and at the 15th and 30th min after abdominal CO2 insufflation were observed to be statistically significant (p < 0.01). In all three groups, the right and left eye ONSD values were not identified to be statistically significantly different (p > 0.01).A significant increase was observed in ONSD values in direct proportion to the increase in intraabdominal pressure in patients undergoing laparoscopic cholecystectomy surgery.Conclusion USG-guided ONSD measurements appear be a guide to ensure optimization of intraabdominal pressures and safe anesthesia administration for patients, especially those at risk of ICP increase, during laparoscopic surgery.

Variation in intraabdominal pressure in patients with acute heart failure according to left ventricular ejection fraction. Results of an intraabdominal pressure study

BackgroundThe increase in intraabdominal pressure (IAP) has been correlated with increased creatinine levels in patients with heart failure with severely reduced left ventricular ejection fraction (HFrEF). However, IAP has not been examined in more stable patients or those with heart failure with preserved ejection fraction (HFpEF). Patients and methodWe conducted an observational, prospective descriptive study that measured the IAP of patients hospitalised for decompensated heart failure (HF). The sample was stratified according to left ventricular ejection fraction (LVEF), with a cut-off of 50%. The objective was to analyse the IAP, the baseline characteristics and degree of congestion using clinical ultrasonography and impedance audiometry. ResultsThe study included 56 patients, 22 with HFrEF and 34 with HFpEF. The patients with HFrEF presented a higher prevalence of ischaemic heart disease (11% vs. 6%; p = 0.010) and chronic obstructive pulmonary disease/asthma (6% vs. 2%; p = 0.025). The IAP was higher in the patients with HFrEF (17.2 vs. 13.3 mmHg; p = 0.004), with no differences in renal function at admission according to the LVEF (CKD-EPI creatinine) (HFrEF 55.0 mL/min/1.73 m2 [32.6–83.6] vs. HFpEF 55.0 mL/min/1.73 m2 [44.0–74.9]; p = 0.485). The patients with HFrEF presented a more congestive profile determined through ultrasonography (inferior vena cava collapse [26% vs. 50%; p = 0.001]), impedance audiometry (total body water at admission, 46 L vs. 41 L; p = 0.052; and at 72 h, 50.2 L vs. 39.1 L; p = 0.038) and CA125 concentration (68 U/mL vs. 39 U/mL; p = 0.037). ConclusionsDuring the decompensation episodes, the patients with HFrEF had a greater increase in IAP and a higher degree of systemic congestion.

How to choose a suitable intraabdominal pressure level during single-incision laparoscopic surgery in children

Laparoscopic surgery has become a common procedure in pediatric patients. However, adverse hemodynamic changes such as the increase of intraabdominal pressure (IAP) may occur laparoscopic surgery. The aim of this study is find a method to set a suitable IAP level in children before laparoscopic surgery. From Jan 2012 to Dec 2014, data were collected from a total of 1776 children needing laparoscopic high ligation of hernia sac. A retrospective data analysis was performed using a new defined variant Index A which had information of age, body mass index (BMI) and duration of pneumoperitoneum. The blood pressures (SBP and DBP) and the PaCO2 were increased but SV showed no changes in patients after CO2 insufflation. The complications were found in 32 cases including 2 cases with subcutaneous emphysemarelated to the CO2 insufflation directly, 3 cases of respiratory infection, 5 cases of incision infection and 2 cases of urinary tract infection) and technique related. Furthermore, the risks of complications were negatively associated with the Index A. An IAP can be optimal set up in laparoscopic high ligation of hernia sac by using the Index A.

MO718ROLE OF CT-PERITONEOGRAPHY IN THE PATIENT WITH GENITAL EDEMA AND PERITONEAL DIALYSIS

Abstract Background and Aims Genital edema is a frequent complication in those patients who are on peritoneal dialysis, generally secondary to the increase in intra-abdominal pressure that it entails. It occurs late after the implantation of the peritoneal catheter (after 30 days of implantation). The typical clinical manifestation of this condition is basically subcutaneous edema in the genital area, accompanied by pain and UF failure. The diagnosis must be made by using an imaging test, mainly CT-peritoneography. Method A series of clinical cases of PD patients who consulted for genital edema is reviewed, analyzing the role of peritoneography Results CASE 1 A 76-year-old male, 15 days after the start of the technique, consulted for right scrotal edema. It was decided to suspend CAPD and start hospital intermittent IPD with low volumes. A CT-peritoneography was requested, which revealed a right peritoneal-vaginal duct and a left inguino-scrotal leak. Surgical correction of the anatomical defect was performed without incident, with subsequent return of the patient to CAPD. CASE 2 A 78-year-old man, 15 days after the start of the technique, consulted for bilateral scrotal edema. A CT-peritoneography was performed, which showed that the leak of peritoneal fluid to the scrotum was due to bilateral inguinal hernia. Subsequently, inguinal hernioplasty of the surgical defect was performed without complications. Conclusion Genital edema, as a complication of patients with CAPD, appears in approximately 4-10% of them. CT-peritoneography is the diagnostic technique of choice. To do this, 150 ml of nonionic iodinated contrast, with a concentration of 300 mg/ml, are diluted in approximately 2 liters of dialysis solution, which are introduced into the peritoneal cavity of the patient 2 h before performing the CT. Subsequently, a CT scan of the abdomen and pelvis including the perineum is performed, in the supine position and craniocaudal direction.

Embodiment of intra-abdominal pressure in a flexible multibody model of the trunk and the spinal unloading effects during static lifting tasks.

The role of intra-abdominal pressure (IAP) in spinal load reduction has remained controversial, partly because previous musculoskeletal models did not introduce the pressure generating mechanism. In this study, an integrated computational methodology is proposed to combine the IAP change with core muscle activations. An ideal gas relationship was introduced to calculate pressure distribution within the abdominal cavity. Additionally, based on flexible multibody dynamics, a muscle membrane element was developed by incorporating the muscular fiber deformation, inter-fiber stiffness, and volume constancy. This element was then utilized in discretizing the diaphragm and transversus abdominis, forming an IAP-muscle coupling system of the abdominal cavity. Based on this methodology, a forward dynamic simulation of spinal flexion was presented to examine the unloading effect of abdominal breathing. The results confirm that core muscle contraction during the abdominal breathing cycle can substantially reduce the forces of spinal compression together with trunk extensor muscles, and this effect is more pronounced when the IAP increase is produced by contraction of the transversus abdominis. This unloading effect still holds even with the co-activation of other abdominal muscles, providing a potential choice when designing trunk movements during weight-lifting tasks.