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Cardiovascular AND Intestinal ischemia, acute [keywords]
- [Laparotomy in acute intestinal ischemia--think before you act!]. [Journal Article, Review]
- Lakartidningen 2012 Dec; 109(49-50):2288-9.
- [More and more people get acute intestinal ischemia--early diagnosis and treatment saves lives]. [Journal Article, Review]
- Lakartidningen 2012 Dec; 109(49-50):2284-6.
- [The treatment process optimization in patients suffering from acute disorder of mesenteric blood circulation]. [English Abstract, Journal Article]
- Klin Khir 2012 Sep; (9):12-6.
The results of treatment of 253 patients, suffering an acute disorder of mesenteric blood circulation, were analyzed; the treatment program, applied in 55 patients, was optimized. Timely diagnosis in the tissues the ischemia stage as well as during restoration of blood circulation in a. mesenterica superior, while its proximal occlusion, application of a "second-look" tactics have had secured beneficial results of treatment in patients, the lethality was 33%. Intraoperative application of redoxmetry for estimation of the intestine life capacity have had promoted prophylaxis of the sutures insufficiency in interintestinal anastomoses. Optimization of the treatment tactics (two-staged surgical treatment with retrograde jejunal intubation, the postponed formation of anastomosis) gave possibility to reduce lethality in patients, suffering arterial occlusion from 75 to 60% (P<0.05).
- [Bowel perforation because of ingestion of a blister-wrapped tablet after post-interventional coronary perforation]. [Case Reports, English Abstract, Journal Article]
- Dtsch Med Wochenschr 2012 Dec; 137(50):2637-40.
History and admission findings: A 70-year-old woman was admitted to hospital with progressive chest pain. Coronary angiography demonstrated a significant stenosis of the left descending artery (LAD), which was treated by percutaneous coronary intervention (PCI) and stent implantation. During this intervention, a coronary perforation occurred which was remedied immediately. Five days after the intervention, the patient complained about severe atypical chest and abdominal pain with nausea and vomitting, but no fever. Physical examination revealed an acute abdomen of uncertain origin.Investigations: Laboratory tests revealed leukocytosis and elevated levels of C-reactive protein while cardiac enzymes were in normal range. The electrocardiogram showed no signs of acute myocardial ischemia. Abdominal x-ray was performed without any pathological findings. Further diagnostic tests, especially computed tomography of the abdomen, revealed an ingestion of a blister-wrapped tablet which had caused small bowel perforation and peritonitis.Diagnosis, treatment and course: An acute abdomen due to ingestion of a foreign body was diagnosed and an emergency laparotomy was performed immediately. The blister pack was removed by ileostomy. The further course was uneventful.
Conclusion:The clinical presentation of abdominal pain is a frequent medical condition in hospital. Determining the cause requires precise assessment and examination and implicates a variety of differential diagnosis including non-cardiac and cardiac pain. Iatrogenic causes must be considered in differential diagnosis.
- Colectomy in intensive care patients: operative findings and outcomes. [Journal Article]
- World J Surg 2013 Feb; 37(2):333-8.
With a critical illness, intestinal complications are associated with high morbidity and mortality.Operative findings and outcomes of 77 intensive care unit (ICU) patients treated with colectomy are described.Three conditions led to colectomy: sepsis (S group; n = 31), fulminant Clostridium difficile colitis (Cl group; n = 25), and cardiovascular surgery (CV group; n = 21). The median Acute Physiology and Chronic Health score was >25 in all groups. Thickening and distension of the colon was more frequent in the Cl group (p = 0.001), and ischemia was more frequent in the S and CV groups (p < 0.001). Widespread necrosis was more frequent in the CV patients (p = 0.001). The kappa value for ischemic operative findings and histologic necrosis was 0.64 (95 % confidence interval 0.49-0.79). Hospital mortality was 35 % without multiple organ failure (MOF) (n = 31) and 74 % with MOF (n = 46) (p < 0.001). Overall, 38 % were alive at the 1-year follow-up.Although colectomy in ICU patients is associated with high hospital mortality, patients who survive beyond their hospital stay have a good 1-year outcome.
- Paneth cell-mediated multiorgan dysfunction after acute kidney injury. [Journal Article, Research Support, N.I.H., Extramural]
- J Immunol 2012 Dec 1; 189(11):5421-33.
Acute kidney injury (AKI) is frequently complicated by extrarenal multiorgan injury, including intestinal and hepatic dysfunction. In this study, we hypothesized that a discrete intestinal source of proinflammatory mediators drives multiorgan injury in response to AKI. After induction of AKI in mice by renal ischemia-reperfusion or bilateral nephrectomy, small intestinal Paneth cells increased the synthesis and release of IL-17A in conjunction with severe intestinal apoptosis and inflammation. We also detected significantly increased IL-17A in portal and systemic circulation after AKI. Intestinal macrophages appear to transport released Paneth cell granule constituents induced by AKI, away from the base of the crypts into the liver. Genetic or pharmacologic depletion of Paneth cells decreased small intestinal IL-17A secretion and plasma IL-17A levels significantly and attenuated intestinal, hepatic, and renal injury after AKI. Similarly, portal delivery of IL-17A in macrophage-depleted mice decreased markedly. In addition, intestinal, hepatic, and renal injury following AKI was attenuated without affecting intestinal IL-17A generation. In conclusion, AKI induces IL-17A synthesis and secretion by Paneth cells to initiate intestinal and hepatic injury by hepatic and systemic delivery of IL-17A by macrophages. Modulation of Paneth cell dysregulation may have therapeutic implications by reducing systemic complications arising from AKI.
- Acute mesenteric ischemia in young adults. [Journal Article]
- Wien Med Wochenschr 2012 Aug; 162(15-16):349-53.
Acute mesenteric ischemia is commonly seen in old patients. This study was undertaken to show that mesenteric ischemia might be seen in individuals under 40 years of age and that its diagnosis is challenging. Twenty-six patients with acute mesenteric ischemia under the age of 40 were studied. The main symptom on admission was abdominal pain. Symptom duration varied between 12 h and 5 days. The medical history of the patients revealed that 9 had no previous diseases. Other 17 had predisposing factors in the first evaluation. None of the patients had any history of narcotic or drug abuse. Ten patients presented with signs and symptoms of sepsis and septic shock. Preoperative diagnosis was acute intestinal ischemia only in 6 patients. Preoperatively, all the patients had intestinal or colonic ischemia and necrosis; one had additional ischemia of the liver, stomach, duodenum, and pancreas. Six patients had massive intestinal necrosis. The overall postoperative complication and overall mortality rates were 61.5 and 26.9 %, respectively. Complications and mortality were determined to be associated with previous pulmonary disease, acidosis, presence of septic shock, acute renal failure, extent of the ischemia and extent of resection, second look operations, previous cardiac events, and the kind of affected bowel (colon involvement).
- Thrombosis of celiacomesenteric trunk: report of a case. [Case Reports, Journal Article]
- World J Gastroenterol 2012 Aug 7; 18(29):3917-20.
Here we present the case of a 79-year-old woman who complained of acute abdominal pain, vomiting and diarrhoea. Laboratory exams demonstrated a severe metabolic imbalance. Abdominal X-rays showed bowel overdistension and pneumatosis of the stomach wall. Abdominal tomography revealed infarction of the stomach, duodenum and small bowel due to thrombosis of the celiacomesenteric trunk. Exploratory laparotomy revealed ischemia of the liver, spleen infarction and necrosis of the gastro-intestinal tube (from the stomach up to the first third of the transverse colon). No further surgical procedures were performed. The patient died the following day. To our knowledge, this is the first reported case about severe gastro-intestinal ischemia due to thrombosis of the celiacomesenteric trunk, a rare anatomic variation of the gastrointestinal vascularisation.
- Upper limb amputation due to a brachial arterial embolism associated with a superior mesenteric arterial embolism: a case report. [Case Reports, Journal Article]
- BMC Res Notes 2012.:372.
Acute mesenteric ischemia due to an embolism of the superior mesenteric artery is associated with a high mortality rate. Over 20 percent of acute mesenteric embolism cases consist of multiple emboli, and the long-term prognosis depends on the incidence of subsequent embolic events at other sites. The incidence of emboli in the upper extremity associated with a superior mesenteric arterial embolism has rarely been described. The signs and symptoms of ischemic change in the upper limb can be masked by other circumstances, such as postoperative conditions or complications. In these cases, a late presentation or delayed diagnosis and treatment can result in limb loss.We present a rare case of a 67-year-old Japanese woman with atrial fibrillation who developed an embolic occlusion of the brachial artery associated with a superior mesenteric arterial embolism. She developed gangrene in her right hand, which had progressed to the point that amputation was necessary by the time the gastrointestinal surgeon had consulted the Department of Orthopedic Surgery. The brachial arterial embolism diagnosis was delayed by the severe abdominal symptoms and shock conditions that followed the emergency enterectomy, resulting in amputation of the upper limb despite anticoagulation therapy. In this case, multiple infarctions of the spleen were also observed, indicating a shower embolism.When treating a superior mesenteric arterial embolism in a patient with atrial fibrillation, the possibility of recurrent or multiple arterial thromboembolic events should be considered, even after the procedure is completed.
- [Volvulus in pregnancy: a case report]. [Case Reports, English Abstract, Journal Article]
- Ginecol Obstet Mex 2012 Mar; 80(3):232-4.
There are several etiologies of abdominal pain during pregnancy, including an extremely rare: the intestinal volvulus. Have been reported about 78 cases in the literature of intestinal volvulus complicating pregnancy, we reported this case occurred in our hospital and to assess the difficult diagnosis of intestinal volvulus in pregnancy.