China has entered an aging society. Elderly patients with acute abdomen have complex clinical manifestations and often have more complications. For elderly acute abdomen, the results of abdominal physical examination and laboratory testing often can not reflect the patient’s condition. The differential diagnosis of diseases should be emphasized in clinical diagnosis and treatment. The treatment of acute abdomen in the elderly not only needs standardized analgesic treatment, but also pays attention to the evaluation of the disease, and adopts multidisciplinary cooperation to formulate appropriate treatment plans.
Inflammatory myofibroblastic tumor (IMT) involving stomach, liver, biliary tract, and peritoneal mesentery was very rare, nonspecific clinical manifestations and laboratory examination were the main reasons for the difficult preoperative diagnosis of IMT. An IMT case involving multiple systems and multiple sites of the abdomen was presented, the CT and MRI imaging signs and pathological basis of IMT were illustrated, so as to strengthen the understanding of IMT for clinicians and radiologists.
ObjectiveTo assess the clinical efficacy of percutaneous transplantation of parathyroid glands into the subcutaneous tissue of the epigastrium for treating malignant secondary hyperparathyroidism (SHPT). MethodsThe clinical data of the patients with SHPT who were treated by puncturing the subcutaneous tissue of the epigastrium and transplanting parathyroid glands in the Xuzhou Central Hospital from January 2020 to June 2022 were collected retrospectively. The preoperative and postoperative parathyroid hormone (PTH) level, calcium ion concentration, alkaline phosphatase (ALP) level, and phosphorus ion concentration, as well as postoperative follow-up results were analyzed. The data analysis was conducted using SPSS 23.0 software, with a testing level of 0.01. ResultsA total of 21 patients successfully underwent this surgery, including 12 males and 9 females, with a median age of 48 years old and a range of 32–71 years old. The dialysis time was (8.62±2.27) years, and 12 patients had hypertension, 9 patients had anemia, 17 patients had bone pain, and 11 patients had skin itching. On day 1 after treatment, the PTH level decreased from (1 893.23±539.30) ng/L to (5.99±3.50) ng/L (P<0.001), the calcium ion concentration decreased from (2.52±0.31) mmol/L to (2.24±0.35) mmol/L (P=0.003), and the phosphorus ion concentration decreased from (2.25±0.71) mmol/L to (1.76±0.38) mmol/L (P=0.006) as compared with the values before surgery. Although the ALP level decreased from (321.78±151.01) U/L to (229.32±89.32) U/L, there was no statistically significant difference (P=0.016). Among the 12 patients with hypertension before surgery, 6 patients improved and reduced the use of antihypertensive drugs after surgery; among the 9 patients with anemia, 3 patients improved before discharge; 17 patients with bone pain showed markedly relief before discharge; and 9 patients with skin itching improved before discharge. There were no complications such as hoarseness, choking cough when drinking water, or incision infection after the operation. All 21 patients were followed up for 6–12 months. The parathyroid hormone levels of the 21 patients all dropped to the normal level within 12 months after the operation. Among them, 3 patients recovered to the normal level at the 3rd month after the operation, 16 patients recovered to the normal level at the 6th month after the operation, and 2 patients recovered to the normal level at the 12th month after the operation. The time to return to the normal level was (5.86±2.70) months. No serious complications occurred in all patients, and there was no recurrent case during follow-up period. Conclusion From the analysis results of our study, parathyroid autotransplantation into the subcutaneous tissue of the epigastrium via puncture is a safe and effective method for patients with SHPT.
ObjectiveTo evaluate the value of ultrasound in the differential diagnosis of thickened bowel wall at the lower quadrant of abdomen. MethodsThe ultrasonic and clinical data of 416 cases of bowel wall thickening at the lower quadrant of abdomen were retrospectively analyzed between January 2009 and April 2013 in Meishan Traditional Chinese Medicine Hospital, Meishan Chinese Railway Hospital and West China Hospital of Sichuan University. The diseases included appendicitis, periappendiceal abscess, Meckel's diverticulum, intestinal duplication, Crohn's disease and intestinal tuberculosis. Misdiagnoses were also analyzed. ResultsAmong the 416 patients, there were 304 cases of inflammation, 90 of tumors, and 22 of congenital diseases. On ultrasound images, they manifested as cystic mass in 19 cases, mixed solid and cystic mass in 77 cases, and solid mass in 320 cases. Of all the cases, there were 56 cases of diffused changes, 54 of multiple-segment changes, and 306 of focal changes. ConclusionUltrasound is a valuable diagnostic imaging tool in the differential diagnosis of bowel thickening diseases at the lower quadrant of abdomen.
ObjectiveTo investigate the feasibility of laparoscopy in the diagnosis and treatment of acute abdomen. MethodsThe clinical data of 81 patients with acute abdomen treated in our hospital from January 2012 to December 2013 were retrospectively analyzed. ResultsOf the 81 patients with acute abdomen, there were 38 cases of acute appendicitis, 15 cases of gastric perforation, 10 cases of duodenal ulcer perforation, 10 cases of acute cholecystitis, 1 case of mesenteric artery embolism, 2 cases of internal hernias, 2 cases of ileocecal tumor, 2 cases of sigmoid colon rupture, 1 case of intestinal adhesion. The 81 cases were treated by laparoscopy, including 79 cases (97.5%) were clearly diagnosed; 73 cases were succeeded by laparoscopy, and 8 cases converted to laparotomy. The operation time were 35-191 minutes, with an average of 76 minutes; the intraoperative blood loss were 20-130 mL, with an average of 43 mL; the postoperative hospital stay were 3-13 days, with an average of 5.6 days. Seventy-six patients received followed-up for 2-24 months, and the median time were 14 months, no special complications occurred during follow-up period, but 1 case of ileocecal tumor suffered from lung metastases in 12 months after operation. ConclusionsLaparoscopy can be used in the preferred way of diagnosis and treatment of acute abdomen.
Objective To summarize the experience of diagnosis and treatment of acute abdominal pain caused by hepatic hydatid. Methods The preoperative diagnosis, the surgical methods and the curative effect after operation of 297 patients with acute abdominal pain caused by hepatic hydatid who were treated in our hospital from 1960 to 2004 were analyzed. Results The healing rate was 95.96% (285/297 cases), and the death rate was 4.04% (12 /297 cases). Six out of 12 cases of death were caused by diffusive biliary peritonitis and allergic shock attributable to the rapture of hydatid into abdominal cavity. Two patients died of malnutrition caused by the spreading of Echinococcus and the correspondingly repeated operations. Another 4 patients with giant hydatid containing 7 000-12 000 ml fluid, died of hepatic insufficiency caused by the postoperative infection in the cyst. Conclusion The acute abdominal pain caused by hepatic hydatid should be treated mainly through emergency operation and the necessary antianaphylaxis, anti-infection and antishock therapies should also be used at the same time.
The pediatric cadaver impact experiments were reconstructed using the validated finite element(FE) models of the 3-year-old and 6-year-old children. The effect of parameters, such as hammer size, material parameters and thorax anatomical structure characteristics, on the impact mechanical responses of 3-year-old and 6-year-old pediatric thorax was discussed by designing reasonable finite element simulation experiments. The research results showed that the variation of thorax contact peak force for 3-year-old group was far larger than that of 6-year-old group when the child was impacted by hammers with different size, which meant that 3-year-old child was more sensitive to hammer size. The mechanical properties of thoracic organs had little influence on the thorax injury because of the small difference between 3-year-old and 6-year-old child in this research. During the impact, rib deformation led to different impact location and deformation of internal organs because the 3-year-old and 6-year-old children had different geometrical anatomical structures, such as different size of internal organs. Therefore, the injury of internal organs in the two groups was obviously different. It is of great significance to develop children finite element models with high biofidelity according to its real anatomical structures.
Objective To summarize the research progress of magnetic resonance quantitative technique in the iron overload of the abdominal parenchyma organ. Methods By reviewing the related literatures domesticly and abroad, the present status and progress of abdominal magnetic resonance quantitative technique and other examinations in the study of iron overload were analyzed. Results MRI multi-sequence examination technique had changed the research model of iron overload in different organs, and had important clinical significance in imaging diagnosis of abdominal parenchyma organ damage. so far, many techniques of MRI had been used in detection of iron overload, which included signal intensity measurements(including signal intensity ratio and signal intensity difference of positive and negative phases), T2/R2 measurements, T2*/R2* measurements, Dixon and its derivatization, ultrashort echo time technique and susceptibility weighted imaging (including conventional susceptibility weighted imaging and quantitative magnetic sensitive imaging). Conclusion Magnetic resonance quantitative examination technique is expected to be the first choice for detection of hepatic iron overload, and can improve the early detection rate of iron overload pancreatic damage.
ObjectiveTo explore the value of gadobutrol enhanced magnetic resonance angiography (MRA) in abdominal artery angiography.MethodsThe patients were prospectively included for gadobutrol enhanced MRA examination from December 2014 to December 2015. The image quality was assessed by two radiologists. The subjective score and signal intensity were measured for the large and medium arteries, and the subjective score for the small artery was recorded. The Kappa consistency analysis was used to assess the two radiologists’ subjective score.ResultsAll 112 patients were enrolled in this study, 96 of whom were included for the physical examination, 16 of whom were included for the liver tumors. No adverse reactions were found in these patients. The MRA images of 2 patients were affected by the severe respiratory artifact. The MRA images of the other 110 cases were clear and could well show the origins, shapes of large and medium arteries and small arteries. The subjective scores were 21.22±1.93 and 6.24±1.33 of the large and medium arteries and small arteries, respectively. The values of signal noise ratio and contrast signal noise ratio of the large and medium arteries were 1 093.27±331.71 and 897.27±333.29, respectively. The Kappa values of the two radiologists’ subjective score were 0.782 and 0.772 for the large and medium arteries and small arteries, respectively.ConclusionsGadobutrol enhanced MRA can clearly display large and medium arteries, and can also display some small arteries. It has a good application value in abdominal artery angiography.
Objective To discuss the application of dual-source computed tomography （CT） low dose technology in the upper abdomen enhanced inspection. Methods Six hundred consecutive patients from July 2011 to February 2012 in this hospital were orderly divided into ordinal tube current （210 mAs） group and low dose tube current group （200 mAs，190 mAs，180 mAs，170 mAs，and 165 mAs）. The standard deviation （SD） of subcutaneous fat，signal to noise ratio （SNR） of liver and pancreas， contrast to noise ratio （CNR） of liver-erector spinae and pancreas-erector spinae，score of subjective diagnosis and the indexes of radiation dose，including CT dose index （CTDI），dose length product （DLP），effective dose （ED） were measured，calculated，and assessed respectively on CT images of arterial phase and portal phase from each group. Results The SD of subcutaneous fat， SNRs of liver and pancreas，score of subjective diagnosis，and the CTDI，DLP，ED of CT images in arterial phase and portal phase were significantly different from each other （P＜0.05），while CNRs of liver-erector spinae and pancreas-erector spinae were not statistically significant （P＞0.05）. The SNR，radiation dose，and score of subjective diagnosis of the 165 mAs tube current group were the lowest among all the groups，but the images of the 165 mAs tube current group could not fulfill the need of diagnosis. Conclusions It is really feasible that the method of decreasing tube current gradually in the upper abdomen enhanced CT inspection could ensure that the radiologists could adapt the low dose image bit by bit，and this methods could be popularized to all kinds of CT facilities we own currently. The images with 170 mAs as tube current in the upper abdomen enhanced inspection of dual-source CT could fulfill the need of diagnosis，and the radiation dose of patients is apparently lower than that the conventional scan．