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W.l. Roelofs – One of the best experts on this subject based on the ideXlab platform.

William G. Ondo – One of the best experts on this subject based on the ideXlab platform.

  • Restless Abdomen: a spectrum or a phenotype variant of restless legs syndrome?
    , 2020
    Co-Authors: Xi-xi Wang, Xiao Ying Zhu, Zan Wang, Jian-wei Dong, William G. Ondo
    Abstract:

    Abstract Background: With the growing awareness of restless legs syndrome (RLS), sensory disorders similar to RLS but initially confined to the arms, Abdomen, and perineum have been reported. One of them is restless Abdomen, which refers to a restless sensation in Abdomen. Our study is designed to evaluate the clinical phenotype of restless Abdomen and investigate its relationship with RLS.Methods: We enrolled 10 patients with restless Abdomen according to RLS diagnostic criteria, excluding the requiring of leg involvement. Laboratory examinations were performed to exclude mimics and notable comorbidities.Results: All 10 patients had RLS like symptoms in the Abdomen and otherwise satisfied all other RLS diagnostic criteria, and responded to dopaminergic therapy.Conclusions: Neurologists and gastroenterologists should be aware that RLS-related restlessness can occur in extra-leg anatomy in the absence of episodes of worsening or augmentation of restlessness.

  • Restless Abdomen: a spectrum or a phenotype variant of restless legs syndrome?
    , 2020
    Co-Authors: Xi-xi Wang, Xiao Ying Zhu, Zan Wang, Jian-wei Dong, William G. Ondo
    Abstract:

    Abstract Background: With the growing awareness of restless legs syndrome (RLS), sensory disorders similar to RLS initially confined to the arms, Abdomen, and perineum are more and more being recognized. One of them is restless Abdomen, which refers to a restless sensation in Abdomen. Our study is designed to evaluate the clinical phenotype of restless Abdomen and investigate its relationship with RLS. Methods: We enrolled 10 patients with restless Abdomen according to the RLS diagnostic criteria. Laboratory examinations were performed to exclude mimics and notable comorbidities. Results: All 10 patients had RLS like symptoms in the Abdomen and otherwise satisfied all other RLS diagnostic criteria, and responded to dopaminergic therapy. Conclusions: Neurologists should be aware of the RLS-related restlessness that can occur in extra-leg anatomy in the absence of episodes of worsening or augmentation of restlessness.

Ho, George Wai-chun – One of the best experts on this subject based on the ideXlab platform.

Michael C Chang – One of the best experts on this subject based on the ideXlab platform.

  • management of the open Abdomen from initial operation to definitive closure
    American Surgeon, 2009
    Co-Authors: Open Abdomen Advisory Panel, Michael C Chang, Andre Campbell, Timothy C Fabian, Michael G Franz, Mark Kaplan, Frederick A Moore, Lawrence R Reed, Bradford Scott, Ronald P Silverman
    Abstract:

    The open Abdomen is a relatively new and increasingly common strategy for the management of abdominal emergencies in both trauma and general surgery. The use of an abbreviated laparotomy can reduce mortality associated with conditions such as abdominal compartment syndrome; however, the resulting open Abdomen is a complex clinical problem. Modern techniques and technologies are now available that allow for improved management of the open Abdomen and the progressive reduction of the fascial defect. Indeed, recent evidence indicates that a large proportion of patients treated with open Abdomen can now be closed within the initial hospitalization. These techniques and technologies include the appropriate use of negative pressure therapy and synthetic or biologic repair materials. It is essential that general and trauma surgeons understand the core principles underlying the need for and management of the open Abdomen. Toward this goal, an Open Abdomen Advisory Panel was established to identify core principles in the management of the open Abdomen and to develop a set of recommendations based on the best available evidence. This review presents the principles and recommendations identified by the Open Abdomen Advisory Panel and provides brief case studies for the illustration of these concepts.

  • prospective evaluation of vacuum assisted fascial closure after open Abdomen planned ventral hernia rate is substantially reduced
    Annals of Surgery, 2004
    Co-Authors: Preston R Miller, Wayne J Meredith, James C Johnson, Michael C Chang
    Abstract:

    Twenty years ago, the idea of electively leaving the Abdomen of a surgical patient open after laparotomy was an abhorrent one to most surgeons. In the intervening years, the development of the concept of the damage control laparotomy and the understanding of the abdominal compartment syndrome has markedly changed this idea. It is now recognized that the combination of acidosis, coagulopathy, and hypothermia represent a potentially lethal combination in the injured patient, and prolonged operation in such a case will only worsen the problem. In this situation, abbreviated laparotomy aimed at stopping surgical bleeding and limiting contamination is usually preformed. This frequently leaves the Abdomen in such a state that the patient requires at least one if not several reoperations to restore intestinal and/or vascular continuity. We also now know that visceral or retroperitoneal edema due to shock and reperfusion may increase intraabdominal pressure to dangerous levels, leading to organ dysfunction. Patients with this constellation of symptoms must have their Abdomens left open temporarily to allow for visceral and renal perfusion as well as adequate pulmonary function. With recognition of optimal management of these 2 patient populations, the care of the injured patient has been greatly improved. With the solution to one problem, however, another has been created. A method for temporary coverage of the open Abdomen is now required. Surgeons have responded with several alternatives, many of which are effective in protecting the viscera and allowing serial access to the peritoneum.1–5 The reported eventual fascial closure rate varies from 50% to 70%, depending on the technique. All of these methods have in common the problem of the inability to obtain primary fascial closure beyond 7 to 10 days. After this, the viscera have adhered to the anterior abdominal wall and the fascia has retracted. This situation requires the creation of a planned ventral hernia and eventual abdominal wall reconstruction in the ensuing months.5 A recent report from our institution outlined the development of a technique of vacuum-assisted fascial closure (VAFC) in which a primary fascial closure rate of 69% was reported with the technique.6 More importantly, VAFC allowed for the fascial closure of 22 of these patients at large intervals after the original laparotomy (mean, 21 days; range, 9 to 49 days). The ability to close the Abdomen at such an interval was felt to be a significant improvement over earlier techniques, and a protocol for management of the open Abdomen incorporating this technique was implemented. The authors speculated on the basis of these results that more aggressive employment of VAFC under such a protocol would lead to higher rates of abdominal closure overall and further decrease need for future abdominal wall reconstruction. The aim of this study is to examine the use of VAFC under this protocol and its effect on abdominal outcome.

  • late fascial closure in lieu of ventral hernia the next step in open Abdomen management
    Journal of Trauma-injury Infection and Critical Care, 2002
    Co-Authors: Preston R Miller, James T Thompson, Byron J Faler, Wayne J Meredith, Michael C Chang
    Abstract:

    Background: The use of open Abdomen techniques in damage control laparotomy and abdominal compartment syndrome has led to development of several methods of temporary abdominal closure. All of these methods require creation of a planned hernia with later reconstruction in patients unable to undergo fascial closure in the early postoperative period. We review a method of late primary fascial closure, thus eliminating the need for delayed reconstruction in some patients. Methods: The records of all patients managed with open Abdomens over a 5-year period at a Level I trauma center were reviewed for injury characteristics, operative treatment, final abdominal closure type and timing, and outcome. Patients requiring open Abdomen who were unable to undergo fascial closure in the early postoperative period were managed with a vacuum-assisted fascial closure (VAFC) technique. This allows for constant tension on the wound edges and facilitates late fascial closure. Patients managed with planned hernia (HERNIA group) were compared with those undergoing fascial closure ≥ 9 days after initial laparotomy (LATE group) for injury severity, fistula rate, and mortality. All patients in the LATE group underwent VAFC. Results: From September 1996 to October 2001, 148 patients required management with an open Abdomen. Fifty-nine underwent fascial closure, 37 of these before postoperative day 9 and 22 on or after day 9. Mean time to closure in the LATE group was 21 days (range, 9-49 days). Injury Severity Scores were similar in the HERNIA and LATE groups (26 vs. 30, p = 0.28), as were admission base deficit (-8.8 vs. -9.5, p = 0.71), number of fistulas (1 vs. 0, p = 0.99), and mortality (17% vs. 14%, p = 0.99). Conclusion: VAFC enables late fascial closure in open Abdomen patients up to a month after initial laparotomy. Complication rates do not differ from patients with planned hernia, and the need for future abdominal wall reconstruction is avoided

R.a. Jurenka – One of the best experts on this subject based on the ideXlab platform.

  • Stimulation of pheromone biosynthesis in the moth Helicoverpa zea: action of a brain hormone on pheromone glands involves Ca2+ and cAMP as second messengers
    Proceedings of the National Academy of Sciences of the United States of America, 1991
    Co-Authors: R.a. Jurenka, Emmanuelle Jacquin, W.l. Roelofs
    Abstract:

    Isolated Abdomen and pheromone gland bioassays were utilized to determine the physiological action of the pheromone-biosynthesis-activating neuropeptide (PBAN) in the corn earworm moth Helicoverpa (= Heliothis) zea. An isolated pheromone gland bioassay showed that synthetic PBAN was active at 0.02 pmol, with maximal activity occurring at 0.5 pmol and 60 min of incubation. Second-messenger studies demonstrated that extracellular Ca2+ is necessary for PBAN activity on isolated pheromone glands. The Ca2+ ionophore A23187 stimulated pheromone biosynthesis alone, whereas the Ca2+ channel blockers La3+ and Mn2+ inhibited PBAN activity. However, the organic Ca2+ channel blockers verapamil and nifedipine did not inhibit PBAN activity. Both forskolin and two cAMP analogues stimulated pheromone biosynthesis in the absence of extracellular Ca2+, indicating that Ca2+ may activate an adenylate cyclase. The biogenic amine octopamine did not elicit pheromone production in isolated gland or Abdomen bioassays or when injected into intact female moths. Removal of the ventral nerve chord, including the terminal abdominal ganglia in isolated Abdomens, did not affect PBAN stimulation of pheromone production. Similar levels of stimulation were found when isolated Abdomens were treated with PBAN in scotophase or photophase.