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Splanchnic ischemia

Adriano Peris, Chiara Lazzeri, Manuela Bonizzoli, Cristiana Guetti, Laura Tadini Buoninsegni, Giorgio Fulceri, Pier Francesco Ticali, Marco Chiostri, Vincenzo Li Marzi, Sergio Serni, Maria Luisa Migliaccio
The use of Donation after circulatory death (DCD) has increased significantly to face the persistent mismatch between supply and demand of organs for transplantation. While controlled (c) DCDs have warm ischemic time (WIT) that can be estimated, the WIT is often inexact and extended in uncontrolled DCD (uDCD), making assessment of injury difficult. We aimed at investigating the effects of cold ischemia on potential donor organ damage in the course of nRP by assessing the dynamic variations of transaminases and creatinine values in 17 uDCD donors...
August 21, 2018: Clinical Transplantation
Alessandra Russo, Corrado Lettieri, Salvatore Ivan Caico, Giuseppe Musumeci, Roberta Rossini, Battistina Castiglioni
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic coronary artery pathology and an important cause of coronary artery disease in young women with an average age of 40 to 50 years with few or no cardiovascular risk factors. There has been a surge in the diagnosis of SCAD due to an increased use of coronary angiography and the clinical availability and application of high-resolution intracoronary imaging. SCAD is due to the separation of coronary wall layers with the formation of intramural hematoma, compression of the true lumen and secondary myocardial ischemia...
September 2018: Giornale Italiano di Cardiologia
Rosa G M Lammerts, Marc J van Det, Rob H Geelkerken, Ewout A Kouwenhoven
Anastomotic leakage of the gastric conduit following surgical treatment of esophageal cancer is a life-threatening complication. An important risk factor associated with anastomotic leakage is calcification of the supplying arteries of the gastric conduit. The patency of calcified splanchnic arteries cannot be assessed on routine computed tomography (CT) scans for esophageal cancer and, as such, in selected patients with known or assumed mesenteric artery disease, additional CT angiography of the abdominal arteries with 1 mm slices is strongly encouraged...
January 2018: Thoracic and Cardiovascular Surgeon Reports
Simon Gelman
The Pathophysiology of Aortic Cross-clamping and Unclamping. By Gelman S. ANESTHESIOLOGY 1995; 82:1026-60. Reprinted with permission.Aortic cross-clamping (AoX) and unclamping are associated with severe hemodynamic disturbances in virtually all organs and systems. The main hemodynamic changes induced by AoX result from an increase in impedance to aortic flow, an increase in systemic vascular resistance and afterload, blood volume redistribution caused by collapse and constriction of venous vasculature distal to the aortic clamp, and a subsequent increase in preload...
August 2018: Anesthesiology
Dawn M Coleman, Jonathan L Eliason, James C Stanley
OBJECTIVE: Pediatric splanchnic arterial occlusive disease is uncommon and a rare cause of clinically relevant intestinal ischemia. This study was undertaken to better define the clinical manifestations and appropriate treatment of celiac artery (CA) and superior mesenteric artery (SMA) occlusive disease in children. METHODS: Clinical courses of 30 consecutive children undergoing operations for splanchnic arterial occlusive disease at the University of Michigan from 1992 to 2017 were retrospectively analyzed...
April 2, 2018: Journal of Vascular Surgery
Brianyell McDaniel Mims, Matthew B Grisham
It is well known that alterations in splanchnic organ perfusion and/or immune regulation may produce inflammatory tissue injury similar to that observed in several human disorders such as ischaemia and reperfusion injury, food allergies, diabetes, inflammatory bowel disease and graft-versus-host disease. Mouse models have been tremendously important in defining the roles of the circulation, leukocyte trafficking, inflammatory mediator generation, immune regulation and the intestinal microbiota in the pathogenesis of acute and chronic inflammation...
September 2018: Journal of Physiology
Stiljan Hoxha, Riccardo Giuseppe Abbasciano, Camilla Sandrini, Lucia Rossetti, Tiziano Menon, Luca Barozzi, Daniele Linardi, Alessio Rungatscher, Giuseppe Faggian, Giovanni Battista Luciani
Aortic arch repair in newborns and infants has traditionally been accomplished using a period of deep hypothermic circulatory arrest. To reduce neurologic and cardiac dysfunction related to circulatory arrest and myocardial ischemia during complex aortic arch surgery, an alternative and novel strategy for cerebro-myocardial protection was recently developed, where regional low-flow perfusion is combined with controlled and independent coronary perfusion. The aim of the present retrospective study was to assess short-term and mid-term results of selective and independent cerebro-myocardial perfusion in neonatal aortic arch surgery...
April 2018: Artificial Organs
Silvia Martini, Luigi Corvaglia
Near infrared spectroscopy (NIRS) provides a non-invasive, continuous monitoring of regional tissue oxygenation. NIRS assessment of neonatal splanchnic oxygenation (SrSO2 ) has gained increasing interest over the last decade, as local hypoxia and ischemia underlie the most feared gut complications in neonates. Current literature provides encouraging evidence in support of SrSO2 reliability in detecting mesenteric hemodynamic changes related to various physiological and pathological conditions in-term and preterm infants...
May 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Claire A Leenarts, Mark J Haagmans, Lee H Bouwman, Cornelis J Sikkink
Reperfusion syndrome (RS) after revascularization of an arterial occlusion of the lower leg is a well-known complication. RS after splanchnic revascularization, however, is an infrequent and less-known phenomenon. We present a patient with persisting abdominal complaints after revascularization of the celiac trunk and superior mesenteric artery suggesting reocclusion. Although computed tomography angiography showed patent splanchnic arteries, an impressive hyperperfusion state of liver and spleen was visualized...
January 2018: Journal of Natural Science, Biology, and Medicine
Gonca Oguz, Gulcin Senel, Nesteren Kocak
We present a patient with metastatic colon carcinoma who developed paraplegia following a neurolytic splanchnic block. A 41-year old man with metastatic adenocarcinoma of the colon received a splanchnic neurolytic block using alcohol because of severe abdominal pain. Bilateral motor weakness and a sensorial deficit in both legs developed after the procedure. Diffusion magnetic resonance imaging revealed spinal cord ischemia between T8 and L1. The motor and sensorial deficits were almost completely resolved at the end of the third month...
January 2018: Korean Journal of Pain
Lin Gao, Huiru Zhao, Tao Zhu, Yeliu Liu, Li Hu, Zhenguo Liu, Hai Huang, Fuxue Chen, Zhenxu Deng, Dechang Chu, Dongshu Du
HIGHLIGHTS The aim of the research was to determine the functional effects and molecular mechanisms of GABAB receptor on ischemia reperfusion-induced gastric injury in rats.The lateral hypothalamus area GABAB receptor attenuated the ischemia reperfusion-induced gastric injury by up-regulating the production of GABA, GABABR, and down-regulating P-GABABR in the brain.This work would provide a new therapeutic strategy for acute gastric injury. Gastric ischemia-reperfusion (GI-R) injury progression is largely associated with excessive activation of the greater splanchnic nerve (GSN)...
2017: Frontiers in Physiology
Georgios Martikos, Alkistis Kapelouzou, Michael Peroulis, Anna Paspala, Dimitris Athanasiadis, Anastasios Machairas, Theodoros Liakakos, Konstantinos Moulakakis, Spyros Vasdekis, Andreas M Lazaris
BACKGROUND: Temporary hepatic ischemia is inevitable during open aortic surgery when supraceliac clamping is necessary, as in thoracoabdominal or pararenal aneurysms. Remote ischemic preconditioning (RIPC) has been described as a potential protective means against ischemia-reperfusion injury (IRI) in various tissues including the liver. The aim of this experimental study was to detect the effect of RIPC on liver IRI in a model of supraceliac aortic cross-clamping. METHODS: An animal study was performed...
April 2018: Annals of Vascular Surgery
Ayse L Mindikoglu, Stephen C Pappas
Hepatorenal syndrome (HRS) continues to be one of the major complications of decompensated cirrhosis, leading to death in the absence of liver transplantation. Challenges in precisely evaluating renal function in the patient with cirrhosis remain because of the limitations of serum creatinine (Cr) alone in estimating glomerular filtration rate (GFR); current GFR estimating models appear to underestimate renal dysfunction. Newer models incorporating renal biomarkers, such as the Cr-Cystatin C GFR Equation for Cirrhosis appear to estimate measured GFR more accurately...
February 2018: Clinical Gastroenterology and Hepatology
Alexandre Nuzzo, Damien Soudan, Lore Billiauws, Julie Bataille, Léon Maggiori, Maxime Ronot, Jeanick Stocco, Yoram Bouhnik, Yves Castier, Olivier Corcos
BACKGROUND: Persistent or chronic intestinal ischemic injury (i3) can lead to severe malnutrition and acute mesenteric ischemia. Although recommended, revascularization of splanchnic arteries is sometimes unrealizable. METHODS: We report a case series of iloprost use in consecutive stable patients with persistent i3 unsuitable for revascularization followed in a tertiary care center. The feasibility of revascularization was discussed and ruled out by a multidisciplinary team, and informed consent was obtained prior to consideration of a vasoactive therapy...
July 2017: Annals of Vascular Surgery
G Cocorullo, A Mirabella, N Falco, T Fontana, R Tutino, L Licari, G Salamone, G Scerrino, G Gulotta
BACKGROUND: Acute mesenteric ischemia is a rare affection with high related mortality. NOMI presents the most important diagnostic problems and is related with the higher risk of white laparotomy. This study wants to give a contribution for the validation of laparoscopic approach in case of NOMI. METHODS: Thirty-two consecutive patients were admitted in last 10 years in ICU of Paolo Giaccone University Hospital of Palermo for AMI. Diagnosis was obtained by multislice CT and selective angiography was done if clinical conditions were permissive...
2017: World Journal of Emergency Surgery: WJES
Michel Rayar, Giovanni B Levi Sandri, Caterina Cusumano, Clara Locher, Pauline Houssel-Debry, Christophe Camus, Nicolas Lombard, Veronique Desfourneaux, Mohamed Lakehal, Bernard Meunier, Laurent Sulpice, Karim Boudjema
During orthotopic liver transplantation (OLT), clamping of the portal vein induces splanchnic venous congestion and accumulation of noxious compounds. These adverse effects could increase ischemia/reperfusion injury and subsequently the risk of graft dysfunction, especially for grafts harvested from extended criteria donors (ECDs). Temporary portocaval shunt (TPCS) could prevent these complications. Between 2002 and 2013, all OLTs performed in our center were retrospectively analyzed and a propensity score matching analysis was used to compare the effect of TPCS in 686 patients (343 in each group)...
February 2017: Liver Transplantation
Jean-Loup Gassend, Maria Dimitrief, Hon Lai Chan, Daniel Roulet, Lysiane Trachsel, Francesco Doenz, Floryn Cherbanyk
We present the case of a 75-year-old patient with asymptomatic gastro-duodenal artery aneurism (GAA) that was coiled through the left femoral artery. The gastro-duodenal artery (GDA) was then embolized. Following the intervention, the patient'™s left foot became cold. A sub-acute ischemia caused by a stenotic effect in the left external iliac artery and by lower limb embolic phenomena caused by the introductor, was diagnosed. A thromboembolectomy of the popliteal, anterior and posterior tibial and peroneal arteries was performed with a Fogarty catheter with good results...
July 2016: Chirurgia
M Praktiknjo, C Meyer, C P Strassburg, J Trebicka
Recent non-cirrhotic and non-malignant splanchnic vein thrombosis is now defined as extrahepatic portal vein thrombosis with or without involvement of the mesenteric vein according to the Baveno VI consensus from 2015. An early diagnosis is often challenging due to unspecific symptoms with abdominal pain or diarrhea but extremely important because of the potential acute and chronic complications, such as mesenteric ischemia and portal hypertension; therefore, rapid treatment is crucial. We present two cases of severe splanchnic vein thrombosis, which were treated with catheter-directed local thrombolysis and thrombus aspiration...
January 2017: Der Internist
Valerie Plant, Ashley Limkemann, Loren Liebrecht, Charles Blocher, Paula Ferrada, Michel Aboutanos, Martin J Mangino
INTRODUCTION: Polyethylene glycol-20k (PEG-20k) is highly effective for low-volume resuscitation (LVR) by increasing tolerance to the low-volume state. In our rodent shock model, PEG-20k increased survival and expanded the "golden hour" 16-fold compared to saline. The molecular mechanism is largely attributed to normalizations in cell and tissue fluid shifts after low-flow ischemia resulting in efficient microvascular exchange. The objective of this study was to evaluate PEG-20k as an LVR solution for hemorrhagic shock in a preclinical model...
December 2016: Journal of Trauma and Acute Care Surgery
Robert Forbrig, Philipp Renner, Piotr Kasprzak, Marc-H Dahlke, René Müller-Wille, Christian Stroszczynski, Peter Heiss
Background Patients with acute mesenteric ischemia (AMI) often exhibit severe co-morbidities and significant surgical risks, leading to high perioperative morbidity. Purpose To investigate the feasibility of primary percutaneous stent-revascularization (PPSR) in atherosclerotic AMI and its impact on patients' outcome. Material and Methods Retrospective analysis of 19 consecutive patients (7 women, 12 men; median age, 69 years) with AMI caused by atherosclerotic, non-embolic stenoses/occlusions of the splanchnic arteries and PPSR...
March 2017: Acta Radiologica
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