Increase In Intra-abdominal Pressure Research Articles

INTRA-ABDOMINAL PRESSURE MONITORING DURING LÁZARO DA SILVA'S PROCEDURE FOR VENTRAL HERNIA REPAIR: A CROSS-SECTIONAL STUDY.

Maintaining normal intra-abdominal pressure (IAP) levels must be one major outcome of any ventral hernia repair, avoiding hypertension or abdominal compartment syndrome. To evaluate IAP during ventral hernia repair using Lázaro da Silva's procedure. IAP measurements using intravesical pressure were performed during four crucial intraoperative moments. Twenty-eight patients submitted to incisional herniorrhaphy were analyzed. The IAP increased by 0.5 mmHg during the procedure, regardless of the type of prior laparotomy, sex, age, obesity, or hernia width. Despite the IAP increase observed, Lázaro da Silva's procedure did not result in intra-abdominal hypertension or abdominal compartment syndrome.

Conocimiento y prevalencia de síntomas de disfunciones del suelo pélvico en mujeres nulíparas que practican deportes de alto impacto: estudio preliminar

ObjectivesTo describe the knowledge about the pelvic floor (PF), pelvic floor dysfunctions (PFD), its main risk factors, and the preventive and treatment strategies for them, as well as to determine the prevalence of PFD symptoms and the distress produced in nulliparous women who play basketball, football or handball. MethodologyDescriptive cross-sectional study, population-based. Women of legal age who practiced basketball, football or handball for at least 3hours a week for 2years were included. Pregnant women, with a history of pregnancy, with cognitive or visual alterations were excluded. To carry out the study, an ad hoc questionnaire was designed on the Google Forms platform, which was disseminated through WhatsApp. ResultsThe participants had greater knowledge about urinary incontinence (10/12 points) than about pelvic organ prolapse (6/12 points). Despite having knowledge about the location of the PF and its functions, they did not perform an anticipated contraction of this muscle before lifting weights. A prevalence of PFD symptoms of 84.6% was obtained, highlighting urinary incontinence (82.9%). The distress produced by these symptoms was mild (median: 11.97; IQR: 16.7). ConclusionsThe women in the sample have high knowledge about the PF and the PFD, however, they do not use the anticipated contraction of the PF muscles as a protection strategy against the increase in intra-abdominal pressure during sports practice. The prevalence of PFD symptoms is high, although the distress that these symptoms cause them is mild.

Comparative Study of Clinical Outcome of Low Pressure Versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy at Birat Medical College Teaching Hospital (BMCTH)

Introduction: Laparoscopic cholecystectomy at standard pressure pneumoperitoneum ( 12-15 mmHg of Co2) is standard of practice among surgeons. The increase in intraabdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of cardiopulmonary systems and also leads to postoperative pain due to stretching of the diaphragm.
 Objective: To minimise this impact on human physiology there is increasing effort of performing laparoscopic cholecystectomy at low pressure pneumoperitoneum (8mm Hg) however its safety has not been established. This study aims to compare outcomes of laparoscopic cholecystectomy at low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in people undergoing laparoscopic cholecystectomy in terms of intraoperative time, postoperative pain including shoulder tip pain and length of hospital stay.Methodology: This descriptive randomised prospective study was conducted from Feb 2023 to Aug 2023 in the department of general surgery, BMCTH in patients diagnosed with symptomatic gallstone disease meeting inclusion criteria and willing for laparoscopic cholecystectomy. All patients were prospectively randomized into two groups randomly by the lottery method. A convenient sampling method was used. Group A odd number patients underwent surgery under low pressure (LPPLC group), Group B patients at standard pressure pneumoperitoneum (SPPLC).
 Results:A total of 145 patients (114 female and 31 male) with mean age 44.99 years of presentation. 73 patients underwent surgery under LPPLC group and 72 under SPPLC group. Mean pain recorded as per VAS score at 6, 12, 24 and 36 hours postoperatively showed no significant difference in pain among two groups with p value 0.972,0.121,0.212,0.072 respectively. Shoulder tip pain and additional need of analgesia was significantly less in LPPLC group, p value 0.002 and 0.015 respectively. No significant difference was observed in terms of operating time p value 0.151.Conversion between two groups p value 0.494 suggested no significant difference between two group.
 Conclusion:LPPLC is feasible, safe and can be considered over SPPLC. LPPLC is non inferior to SPPLC in terms of postoperative pain including shoulder tip pain and additional need of analgesia.

The treatment for closure of the bladder neck via transvaginal approach

Urinary incontinence is described as the involuntary loss of urine due to an increase in intra-abdominal pressure combined with a lack of contraction of the detrusor muscle. The most common being stress incontinence, as it occurs in 30% of women between 30 and 60 years old. There is another condition called hidden stress incontinence as a result of a coiling of the urethra that causes obstruction in its lumen. This can manifest itself when performing any activity that involves effort, such as coughing or sneezing. Nowadays there are numerous surgical interventions for the treatment of these pathologies, so there is a discrepancy in the choice of the appropriate surgical technique to correct these conditions in isolation.

Numerical investigation of intra-abdominal pressure and spinal load-sharing upon the application of an abdominal belt

Chronic low back pain patients may experience spinal instability. Abdominal belts (ABs) have been shown to improve spine stability, trunk stiffness, and resiliency to spinal perturbations. However, research on the contributing mechanisms is inconclusive. ABs may increase intra-abdominal pressure (IAP) and reduce paraspinal soft tissue contribution to spine stability without increasing spinal compressive loads. A finite element model (FEM) of the spine inclusive of the T1-S1 vertebrae, intervertebral discs (IVDs), ribcage, pelvis, soft tissues, and abdominal cavity, without active muscle forces was developed. An identical FEM with an AB was developed. Both FEMs underwent trunk flexion. Following validation, the models’ intervertebral rotation (IVR), IAP, IVD pressure, and tensile stress in the multifidus (MF), erector spinae (ES), and thoracolumbar fascia (TLF) were compared. The inclusion of an AB resulted in a 3.8 kPa IAP increase, but a decreased average soft tissue tensile stress of 0.28 kPa. The TLF withstood the majority of tension being transferred across the paraspinal soft tissues (>70 %). The average IVR in the AB model decreased by 10 %, with the lumbar spine experiencing the largest reduction. The lumbar IVDs of the AB model likewise showed a 31 % reduction in average IVD pressure. Using an AB improved trunk bending stiffness, primarily in the lumbar spine. Wearing an AB had minimal effect on reducing tensile stress in theES. The skewed stress distribution towards the TLF suggests its large contribution to spine stability and the potential advantage in unloading the structure when wearing an AB, measured herein at8 %.

The association between maternal intra-abdominal pressure and hypertension in pregnancy.

Pregnancy leads to a state of chronically increased intra-abdominal pressure (IAP) caused by a growing fetus, fluid, and tissue. Increased intra-abdominal pressure is leading to state of Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome. Clinical features and risk factors of preeclampsia is comparable to abdominal compartment syndrome. IAP may be associated with the hypertension in pregnancy (HIP). The study aimed to determine the antepartum and postpartum IAP levels in women undergoing caesarean delivery (CD) and association between hypertension in pregnancy, and antepartum and postpartum IAP levels in women undergoing CD. Seventy pregnant women (55 normotensive, 15 HIP) undergoing antepartum, non-emergency CD, had their intravesical pressure measured before and after the CD, the intravesical pressure measurements obtained with the patient in the supine position were considered to correspond to the IAP. Multivariable linear regression models were used to study associations between intraabdominal pressure and baseline characteristics in normotensive pregnancies and hypertensive pregnancies. In normotensive pregnancies at mean gestation age of 38.2 weeks (95%CI 37.9 to 38.6), mean antepartum IAP was 12.7 mmHg(95%CI 11.6 to 13.8) and the mean postpartum IAP was 7.3 mmHg (95% CI 11.6 to 13.8). Multivariable linear regression models showed HIP group antepartum IAP positively associated with coefficient value of 1.617 (p = 0.268) comparing with normotensive pregnancy group. Postpartum IAP in HIP group positively associated with coefficient value of 2.519 (p = 0.018) comparing with normotensive pregnancy group. IAP difference is negatively associated with HIP (coefficient -1.013, p = 0.179). In normotensive pregnancies at term, the IAP was in the IAH range of the non-pregnant population. Higher Antepartum IAP and Postpartum IAP are associated with HIP. Reduction of IAP from antepartum period to postpartum period was less with HIP.

Abdominal Wall Movements Predict Intra-Abdominal Pressure Changes in Rats: A Novel Non-Invasive Intra-Abdominal Pressure Detection Method.

(1) Background: As increases in intra-abdominal pressure (IAP) result in irreversible tissue damage, monitoring IAP in critically ill patients using the common urinary bladder catheter method is essential. However, this method can result in complications and is not suitable for very low birth weight neonates. The aim of this study was to establish a non-invasive and accurate method to detect IAP changes using an animal model. (2) Methods: IAP changes via intra-abdominal air application (up to 20 mmHg) were measured in 19 Wistar rats via an intra-abdominally placed intracranial pressure probe. Concurrently, abdominal surface tension was measured using a Graseby capsule (GC). (3) Results: A high correlation between abdominal wall distension and IAP (r = 0.9264, CI 0.9249-0.9279) was found for all subjects. (4) Conclusions: IAP changes in rats can be detected non-invasively using a GC. However, further studies are necessary to assess whether IAP changes can be measured using a GC in the neonatal population.

The Association Between Intra-abdominal Pressure and Diuretic Response in Heart Failure.

An efficient diuretic response is vital during cardiac decompensation in heart failure (HF) patients. The increase in intra-abdominal pressure (IAP) could be one of the keys for understanding cardiorenal syndrome and guiding diuretic treatment during hospitalization. In this review, we analyze the relationship between IAP and diuretic response in HF patients. Increased IAP is associated with worsening renal function (WRF) in patients with advanced HF. Furthermore, the persistence of a rise in IAP after the first 72 h of intravenous diuretic treatment has been correlated with a worse diuretic response, a higher degree of congestion, and an impaired prognosis. The rise in IAP in HF patients has been associated with impaired renal function and a lower diuretic response. Nonetheless, more studies are needed to elucidate the actual role of IAP in congestive nephropathy and whether it may help guide diuretic therapy during acute decompensations.

Progressive preoperative pneumoperitoneum in a patient with giant inguinal hernia: report of a case

Giant hernias have chronic abdominal wall defects that slowly and progressively grow and alter the normal physiology of the abdominal wall. The clinical case we report is a 76-year-old male who began 7 years ago with protrusion in the left inguinal area with progressive increase in volume until reaching the inability to walk is presented. The protocol is followed by pneumoperitoneum insufflation with 500-1000 milliliters (ml) of carbon dioxide daily for 10 days. The treatment of large hernia defects of the abdominal wall produces a large increase in intra-abdominal pressure during visceral reduction, which entails an alteration in cardiorespiratory biomechanics by elevating the diaphragm and reducing venous return. This technique would be indicated in hernias greater than 10 centimeters (cm), as well as in large inguinal and umbilical hernias, with irreducible sacs, with "loss of domain". It is protocolized with preoperative preparation with pneumoperitoneum for 10 days, for subsequent inguinal plasty with Lichtenstein technique, during which a minimum of adhesions were found, managing to preserve the ipsilateral testicle, reducing surgical time and hospital stay, with no data on compartment syndrome in the abdomen after surgery, providing a good alternative in this type of condition.

THE EFFECT OF INTRA-ABDOMINAL PRESSURE EXPERIMENTAL CHANGES ON THE ULTRASTRUCTURE OF THE RAT'S LEVATOR ANI MUSCLE

In clinical practice, it is well known that an increase in intra-abdominal pressure can lead to disorders in the functioning of internal organs, cause the development of multiple organ failure and the formation of pelvic organ prolapse. Despite the fact that the pelvic bottom along with the muscles of the anterior abdominal wall and the diaphragm, takes an active part in the formation of intra-abdominal pressure, so far there are practically no morphological studies of the muscles of the pelvic diaphragm and their reactive changes that occur in response to an increase in intra-abdominal pressure. The aim of the study was to study the ultrastructural rearrangements of the levator ani muscle in response to experimentally formed states of increase and decrease in intra-abdominal pressure. The work was performed on 21 male outbred adult white laboratory rats. It has been established that after damage to the myofibrillar apparatus of the muscle fibers of the levator ani muscle in response to an increase in intra-abdominal pressure, the processes of sarcoplasmic adaptation and activation of the synthetic apparatus begin in them, which leads to a gradual restoration of their structure to its initial state. These changes are subject to certain time dynamics. 4 weeks after the increase in intra-abdominal pressure, a slight atrophy of the myofibrillar apparatus is observed and expansions of the intermyofibrillar cytoplasmic matrix appear. In mitochondria distinctly expressed irreversible changes in mitochondria occur, many mitochondria die. Subsequently, a significant amount of glycogen granules appears between the myofibrils, the structure of the myons is restored. Eight weeks after the start of the experiment, the structure of most muscle fibers is restored almost completely. The structure of the levator ani muscle did not change during the simulation of reduced intra-abdominal pressure in comparison with the control group at all periods of observation. In general, the study shows that the levator ani muscle skeletal muscle tissue has a high mechanic-dependent plasticity, which manifests itself in compensatory rearrangements of the ultrastructure of its fibers in response to changes in intra-abdominal pressure.

A 3D multi-scale skeletal muscle model to predict active and passive responses. Application to intra-abdominal pressure prediction

Computational models have been used extensively to study the behavior of skeletal muscle structures, however few of these models are able to evaluate their 3D active response using as input experimental measurements such as electromyography. Hence, improving the activation mechanisms in simulation models can provide interesting and useful achievements in this field. Therefore, the purpose of this paper was to develop a multi-scale chemo-mechanical material model to consider the active behavior of skeletal muscle in 3D geometries. The model was used to investigate the response of abdominal muscles which represent a challenging scenario due to their complex geometry and anatomical conditions. Realistic muscle geometries and other tissues of the human abdomen, including transverse abdominis (TA), internal oblique (IO), external oblique (EO), rectus abdominis (RA), rectus sheath (RSH), linea alba (LA) and aponeurosis (APO) were considered. Since the geometry of these tissues was obtained from magnetic resonance images, an iterative algorithm was implemented to find the initial stress state that achieve the equilibrium of them with the intra-abdominal pressure. In order to investigate the functionality of the proposed model, the increase of intra-abdominal pressure was calculated during cough in the supine position while the Ca2+ signal for activating the muscles was set in regard to experimentally recorded electrical activity from previous studies. The amount of intra-abdominal pressure calculated by the model is consistent with reported experimental results. This model can serve as a virtual laboratory to analyze the role of the abdominal wall components in different conditions, such as the performance of meshes used for repairing hernia defects.

MODERN IDEAS ON THE ROLE OF HEMODYNAMIC DISORDERS IN THE PATHOGENESIS OF ACUTE PANCREATITIS

Acute pancreatitis remains one of the most common abdominal diseases, causing a large number of both local and systemic complications. Acute pancreatitis has a high death rate. The pathogenesis of acute pancreatitis is complex and needs careful examination. Many authors suppose, that hemodynamic disorders lead to the development of complications, often fatal. Thus, such disorders need be studied separately. 
 The review is based on the analysis of articles included in such databases as elibrary.ru, cyberleninka.ru, and e-versions of specialized open access journals. All the articles outline modern views on the role of hemodynamic disorders in the pathogenesis of acute pancreatitis.
 The causes and mechanisms of development of hemodynamic disorders are considered in terms of central and regional hemodynamics, and microcirculation. The authors describe their mutual influence and role in the development of both local and systemic complications of acute pancreatitis.
 Contractility disorders can be observed in the pathogenesis of central hemodynamics. They can be caused by a highly active myocardial depressant factor. These disorders are supported and aggravated by other organs and systems with the development of multiple organ failure.
 Violations of regional hemodynamics are associated mainly with an increase in intra-abdominal pressure. A direct dependence of intestinal wall perfusion on intra-abdominal pressure is established. Intestinal barrier dysfunction contributes to the infection of necrosis foci.
 Microcirculation disorders are the most important element in the pathogenesis of acute pancreatitis, often defining its outcome. Microcirculation disorders include angiospasm, venous stasis, microthrombi formation, and interstitial edema. A decrease in local perfusion due to impaired gland microcirculation can cause tissue ischemia and pancreonecrosis.

Modern approaches to physical therapy of women with diastasis recti of the abdominal muscles as a result of multiple pregnancy


 
 
 It is a well-known fact that the development of diastasis of the rectus muscles with the progression of pregnancy is considered a natural and practically physiological phenomenon. World information sources indicate that in the last trimester, diastasis of the rectus muscles is recorded in 66-100% of all pregnancies in women. An increase in the volume of the pregnant uterus leads to an increase in intra-abdominal pressure and stretches the anterior abdominal wall. The development of diastasis is facilitated by a decrease in the strength of connective tissue collagen, which occurs as a result of physiological changes in the body of a pregnant woman. During pregnancy, the production of the hormone relaxin, whose biological function is to inhibit collagen synthesis and stimulate its breakdown, increases dramatically. The purpose of the study is to determine the effectiveness of the author’s physical therapy programme for women with diastasis of the rectus abdominis muscles due to multiple pregnancy and to characterise the diagnostic tools used in the study. Based on the analysis of information sources, effective innovative means of physical therapy for pregnant women with diastasis of the rectus abdominis due to multiple pregnancy were identified. They include (special therapeutic exercises for the indicated dysfunction (diastasis recti); post-isometric relaxation exercises; exercises from the Body&Mind Fitness system such as yoga therapy and elements of the Pilates system; hydroki-
 
 
 
 nesitherapy and kinesotaping; therapeutic massage and electro-myostimulation). The diagnostic card included such methods of determining such indicators as your pain at rest; determination of cortical muscle tone during movements and palpation using the Lovett manual muscle test; the Pelvic Floor Impact Questionnaire – Short Form 7 (PFIQ-7) was used; the Hospital Anxiety and Depression Scale, SAN, PHQ-9, and Quality of Life were used to determine the psycho-emotional state; and mathemat- ical statistics methods were applied. The paper presents the results of the study obtained during the work with 20 women in labour, on the basis of which the authors draw conclusions about the effec- tiveness of the developed and implemented author’s physical therapy programme. However, realising that the study used a small sample of patients in the main group with the above-mentioned pregnancy characteristics, we continued to work with this contingent and further implement the author’s pro- gramme of physical therapy for parturients with diastasis of the rectus abdominis muscles due to multiple pregnancies. In the course of solving the tasks of the work, the effectiveness of individual and integrated approaches in the construction of individual physical therapy programmes for women withthese dysfunctions due to pregnancy has been proven to significantly improve and contribute to a more complete and qualitative restoration of the functional capabilities of the musculoskeletal system of women with diastasis recti.
 
 
 
 
 

Evaluation of Intra-Abdominal Hypertension Parameters in Patients with Acute Pancreatitis.

Patients with acute pancreatitis develop numerous complications and organ damage due to increased intra-abdominal pressure (IAP). These extrapancreatic complications determine the clinical outcome of the disease. A total of 100 patients with acute pancreatitis were included in the prospective cohort study. Observed patients were divided into two groups according to their mean values of IAP (normal IAP values and elevated IAP values), which were compared with examined variables. Patients with intra-abdominal hypertension (IAH) were divided into four groups by IAP values, and those groups of patients were also compared with the examined variables. Differences between body mass index (BMI) (p = 0.001), lactates (p = 0.006), and the Sequential Organ Failure Assessment (SOFA) score (p = 0.001) were statistically significant within all examined IAH groups. Differences between the mean arterial pressure (MAP) (p = 0.012) and filtration gradient (FG) (p < 0.001) were statistically significant between the first and second IAH groups in relation to the fourth. Differences in diuresis per hour (p = 0.022) showed statistical significance in relation to the first and third groups of IAH patients. Changes in IAP values lead to changes in basic vital parameters MAP, APP, FG, diuresis per hour, and lactate levels in patients with acute pancreatitis. Early recognition of changes in the SOFA score accompanying an increase in the IAP value is essential.

Preoperative Progressive Pneumoperitoneum in the Treatment of Hernias With Loss of Domain. Our Experience in 50 Cases.

Introduction: Surgical planning for repair of giant hernias with loss of domain needs to consider patient comorbidities, potential risks and possible postoperative complications. Some postoperative complications are related to the increase in intra-abdominal pressure caused by the reintroduction of abdominal contents into the peritoneal space. Preoperative progressive pneumoperitoneum (PPP) increases the capacity of abdominal cavity prior to hernia repair and allows for better physiological postoperative adaptation. The aim of this study is to analyze perioperative and intraoperative characteristics as well as outcomes of a cohort of patients treated with PPP prior to giant hernia repair at a single, high volume center. Methods: Prospective, descriptive, observational single-center study including 50 patients undergoing PPP prior to hernia with loss of domain repair between January 2005 and June 2022. We analysed epidemiological, surgical and safety variables. Results: Fifty patients were included: 43 incisional hernias, 6 inguinal hernias and 1 umbilical hernia. Mean age was 66years (36-85). Median insufflation time was 12days (4-20) and median insufflated volume of ambient air was 10,036 cc. There were complications during PPP in nine patients: 2 decompensation of chronic respiratory disease and 7 subcutaneous emphysema. PPP was prematurely suspended in patients with respiratory decompensation. All patients with incisional and umbilical hernias underwent open repair with mesh placement. Preperitoneal repair was performed in inguinal hernias. Three cases of hernia recurrence were reported during the follow up. Conclusion: PPP is a safe and effective tool in the preoperative management of patients with giant hernias. It helps to achieve the decrease or absence of abdominal wall tension and can favour the results of complex eventroplasty techniques.

Modeling the Impact of Abdominal Pressure on Hypoxia in Laboratory Swine

Abstract This paper presents an experimentally parameterized model of the dynamics of oxygen transport in a laboratory animal that simultaneously experiences: (i) a reduction in inspired oxygen plus (ii) an increase in intra-abdominal pressure. The goal is to model the potential impact of elevated intra-abdominal pressure on oxygen transport dynamics. The model contains three compartments, namely, the animal’s lungs, lower body vasculature, and upper body vasculature. The model assumes that intra-abdominal pressure affects the split of cardiac output among the two vasculature compartments and that aerobic metabolism in each compartment diminishes with severe hypoxia. Fitting this model to a laboratory experiment on an adult male Yorkshire swine using a regularized nonlinear least-squares approach furnishes both physiologically plausible parameter values plus a reasonable quality of fit.

A finite element analysis of different postures and intra-abdominal pressures for the uterine ligaments in maintaining the normal position of uterus

Uterine prolapse is a common gynecological disease, which seriously affects the quality of life and physical and mental health of elderly women. The aim of this study was to analyze the influence of different conditions (intra-abdominal pressure (IAP) and posture) on stress and displacement of uterine ligaments using the finite element method, and evaluate the contribution of uterine ligaments on uterus. The three-dimensional (3D) models of retroverted uterus and its accessory ligaments were established, loads and constraints were set in ABAQUS software, and the stress and displacement of uterine ligaments were calculated. The uterine displacement increased with the increase of IAP, and then the stress and displacement of each uterine ligament also increased. The uterine displacement was in the order of forward < upright < backward with different postures, and USL, CL and RL got larger values when the body was backward, while BL got a larger value when the body was forward. With the same condition, the stress of the uterine ligaments was in the order of USL > BL > CL > RL, and the displacement of the ligaments was in the order of BL > RL > USL > CL. The contribution of each uterine ligament changing with different IAP and postures was studied through finite element analysis, and the research results were consistent with the clinical data, which can provide a basis for exploring the mechanism of uterine prolapse.

Внутрішньочеревна гіпертензія як ускладнення гострого панкреатиту

The aim of our work was to review modern aspects of pathogenesis, diagnosis and treatment of intra-abdominal hypertension as a complication of the severe course of acute pancreatitis. Acute pancreatitis is a systemic disease, the severe course of which is associated with organ dysfunction and increased intra-abdominal pressure. The frequency of intra-abdominal hypertension in patients with severe acute pancreatitis is 60%, while 10-30% of patients in this category hospitalized in the intensive care unit have abdominal compartment syndrome. An increase in intraabdominal pressure has a negative effect on the course of acute pancreatitis. Namely, multiple organ failure occurs more often; pancreatic and peripancreatic necrosis, prolonged systemic inflammatory response syndrome, complications during the use of enteral nutrition, the need for invasive interventions, the length of hospitalization and the percentage of deaths increase. Determination of intra-abdominal pressure through the urinary bladder in patients with severe acute pancreatitis should be considered as a standard for diagnosing intraabdominal hypertension. It has been proven that the use of paracentesis with drainage of the abdominal cavity in the staged treatment of patients with a complicated course of acute pancreatitis (peripancreatic accumulation of fluid in the early period of the disease) reliably reduces intra-abdominal pressure after 72 h since the detection of fluid (17.4 ± 2.6 and 11.4 ± 1.6 mm Hg), serum amylase (774.3 ± 233.9 and 472.7 ± 168.6 Units/l), procalcitonin (1.3 ± 0.7 and 0.6 ± 0.5 ng/ml) and interleukin-6 (531.3 ± 120.9 and 417.1 ± 82.4 pg/ml). Achievements in intensive care, optimization of indications for surgical interventions, early enteral nutrition, rational use of liquid resuscitation and the growing role of minimally invasive interventions have had a positive effect on the prognosis of acute pancreatitis, overall morbidity and led to a decrease in deaths in this category of patients. However, the prevention and treatment of persistent intra-abdominal hypertension and abdominal compartment syndrome require further study and improvement.

Effects of abdominal girdle belt on pulmonary function variables of postpartum women in Enugu, Nigeria: a quasi-experimental study

This quasi-experimental study was aimed at investigating the effects of wearing an abdominal girdle belt on pulmonary function variables of postpartum women. 40 consenting postpartum women aged between 18 and 35 years were recruited from a post-natal clinic in Enugu, Nigeria. The participants were conveniently assigned into girdle belt and control groups (20 each). Their lung function (forced expiratory volume in first second[FEV1], and %FEV1, forced vital capacity[FVC], peak expiratory flow [PEF], forced expiratory flows [25th, 75th & 25–75th percentiles]) values were measured prior to and after eight weeks of the study intervention period for each participant. Data obtained were analysed using descriptive and inferential statistics. Following the intervention period, 19 and 13 participants completed the study in the girdle belt and control groups, respectively. The main results showed that both groups were comparable at baseline for all the study variables assessed (p > 0.05). Following the intervention period, only the PEF was significantly reduced in the girdle belt group compared to control group participants (p = 0.012). Thus, wearing girdle belts for an extended period of time has no effect on the lung function values of postpartum women. IMPACT STATEMENT What is already known on the subject? Postpartum abdominal girdle belts are commonly utilised for resolution of abdominal protrusion and obesity after childbirth. Unfortunately, several adverse effects, including bleeding, compressive pain and discomfort and abnormally increased intra-abdominal pressure, have been associated with this practice. Consistent increase in intra-abdominal pressure of variable duration has been reported to affect pulmonary functions. What do the results of this study add? The study findings indicate that wearing girdle belts for eight weeks by postpartum women has no substantial effect on the pulmonary function variables. What are the implications of these findings for clinical practice and/or further research? Utilisation of abdominal girdle belts of equal or less than 8 weeks duration should not be discouraged for post-partum women due to fear of its potential negative impact on pulmonary function.

Intracranial Hypertension following Acute Mesenteric Ischemia: A Case Study on the Multiple Compartment Syndrome.

In this case study, we describe a 25-year-old male who was admitted due to a severe traumatic brain injury, requiring invasive intracranial pressure monitoring. At 48 hours posttrauma, he developed intracranial hypertension refractory to medical treatment without tomographic changes in the brain. Subsequently, intra-abdominal hypertension and tomographic signs of abdominal surgical pathology were observed. An exploratory laparotomy was performed with an intraoperative diagnosis of acute mesenteric ischemia. After surgical intervention for the abdominal pathology, intracranial pressure was restored to physiological values with a favorable recovery of the patient. In this report, the relationship between intracranial pressure and intra-abdominal pressure is discussed, highlighting the delicate association between the brain, abdomen, and thorax. Measures should be taken to avoid increases in intra-abdominal pressure in neurocritical patients. When treating intracranial hypertension refractory to conventional measures, abdominal causes and multiple compartment syndrome must be considered. The cranial compartment has physiological interdependence with other body compartments, where one can be modified by variations from another, giving rise to the concept of multiple compartment syndrome. Understanding this relationship is fundamental for a comprehensive approach of the neurocritical patient. To the best of our knowledge, this is the first report of a comatose patient post-traumatic brain injury, who developed medically unresponsive intracranial hypertension secondary to acute mesenteric ischemia, in which surgical resolution of intra-abdominal pathology resulted in intracranial pressure normalization and restitutio ad integrum of neurological status.