Shamimi K, Aminian A, Moazami F, Jalali M,
Volume 64, Issue 12 (6 2006)
Abstract
Background: Abdominal compartment syndrome (ACS) is a clinical entity that develops from progressive, acute increases in intra-abdominal pressure (IAP) and adversely affects all vital organ systems In this study, the development of intra-abdominal hypertension (IAH) and ACS in a surgical ICU population is described and examined.
Methods: Over a one-year period (2004), urinary bladder pressure (UBP) was measured prospectively in all surgical patients with abdominal problems admitted to the ICU of the Imam Hospital complex. UBP of >20 cm H2O indicated IAH. ACS was defined as the development of multiple organ dysfunction including peak airway pressure (PAP) >50 cm H2O, Horowitz quotient <150 torr or urine output <0.5 ml/kg/hr in the setting of IAH. Data were gathered on all patients with IAH and ACS.
Results: We evaluated some 353 patients, consisting of 165 elective laparatomies and 188 emergency cases, including 28 trauma patients. The incidence of IAH and ACS was 2 and 1 per cent (7 and 3 patients, respectively). The mean IAP of these seven patients was 29.8 cm H2O. No elevated IAP was observed after elective laparotomy (165 patients), nor in emergency cases with temporary abdominal wall closure (29 patients). APACHE II score, PAP and worst base deficit were significantly higher in patients with elevated IAP. None of the three patients with ACS underwent decompressive laparotomy. The mortality rate for patients with elevated IAP was 85%, significantly higher than the total study population.
Conclusion: IAH is a rare disease of the rarity of IAH, routine measurement of IAP is necessary only in high-risk patients. Prophylactic temporary abdominal wall closure may prevent IAH and ACS in high-risk patients. Patients with elevated IAP have dismal outcomes. Critical care practitioners should become familiar with different aspects of IAH and ACS, including decompressive laparotomy.
Hamid Ghaderi, Kourosh Shamimi, Fereydoon Moazzami, Seyed Hasan Emami Razavi, Ali Aminian, Seyed Mehdi Jalali, Reza Afghani, Morteza Noaparast, Seyyed Habibollah Dashti, Saeed Safari, Alireza Ahmadvand, Seyede Adeleh Mirjafari Daryasari, Fatemeh Sadat Naeemie,
Volume 68, Issue 1 (4 2010)
Abstract
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Background: Appendicitis is more common during the second
and third decade of life and appendectomy scar is important in terms of
cosmetic issues. The scar is an important factor in the patient's satisfaction.
Conventional teaching has an emphasis on the closure of skin incision with
"separate" sutures. The aim of this study was to reconsider this dogma.
Methods: Among 321 patients with acute
appendicitis who came to the emergency unit of Imam Khomeini Hospital in
Tehran, Iran since april 2007
till april 2008, 278 (86.6%) patients had
uncomplicated appendicitis and were enrolled in our clinical trial. The
patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular
suture closure (n=139). Anesthesia method and
surgical technique were similar between the two groups. All patients were
followed up post-operatively (four weeks) for the presence of infectious
drainage, pain, erythema, swelling and warmness at the surgical site.
Results: The patients' sex and
their mean age were not statistically different between the groups. There was
no significant difference in the frequency of surgical site complications between
the two groups (five cases in the "interrupted" group and eight cases in the
"subcuticular" group p=0.415).
Conclusion: This study showed that
appendectomy incision closure with subcuticular sutures did not increase the
risk of wound complications. From the point of better cosmetic outcome of
subcuticular sutures, this method may be the method of choice for the closure
of appendectomy incisions in uncomplicated appendicitis.
