Stomach Position Research Articles

Physiological Magnetic Stimulation for Arousal of Elderly Car Driver Evaluated With Electro-Encephalogram and Spine Magnetic Field

Reliable evaluation for the arousal effect of magnetized olivine-crushed-stone-crammed vinyl pipe set on an elderly car driver's spine has been carried out measuring a four-points electroencephalogram using driving simulators considering a defined arousal index β/(δ+θ) . A sintered-magnetized-spherical-particles-crammed pipe is developed for realization of periodically pulse distributed surface magnetic field train matching with the magneto-protonics principle. Transition of the magnetic field time series generated from the spine with application of the physiological magnetic stimulation have also been measured using the amorphous wire and CMOS IC based pico-Tesla resolution magneto-impedance sensor, in which existence of alternative areas of cooperativeness and anti-cooperativeness for transition of the arousal index each other along the spine length direction is suggested. A special point on the central spine generating a large bio magnetic field of around 10 nT amplitude as well as corresponding pit of the stomach position was found.

Experimental Evaluation of Adult Spring Chinook Salmon Radio‐Tagged during the Late Stages of Spawning Migration

AbstractWe conducted an experiment to assess the effects of radio‐ tagging on adult spring Chinook salmon Oncorhynchus tshawytscha during the late stages of their spawning migration. Fish were captured at Roza Dam, Yakima River, Washington (river kilometer 208). Each fish had a radio tag inserted into the stomach via the esophagus and was then transported to a raceway and held for 50 d to assess survival. In the same raceway we also held a control group that was handled but not tagged and a group with externally attached transmitters. Survival of fish with gastrically implanted radio tags was low (10%), while 70% of controls and 90% of fish with externally mounted tags survived to the end of the experiment. Postmortem dissections revealed that after implantation, some radio tags had migrated from the stomach position to the posterior digestive tract and peritoneum. Fish from all treatments exhibited some level of tissue degeneration of the gastrointestinal tract. Gastric implantation should be used with caution, particularly for fish at vulnerable life stages. For spring Chinook salmon in the Columbia River basin, tagging with gastric implants should be conducted early in the freshwater migration to improve survival and reduce tag effects.Received September 30, 2011; accepted June 4, 2012

Prediction of Survival in Infants with Congenital Diaphragmatic Hernia Based on Stomach Position, Surgical Timing, and Oxygenation Index

To identify characteristics predictive of survival of patients with congenital diaphragmatic hernia (CDH). Retrospective analysis of clinical characteristics including severity of lung disease measured by oxygenation index (OI) associated with single-center survival in CDH patients (n = 81) from 1992 to 2008. Data were analyzed using univariate and multivariable logistic regression, effect plots, and receiver operating characteristic (ROC) plots. No patient died if the stomach was located in the abdomen. A left thoracic stomach position predicted decreased survival with ROC area under the curve (AUC) = 0.70. OI of ≤ 26 averaged over the first 12 hours of life predicted ≥ 50% survival for all patients, with AUC = 0.86. OI effect plots allow prediction of survival over a continuous OI range. No patient survived if mean OI was >51 in the first 12 hours of life. Delaying surgery for a median of 6 days improved survival probability for all patients with presurgery OI values ≤ 51. Position of the stomach in the abdomen, delayed surgery, and less severe cardiopulmonary disease during the first 12 hours of life, as measured by mean OI, predicted improved survival probability among patients with CDH. Our CDH model, using mean OI, permits specific individual prediction of survival probability over a range of OI values.

Determination of planning target volume for whole stomach irradiation using daily megavoltage computed tomographic images

PurposeWhole stomach radiation therapy is often used in the management of gastric lymphoma. However, very limited data exist with regard to planning target volume requirements for the whole stomach. This study retrospectively analyzed daily megavoltage computed tomographic (CT) scans of gastric lymphoma patients in order to help determine the interfraction variation of the stomach position. Methods and MaterialsForty-one daily megavoltage CT images from 3 gastric lymphoma patients were used for stomach contouring. Each patient's megavoltage CT images were rigidly registered to their CT simulation data sets, and the margin in each direction that covered at least 95% of the daily stomach volumes was computed using a simple grid search. Patient setup variation was also calculated from the daily patient shifts. The organ motion margin was then added to the setup margin to render the total margin. ResultsA uniform margin of 2.2 cm is required to cover 95% of the stomach over the treatment course. However, direction-specific margins were observed from 1.72, 1.88, 0.92, 2.23, 1.90, and 0.86 cm for the right, left, posterior, anterior, superior, and inferior directions, respectively. ConclusionsThe results of this study provide helpful 3-dimensional volumetric information to the limited existing data on margin requirements for whole stomach radiation therapy.

Stomach outline visualization in gastrointestinal transit studies using scintigraphy.

A major disadvantage of gamma scintigraphy in gastrointestinal transit studies is the inability to provide adequate delineation of anatomical details. As an aid to the important requirement of outlining the stomach to ensure accurate quantification of the time at which material empties from this organ, a new technique is described, using short half-life 81mKr gas to provide clearer identification of the stomach outline and position.

Re‐evaluation of stomach position as a simple prognostic factor in fetal left congenital diaphragmatic hernia: a multicenter survey in Japan

To document outcome and to explore prognostic factors in fetal left congenital diaphragmatic hernia (CDH). This was a multicenter retrospective study of 109 patients with prenatally diagnosed isolated left CDH born between 2002 and 2007. The primary outcome was intact discharge, defined as discharge from hospital without major morbidities, such as a need for respiratory support including oxygen supplementation, tube feeding, parenteral nutrition or vasodilators. All patients were managed at perinatal centers with immediate resuscitation, gentle ventilation (mostly with high-frequency oscillatory ventilation) and surgery after stabilization. Prenatal data collected included liver and stomach position, lung-to-head ratio, gestational age at diagnosis and presence or absence of polyhydramnios. Stomach position was classified into four grades: Grade 0, abdominal; Grade 1, left thoracic; Grade 2, less than half of the stomach herniated into the right chest; and Grade 3, more than half of the stomach herniated into the right chest. Overall intact discharge and 90-day survival rates were 65.1% and 79.8%, respectively. Stomach herniation was classified as Grade 0 in 19.3% of cases, Grade 1 in 45.9%, Grade 2 in 13.8% and Grade 3 in 21.1%. Multivariate analysis revealed that liver position was the strongest prognostic variable for intact discharge, followed by stomach position. Based on our results, we divided patients into three groups according to liver (up vs. down) and stomach (Grade 0-2 vs. Grade 3) position. Intact discharge rates declined significantly from liver-down (Group I), to liver-up with stomach Grade 0-2 (Group II), to liver-up with stomach Grade 3 (Group III) (87.0%, 47.4% and 9.5% of cases, respectively). Current status and outcomes of prenatally diagnosed left CDH in Japan were surveyed. Stomach herniation into the right chest was not uncommon and its grade correlated with outcome. The combination of liver and stomach positions was useful to stratify patients into three groups (Group I-III) with different prognoses.

OP33.03: Fetal heart measurement assessed by 4D ultrasound using STIC combined with inversion mode - preliminary results

Results: In normal fetuses, it was possible to identify the respective position of the inferior vena cava and the descending aorta in all cases. In the 3 cases with left atrial isomerism, it was possible to identify the azygos continuation adjacent to the descending aorta and the abnormal stomach position. In no case could the multiple spleens be identified. In the 3 cases with right atrial isomerism, it was possible to identify the abnormal central position of the inferior vena cava and the displacement of the stomach to the left. The abnormal liver morphology consistent with left and right isomerism could be identified in 5/6 cases. Discussion: Identification of fetal situs has so far been carried out by assessing the position of the abdominal vessels on an axial view of the fetal abdomen. Using the coronal plane of the fetal trunk from three-dimensional volumes, it was possible to identify visceral anatomic patterns consistent with a diagnosis of situs solitus or ambiguous (left or right isomerim) independently from the type of congenital heart disease present. This may be of help in difficult cases to tag the type of cardiosplenic syndrome.

Heterotaxy Syndrome with Mirror Image Anomalies in Identical Twins

Heterotaxy syndrome is a term used to describe disorders of lateralization of thoracic and abdominal organs as well as atria. It is commonly associated with complex congenital heart disease as well as abnormalities of the spleen, intestinal malrotation, and abnormalities of liver and stomach position. Most reported cases of heterotaxy syndrome are sporadic, though familial occurrences have also been reported. We report a case of monozygotic twins, both with heterotaxy syndrome, complex congenital heart disease, and anatomical features in both twins that are almost mirror images to each other.

Radiation Treatment Planning Techniques for Lymphoma of the Stomach

Radiotherapy is often used in the curative treatment of gastric lymphoma. But the optimal technique to irradiate the stomach with minimal morbidity has not been well established. This study was designed to define the variation of stomach position and shape produced by the filling status and the peristaltic movement of the stomach in serial computerized tomographic (CT) scans and to improve the dose coverage to target volume.

Transcutaneous ultrasonographic evaluation of gastric distension with fluid in horses

To develop a transcutaneous ultrasonography (TUS) method for measuring the location of the stomach during various levels of fluid distension and evaluate any correlation between gastric fluid distension and stomach position. 6 adult horses. Known volumes of water were administered in 2 trials. In trial 1, the stomach was evaluated prior to and after the administration of 2, 4, and 6 L of water. In trial 2, the stomach was evaluated after administration of 6, 8, 10, and 12 L of water. The TUS was performed at the 7th through 16th left intercostal spaces (ICSs). For each volume of water, an image was captured at the most dorsal point in each ICS where the dorsolateral aspect of the stomach wall was viewed. The distance between this point and a horizontal line drawn on the skin at the level of the elbow joint was measured. The measurements at all ICSs were used to estimate the gastric wall height at ICS 12, which was subsequently evaluated for statistical association with volume administered. Significant correlation between the estimated height of the stomach wall at ICS 12 and the volume of fluid administered was detected. A regression equation to estimate gastric fluid volume when initial values for gastric wall height (cm) at ICS 12 and fluid volume (L) are known was developed. Results suggested that use of TUS for gastric fluid volume estimation is a potentially useful technique.

Entristar skin-level gastrostomy tube: primary placement with radiologic guidance in patients with amyotrophic lateral sclerosis.

To retrospectively review the authors' experience with a radiologic method of primary insertion of a skin-level gastrostomy tube (Entristar; Tyco Healthcare, Mansfield, Mass) in patients with amyotrophic lateral sclerosis (ALS). Over a 12-month period (September 2002 through September 2003), 25 patients with ALS (mean age, 62.4 years; age range, 41-83 years; 15 men, 10 women) who had bulbar impairment and a body mass index of less than 20 kg/m(2) or weight loss of greater than 10% were selected for placement of an enteral feeding tube. Patients with overnight oxygen desaturation or respiratory acidosis were referred for placement of the Entristar tube with radiologic guidance. This procedure was performed with local anesthesia and without sedation by using a modified percutaneous lateral fluoroscopic technique that aided tube insertion in patients with elevation of the hemidiaphragm and a "high" stomach position. Technical success and immediate and delayed procedure complications were recorded. The Entristar tube was successfully inserted in all 25 patients. Pneumoperitoneum as an early complication was documented in one patient, and one patient developed a pelvic abscess that required drainage. Follow-up for a median of 112 days (range, 14-343 days) revealed superficial wound infections in four patients and weight gain in two patients; weight gain necessitated tube replacement in one patient. There were no procedure-related deaths. Radiologically guided insertion of the Entristar skin-level gastrostomy tube is a safe procedure in patients with ALS that allows the creation of a permanent feeding gastrostomy without the need for sedation or endoscopy.

OC255: Fetal cardiosplenic syndromes (isomerism)?how alerting is the heart and stomach position on ultrasonography?

OC255: Fetal cardiosplenic syndromes (isomerism)?how alerting is the heart and stomach position on ultrasonography?

Congenital Diaphragmatic Hernia: Risk Factors and Experience in Southwest Region of Saudi Arabia

Congenital diaphragmatic hernia is a common surgical emergency in neonatal referral centres. Various pre- and post- operative radiologic, ven- tilatory, and clinical data parameters were studied as factors to predict the out- come of this condition. A total of 27 cases were admitted to King Fahad Hos- pital in Al Baha (Southwest region of Saudi Arabia) between October, 1981, and October, 1992 inclusive the gross mortality rate was 22% but when ap- plied on patients presented within the first 6 hours of life, it was 40%. About 30 risk factors were studied and its statistical significance was drawn out when applied to each patient. In conclusion, we found the incidence of congenital diaphragmatic hernia in Southwest region of Saudi Arabia to be 1 : 2,320 live births. The major risk factors adversely affect survival were low birth weight, low PaO2, oxygenation index, and thoracic stomach position. Other risk fac- tors affected the survival to lesser extent were high PaCo2, and alveolar- arterial oxygenation index. The details of the risk factors and the cases are pre- sented.

A rapid and strong laparoscopic-assisted gastropexy in dogs.

To develop a technique for laparoscopic gastropexy in dogs and evaluate effects on stomach position and strength of the adhesion between the stomach and abdominal wall. 8 healthy dogs. Dogs were anesthetized, and the abdomen was insufflated with carbon dioxide. A laparoscope was placed through a cannula inserted on the abdominal midline caudal to the umbilicus. Babcock forceps placed through a cannula inserted lateral to the right margin of the rectus abdominus muscle were used to exteriorize the pyloric antrum, a longitudinal incision was made through the serosa and muscular layer of the pyloric antrum, and the seromuscular layer of the pyloric antrum was sutured to the transversus abdominus muscle. After surgery, positive-contrast gastrography was used to evaluate stomach position and the onset of gastric emptying, and ultrasonography was used to assess stomach wall activity and mobility. Dogs were euthanatized 1 month after surgery, and tensile strength of the adhesion was tested. In all dogs, stomach position and the onset of gastric emptying were normal 25 days after surgery, and the pyloric antrum was firmly attached to the abdominal wall 30 days after surgery. Mean +/- SD ultimate load of the adhesion in tension was 106.5 +/- 45.6 N. The laparoscopic gastropexy technique described in the present study could be performed quickly and easily by an experienced surgeon, resulted in a strong fibrous adhesion between the stomach and abdominal wall, and appeared to cause minimal stress to the dogs.

Mortality among infants with high-risk congenital diaphragmatic hernia in Singapore

Several factors suggested to predict mortality in congenital diaphragmatic hernia (CDH) have not always been applicable in different centers. A retrospective review was conducted of 19 consecutive neonates in Singapore in whom CDH was diagnosed within 12 hours of birth to identify factors associated with mortality. Of the 19 cases, 15 (79%) were diagnosed using antenatal ultrasonography. Eight (42%) underwent primary repair at a median age of 23 hours (range, 12 to 50 hours). Of the 19 infants, 15 died (mortality rate, 79%). Survivors until hospital discharge were compared with nonsurvivors. Antenatal diagnosis and stomach position in left-sided defects had no effect on outcome, although polyhydramnios tended to be associated with nonsurvival. Significant postnatal factors associated with mortality included a low initial arterial pH level, low initial arterial-alveolar oxygen ratio, high initial alveolar-arterial oxygen gradient, as well as high oxygenation and ventilation indices. These results reflect difficulty in oxygenation because of pulmonary hypoplasia despite evidence of adequate ventilation. There was no difference between survivors and nonsurvivors in either their initial or best postductal blood gases. The “Bohn quadrants” did not aid in predicting survival of infants who underwent repair because all eight such infants had best postductal carbon dioxide values of less than 40 mm Hg and ventilation indices of less than 1,000. Yet only four (50%) survived until hospital discharge. Large-scale evaluation of these factors may be required in the future to demonstrate their validity and reliability because of changing management strategies for CDH.

Sonographic predictors of survival in fetal diaphragmatic hernia

The authors studied the predictive value of detailed fetal sonographic parameters on outcome for 55 patients with prenatally diagnosed congenital diaphragmatic hernia managed at an ECMO center. Their sonographic assessment included gestational age at time of diagnosis, polyhydramnios (largest amniotic fluid pocket diameter), presence of liver and/or stomach herniation, and abdominal circumference at the level of the umbilical cord. They measured the right lung two-dimensional area at the level of the atria as an estimate of lung size and mediastinal shift. The ratio of right lung area to head circumference (LHR) was calculated to minimize lung size differences owing to gestational age. The principal outcome variable was survival. The overall survival rate was 65%. If the diagnosis was made after 25 weeks' gestation, the survival rate was 100% (12 of 12); the rate was 56% if the diagnosis was made at or before 25 weeks ( P < .005). All five neonates with an LHR of less than 0.6 died; the survival rate was 100% for those whose LHR was greater than 1.35; and those with an LHR between 0.6 and 1.35 had a 61% survival rate ( P < .001). The survival rate for those whose liver was not herniated was 100% (10 of 10); herniation of the liver decreased the survival rate to 56% ( P < .05). Stomach position, polyhydramnios, and abdominal circumference were not found to be useful survival predictors. No prenatal sonographic parameter was absolutely predictive of postnatal death except very small right lung size, which was present in only 5 of the 55 patients. Survival is highly likely if the liver is not herniated into the thorax and/or the right lung is large.

Prenatal sonographic predictors of liver herniation in congenital diaphragmatic hernia.

We conducted a retrospective review of prenatal sonograms of all fetuses (n = 25) with left sided congenital diaphragmatic hernia undergoing in utero surgical repair of the defect at the University of California, San Francisco, Fetal Treatment Center. Sixteen candidates were selected for analysis to determine reliable predictors of liver herniation. Bowing of the umbilical segment of the portal vein (portal sinus) to the left of midline and coursing of portal branches to the lateral segment of the left hepatic lobe toward or above the diaphragmatic ridge were the best predictors for liver herniation into the fetal thorax (positive predictive values of 85% and 100%, respectively). The stomach position was a good predictor if observed in a posterior or midthoracic location (positive predictive value = 100%). However, this occurred in only 7 of 16 (44%) cases. Visibility of the right lung was less informative (positive predictive value = 63%). We do not recommend in utero primary closure of congenital diaphragmatic hernia when there is sonographic evidence of liver herniation into the fetal thorax.

Direct Percutaneous Jejunostomy

Enteral feeding via gastrostomy or gastrojejunostomy tubes has an established role in patients unable to maintain adequate oral intake. However, creation and maintenance of a site for long-term nutritional support can be significant problems in patients who have undergone previous surgery or in patients with chronic aspiration, abnormal stomach position, or recurrent inadvertent tube dislodgment. Direct percutaneous jejunostomy (DPJ) tube placement performed with fluoroscopic guidance was evaluated in these patients. Fourteen DPJ tube placements for enteral feeding were attempted in 13 patients with use of local anesthesia, fluoroscopic guidance, the Seldinger technique, and jejunopexy. There were nine male and four female patients with a mean age of 75.2 years (range, 45-95 years). DPJ was successful in 11 of 13 patients. A mean follow-up of 58.9 days (range, 3-291 days) was obtained in all 11 patients. DPJ is a safe and viable alternative for the creation and maintenance of long-term enteral tube feeding, particularly in patients with underlying esophagogastric malignancy, recurrent inadvertent tube dislodgement, or previous gastric surgery.

The effects of positive airway pressure and intra-abdominal pressure in diaphragmatic rupture.

Arterial blood gases (80% oxygen), intraperitoneal pressure (IP), stomach position relative to the diaphragm (S/D by fluoroscopy), blood pressure, and cardiac output were monitored in 16 anaesthetized New Hampshire piglets with a 12 cm laceration of the left hemidiaphragm. Group I (8 animals) were spontaneously breathing. Group II (8 animals) had a pneumatic antishock garment (PASG) inflated to an IP of 40 torr for 15 mins followed by positive pressure ventilation (PPV) of 20 cm H2O for 15 min and PPV of 40 cm H2O (PPV-40) for 30 more minutes. All Group I animals survived. Three Group II animals died by 15 min after PASG inflation. Seven Group I animals showed no displacement of the stomach above the diaphragm. Blood pressure, cardiac output, and blood gases remained unchanged in Group I compared to baseline with pO2 varying from 436 +/- 44 torr to 417 +/- 31 torr, pCO2 from 38 +/- 1 torr to 39 +/- 1 torr, and pH 7.4 +/- 0.02. Blood pressure in Group I was 109 +/- 3 torr at baseline to 110 +/- 2 torr at 60 mins, and baseline cardiac output was 3.9 +/- 0.2 L/min and 3.8 +/- 0.2 L/min at 60 min. Group II animals had a baseline arterial pO2 of 423 +/- 15 torr and 100 +/- 15 torr at 15 min after PASG. With PPV-20 arterial pO2 increased to 178 +/- 13 torr and further increased to 230 +/- 9 torr at PPV-40.(ABSTRACT TRUNCATED AT 250 WORDS)

Stomach position as an in utero predictor of neonatal outcome in left-sided diaphragmatic hernia

An 8-year review of neonates with left-sided congenital diaphragmatic hernia who presented in severe respiratory distress at birth was retrospectively reviewed looking at stomach position, thoracic or abdominal, as a predictor of survivability. Survival was 93% with the stomach below the diaphragm compared with 29% when the stomach was thoracic in location. Stomach position may be an important early in utero predictor of high mortality in neonates with left-sided congenital diaphragmatic hernias.