• Archives of Plastic Surgery
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• 제37권1호
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• pp.22-25
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• 2010

Purpose: As patients who take immediate breast reconstructions with TRAM flap have increased, concomitant or delayed other elective intra-abdominal operations in these patients also have increased. There are few reports of concomitant or delayed intra-abdominal operation in TRAM flap patients. We report our experiences and outcomes of these operations which is safe and feasible. Methods: We reviewed the charts and postoperative follow-up results of 11 patients among 471 consecutive patients who took immediate breast reconstruction with TRAM flap from December of 2002 to September of 2006. Four patients took concomitant intra-abdominal operation and 7 patients took delayed intra-abdominal operation between 1 to 52 months after TRAM flap Results: There were no significant postoperative abdominal and systemic complications. One patient who took concomitant intra-abdominal operation presented partial skin necrosis of abdomen, but recovered completely with conservative treatments. Two patients took transfusion in peri-operative periods. Conclusion: Concomitant or delayed intra-abdominal operation in immediate breast reconstruction with TRAM flap could be performed safely and feasibly when it is necessary. Furthermore, it could be helpful to patients and surgeons.

• Journal of Chest Surgery
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• 제45권4호
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• pp.246-250
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• 2012

Background: Although it is rare for the fracture itself to become a life threatening injury in patients suffering from rib fracture, the lives of these patients are occasionally threatened by other associated injuries. Especially, early discovery of patients with rib fracture and intra-abdominal organ injury is extremely important to the prognosis. This study analyzed the link between rib fracture and intra-abdominal injury to achieve improved treatment. Materials and Methods: Among trauma patients that had visited the hospital emergency room from January 2007 to December 2009, a retrospective study was conducted on 453 patients suffering from rib fracture due to blunt trauma. Rib fracture was classified according to location (left, right, and bilateral), and according to level (upper rib fracture [1-2nd rib], middle rib fracture [3-8th rib], and lower rib fracture [9-12th rib]). The researched data was statistically compared and analyzed to investigate the correlation between the location, level, and number of rib fracture and intra-abdominal organ injury. Results: Motor vehicle injury was found to be the most common mechanism of injury with 208 cases (46%). Associated injuries accompanied with rib fracture were generated in 276 cases (61%). Intra-abdominal organ injury was discovered in 97 cases (21%). Liver injury was the most common intra-abdominal injury associated with rib fracture with 39 cases (40%), followed by spleen injury, with 23 cases (23%). Intra-abdominal injury according to level of rib fracture was presented as upper rib fracture in 11 cases (11%), middle rib fracture in 31 cases (32%), and lower rib fracture in 55 cases (57%), thus verifying that intra-abdominal injuries were commonly accompanied in lower rib fractures (p=0.03). In particular, significant increase of intra-abdominal injury was presented in fractures below the 8th rib (p=0.03). The number of intra-abdominal injuries requiring emergency operations was significantly higher in patients with more than 6 rib fractures (p=0.04). Conclusion: Intra-abdominal organ injury is more common in patients with lower rib fracture, especially fractures below the 8th rib. Intra-abdominal organ injuries generated in multiple rib fracture patients with more than 6 fractures significantly higher severity. These cases must be thoroughly inspected and carefully observed as there is possibility of emergency operation.

• Journal of Gastric Cancer
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• 제20권4호
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• pp.376-384
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• 2020

Purpose: The role of prophylactic abdominal drainage in total gastrectomy is not well-established. This study aimed to evaluate the efficacy of abdominal drainage in the prevention and management of major intra-abdominal complications after total gastrectomy for gastric carcinoma. Materials and Methods: We retrospectively reviewed the data of 499 patients who underwent total gastrectomy for gastric carcinoma in a high-volume institution. The patients were divided into drainage and non-drainage groups and compared for the development and management of major intra-abdominal complications, including anastomotic leak, abdominal bleeding, abdominal infection, and pancreatic fistulas. Results: The drainage group included 388 patients and the non-drainage group included 111 patients. The 2 groups showed no significant differences in clinicopathological characteristics or operative procedures, except for more frequent D2 lymphadenectomies in the drainage group. After surgery, the overall morbidity (drainage group vs. non-drainage group: 24.7% vs. 28.8%, P=0.385) and incidence of major intra-abdominal complications (6.4% vs. 6.3%, P=0.959) did not significantly differ between the two groups. The non-drainage group showed no significant increase in the incidence rate of major intra-abdominal complications in the subgroups divided by age, sex, comorbidity, operative approach, body mass index, extent of lymphadenectomy, and pathological stage. Abdominal drainage had no significant impact on early diagnosis, secondary intervention or reoperation, or recovery from major intra-abdominal complications. Conclusions: Prophylactic abdominal drainage showed little demonstrable benefit in the prevention and management of major intra-abdominal complications of total gastrectomy for gastric carcinoma.

• Industrial Engineering and Management Systems
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• 제7권1호
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• pp.90-98
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• 2008

This research selects the lifting task to be the main subject. Four experiments were designed to measure which among lifting postures, lifting heights, waist-belt, and breathing control significantly influences intra-abdominal pressure (Gallagher, 1991; Lavender, Andersson and Natarajan, 1999). The experimental results were taken to be the recommendations of the manual materials handling work design. The research findings reveal that the symmetrical stoop posture is the most significant to the intra-abdominal pressure within all lifting postures. When the lifting height is increased, the intra-abdominal pressure produced relatively goes up. Also, the combination of symmetrical stoop posture, waist-belt use, and inspiration and holding at the same time is the most efficient in carrying out lifting tasks. Simultaneously, the research discovers that for any posture, the volume of the intra-abdominal pressure is much bigger when using the waist-belt compared to when it is not used. Therefore, the waist-belt design for the lifting works might be the future research approach.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.172-177
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• 2012

Purpose: After damage control surgery, abdominal wall closure may be impossible due to increased intra-abdominal pressure (IAP), and primary closure may induce abdominal compartment syndrome. The purpose of this study was to investigate changes in the IAP and the feasibility of abdominal wall closure using artificial mesh. Methods: From July 2010 to July 2011, 8 patients with intra-abdominal hypertension underwent abdominal wall closure using artificial mesh. Medical data such as demographics, diagnosis, operation, IAP, postoperative complications, mortality and length of hospital stays were collected and reviewed, retrospectively. One patient was excluded because of inadequate measurement of the IAP. Results: Seven patients, 4 males and 3 females, were enrolled, and the mean age was 54.1 years old. Causes of operations were six traumatic abdominal injuries and one intra-abdominal infection. The IAP was reduced from $21.9{\pm}6.6mmHg$ before opening the abdomen to $15.1{\pm}7.1mmHg$ after fascial closure. Fascial closure was done on $14.9{\pm}17.5$ days after the first operation. The mean lengths of the hospital and the intensive care unit (ICU) stays were 49.6 days and 29.7 days respectively. Operations were performed $3.1{\pm}1.5$ times in all patients. Two patients expired, and one was transferred in a moribund state. Three patients suffered from complications, such as retroperitoneal abscesses, enterocutaneous fistulas, and bleeding that was related to the negative pressure wound therapy. Conclusion: After abdominal wall closure using artificial mesh, intra-abdominal pressure was well controlled, and abdominal compartment syndrome does not occur. When the abdominal wall in patients who have intra-abdominal hypertension is closed, artificial mesh may be useful for maintaining a lower abdominal pressure. However, when negative pressure wound therapy is used, the possibility of serious complications must be kept in mind.

• The Korean Journal of Physiology and Pharmacology
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• 제19권2호
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• pp.99-104
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• 2015

The aim of this study is to develop a physiologically based pharmacokinetic (PBPK) model in intra-abdominal infected rats, and extrapolate it to human to predict moxifloxacin pharmacokinetics profiles in various tissues in intra-abdominal infected human. 12 male rats with intra- abdominal infections, induced by Escherichia coli, received a single dose of 40 mg/kg body weight of moxifloxacin. Blood plasma was collected at 5, 10, 20, 30, 60, 120, 240, 480, 1440 min after drug injection. A PBPK model was developed in rats and extrapolated to human using GastroPlus software. The predictions were assessed by comparing predictions and observations. In the plasma concentration versus time profile of moxifloxcinin rats, $C_{max}$ was $11.151{\mu}g/mL$ at 5 min after the intravenous injection and $t_{1/2}$ was 2.936 h. Plasma concentration and kinetics in human were predicted and compared with observed datas. Moxifloxacin penetrated and accumulated with high concentrations in redmarrow, lung, skin, heart, liver, kidney, spleen, muscle tissues in human with intra-abdominal infection. The predicted tissue to plasma concentration ratios in abdominal viscera were between 1.1 and 2.2. When rat plasma concentrations were known, extrapolation of a PBPK model was a method to predict drug pharmacokinetics and penetration in human. Moxifloxacin has a good penetration into liver, kidney, spleen, as well as other tissues in intra-abdominal infected human. Close monitoring are necessary when using moxifloxacin due to its high concentration distribution. This pathological model extrapolation may provide reference to the PK/PD study of antibacterial agents.

• 한국멀티미디어학회논문지
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• 제20권8호
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• pp.1430-1438
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• 2017

Recently, interest that intra-abdominal pressure has been increased as change of pathophysiology to critical patients. The intra-abdominal pressure is measured by cystometry what can be available for non-inclusively. However, conventional methods have some problems such as low SNR, weakness of environment temperature, and unsuitable size of sensor. In this paper, a new subminiature pressure sensor module and sensing system are proposed using a sensor of semiconductor type and FPCB. The module is more stable, flexible, and smaller than the conventional catheter. The performance of the developed module is evaluated by various quantitative analysis indexes. The proposed sensor has the high sensitivity and suitable size for measurement of cystometry more than the conventional method. In order to prove efficiency between conventional and proposed method, proposed method compared for sensitivity, fixable, and size. The proposed method will be help measurement of intra-abdominal pressure of patients due to high accuracy and comfortableness.

• The Journal of Korean Physical Therapy
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• 제32권2호
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• pp.75-79
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• 2020

Purpose: This study analyzed the immediate effects of intra-abdominal pressure with visual feedback on the muscle activation of the upper trapezius and sternomastoid during natural inspiration and forced inspiration in individuals with costal respiration. Methods: The eighteen individuals with upper costal breathing pattern participated in this study. Surface electromyography was used to analyze the muscle activity of the upper trapezius and sternomastoid during natural inspiration and forced inspiration before and after intra-abdominal pressure. Results: A significant difference in muscle activation was observed with the muscle type, inspiration type, and test session (p<0.05). The muscle activities of the sternomastoid and upper trapezius decreased significantly during forced inspiration after intra-abdominal pressure training (p<0.05). On the other hand, there was no significant difference during natural inspiration in both muscles (p>0.05). A comparison of the difference between the pre-test and post-test during forced inspiration revealed the upper trapezius to be significantly larger than the sternomastoid (p<0.05). No significant difference was noted during natural inspiration (p>0.05). Conclusion: The intra-abdominal pressure has positive effects on correcting the breathing patterns in individuals with costal respiration.

• Annals of Surgical Treatment and Research
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• 제95권5호
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• pp.258-266
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• 2018

Purpose: This study analyzes the impact of laparoscopic liver resection on intra-abdominal adhesion. Methods: Patients who underwent salvage liver transplantation after liver resection for hepatocellular carcinoma from January 2012 to October 2017 at our institution were included. Information about the severity of intra-abdominal adhesions was collected from a prospectively maintained database. Intra-abdominal adhesions were graded after the agreement of 2 surgeons who participated in the salvage liver transplantation based on predetermined criteria. Adhesion severity and demographic, operative, and postoperative data were compared between the laparoscopic group and the open group. Multivariate logistic regression was performed to consider potential factors related to severe adhesion during salvage transplantation. Results: Sixty-two patients who underwent salvage liver transplantation after liver resection were included in this study. Among them, 52 patients underwent open surgery, and 10 patients underwent laparoscopy. Adhesion was significantly more severe in the open group than in the laparoscopy group (P = 0.029). A multivariate logistic regression model including potential factors related to severe adhesion showed that laparoscopy (odds ratio, 0.168; 95% confidence interval, 0.029-0.970; P = 0.048) was the only significant factor. Conclusion: Laparoscopic liver resection for hepatocellular carcinoma can minimize intra-abdominal adhesion during salvage liver transplantation.

• Archives of Plastic Surgery
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• 제50권6호
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• pp.535-540
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• 2023

Background Abdominoplasty with abdominal plication increases intra-abdominal pressure (IAP) and has been previously associated with limited diaphragmatic excursion and respiratory dysfunctions. Many factors found in abdominoplasties and among postbariatric patients predispose them to a higher occurrence. This study aims to evaluate the impact of abdominal plication among postbariatric patients, assess whether the plication increases their IAP, and analyze how these IAP correlate to their postoperative outcome. Methods This prospective study was performed on all patients who underwent circumferential Fleur-De-Lis abdominoplasty. For this intended study, the IAP was measured by an intravesical minimally invasive approach in three stages: after the initiation of general anesthesia, after a 10-cm abdominal wall plication and skin closure, and 24 hours after the procedure. Results We included 46 patients, of which 41 were female and 5 were male. Before the bariatric procedure, these patients had an average maximum weight of 121.4 kg and an average maximum body mass index of 45.78 kg/m²; 7 were grade I obese patients, 10 were grade II, and 29 were grade III. Only three patients were operated on with a gastric sleeve and 43 with gastric bypass. We presented six patients with transitory intra-abdominal hypertension in the first 24 hours, all of them from the grade I obesity group, the highest presented was 14.3 mm Hg. We presented 15% (7/46) of complication rates, which were only four seroma and five dehiscence; two patients presented both seroma and wound dehiscence. Conclusion Performing a 10-cm abdominal wall plication or greater represents a higher risk for intra-abdominal hypertension, slower general recovery, and possibly higher complication rate in patients who presented a lower degree of obesity (grade I) at the moment of the bariatric surgery.