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Mesenteric ischemia

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https://www.readbyqxmd.com/read/29028769/activation-of-the-nuclear-receptor-fxr-improves-intestinal-cell-tolerance-to-ischemia-reperfusion-injury
#1
Xuan Wang, Shuo Li, Man Chen, Jing Liu, Ruirui Dong, Humin Wang, Shigong Zhu
The farnesoid X receptor (FXR) plays an important role in bile acid metabolism, intestinal homeostasis, and intestinal ischemia-reperfusion (I/R) injury. We aimed to clarify the potential effects of FXR on intestinal epithelial cell tolerance to intestinal I/R injury and reveal the underlying mechanisms. An intestinal I/R injury model was established by the occlusion of the superior mesenteric artery for ischemia for 1 h, followed by reperfusion for 4 h in C57BL/6 (wild-type; WT)and FXR mice. The small intestine injury was assessed by histological analysis...
October 12, 2017: Shock
https://www.readbyqxmd.com/read/28987434/mesenteric-ischemia-a-deadly-miss
#2
REVIEW
Manpreet Singh, Brit Long, Alex Koyfman
Mesenteric ischemia has 4 etiologies: arterial embolus, arterial thrombosis, venous thrombosis, and nonocclusive. No history or physical examination finding can definitively diagnose the condition. A wide variety of presentations occur. Pain out of proportion and gut emptying may occur early, with minimal tenderness. Once transmural infarction occurs, peritoneal findings and tenderness to palpation may occur. Physicians must be suspicious of pain out of proportion and scrutinize risk factors. Computed tomography angiography is the best imaging modality...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28986677/split-bolus-single-scan-cta-for-evaluation-of-mesenteric-ischemia
#3
Patricia C Jo, Fernanda C Cabral, Azize Sahin, Andrés Camacho, Alexander Brook, Olga R Brook
PURPOSE: To evaluate split-bolus single scan CTA protocol for evaluation of acute mesenteric ischemia. MATERIALS AND METHODS: In this HIPAA-compliant IRB-approved study, consecutive patients evaluated for mesenteric ischemia between 11/2015 and 10/2016 were included. Patients scanned prior to 4/2016 were scanned with multiphasic CTA protocol and after with split-bolus single scan CTA. Objective and subjective evaluation was performed by three board-certified readers...
October 6, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/28972809/non-occlusive-mesenteric-ischemia-ct-findings-clinical-outcomes-and-assessment-of-the-diameter-of-the-superior-mesenteric-artery
#4
Carlos Pérez-García, Enrique de Miguel Campos, Adriana Fernández Gonzalo, Carlos Malfaz, Jesus Martín Pinacho, Carmen Fernández Álvarez, Raquel Herranz Pérez
OBJECTIVE: Review of the experience of a tertiary care centre for almost 10 years in the CT diagnosis of non-occlusive mesenteric ischemia (NOMI). Analysis of CT findings, correlation with clinical outcomes and evaluation of the usefulness of measuring the superior mesenteric artery (SMA) diameter for the diagnosis of NOMI. METHODS: 106 patients were diagnosed with NOMI in a biphasic CT examination from 2008 to 2017 in our hospital. Clinical outcomes and CT findings were reviewed...
October 3, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/28956274/successful-treatment-of-non-occlusive-mesenteric-ischemia-with-indocyanine-green-fluorescence-and-open-abdomen-management
#5
Toshiyuki Irie, Takeshi Matsutani, Nobutoshi Hagiwara, Tsutomu Nomura, Itsuo Fujita, Yoshikazu Kanazawa, Daisuke Kakinuma, Eiji Uchida
Non-occlusive mesenteric ischemia (NOMI), which can lead to multifocal and segmental intestinal necrosis without demonstrable occlusion in the main mesenteric artery, is associated with extremely high mortality. Because these intestinal ischemic changes can progress, it is difficult to make a definitive determination intraoperatively as to whether resection of damaged intestine is required. A 62-year-old man who underwent esophagectomy for advanced cervicothoracic esophageal cancer complained of severe abdominal pain on postoperative day 4...
September 27, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28955699/effect-of-clinical-suspicion-by-referral-physician-and-early-outcomes-in-patients-with-acute-superior-mesenteric-artery-embolism
#6
Hyung-Kee Kim, Deokbi Hwang, Sujin Park, Seung Huh, Jong-Min Lee, Woo-Sung Yun, Young-Wook Kim
PURPOSE: To investigate the pattern of referral of patients with superior mesenteric artery embolism (SMAE) and its effect on outcomes, and to evaluate the risk factors for bowel infarction. MATERIALS AND METHODS: This retrospective study included 66 consecutive patients diagnosed with acute SMAE between January 2001 and June 2016. Appropriate diagnosis by the referring physician was defined if the referral letter indicated that acute mesenteric ischemia was suspected or had been diagnosed at the referral center...
September 2017: Vascular Specialist International
https://www.readbyqxmd.com/read/28948335/damage-control-surgery-for-non-traumatic-abdominal-emergencies
#7
Edouard Girard, Julio Abba, Bastien Boussat, Bertrand Trilling, Adrian Mancini, Pierre Bouzat, Christian Létoublon, Mircea Chirica, Catherine Arvieux
BACKGROUND: Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies. METHODS: Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7...
September 25, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28946776/complications-and-perioperative-management-of-patients-undergoing-thoracic-endovascular-aortic-repair
#8
Anna P Sattah, Michael H Secrist, Shawn Sarin
Endovascular treatments have become increasingly common for patients with a variety of thoracic aortic pathologies. Although considered less invasive than traditional open surgical approaches, they are nonetheless complex procedures. Patients undergo manipulation of an often calcified aorta near the origin of the carotid and subclavian vessels and have stents placed in a curved vessel adjacent to a perpetually beating heart. These stents can obstruct blood flow to the spinal cord, induce an inflammatory response, and in rare cases erode into the adjacent trachea or esophagus...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28920529/surgical-interventions-for-organ-and-limb-ischemia-associated-with-primary-and-secondary-antiphospholipid-antibody-syndrome-with-arterial-involvement
#9
Carlos A Hinojosa, Javier E Anaya-Ayala, Karla Bermudez-Serrato, Ramón García-Alva, Hugo Laparra-Escareno, Adriana Torres-Machorro, Rene Lizola
OBJECTIVE: The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience. METHODS: Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28920023/re-tubularization-of-highly-ischemic-anti-mesenteric-border-rehab-a-novel-bowel-preservation-technique-in-complex-gastroschisis
#10
Richard J Hendrickson, Ashwini S Poola, Katherine W Gonzalez, Joel Lim, Tolulope A Oyetunji
Complex gastroschisis with bowel necrosis poses an operative challenge. Surgeons must weigh the decision between resection versus preservation of ischemic bowel. As one of the leading causes of short bowel syndrome, aggressive resection in complicated gastroschisis subjects children to prolonged dependence on parenteral nutrition and its attendant complications. Herein, we describe a novel technique aimed towards bowel preservation in complex gastroschisis patients with severe bowel ischemia with the ultimate goal for enteral autonomy...
July 2017: Journal of Neonatal Surgery
https://www.readbyqxmd.com/read/28915217/estradiol-modulates-local-gut-injury-induced-by-intestinal-ischemia-reperfusion-in-male-rats
#11
Fernanda Yamamoto Ricardo-da-Silva, Evelyn Thaís Fantozzi, Sara Rodrigues-Garbin, Ricardo Martins Oliveira-Filho, Bernardo Boris Vargaftig, Ana Cristina Breithaupt-Faloppa, Wothan Tavares de Lima
Intestinal ischemia and reperfusion (I/R) triggers a systemic inflammatory response characterized by leukocyte mobilization from the bone marrow, release of cytokines to the circulation, and increased microvascular permeability, leading to high mortality. Females have shown attenuated inflammatory response to trauma when compared with males, indicating a role for female sex hormones in this process. Here, we have evaluated the effect of estradiol on the local gut injury induced by I/R in male rats. I/R was induced by the clamping of the superior mesenteric artery for 45 min, followed by 2 h of reperfusion...
October 2017: Shock
https://www.readbyqxmd.com/read/28914638/long-term-risk-and-predictors-of-cardiovascular-death-in-stable-coronary-artery-disease-the-coronor-study
#12
Christophe Bauters, Olivier Tricot, Thibaud Meurice, Nicolas Lamblin
BACKGROUND: There is limited knowledge on the residual risk of cardiovascular death (CVD) in patients with stable coronary artery disease (CAD) who receive modern secondary prevention. Our aim was to analyze the causes of death and to determine predictors of CVD in the 5-year CORONOR registry. METHODS: We studied 4184 consecutive CAD outpatients who were free from any myocardial infarction (MI) or coronary revascularization for more than 1 year at inclusion. Antithrombotics were prescribed in 99%, statins in 92%, inhibitors of renin-angiotensin system in 82%, and β-blockers in 79%; 86% had prior coronary revascularization...
September 13, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28906389/risk-factor-analysis-for-nonocclusive-mesenteric-ischemia-following-cardiac-surgery-a-case-control-study
#13
Ju Yong Lim, Joon Bum Kim, Sung Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
Although rare, postcardiac surgery nonocclusive mesenteric ischemia (NOMI) is a life-threatening condition. Identifying the risk factors for NOMI during immediate postoperative period may help early detection and intervention, which leads to improved clinical outcomes. The objective of this study was to identify the clinical features and risk factors of NOMI for prognosis identification after cardiac surgery, focusing on immediate postoperative parameters.Among 9445 patients who underwent cardiac surgery over a span of 9 years, 40 NOMI cases (0...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28902940/bacterial-translocation-and-mortality-on-rat-model-of-intestinal-ischemia-and-obstruction
#14
Rafael Izar Domingues da Costa, Roberto Rasslan, Marcia Kiyomi Koike, Edivaldo Massazo Utiyama, Edna Frasson de Souza Montero
Purpose: To develop an experimental model of intestinal ischemia and obstruction followed by surgical resection of the damaged segment and reestablishment of intestinal transit, looking at bacterial translocation and survival. Methods: After anesthesia, Wistar rats was subject to laparotomy, intestinal ischemia and obstruction through an ileal ligature 1.5cm of ileum cecal valve; and the mesenteric vessels that irrigate upstream of the obstruction site to approximately 7 to 10 cm were ligated...
August 2017: Acta Cirúrgica Brasileira
https://www.readbyqxmd.com/read/28893640/agmatine-attenuates-intestinal-ischemia-and-reperfusion-injury-by-reducing-oxidative-stress-and-inflammatory-reaction-in-rats
#15
Inci Turan, Hale Sayan Ozacmak, V Haktan Ozacmak, Figen Barut, Mehmet Araslı
AIMS: Oxidative stress and inflammatory response are major factors causing several tissue injuries in intestinal ischemia and reperfusion (I/R). Agmatine has been reported to attenuate I/R injury of various organs. The present study aims to analyze the possible protective effects of agmatine on intestinal I/R injury in rats. MAIN METHODS: Four groups were designed: sham control, agmatine-treated control, I/R control, and agmatine-treated I/R groups. IR injury of small intestine was induced by the occlusion of the superior mesenteric artery for half an hour to be followed by a 3-hour-long reperfusion...
September 8, 2017: Life Sciences
https://www.readbyqxmd.com/read/28890065/comparison-of-endovascular-stent-grafts-for-abdominal-aortic-aneurysm-repair-in-medicare-beneficiaries
#16
Dominique B Buck, Peter A Soden, Sarah E Deery, Sara L Zettervall, Klaas H J Ultee, Bruce E Landon, A James O'Malley, Marc L Schermerhorn
BACKGROUND: Increased renal complications have been suggested with suprarenal stent grafts, but long-term analyses have been limited. Therefore, the purpose of this study was to evaluate the effect of endograft choice on perioperative and long-term outcomes. METHODS: We compared Medicare beneficiaries undergoing endovascular AAA repair from 2005-2008 with endografts with infrarenal fixation and a single docking limb (AneuRx, Excluder) to those with suprarenal fixation and two docking limbs (Zenith), or a unibody configuration (Powerlink)...
September 7, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28890058/reversal-of-acute-mesenteric-ischemia-by-salvation-of-the-meandering-mesenteric-artery-with-stenting-of-the-left-internal-iliac-artery
#17
Kotsis Thomas, Christoforou P, Nastos C, Chatziioannou A, Theodosopoulos T
The presence of the meandering mesenteric artery, which is a non-constant tortuous arterial component unifying the peripheral intestinal circulation, is evidence of chronic occlusive disease of the main intestinal arteries. This collateral intestinal arterial pathway, when present, must be preserved in any abdominal intervention, as it is often the only remaining arterial supply of the intestine; its ligation can be accompanied by intestinal ischemia. We present herein, the case of a 42-year old man, heavy smoker, who had chronic mesenteric ischemia without particular clinical manifestations till the hospitalization for acute myocardial infarction for which he underwent balloon angioplasty and stenting of the left circumflex coronary artery...
September 7, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28877988/il-17a-produced-by-innate-lymphoid-cells-is-essential-for-intestinal-ischemia-reperfusion-injury
#18
Mayya Geha, Maria G Tsokos, Robin E Bosse, Tatyana Sannikova, Yoichiro Iwakura, Jurandir J Dalle Lucca, Rene De Waal Malefyt, George C Tsokos
Ischemia-reperfusion (IR) injury to the small intestine following clamping of the superior mesenteric artery results in an intense local inflammatory response that is characterized by villous damage and neutrophil infiltration. IL-17A, a cytokine produced by a variety of cells in response to inflammatory cytokines released following tissue injury, has been implicated in IR injury. Using Il17a(-/-) , Il23r(-/-) , and Rorc(-/-) mice and administration of anti-IL-17A and anti-IL-23 neutralizing Abs to wild-type mice, we demonstrate that intestinal IR injury depends on IL-17A and that IL-17A is downstream of the binding of autoantibody to ischemia-conditioned tissues and subsequent complement activation...
October 15, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/28877534/open-abdomen-improves-survival-in-patients-with-peritonitis-secondary-to-acute-superior-mesenteric-artery-occlusion
#19
Weiwei Ding, Kai Wang, Baochen Liu, Xinxin Fan, Shikai Wang, Jianmin Cao, Xingjiang Wu, Jieshou Li
BACKGROUND: Damage control surgery and open abdomen (OA) have been extensively used in the severe traumatic patients. However, there was little information when extended to a nontrauma setting. The purpose of this study was to evaluate whether the liberal use of OA as a damage control surgery adjunct improved the clinical outcome in acute superior mesenteric artery occlusion patients. STUDY DESIGN: A single-center, retrospective cohort review was performed in a national tertiary surgical referral center...
October 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28876118/-effects-of-complement-c5a-inhibitor-therapy-in-animal-models-of-non-occlusive-mesenteric-ischemia
#20
Miklós Nógrády, Gabriella Varga, Szilárd Szűcs, József Kaszaki, Mihály Boros, Dániel Érces
INTRODUCTION: Non-occlusive mesenteric ischemia (NOMI) develops without anatomical causes. Early diagnosis is challenging and treatments are of questionable effectiveness. We investigated the role of complement activation in the pathophysiology of NOMI in animal models through the inhibition of complement C5a. MATERIALS AND METHODS: 60-min partial aortic occlusion (PAO; abdominal aorta, proximal to celiac trunk; mean arterial pressure: 30-40 mmHg) was established in Sprague-Dawley rats (n = 28) and 60-min cardiac tamponade in minipigs (n = 19; mean arterial pressure: 40-50 mmHg) to observe short- and long-term circulatory and inflammatory consequences of NOMI...
September 2017: Magyar Sebészet
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