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1.
Enhancing the Appearance of the "Six-Pack" Muscles Using Cryolipolysis: A Safe and Effective Method.
Lim, T, Ding, SW, Chua, CH, Moey, HX
Plastic and reconstructive surgery. 2021;(4):775-779
Abstract
Many individuals desire a defined and athletic body with "six-pack" abdominal muscles, but even with a strict regimen of diet and exercise, this result is unattainable for many. Cryolipolysis is a noninvasive method of reducing the subcutaneous adipose tissues lying above the rectus abdominis muscles, enhancing the six-pack appearance. Eleven nonobese adults with an average body mass index of 22.5 kg/m2 were enrolled in this study. All subjects were treated with the CoolSculpting cryolipolysis system, with most of them undergoing two rounds of treatment. Improvement in appearance of the abdominal muscles was rated using the Global Aesthetic Improvement Scale, and adverse events and subjects' satisfaction scores were recorded. Treatments were well tolerated, with no reported instances of blanching, bruising, or blistering, and with only mild cases of edema, erythema, and numbness reported by some. Mean Global Aesthetic Improvement Scale rating was 1.7, corresponding to a rating of improved to much improved. Subjects were comfortable with the procedure and satisfied with the results. In conclusion, cryolipolysis is an effective and well-tolerated method for noninvasive enhancement of abdominal muscle definition.
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2.
Effect of the Combination of Ketorolac and Bupivacaine on Transversus Abdominis Plane Block for Postoperative Analgesia After Gynecological Laparoscopic Surgery.
Jiang, Q, Huang, SQ, Jiao, J, Zhou, XM
Medical science monitor : international medical journal of experimental and clinical research. 2020;:e925006
Abstract
BACKGROUND This study assessed the additional benefits of bupivacaine when combined with ketorolac for transversus abdominis plane (TAP) block after gynecological laparoscopic surgery. MATERIAL AND METHODS This randomized, observer-blind trial recruited 153 patients who underwent gynecological laparoscopic surgery. Patients were randomly assigned to receive bupivacaine combined with ketorolac 15 mg/side for TAP block (TK group), bupivacaine for TAP block and 30 mg postoperative intravenous ketorolac (T group), or 30 mg postoperative intravenous ketorolac alone (C group). The primary endpoints included consumption of sufentanil for 24 h postoperatively, actual press times of the patient-controlled analgesia (PCA) pump, and effective press times of the PCA pump, whereas the secondary endpoints included numerical rating scale (NRS) pain scores at rest and during activity, satisfaction with analgesia, episodes of nausea and vomiting and length of hospital stay. RESULTS Sufentanil consumption, actual press times of the PCA pump, and effective press times of the PCA pump were lower in the TK and T groups than in the C group. NRS scores at rest and during activity at 1, 2, 4, 6, and 24 hours were significantly lower in the TK and T groups than in the C group. The TK and T groups showed greater satisfaction with analgesia than the C group, while the TK group showed greater overall satisfaction than the C group. Lengths of stay, rates of nausea and vomiting, and venting times did not differ significantly among the three groups. CONCLUSIONS Combined ketorolac and bupivacaine as TAP block improved the effectiveness of analgesia without increasing adverse events. Trial registration number: ChiCTR1900022577.
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3.
Acid/base alterations during major abdominal surgery: 6% hydroxyethyl starch infusion versus 5% albumin.
Kwak, HJ, Lim, OK, Baik, JM, Jo, YY
Korean journal of anesthesiology. 2018;(6):459-466
Abstract
BACKGROUND To compare the effects of intraoperative infusions of balanced electrolyte solution (BES)-based hydroxyethyl starch (HES) and saline-based albumin on metabolic acidosis and acid/base changes during major abdominal surgery conducted using Stewart's approach. METHODS Forty patients, aged 20-65 years, undergoing major abdominal surgery, were randomly assigned to the HES group (n = 20; received 500 ml of BES-based 6% HES 130/0.4) or the albumin group (n = 20; received 500 ml of normal saline-based 5% albumin). Acid-base parameters were measured and calculated using results obtained from arterial blood samples taken after anesthesia induction (T1), 2 hours after surgery commencement (T2), immediately after surgery (T3), and 1 hour after arriving at a postanesthetic care unit (T4). RESULTS Arterial pH in the HES group was significantly higher than that in the albumin group at T3 (7.40 ± 0.04 vs. 7.38 ± 0.04, P = 0.043), and pH values exhibited significant intergroup difference over time (P = 0.002). Arterial pH was significantly lower at T3 and T4 in the HES group and at T2, T3, and T4 in the albumin group than at T1. Apparent strong ion difference (SIDa) was significantly lower at T2, T3, and T4 than at T1 in both groups. Total plasma weak nonvolatile acid (ATOT) was significantly lower in the HES group than in the albumin group at T2, T3 and T4 and exhibited a significant intergroup difference over time (P < 0.001). CONCLUSIONS BES-based 6% HES infusion was associated with lower arterial pH values at the end of surgery than saline-based 5% albumin infusion, but neither colloid caused clinically significant metabolic acidosis (defined as an arterial pH < 7.35).
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4.
Transversus abdominis plane block for postoperative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial.
Tikuisis, R, Miliauskas, P, Lukoseviciene, V, Samalavicius, N, Dulskas, A, Zabuliene, L, Zabulis, V, Urboniene, J
Techniques in coloproctology. 2016;(12):835-844
Abstract
BACKGROUND Although hand-assisted laparoscopic surgery (HALS) offers patients smaller surgical incisions, they still experience pain. Currently, there is no consensus on the optimal analgesic package for patients undergoing HALS. The aim of this prospective, randomized, double-blinded, placebo-controlled clinical trial was to evaluate the effect of transversus abdominis plane (TAP) block on postoperative pain control (pain score and analgesic use) and other outcomes in colon cancer patients undergoing hand-assisted laparoscopic left hemicolectomy. METHODS Sixty-four patients with colon cancer scheduled for an elective colon resection were enrolled in this study. Patients were randomized into two groups to receive either TAP block using 20 mL of 0.375% ropivacaine (TAP block group: 32 patients) or 20 mL of 0.9% normal saline infusion (placebo group: 32 patients). Anaesthetic and surgical techniques were standardized. Twenty-four-hour postoperative analgesia was maintained by continuous infusion of 0.1-0.9 µg/kg/h fentanyl and intravenous injection of ketorolac. The primary outcome of the study was postoperative pain control (pain score and analgesic use). Pain was assessed using numeric rating scale at 2, 4, 8, 12, and 24 h after surgery at rest and during movement. Secondary outcomes included the time to resumption of intestinal function and the length of hospital stay. The data of the two groups were compared using Mann-Whitney U test. All statistical tests were two-tailed at a significance level of 0.05. RESULTS The patients' mean age was 60.50 ± 6.77 years, and 68.75% of patients were males. The mean body mass index was 26.23 ± 4.83 kg/m2. The TAP block group had lower pain scores after surgery at 2, 4, and 12 h at rest (p < 0.05), at 2 and 4 h during movement (p < 0.01) and used less fentanyl and ketorolac than the placebo group (p < 0.01). The mean time to resumption of intestinal function was shorter in the TAP block group than that in the placebo group (p < 0.0001). The mean length of hospital stay was by 2.7 days shorter in the TAP block group than in the placebo group (p = 0.001). CONCLUSIONS The ultrasound-guided TAP block given during hand-assisted laparoscopic colon surgery as part of a multimodal analgesic regimen is a feasible and effective technique for postoperative analgesia in colon cancer patients and significantly reduces both pain experienced by patients and short-term postoperative analgesic use and promotes early ambulation. Future studies are needed to determine the efficacy and costs/benefits of the ultrasound-guided TAP block in HALS.
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5.
Circulating 20S proteasome is independently associated with abdominal muscle mass in hemodialysis patients.
Fukasawa, H, Kaneko, M, Niwa, H, Matsuyama, T, Yasuda, H, Kumagai, H, Furuya, R
PloS one. 2015;(3):e0121352
Abstract
UNLABELLED Protein-energy wasting is highly prevalent in hemodialysis patients, and it contributes to patient morbidity and mortality. The ubiquitin-proteasome system is the major pathway for intracellular protein degradation and it is involved in the regulation of basic cellular processes. However, the role of this system in the determination of nutritional status is largely unknown. To examine a relationship between protein-energy wasting and the ubiquitin-proteasome system, a cross-sectional study of 76 hemodialysis patients was performed. Plasma concentrations of 20S proteasome were studied to evaluate its association with muscle and fat mass, which were investigated by abdominal muscle and fat areas measured using computed tomography and by creatinine production estimated using the creatinine kinetic model. Plasma 20S proteasome concentrations significantly and negatively correlated with abdominal muscle areas and creatinine production (rho = -0.263, P < 0.05 and rho = -0.241, P < 0.05, respectively), but not abdominal subcutaneous and visceral fat areas. Multiple regression analyses showed that 20S proteasome was a significant independent predictor of abdominal muscle area (P < 0.05). In conclusion, plasma 20S proteasome concentrations were independently associated with abdominal muscle mass in hemodialysis patients. Our findings indicate a relationship between circulating 20S proteasomes and muscle metabolism in these patients. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000012341.
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6.
Randomized controlled double-blind trial of transversus abdominis plane block versus trocar site infiltration in gynecologic laparoscopy.
El Hachem, L, Small, E, Chung, P, Moshier, EL, Friedman, K, Fenske, SS, Gretz, HF
American journal of obstetrics and gynecology. 2015;(2):182.e1-9
Abstract
OBJECTIVE The objective of the study was to determine whether transversus abdominis plane (TAP) block reduces postoperative pain when compared with trocar site infiltration of bupivacaine in gynecological laparoscopy. STUDY DESIGN This was a prospective, randomized, double-blinded clinical trial using patients as their own controls. Women undergoing gynecologic laparoscopy using a 4-port symmetrical technique were randomly assigned to right- or left-sided TAP block using 30 mL of 0.25% bupivacaine with epinephrine. Two cohorts of patients were studied. Cohort 1 consisted of anesthesiologist-administered ultrasound-guided TAP block. Cohort 2 consisted of surgeon-administered laparoscopic-guided TAP block. In both cohorts, contralateral port sites were infiltrated with an equal amount of bupivacaine in divided doses. All patients received intraoperative acetaminophen and ketorolac. Postoperative abdominal pain was assessed at 1, 2, 4, 6, 8, 12, 18, 24, and 48 hours on the block and contralateral sides, before and after palpation, using the 10 point visual analog scale. A 2 point difference in the reported pain scores was considered clinically meaningful. RESULTS Eighty-eight patients were eligible for statistical analysis: 45 and 43 patients in cohorts 1 and 2, respectively. In both cohorts, most patients reported equal pain on the block side and local side. In cohort 1, there was a statistically significant difference in mean reported pain scores at 2 hours and across time favoring the ultrasound-guided block; however, this did not reach clinical significance. There was no statistically significant difference found at all other time points or when pain scores were objectively assessed after palpation of the incisions. When comparing laparoscopic-guided block with local infiltration, there was no statistically significant difference in reported mean pain scores at all time points or after palpation. CONCLUSION As part of this multimodal analgesic regimen, neither block method provided a significant clinical benefit compared with trocar site bupivacaine infiltration.
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7.
Recurrent metastatic spread to a percutaneous gastrostomy site in a patient with squamous cell carcinoma of the tongue: a case report and review of the literature.
Nevler, A, Gluck, I, Balint-Lahat, N, Rosin, D
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2014;(4):829-32
Abstract
Patients diagnosed with head and neck squamous cell cancer (HNSCC) frequently develop dysphagia and odynophagia owing to advancing disease or as a result of medical interventions. Selected patients diagnosed with advanced HNSCC may require the insertion of a percutaneous endoscopic gastrostomy (PEG) tube as part of their management. During the past 2 decades, there have been increasing reports describing tumor seeding at the PEG exit site, which have caused controversy relating to the technique used in PEG insertion. Although PEG placement is considered a safe procedure for patients with advanced head and neck cancer, the method can lead to tumor seeding, probably from direct traumatic tumor shedding. This report describes a case of tumor implantation at the PEG site in a patient with an advanced SCC of the tongue, with a review of the available literature concerning this rare condition and its possible pathogenesis.
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8.
The effect of abdominal resistance training and energy restricted diet on lateral abdominal muscles thickness of overweight and obese women.
Noormohammadpour, P, Kordi, R, Dehghani, S, Rostami, M
Journal of bodywork and movement therapies. 2012;(3):344-350
Abstract
The role of transabdominal muscles (external oblique, internal oblique and transversus abdominis) on core stability has been shown previously. Energy restricted diet and abdominal resistance training are commonly used by overweight and obese people to reduce their weight. In this study we investigated the impact of 12 weeks concurrent energy restricted diet and abdominal resistance training on the thickness of the lateral abdominal muscles of 19 obese and overweight women employing ultrasonography in resting and drawing-in maneuvers. The results showed significant increase of the muscle thicknesses during drawing-in maneuver after 12 weeks intervention. Based on our findings, it can be concluded that 12 weeks concurrent abdominal resistance training and energy restricted diet in addition to weight loss lead to improvement of transabdominal muscles thickness in obese and overweight people. Considering the role of these muscles in core stability, using this therapeutic protocol in obese people, particularly in those who have weakness of these muscles might be helpful.
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9.
The effect of abdominal exercise on abdominal fat.
Vispute, SS, Smith, JD, LeCheminant, JD, Hurley, KS
Journal of strength and conditioning research. 2011;(9):2559-64
Abstract
The purpose of this study was to investigate the effect of abdominal exercises on abdominal fat. Twenty-four healthy, sedentary participants (14 men and 10 women), between 18 and 40 years, were randomly assigned to 1 of the following 2 groups: control group (CG) or abdominal exercise group (AG). Anthropometrics, body composition, and abdominal muscular endurance were tested before and after training. The AG performed 7 abdominal exercises, for 2 sets of 10 repetitions, on 5 d·wk(-1) for 6 weeks. The CG received no intervention, and all participants maintained an isocaloric diet throughout the study. Significance was set at p = 0.05 for all tests. There was no significant effect of abdominal exercises on body weight, body fat percentage, android fat percentage, android fat, abdominal circumference, abdominal skinfold and suprailiac skinfold measurements. The AG performed significantly greater amount of curl-up repetitions (47 ± 13) compared to the CG (32 ± 9) on the posttest. Six weeks of abdominal exercise training alone was not sufficient to reduce abdominal subcutaneous fat and other measures of body composition. Nevertheless, abdominal exercise training significantly improved muscular endurance to a greater extent than the CG.
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10.
Unique management of stage 4S neuroblastoma complicated by massive hepatomegaly: case report and review of the literature.
Roberts, S, Creamer, K, Shoupe, B, Flores, Y, Robie, D
Journal of pediatric hematology/oncology. 2002;(2):142-4
Abstract
Stage 4S neuroblastoma is an unusual malignancy that has an excellent prognosis, except in young infants. A 2-month-old with 4S neuroblastoma complicated by massive hepatomegaly, managed by abdominal decompression surgery and a negative-pressure dressing system is presented. Diffuse alveolar hemorrhage also developed, which was treated with high-dose corticosteroids.