PubMed · 14787957
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W M PALM. 1950. Subphrenic abscess.. https://pubmed.ncbi.nlm.nih.gov/14787957/
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We report on the case of a woman with belly dancer's syndrome. This case presented two peculiarities: (1) the condition was induced by the chronic use of clebopride, and (2) abdominal dyskinesias showed a dramatic response to the application of transcutaneous electrical nerve stimulation.
The most popular techniques for repairing large diaphragmatic defects involve the use of synthetic patches. We present an alternative approach using living tissue. We reviewed our cases of congenital diaphragmatic hernia (CDH) diagnosed within the first 24 h of life from 1991 to 2003. Toldt's fascia (TF) flap was used to repair defects that were too large to repair primarily even though the anterior rim of the diaphragm was present. After confirming that a small medial muscle remnant of the diaphragm was present, its mesothelial covering was incised, and the incision was extended to the TF far enough to create a flap sufficiently large to repair the defect. The TF flap, consisting of the small medial muscle remnant, TF, peritoneum, and retroperitoneal connective tissue, was mobilized carefully from the ipsilateral kidney and adrenal gland, and the repair completed with interrupted sutures using nonabsorbable material. We used this TF flap approach in seven of 43 patients with CDH. Two had right-sided CDH. Six survived. The mean size of the diaphragmatic defects in the seven TF flap cases was 5.43+/-0.53 x 3.86+/-1.07 cm, which was significantly larger than the defects in direct primary repair cases (3.40+/-0.77 x 2.03+/-0.59 cm) (p<0.01). The six survivors had good outcomes, and none of them have had recurrence of herniation or required any additional surgical intervention (mean follow-up period: 4.7 years). To the best of our knowledge, this is the first report of TF being used to repair large diaphragmatic hernias. Our technique is simple and has proven to be reliable for durable restoration of the diaphragm, suggesting that it could reduce the dependence on synthetic patch repair, which is associated with certain long-term complications.
STUDY DESIGN: Ten participants were exposed to heavy sudden trunk loads as they might occur during patient handling. OBJECTIVES: The aim was to observe if well-trained men and women use their full rate of intra-abdominal pressure (IAP) development when exposed to heavy sudden trunk loads. Further, to elucidate to what degree the rectus abdominus muscle is activated when the IAP is developed. SUMMARY OF BACKGROUND DATA: Well-trained judo fighters are used to heavy sudden trunk loads and can produce a high IAP. It is unknown whether they use their full potential. IAP can increase the spinal stability and has been suggested to unload the spine. The unloading effect will, however, disappear if the development of the IAP demands substantial activity in the vertical fibers of the abdominal muscles. METHODS: Five male and five female well-trained judo and jujitsu fighters were exposed to heavy sudden trunk loadings through imitated patient handling situations where the patient fell and the fighters should hold the patient and prevent the fall. IAP was measured with a catheter in the stomach. Along with the IAP measurement, EMG was measured on the abdominal muscles, and the load on the low back was quantified by a three-dimensional dynamic biomechanical calculation of the torques at the L4-L5 joint. RESULTS: The well-trained judo fighters did not use their full potential of the IAP development when exposed to the heavy sudden trunk loads, but the women had to use a higher level of their IAP and extension torque capacity to comply with the heavy loads. The rectus abdominus muscle does not contribute to the IAP development when the trunk is exposed to a sudden heavy load.