Duration of insufficient blood flow is the most important prognostic factor which makes timely diagnosis and surgical intervention the cornerstones of improved outcome . Although X-ray (abdominal or upright chest) and abdominal ultrasound play a vital role in the first-line diagnostic workup of acute abdomen, they usually yield non-diagnostic results in case of ABI . Abdominal x-ray can show pneumoperitoneum, caused by bowel perforation in advanced stages of ABI, or even in some instances may show pneumatosis intestinalis in late in the disease course. Abdominal X-ray can also depict bowel distention as a non-specific finding caused by paralytic ileus in early stages of ABI. Abdominal ultrasound might be useful to assess intraperitoneal free fluid or portal venous gas in advanced ABI. Doppler study may also infrequently reveal arterial or venous occlusion in larger vessels.
A 32 y/o male presenting with acute SMV thrombosis due to protein C deficiency. CT images on first day of admission (a, b) display thrombosis (arrowhead) in SMV with segmental circumferential mural thickening in ileum (thin arrow), mesenteric fat stranding and free fluid. On day 3 (c, d), mural hyperdensity (thick arrow) is noted in non-contrast CT at the same segment without post contrast hyper-enhancement (curved arrow) suggestive of intramural hemorrhage. Mural thickening has relatively decreased. On day 9 (e, f), mural pneumatosis (asterisks) and thinning (paper thin) are depicted consistent with development of transmural necrosis which was confirmed in laparotomy
From the total of 1145 miRNAs, we obtained 16 and 17 miRNAs that showed positive and negative fold changes (FCs, tumors vs. normal tissues) in the top 1% differentially expressed miRNAs, respectively. We uncovered the target genes that were predicted by at least two prediction tools and overlapped by at least one-half of the top miRNAs, which yielded 44 genes (FC2), respectively. Higher expressions of CREB5, PTPRB and COL4A3 predicted favorable disease free survival (Hazard ratio: 0.03, 0.19 and 0.36; P value: 0.03, 0.03 and 0.08). Additionally, 79 mutated genes have been found in nine PCTs where TP53 was the only repeated mutation.
Follow-up was conducted through detailed medical records data abstraction and self-administered questionnaires, starting within six months post diagnosis and then annually, thereafter. For deceased patients, the follow-up questionnaire was sent to the next-of-kin to acquire the death information, e.g., death date. We used disease free survival (DFS) as progression-free or recurrence-free survival from the operation. Recurrence, progression or death were counted as events. We evaluated the statistical power for survival analysis, considering numbers of events and sample size and Hazard ratio (HR).
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Prepare manuscripts according to the Publication Manual of the American Psychological Association using the 7th edition. Manuscripts may be copyedited for bias-free language (see Chapter 5 of the Publication Manual). APA Style and Grammar Guidelines for the 7th edition are available.
Prepare manuscripts according to the Publication Manual of the American Psychological Association using the 7th edition. Manuscripts may be copyedited for bias-free language (see Chapter 5 of the Publication Manual).
Radiologic supine film of the abdomen demonstrated freeintraperitoneal air. A computed tomography (CT) scan of the abdomen andpelvis with oral and intravenous contrast revealed a large amount ofintraperitoneal air with extensive subcutaneous air of the abdominal andchest wall. There was no intra-abdominal fluid or extravasation ofcontrast from the gastrointestinal tract. There was no evidence ofretroperitoneal air or pneumotosis coli (Figure 2).
Although pneumoperitoneum is most commonly discovered on radiography,CT has a higher sensitivity for demonstrating the presence of freeintraperitoneal gas versus conventional radiography, 92% vs. 74%respectively.4 By monitoring for CT findings specific forintrabdominal hollow-organ perforation as the cause of freeintraperitoneal air (Table 3), CT contrast examination has been shown tobe 100% sensitive in the detection of perforation of the stomach,duodenum, and colon.4
Once pneumoperitoneum is discovered on CT, the search for a source ofperforation ensues. The most accurate evidence of an oral-contrast CTfor perforation of a hollow abdominal organ requiring surgery is theextravasation of contrast and/or free intra-abdominal fluid, not thepresence of intraperitoneal air.4 In cases ofpneumoperitoneum with CT findings of intra-peritoneal fluid orextravasation of contrast, the decision for operative intervention isclear. As seen in this case, however, only intraperitoneal air withoutadditional evidence of perforation should lead the physician to considernonsurgical causes of pneumoperitoneum. Factors such as patienthistory, previous surgeries, concurrent medical conditions, and courseof events must be evaluated prior to determining the cause of free airand subsequently the need for operative intervention versus observationand supportive care. In the sole presence of intraperitoneal air,concurrent CT findings of ventilation-induced barotrauma, such aspneumothoraces, pneumomediastinum, or subcutaneous emphysema,strengthens the argument for observation.3 Although there iscurrently no predictive correlation between the incidence of computedtomography findings of barotrauma and the occurrence of nonsurgicalpneumoperitoneum, these findings should be used as a retrospective toolto direct the physician to consider a nonsurgical cause of thepneumoperitoneum.
International Journal of Radiology and Imaging Technology is an open access, peer reviewed journal focused on radiation physics, diagnostic and therapeutic radiology. The main objective of the journal is to promote research and publications globally. The Journal provides a podium for healthcare professionals to contribute their findings and help raise awareness among readers in various aspects of radiation and therapeutic radiology. We aim to publish highest quality clinical content via open access platform providing the readers free, immediate and unlimited access. 1e1e36bf2d