Identifica las causas de dosis de radiación usadas en pacientes con problemas abdominales que se realizan una tomografía computada, identificando los hallazgos tomográficos. El presente estudio permite conocer dichas dosis de radiaciones en este grupo de pacientes evaluando posibles lesiones tomográficas, con lo cual se podrá saber, a la par, si la cantidad de las dosis empleadas son las más convenientes para el paciente. Es un Estudio observacional, analítico, retrospectivo y transversal. La muestra está conformado por 125 informes de pacientes con tomografías abdominales atendidos en la institución en mención divididos en dos grupos (Grupo de estudio: 18, grupo comparativo: 107). Para el análisis univariado se utilizan frecuencias absolutas y relativas, promedio y desviación estándar. Para el análisis inferencial se utiliza la prueba chi cuadrado siendo significativo cuando p <0.05. / Tesis

Radiography is a common radiologic investigation despite abundant evidence of its limited diagnostic value. On the other hand, computed tomography (CT) has a high diagnostic value and is widely considered to be among the most important advances in medicine. However, CT exposes patients to a higher radiation dose and it might therefore not be acceptable simply to replace radiography with CT, despite the powerful diagnostic value of this technique. At the expense of reduced CT image quality, which could be adjusted to the diagnostic needs, low-dose CT of abdomen and lumbar spine can be performed at similar dose to radiography. The aim of the current thesis project was to evaluate low-dose CT of the abdomen and lumbar spine and to compare it with radiography. The hypothesis was that CT would give better image quality and diagnostic information compared to radiography at similar dose levels. Firstly, the diagnostic accuracy of low-dose CT of the abdomen was evaluated. Results showed that low-dose CT of abdomen has a high sensitivity and specificity compared to radiography, i.e., it has higher diagnostic accuracy. Similar results were obtained from our systematic review. Secondly, in a phantom study, an ovine phantom was scanned at various CT settings. The image quality was evaluated to obtain a protocol for the optimal settings for low-dose CT of lumbar spine at 1 mSv. This new protocol was then used in a clinical study to assess the image quality of low-dose CT of the lumbar spine and compare it to radiography. Results showed that low-dose CT has significantly better image quality than radiography. Finally, the impact of Iterative reconstruction (IR) on image quality of lumbar spine CT was tested. Iterative reconstruction is a recent CT technique aimed to reduce radiation dose and/or improve image quality. The results showed that the use of medium strength IR levels in the reconstruction of CT image improves image quality compared to filtered back projection. In conclusion, low-dose CT of the abdomen and lumbar spine, at about 1 mSv, has better image quality and gives diagnostic information compared to radiography at similar dose levels and it could therefore replace radiography.

Abstract Magnetic resonance imaging (MRI) provides high contrast and spatial resolution images in arbitrarily chosen plane without ionizing radiation. These valuable features make it an attractive technique for guiding percutaneous interventional procedures. The purpose of this study was to develop percutaneous abdominal diagnostic and therapeutic procedures in MRI surroundings by evaluating the feasibility, safety and clinical results of specific interventional procedures. The safety and accuracy of MRI-guided abdominal biopsy was evaluated by performing MRI-guided biopsy on 31 patients who were not amenable for an ultrasound-guided biopsy. The locations of the lesions were liver, pancreas, lymph node, retroperitoneal mass, adrenal gland, and spleen. Fine-needle aspiration (FNA) biopsy was performed on all 31 patients; 18 patients underwent both FNA biopsy and cutting needle core biopsy. The sensitivity, specificity and accuracy of FNA and core biopsies were 71, 100 and 81%, and 90, 100 and 94%, respectively. No immediate or late complications occurred. The feasibility and safety of MRI-guided percutaneous drainage of pancreatic fluid collections was assessed by performing ten percutaneous drainages under MRI-guidance. Five of the patients had symptomatic pseudocysts and five had pancreatic abscesses. All procedures were performed with an MRI-compatible drainage kit using the Seldinger technique. All drainage catheters could be successfully placed into the pancreatic fluid collections under MRI-guidance with a mean procedure time of 44 minutes. No immediate complications occurred. The feasibility and safety of MRI-guided percutaneous nephrostomy was evaluated by performing eight nephrostomies with MRI-guidance. The degree of the dilatation of the renal collecting system varied from minimal to severe. All procedures were performed solely under MRI guidance with MRI-compatible instruments. Seven out of eight nephrostomies were successfully performed under MRI guidance; nephrostomy catheter could not be placed in a nondilated system. The mean procedure time was 26 minutes. No major complications occurred during the procedures or follow-up. The safety and effectiveness of MRI-guided percutaneous laser ablation for the treatment of small renal cell carcinoma (RCC) was assessed by treating eight patients with ten tumors with percutaneous MRI-guided laser ablation. All tumors were biopsy-proven RCCs. One to four laser fibers were used per tumor and the tumors were ablated under near real-time MRI control. All but one tumor were successfully ablated in one session. One complication, a myocardial infarction, occurred; all other patients tolerated the procedure well. No local recurrence was discovered during the follow-up with a mean time of 20 months. / Tiivistelmä Magneettikuvauksella elimistön kudoksista ja sairauksista saadaan tarkkaa tietoa missä tahansa kuvaussuunnassa ilman ionisoivaa säteilyä. Näiden ominaisuuksiensa takia magneettikuvaus on houkutteleva menetelmä myös kuvantaohjattujen perkutaanisten toimenpiteiden tekemiseen. Tämän tutkimuksen tavoitteena oli kehittää perkutaanisia vatsan magneettiohjattuja toimenpiteitä. Tämä tehtiin arvioimalla magneettikuvauksen soveltuvuutta, turvallisuutta ja kliinisiä tuloksia erilaisten diagnostisten ja terapeuttisten toimenpiteiden ohjaamisessa. Magneettiohjattujen vatsan neulanäytteiden turvallisuutta ja tarkkuutta arvioitiin 31 potilaalla, joille ei voitu tehdä ultraääniohjattua biopsiaa. Näytteitä otettiin maksasta, haimasta, imusolmukkeista, retroperitoneaalisista kasvaimista, lisämunuaisista ja pernasta. Kaikilta 31 potilaalta otettiin solunäyte, 18 potilaalta otettiin lisäksi kudosnäyte. Solunäytteiden sensitiivisyys oli 71&#160;%, spesifisyys 100&#160;% ja tarkkuus 90&#160;%; kudosnäytteissä vastaavat luvut olivat 90&#160;%, 100&#160;% ja 94&#160;%. Neulanäytteiden otosta ei aiheutunut yhtään komplikaatiota. Magneettiohjauksen soveltuvuutta ja turvallisuutta haiman nestekertymien perkutaanisessa dreneerauksessa arvioitiin kymmenellä potilaalla, joista puolella oli oireileva haiman pseudokysta ja puolella haiman absessi. Kaikki kanavoinnit tehtiin Seldingerin tekniikalla käyttäen magneettiyhteensopivia toimenpidevälineitä. Kaikkien nestekertymien dreneeraus magneettiohjatusti onnistui ilman välittömiä komplikaatioita ja keskimäärin toimenpiteeseen kului aikaa 44 minuuttia. Magneettiohjauksen soveltuvuutta ja turvallisuutta punktionefrostomian tekemiseen tutkittiin kahdeksalla potilaalla, joilla hydronefroosin aste vaihteli vähäisestä vaikeaan. Kaikki toimenpiteet tehtiin magneettiyhteensopivilla toimenpidevälineillä. Magneettiohjatut punktionefrostomiat onnistuivat lukuun ottamatta yhtä potilasta, jolla munuaispikareissa oli vähäistä laajentumaa. Keskimääräinen toimenpideaika oli 26 minuuttia eikä yhtään hoitoa vaativaa komplikaatiota tapahtunut. Magneettiohjatun perkutaanisen munuaissyövän laserpolton turvallisuutta ja tehokkuutta tutkittiin kahdeksalla potilaalla, joilla oli yhteensä kymmenen kasvainta. Kaikki kasvaimet olivat biopsialla varmennettuja munuaissyöpiä. Laserpoltot tehtiin lähes reaaliaikaisessa magneettikuvauskontrollissa käyttäen yhdestä neljään laserkuitua jokaista kasvainta kohden. Yhtä lukuun ottamatta kaikkien kasvainten poltto onnistui yhdellä hoitokerralla. Yhdellä potilaalla hoitoa komplisoi sydäninfarkti, mutta muut sietivät hoidon hyvin. Potilaita seurattiin hoidon jälkeen keskimäärin 20 kuukautta eikä seurannassa todettu yhtään taudin uusiutumaa.

In extremely preterm infants, acute abdominal emergencies are fortunately less common with improving care. Spontaneous intestinal perforation and necrotizing enterocolitis are conditions where emergency surgery is most often needed. Conservative medical management and placement of temporary drain are often used in the initial management. Internal hernia (IH) is an uncommon cause of bowel obstruction in neonates, is difficult to diagnose and unfortunately are found only at autopsy. The presentation in preterm infants, distinction between these conditions, and the need for early diagnosis of IH are discussed.

M.Tech. / Purpose: Chiropractic adjustment has been shown to be an effective treatment for low back pain (Cox, 1999 and Lawrence et al, 2008). The role that the transverse abdominus plays in low back pain is not clear. Sacroiliac adjustment changes the activation speed (Marshall and Murphy, 2006) and the strength of contraction of transverse abdominus. This study aims to determine the short-term effects of chiropractic manipulative treatment on the feed-forward activation of the deep abdominal muscles in patients with chronic low back pain. Method: Forty five participants with chronic mechanical low back pain were used in this study. The primary cause of their back pain was mechanical. The study consisted of three randomly selected groups of participants. Group one was treated using abdominal exercise only. Group two was treated using both chiropractic manipulation and abdominal exercise. Group three was treated using chiropractic manipulation only. Procedure: The effect on the feed-forward activation of transverse abdominus and internal oblique was measured and recorded using surface electromyography in each group. The participants also completed an Oswestry Low Back Pain and Disability Questionnaire and a Numerical Pain Rating Scale in order to record any change in back pain. Participants were seen seven times over a maximum four week period. Readings were taken on the first, third and fifth and seventh visits. Results: Statistically significant (p<0.05) results were seen in all three groups for the Oswestry Pain and Disability Questionnaire and Numerical Pain Rating Scale. Minimum EMG results were not statistically significant, however group three showed improvement clinically. Maximum EMG results were also did not show a statistically significant change. Feed-forward activation of the transverse abdominus muscle showed no statistically significant change. Conclusion: Favourable results were obtained clinically for all three groups. Group three (chiropractic manipulation only) was shown to be the most effective in terms of patient perception of pain and disability. Objectively, the results were less definitive. Chiropractic manipulation alone had the most favourable effect on the resting surface EMG readings of the transverse abdominus, while chiropractic manipulation combined with abdominal exercises and abdominal exercises alone did not show this change. This too was seen in the results for the maximum EMG readings. Onset times of the transverse abdominus muscle showed no improvement.

Publicación a texto completo no autorizada por el autor / Determina cuales son los factores asociados a la mortalidad postoperatoria en los pacientes adultos mayores sometidos a cirugía abdominal en el Centro Médico Naval durante el periodo de Enero del 2009 a Diciembre 2011. Es un estudio observacional, analítico, retrospectivo de casos controles, se incluyo a todos los pacientes mayores de 65 años operados durante el periodo 2009-2011 y cuyas historias clínicas estén completas, de las cuales se obtendrán las variables en estudio, a través de una ficha de recolección de datos. Se analizaron variables preoperatorias, intraoperatorias y postoperatorias. Se analizaron los factores de riesgo de morbimortalidad en los pacientes intervenidos de emergencia y en los intervenidos electivamente. Se realizaró un análisis multivariable correlacionando las diferentes variables mediante la prueba de la X2 Pearson con un intervalo de confianza del 95%. Durante el periodo que abarca el estudio fueron intervenidos 385 pacientes ancianos con ingreso hospitalario: 122 de emergencia y 263 de forma electiva. Durante el ingreso Hospitalario murió un total de 28 pacientes; 1 intraoperatoriamente y 27 tras la intervención quirúrgica. Variables preoperatorias: Existe asociación entre el número de patologías y la reducción de la sobrevida (p < 0.0001); La edad mayor a 75 años demostró tener una mayor mortalidad estadísticamente significativa (p=0.004 y Ji2 = 8.145); Se encontró que existe asociación entre un mayor grado de ASA y una menor sobrevida, la cual fue estadísticamente significativa (p < 0.0001 y Ji2 = 60.717) ;La mayor mortalidad se encontró en pacientes con patología de esófago, estómago, intestino Delgado y colon, con sobrevidas menores al 77.1%,esto fue estadísticamente significativo. (p < 0.0001 y Ji2 = 23.212). Variables intraoperatorias: La cirugía de emergencia es un factor de riesgo independiente de mortalidad (22.13% de mortalidad en relación con el 0,38% para la cirugía electiva), La clase de herida mostro estar asociada a una menor sobrevida la cual fue estadísticamente significativa. (p < 0.0001 y Ji2 =60.029); respecto a la complejidad de la cirugía encontramos que la mayor mortalidad se ve en los grados II y III, que la sobrevida en grado II fue de 13.5%, grado III 47.8%. Esta diferencia de proporciones fue asociada estadísticamente (p=0.0001). Variables postoperatorias: Las complicaciones postoperatorias fueron los principales factores de riesgo de mortalidad, Se encontró que la menor sobrevida se presento en el grupo con shock séptico y fistula intestinal, esta fue estadísticamente significativa. (p < 0.0001 y Ji2 = 153.122). La neumonía mostro ser una de las complicaciones extra abdominales con una menor sobrevida estadísticamente significativa. (p < 0.0001 y Ji2 = 117.318). La prevención y el correcto tratamiento de todos los factores de riesgo Preoperatorios, Intraoperatorios y Postoperatorios se presume disminuirían de forma Significativa los índices de mortalidad y morbilidad de los pacientes intervenidos quirúrgicamente, en especial en aquellos intervenidos de emergencia. / Trabajo de investigación

La presente revisión es una investigación secundaria en metodología enfermería basada en evidencias; tiene como objetivo: describir los beneficios de las técnicas de expansión pulmonar en pacientes adultos mayores postoperados de cirugía abdominal. Para esta investigación se formuló siguiente pregunta clínica: ¿Cuál es la eficacia de los ejercicios de respiración en la mejora de la función pulmonar y complicaciones en adultos mayores post operados en cirugía abdominal? Las estrategias de búsqueda de evidencias se desarrollaron accediendo la base de datos (Pubmed, Scielo, Science Direct). La investigadora mediante una revisión sistemática selecciona 01 artículo que cumplió con criterios de validez, el cual se sometió a una revisión con lista de chequeo PRISMA para el comentario crítico. La respuesta a la pregunta clínica es: Las complicaciones respiratorias son frecuentes en pacientes de cirugía toraco-abdominal, es por ello que las técnicas de expansión pulmonar son una buena opción para los pacientes, porque mediante ellas se evitaran complicaciones como por ejemplo acúmulo de secreciones, atelectasias, neumonías, etc. El nivel de evidencia según Scottish Intercollegiate Guidel Network 1 +

Identifica los hallazgos imagenológicos del cáncer gástrico en pacientes con tomografía computada abdominal atendidos en el Hospital PNP Luis N. Sáenz de Lima en el año 2016. El estudio es de tipo observacional, enfoque cuantitativo, diseño descriptivo, retrospectivo y de corte transversal. La muestra se conformó por 40 historias clínicas - radiológicas de los pacientes con tomografía abdominal (gástrica) con administración de contraste endovenoso atendidos en el Hospital PNP Luis N. Sáenz, que cumplieron con los criterios de selección. El cáncer gástrico por tomografía computada se localizó a nivel anatómico en el tercio inferior (60%) y a nivel circunferencial en la curvatura menor (55%). La morfología fue de bordes irregulares (65%), diámetro de 5 a 10 cm (55%), zona de necrosis en un 25%, ulceración en un 27.5%, calcificación en un 12.5%. Las alteraciones más frecuentes fueron el engrosamiento parietal según patrón de atenuación blanco (70%) y el realce heterogéneo a la administración de contraste (62.5%). Las adenopatías tuvieron un diámetro de 2.12 cm, en un número de 5 a 9 ganglios (42.5%) y de localización perigástrica (32.5%). Se concluye que los hallazgos imagenológicos del cáncer gástrico en pacientes con tomografía computada atendidos en el Hospital PNP Luis N. Sáenz de Lima fueron localización anatómica en el tercio inferior, con bordes irregulares, tamaño del diámetro del tumor de 5 a 10cm, espesor parietal de 1.92cm, frecuencia de 5 a 9 ganglios con mayor diámetro de 2.12 cm y su localización perigástrica. / Tesis

The Wnt family of secreted proteins consists of 19 family members (in the mouse) and is known to signal through multiple pathways that regulate crucial processes in the development of almost all tissues. Dissecting the roles of individual Wnts has been hampered due to functional redundancy that exists between family members. We made use of a conditional allele of the acyltransferase, Porcupine (Porcn), that is required for the secretion of all Wnt ligands, and the Msx2Cre deleter to eliminate the secretion of all Wnt ligands from the ventral limb ectoderm, ventral abdominal ectoderm, and urogenital ectoderm. Phenotypically the limbs of these mice have several similarities with En1 mutant mice which have a double-dorsal phenotype. however, we show that appropriate dorsoventral limb pattern is maintained at the molecular level and that the observed defects are due to a failure to appropriately execute ventral pattern. Additionally, newborn mice lack ventral digital tendons and the most superficial musculature in the regions of strongest and earliest deletion. Molecular analysis indicates that tendons are lost downstream of the absent musculature and are initially patterned correctly. Thus we show a role for ectodermal Wnts in the development of underlying musculature. We additionally examine the role of limb mesenchymal Wnts in the development of deeper limb musculature utilizing the Prx1Cre deleter. The deep musculature of the autopod and zeugopod is reduced or absent in mutants and the development of superficial musculature appears to proceed normally. Hence we show that superficial muscles require only ectodermal Wnts and deeper muscles require only mesenchymal Wnts.

The use of computed tomography in patients with gastrointestinal disease is increasing. However, the triple-phase computed tomographic angiographic appearance of the canine small intestine and the effects that phase of contrast enhancement and plane of reconstruction have on the appearance of the small intestine have not been fully evaluated. The purposes of this study were to investigate these effects on the appearance of the small intestinal wall. The minimal and maximal small intestinal diameter, wall thickness, number of wall layers identified, and degree of mucosal enhancement were recorded. The plane of reconstruction did not have any significant effects on wall thickness, diameter, degree of mucosal enhancement, or number of wall layers identified. There was a positive association between body weight and intestinal diameter. The arterial phase demonstrated the greatest mucosal enhancement and number of wall layers identified. The transverse plane was subjectively the most useful for evaluation of the small intestines.