• 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.

• 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.

• Journal of Yeungnam Medical Science
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• 제40권1호
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• pp.102-105
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• 2023

Symptomatic extravasation of irrigation fluid is a rare complication of hip arthroscopy. However, depending on the amount of fluid, intra-abdominal hypertension (IAH) may occur and even develop into abdominal compartment syndrome, which can seriously alter hemodynamic circulation. Therefore, it is important for anesthesiologists to promptly recognize the abnormal signs of IAH for early diagnosis and better clinical outcomes. Nevertheless, these signs are difficult to detect because they are usually obscured when the patient is under anesthesia and masked by surgical drapes. We report a case of IAH under general anesthesia during hip arthroscopy to highlight possible symptoms and signs.

• 한국임상수의학회지
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• 제39권5호
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• pp.277-281
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• 2022

The dog with tetraplegia was presented for magnetic resonance imaging and cervical ventral slot decompression. Intra-abdominal pressure (IAP) was measured every hour after surgery, along with respiratory rate, heart rate, and arterial pressure. Three hours after surgery, abdominal distension with agitation and respiratory distress were observed, and IAP rose to 12 mmHg, indicating mild intra-abdominal hypertension (IAH). Additional fentanyl and ketamine CRI did not alleviate IAH and acepromazine (0.01 mg/kg, IV) was administered to alleviate the agitation and respiratory distress. After acepromazine administration, the agitation subsided and IAP dropped to 4 mmHg. During the next 24 hours, the patient's vital signs and IAP remained stable, with normal urine output. This case report suggests the possibility of postoperative IAH monitoring in dogs. However, considering the nature of a single surgical case of cervical ventral slot, further study is required for indication of IAH monitoring.

• Journal of Trauma and Injury
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• 제32권2호
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• pp.86-92
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• 2019

Purpose: There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population. Methods: Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8-12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as $IAP{\geq}12mmHg$. Abdominal compartment syndrome was defined as $IAP{\geq}20mmHg$ plus ${\geq}1$ new organ failure. The main outcome measure was in-hospital mortality. Results: According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with $IAP{\geq}20mmHg$ than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum $IAP{\geq}20mmHg$ exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values. Conclusions: Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.

• 전기학회논문지
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• 제58권4호
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• pp.849-856
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• 2009

Truncal obesity associated with insulin resistance and metabolic syndrome increase the likelihood of hypertension, various cardiovascular diseases, hyperlipidemia and coronary heart diseases. International Diabetes Federation (IDF) experts recognized that it is necessary to develop the simple diagnostic tool which is applicable to diagnose truncal obesity worldwide, and proposed the method using a waist circumference but there is a limit to estimate subcutaneous fat distribution. However, waist line is also influenced by total fat capacity less than the intra abdominal fat. The more having severe obesity, the more correlation coefficient between waist line and intra abdominal fat is low. Therefore, this thesis defines a new abdominal impedance measurement position and impedance-index to analysis central obesity. This proposes the new model to estimate abdominal obesity using the abdominal impedance-index and CT images acquired fro 160 Korean subjects. The proposed model shows that the abdominal fat distribution has a higher correlation than waist line. (Adj R2=0.809, 0.667 and 0.687 with abdominal fat area, visceral fat area and subcutaneous fat area respectively).

• Journal of Trauma and Injury
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• 제24권1호
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• pp.56-59
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• 2011

Abdominal compartment syndrome (ACS) is a life-threatening disorder caused by rapidly increasing intra-abdominal pressure. ACS can result in multiorgan failure and carries a mortality of 60~70%. The treatment of choice in ACS is surgical decompression. There are very few reports of ACS and experience in Korea. We report 12-year-old male patient who developed an abdominal compartment syndrome due to traffic-accident-induced retroperitoneal hematomas, Which was successfully treated by performing a bedside emergency surgical decompression with open linea alba fasciotomy with intact peritoneum. When patients do not respond to medical therapy, a decompressive laparotomy is the last surgical resort. In patients with severe abdominal compartment syndrome, the use of a linea alba fasciotomy is an effective intervention to lower intra-abdominal hypertension (IAH) without the morbidity of a laparotomy. Use of a linea alba fasciotomy as a first-line intervention before committing to full abdominal decompression in patients with abdominal compartment syndrome improves physiological variables without mortality. Consideration for a linea alba fasciotomy as a bridge before full abdominal decompression needs further evaluation in patients with polytrauma abdominal compartment syndrome.

• Journal of Yeungnam Medical Science
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• 제33권2호
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• pp.90-97
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• 2016

Background: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. Methods: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. Results: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). Conclusion: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.

• Clinical and Experimental Reproductive Medicine
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• 제42권2호
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• pp.72-76
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• 2015

$17{\alpha}$-hydroxylase and 17,20-lyase are enzymes encoded by the CYP17A1 gene and are required for the synthesis of sex steroids and cortisol. In $17{\alpha}$-hydroxylase deficiency, there are low blood levels of estrogens, androgens, and cortisol, and resultant compensatory increases in adrenocorticotrophic hormone that stimulate the production of 11-deoxycorticosterone and corticosterone. In turn, the excessive levels of mineralocorticoids lead to volume expansion and hypertension. Females with $17{\alpha}$-hydroxylase deficiency are characterized by primary amenorrhea and delayed puberty, with accompanying hypertension. Affected males usually have female external genitalia, a blind vagina, and intra-abdominal testes. The treatment of this disorder is centered on glucocorticoid and sex steroid replacement. In patients with $17{\alpha}$-hydroxylase deficiency who are being raised as females, estrogen should be supplemented, while genetically female patients with a uterus should also receive progesterone supplementation. Here, we report a case of a 21-year-old female with $17{\alpha}$-hydroxylase deficiency who had received inadequate treatment for a prolonged period of time. We also include a brief review of the recent literature on this disorder.

• Tuberculosis and Respiratory Diseases
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• 제61권1호
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• pp.46-53
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• 2006

연구배경: IAP의 증가는 혈류량을 감소시켜 여러 장기에 영향을 준다. IAH는 IAP가 12 mmHg 이상 또는 APP가 60 mmHg 이하로, ACS는 IAP가 20 mmHg 이상이면서 동시에 하나 이상의 장기 손상이 있는 경우로 각각 정의한다. 저자들은 중환자에서 IAH 및 ACS의 유병률과 이들이 환자의 예후에 미치는 영향을 고찰하고자 하였다. 방 법: 고려대학교 의료원 중환자실에 입원하는 내과계 환자를 대상으로 하여, APACHE II 및 III 점수, SAPS II 점수를 기록하였다. IAP는 삼중관 요도관을 통하여, 입원 7일째까지 매일 3회 측정하였고, 환자가 사망하거나 일반 병실로 전실 또는 요도관을 제거할 때까지 계속하였다. 환자의 예후는 28일을 기준으로 판단하였다. 결 과: 총 111명 대상 환자들의 입원 1일 IAH 및 ACS의 유병률은 각각 47.7%, 15.3%였다. 사망군과 생존군 사이에 IAH의 유병률은 유의한 차이가 없었으나, ACS는 사망군에서 더 높았다 (p=0.004). 사망군에서 IAP는 더 높았고 (p=0.012), APP는 유의하게 낮았다 (p<0.001). 결 론: 중환자에서 입원 1일에 측정한 IAP의 증가, APP의 감소 및 ACS 발생은 환자의 사망과 연관이 있을 것으로 판단된다.