Relationship between Kawasaki disease and abdominal pain

This editorial presents an analysis of an article recently published in the World Journal of Clinical Cases.Kawasaki disease(KD)is a well-known pediatric vasculitis characterized by fever,rash,conjunctivitis,oral mucosal changes,and swelling of the extremities.This editorial aims to delve into the intricate relationship between KD and abdominal pain,drawing insights from recent research findings to provide a comprehensive understanding and potential avenues for future investigation.

Histopathological Observation of Cynoglossus semilaevis Günther Infected with Red Abdominal Shell Disease

The histopathological changes in various organs of Cynoglossus semilaevis Günther infected with red abdominal shell disease were observed by dissection and HE staining. In the ill C. semilaevis, the body surface was congestive and bleeding;the skin in the blind side ulcerated with extravasated blood; the gill filaments ulcerated with a lot of mucus; the liver, pancreas and spleen were swelling and bleeding with extravasated blood; the small intestine was congestive and bleeding. Degeneration and necrosis, and submucosal bleeding occurred in the skin of C. semilaevis infected with red abdominal shell disease. There was red blood cell infiltration and deposition in the space among muscle fibers. Epithelial degeneration and necrosis occurred in the parotid gland. The efferent branchial artery was congestive. The myocardial fibers had a loose structure, and a large area of fracture appeared. The liver cells were swelling with degeneration and necrosis and concentrated nucleus. A large area of the renal interstitial was broken down and necrotic. The submucosa of the small intestine had necrosis and hemorrhage.

Management of abdominal and pelvic abscess in Crohn's disease

Patients with Crohn's disease may develop an abdominal or pelvic abscess during the course of their illness.This process results from transmural in ammation and penetration of the bowel wall,which in turn leads to a contained perforation and subsequent abscess formation.Management of patients with Crohn's related intra-abdominal and pelvic abscesses is challenging and requires the expertise of multiple specialties working in concert.Treatment usually consists of percutaneous abscess drainage(PAD)under guidance of computed tomography in addition to antibiotics.PAD allows for drainage of infection and avoidance of a two-stage surgical procedure in most cases.It is unclear if PAD can be considered a definitive treatment without the need for future surgery.The use of immune suppressive agents such as anti-tumor necrosis factor-α in this setting may be hazardous and their appropriate use is controversial.This article discusses the management of spontaneous abdominal and pelvic abscesses in Crohn's disease.

Metabolic Syndrome and Insulin Resistance Are Associated with Chronic Kidney Disease in Nondiabetic Adults with Abdominal Obesity

Aims: we investigate whether insulin resistance is associated with an increased prevalence for chronic kidney disease irrespective of the concurrent presence of metabolic syndrome. Methods: 1638 patients with abdominal obesity were selected. Metabolic syndrome and abdominal obesity were defined according to the International Diabetes Federation criteria. Insulin resistance was defined by Homeostasis Model Assessment Index >P75. Chronic kidney disease was defined by the presence of a low estimated glomerular filtration rate (Results: metabolic syndrome was present in 1030 (62.9%) patients and insulin resistance in 787 (48%). Conversely 61% of those with metabolic syndrome were insulin resistant and 79% of those with insulin resistance had metabolic syndrome. Chronic kidney disease was present in 18%. In multivariate analysis, chronic kidney disease was increased in subjects with insulin resistance (odds ratio [OR] = 1.350;CI 95%: 1.021 - 1.785;p = 0.035) and in those with metabolic syndrome (OR = 1.417;CI 95%: 1.045 - 1.922;p = 0.025). Conclusions: Metabolic syndrome and insulin resistance were significant and independently associated with chronic kidney disease in nondiabetic adults with abdominal obesity.

Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults

This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominal pain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials, the majority of which are multi-modal in orientation, incorporating elements of cognitive behavioral therapy, social learning, and relaxation. Based on this review, we offer methodological and clinical suggestions: (1) Research investigations should include adequate sample sizes, long-term follow-up assessments, and a credible, active control group. (2) Standard gastrointestinal practice should include, when appropriate, learning opportunities for patients and family members, for example, instruction regarding the encouragement of wellness behavior.

The clinical application of multi-slice spiral CT angiography in abdominal aortic disease

Objective： To evaluate the clinical application of multi-slice spiral CT angiography（MSCTA） in the assessment of abdominal aortic disease. Methods： Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent （Omnipaque 300 I g/L） 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique, Tll level abdominal aorta was set as the target vessel and the threshold was 180-200Hu, slice width was 3mm and with a pitch of 4-6. Original data were transferred to working-station to perform functional reconstruction. Results： Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms （Debakay type Ⅲ） and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rapture site of abdominal aorta intima and mural thrombus. Conelusion： MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.

Long-Term Efficacy Analysis of Exclusive Enteral Nutrition for the Treatment of Abdominal Abscess in Crohn’s Disease

Objective: The objective is to explore the long-term efficacy of total enteral nutrition in the treatment of abdominal abscess in Crohn’s disease. Methods: Patients treated with EEN in our hospital and whose abdominal abscess disappeared after 12 weeks of treatment were included, and the data of abscess recurrence and surgical treatment during follow-up were included. Results: A total of 44 consecutive cases meeting the criteria were included. The 1-year and 2-year recurrence rates were 22.5% and 39.9% respectively. Among the patients with recurrence, 10 patients chose EEN treatment again, and 5 patients received direct surgical treatment. Of the patients who chose to undergo EEN treatment again, 8 still eventually required surgery. The 1-year operative rate was 16.9%, and the 2-year operative rate was 35.6%. The median operative time was 33.3 (95% CI: 21.3, 45.4) months. Conclusions: The 2-year cumulative incidence of recurrence of abdominal abscess in CD patients whose abdominal abscess disappeared after EEN was 39.9%, and the 2-year cumulative surgical rate was 35.6%. The operative stomy rate decreased after EEN, and the primary anastomosis rate increased significantly.

Modified upper abdominal cluster transplantation in patients with end-stage liver diseases associated with insulin dependent type 2 diabetes mellitus

Objective Modified upper abdominal cluster transplantation ( MCT) ,which was inspired by classical cluster transplant technique,has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin - dependent

Effects of lornoxicam combining with fentanyl on postoperative arrhythmia and platelet function in patients with coronary artery disease after abdominal surgery

To investigate the effects of patient-controlled intravenous analgesia (PCIA) with lornoxicam and fentanyl on arrhythmia and the expression of platelet membrane glycoproteins in patients with coronary artery disease (CAD) after abdominal surgery.Methods Eighty ASA Ⅱ or Ⅲ patients with CAD aged 51～66 yrs weighing 59～68 kg presenting for abdominal surgery participated in this study.CAD was diagnosed by clinical symptoms and ischemic changes on ECG.The patients were premedicated with intramuscular henobarbital 0.1 g and scopolamine 0.3 mg.Anesthesia was induced with fentanyl,droperidol,propofol and vecuronium and maintained with propofol,fentanyl and vecuronium.The patients received PCIA after operation.The PCIA solution contained fentanyl 0.9 mg and droperidol 5 mg in 100 ml of normal saline (N.S.) in group A (n=40) or lornoxicam 56 mg,fentanyl 0.2 mg and droperidol 5 mg in 100 ml N.S. in group B (n=40).In group A the loading dose was fentanyl 0.05 mg and group B lornoxicam 4 mg.PCIA included a background infusion at 2 ml·h -1 and a bolus of 0.5 ml with a 15 min lock-out.VAS(0=no pain,10= worst pain) was used to measure pain intensity.In addition to BP,HR and SpO2 monitoring ECG was continuously monitored with a Holter monitor after operation.Blood samples were taken from peripheral vein before and 6 h after operation and on the 1st,2nd,7th and 8th postoperative days for determination of the expression of CD 62p ,CD 63 and CD 41 /CD 61 on the platelet membrane,platelet count,prothrombin time (PT) thrombin time (TT) and partial thromboplastin time (PTT).Results The two groups were comparable with respect to sex,age,body weight,severity of CAD,duration of operation and intraoperative blood loss.The patients received no blood transfusion during operation.There was no significant difference in VAS score,platelet count,PT,TT and PTT between the two groups.The incidence of atrial and ventricular premature beat on ECG and the expression of CD 41 /CD 61 ,CD 62p and CD 63 on the platelet membrane were significantly lower in group B than in group A on the 7th and 8th postoperative days(P<0.05 or 0.01).Conclusion Postoperative PCIA with lornoxicam and fentanyl can more effectively reduce the incidence of postoperative arrhythmia in patients with CAD.Suppression of activation of platelets by lornoxicam may contribute to the mechanism.10 refs,3 tabs.

Bo’s abdominal acupuncture treatment for adult-onset Still's disease:A case report

BACKGROUND Adult-onset Still's disease(AOSD)is a rare autoinflammatory disease charac-terized by nonspecific symptoms such as fever,rash,sore throat and arthralgia.This paper reports a clinical case of AOSD successfully treated with Bo’s abdo-minal acupuncture(BAA).CASE SUMMARY We report a 20-year-old man who suffered from cold exposure,presenting with high fever,rash,sore throat,arthralgia,and elevated erythrocyte sedimentation rate,leukocytosis with neutrophilic predominance,elevated ferritin,elevated C-reactive protein,and negative rheumatoid factors.He was diagnosed with AOSD based on the Yamaguchi criteria.After treatment with traditional Chinese medi-cine(TCM)decoction and prednisone acetate tablets,there was some alleviation of sore throat,joint and muscle pain,and fever,but he still had persistent low-grade fever,rash,sore throat and arthralgia.He went to the TCM acupuncture outpatient department to receive BAA.Abdominal acupoints Zhongwan(CV12),Xiawan(CV10),0.5 cm below Xiawan(CV10),Qihai(CV6),Guanyuan(CV4),bilateral Qixue(KI13),bilateral Huaroumen(ST24),bilateral Shangfengshidian(AB1)and bilateral Daheng(SP15)were selected.After 3 months treatment,all symptoms disappeared,and the laboratory examination returned to normal levels.He did not take glucocorticoids or nonsteroidal anti-inflammatory drugs afterwards,and no relapse was observed during the 3-year follow-up period.CONCLUSION BAA can be used as a complementary medical approach for treatment of AOSD.

Incidence of gallstone disease in Italy:Results from a multicenter,population-based Italian study (the MICOL project)

AIM:To evaluate gallstone incidence and risk factors in a large population-based study. METHODS: Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively, in 9611 of 11 109 (86.5%) subjects who were gallstone-free at the cross-sectional study. RESULTS: Six centers throughout Italy enrolled 9611 subjects (5477 males, 4134 females, aged 30-79 years), 9517 of whom were included into analysis: 424 subjects (4.4%) had gallstones and 61 (0.6%) had been cholecystectomized yielding a cumulative incidence of 0.67% per year (0.66% in males, 0.81% in females). Increasing age, a high body mass index (BMI), a history of diabetes, peptic ulcer and angina, and low cholesterol and high triglyceride levels were identifi ed as risk factors in men while, in females, the only risk factors were increasing age and a high BMI.Increasing age and pain in the right hypocondrium in men and increasing age in females were identifi ed as predictors of gallstones. Pain in the epigastrium/ right hypocondrium was the only symptom related to gallstones; furthermore, some characteristics of pain (forcing to rest, not relieved by bowel movements) were significantly associated with gallstones. No correlation was found between gallstone characteristics and clinical manifestations, while increasing age in men and increasing age and BMI in females were predictors of pain. CONCLUSION:Increasing age and BMI represent true risk factors for gallstone disease (GD); pain in the right hypocondrium and/or epigastrium is confi rmed as the only symptom related to gallstones.

Anthropometric indicators of visceral adiposity as predictors of non-alcoholic fatty liver disease: A review

The objective was to critically analyze studies that evaluated the predictive capacity of indicators of visceral adiposity in non-alcoholic fatty liver disease(NAFLD). The bibliographic research was carried out using the electronic database PubMed, LILACS and SciELO, references of selected articles. Although we found few studies, they have already used several indicators of visceral adiposity as waist circumference, waist-to-hip ratio, waist-to-height ratio, Lipid accumulation product, Body Shape Index, Body Roundness Index and most them were good predictors of NAFLD. Thus, the anthropometric indicators may contribute for the diagnosis of NAFLD in a simple, low-cost and noninvasive way, allowing early therapeutic measures to prevent the evolution to non-alcoholic steatohepatitis.

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Despite advancements in medical therapy of Crohn's disease(CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD(and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

Comparison of the short-term and long-term outcomes of laparoscopic hysterectomies and of abdominal hysterectomies： a case study of 4,895 patients in the Guangxi Zhuang Autonomous Region, China

Background： To evaluate the short-term and long-term outcomes after laparoscopic hysterectomy （LH） compared with abdominal hysterectomy （AH） in case of benign gynecological disease. Methods： A multi-center cohort retrospective comparative study of population among 4,895 hysterectomies （3,539 LH vs.1,356 AH） between 2007 and 2013 was involved. Operative time （OT）, estimated blood loss （EBL）, intra-operative and post-operative complications, passing flatus; days with indwelling catheter, questionnaires covering pelvic floor functions and sexual functions were assessed. Results： The EBL （174.1±157.4 vs. 263.1±183.2 cc, LH and AH groups, respectively）, passing flatus （38.7±14.1 vs. 48.1±13.2 hours）, days with indwelling catheter （1.5±0.6 vs. 2.2±0.8 days）, use of analgesics （6.5% vs. 73.1%）, intra-operative complication rate （2.4% vs. 4.1%）, post-operative complication rate （2.3 % vs. 5.7%）, post-operative constipation （12.1% vs. 24.6%）, mild and serious stress urinary incontinence （SUI） post-operative （P〈0.001; P=0.014）, and proportion of Female Sexual Functioning Index （FSFI） total score 〈26.55 post-operative （P〈0.001） of the LH group were significantly less than those of AH group. There were no significant differences in OT （106.5±34.5 vs. 106.2±40.3 min） between the two groups. Conclusions： LH is a safe and efficient operation for improving patients＇ long-term quality of life （QoL）, and LH is a cost-effectiveness procedure for treating benign gynecological disease. LH is superior to AH due to reduced EBL, reduced post-operative pain and earlier passing flatus.

Acute abdomen and ascites as presenting features of autosomal dominant polycystic kidney disease

We describe a patient with sudden onset of abdominal pain and ascites,leading to the diagnosis of autosomal dominant polycystic kidney disease(ADPKD).Her presentation was consistent with acute liver cyst rupture as the cause of her acute illness.A review of literature on polycystic liver disease in patients with ADPKD and current management strategies are presented.This case alerts physicians that ADPKD could occasionally present as an acute abdomen;cyst rupture related to ADPKD may be considered in the differential diagnoses of acute abdomen.

Transumbilical enterostomy for Hirschsprung’s disease with a two-stage laparoscopy-assisted pull-through procedure

BACKGROUND A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease(HD)due to its superior cosmetic results.One-stage transanal endorectal pull-through for the treatment of rectosigmoid HD has been widely used in newborns without complications.However,enterostomy is required in some HD cases for enterocolitis and dilated colon.Our transumbilical enterostomy(TUE)and twostage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to one-stage laparoscopy on the abdominal wall in patients with anorectal malformation,but the effect in patients with HD is unclear.AIM To evaluate the safety,efficacy and cosmetic results of TUE in two-stage laparoscopy-assisted pull-through for HD.METHODS From June 2013 to June 2018,53 patients(40 boys,13 girls;mean age at enterostomy:5.5±2.2 mo)who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution.Two enterostomy approaches were used:TUE in 24 patients,and conventional abdominal enterostomy(CAE)in 29 patients.Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon.26 patients had long-segment HD,and 16 patients had total colonic aganglionosis(TCA).The patients with left-sided HD underwent the two-stage laparoscopic Soave procedure,and the patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure.Demographics,enterostomy operative time,complications and cosmetic results were respectively evaluated.RESULTS There were no differences between the groups with respect to gender,age at enterostomy,weight and clinical type(P>0.05).No conversion to open technique was required.Two patients experienced episodes of stomal mucosal prolapse in the TUE group and 1 patient in the CAE group(8.33%vs 3.45%,P>0.05).No parastomal hernia was observed in either of the two groups.Wound infection at the stoma was seen in 1 case in the TUE group,and 2 cases in the CAE group(4.17%vs 6.90%,P>0.05).No obstruction was noted in any of the patients in the TUE group,whereas obstruction was found in 1 patient in the CAE group.Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group,respectively(12.50%vs 17.24%,P>0.05).There was no significant difference between the TUE group and CAE group in terms of the incidence of soiling and constipation(P>0.05).The cosmetic result using the scar score in the TUE group was better than that in the CAE group(6.83±0.96 vs 13.32±1.57,P<0.05).CONCLUSION TUE is a safe and feasible method for the treatment of HD,and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.

Endoscopic trans-esophageal submucosal tunneling surgery:A new therapeutic approach for diseases located around the aorta ventralis

AIM To assess the efficiency of endoscopic trans-esophageal submucosal tunneling surgery(EESTS) technique for diseases located around the aorta ventralis.METHODS Nine pigs were assigned to EESTs. The procedures were as follows: First, a long esophageal submucosal tunnel was established. Second, full-thickness myotomy was created. Third, an endoscope was entered into the abdominal cavity through a muscle incision and the endoscope was around the aorta ventralis. Eventually,celiac trunk ganglion neurolysis, partial hepatectomy and splenectomy, partial tissue resection in the area of the posterior peritoneum, and endoscopic submucosal dissection(ESD) combined with lymph node dissection were performed. The animals were given antibiotics for 5 d and necropsied 7 d after surgery.RESULTS In all surgeries, one pig died from intraperitoneal hemorrhage after doing partial splenectomy, while the other pigs were alive after successfully operating other surgeries. For surgery of celiac trunk ganglion damage, at necropsy, there was no exudation in the abdominal cavity. Regarding surgery of partial hepatectomy, the wound with part healing was observed in the left hepatic lobe, and no bleeding or obvious exudation was seen. In surgery of partial splenectomy, massive hemorrhage was observed on the splenic wound surface, and the metal clips could not stop bleeding. After surgery of retroperitoneal tissue resection, mild tissue adhesion was observed in the abdominal cavity of one animal, and another one suffered from severe infection. For surgery of ESD and lymph node dissection, a moderate tissue adhesion was observed.CONCLUSION EESTS is a feasible and safe technique for diseases located around the aorta ventralis.

Novel insight into perirenal adipose tissue: A neglected adipose depot linking cardiovascular and chronic kidney disease

Obesity is associated with adverse metabolic diseases including cardiovascular disease(CVD) and chronic kidney disease(CKD).These obesity-related diseases are highly associated with excess fat accumulation in adipose tissue.However,emerging evidence indicates that visceral adiposity associates more with metabolic and cardiovascular risk factors.Perirenal adipose tissue,surrounding the kidney,is originally thought to provides only mechanical support for kidney.However,more studies demonstrated perirenal adipose tissue have a closer association with renal disease than other visceral fat deposits in obesity.Additionally,perirenal adipose tissue is also an independent risk factor for CKD and even associated more with CVD.Thus,perirenal adipose tissue may be a connection of CVD with CKD.Here,we will provide an overview of the perirenal adipose tissue,a neglected visceral adipose tissue,and the roles of perirenal adipose tissue linking with CVD and CKD and highlight the perirenal adipose tissue as a potential strategy for future therapeutics against obesity-related disease.

Serum type Ⅳ collagen level is predictive for esophageal varices in patients with severe alcoholic disease

AIM： To determine factors predictive for esophagea varices in severe alcoholic disease （SAD）. METHODS： Abdominal ultrasonography （US） was performed on 444 patients suffering from alcoholism. Forty-four patients found to have splenomegaly and/ or withering of the right liver lobe were defined as those with SAD. SAD patients were examined by upper gastrointestinal （UGI） endoscopy for the presence of esophageal varices. The existence of esophageal varices was then related to clinical variables. RESULTS： Twenty-five patients （56.8%） had esophageal varices. A univariate analysis revealed a significant difference in age and type Ⅳ collagen levels between patients with and without esophageal varices. A logistic regression analysis identified type Ⅳ collagen as the only independent variable predictive for esophageal varices （P = 0.017）. The area under the curve （AUC） for type Ⅳ collagen as determined by the receiver operating characteristic （ROC） for predicting esophageal varices was 0.78. CONCLUSION： This study suggests that the level of type Ⅳ collagen has a high diagnostic accuracy for the detection of esophageal varices in SAD.

Abdominal lymphangiomatosis in a 38-year-old female:Case report and literature review

Lymphangioma is an uncommon benign tumor that develops in the lymphatic system. Abdominal lymphangiomatosis is extremely rare in adult patients, and the clinical symptoms of this condition are complicated and atypical. We report a case of abdominal lymphangiomatosis in a 38-year-old female who presented with intestinal bleeding and protein-losing enteropathy, as well as lesions in the lung and bones. A computed tomography scan revealed multiple small cystic lesions without enhancement. Histological examination revealed microscopic cysts were submucosal, with walls composed of thin fibrous tissue, and D2-40 stained highlight the lining of the lymphatic channels by immunohistochemical method. We make a comparison with the cases reported before, and also discuss the diagnose of diffuse pulmonary lymphangiomatosis and Gorham&#x02019;s disease.