- An international study of the quality of life of adult patients treated with home parenteral nutrition. [Journal Article]
- CNClin Nutr 2018 Aug 06
- CONCLUSIONS: The HPN-QOL©, is a valid tool for measurement of QOL in patients on HPN, to be used in the clinical practice as well as in research.
- Intestinal fatty acid-binding protein as a predictor of prognosis in postoperative cardiac surgery patients. [Journal Article]
- MMedicine (Baltimore) 2018; 97(33):e11782
- During the perioperative period of cardiac disease, as many risk factors exist, such as primary cardiac diseases, the use of vasopressors, ischemia-reperfusion injury during cardiopulmonary bypass (C...
During the perioperative period of cardiac disease, as many risk factors exist, such as primary cardiac diseases, the use of vasopressors, ischemia-reperfusion injury during cardiopulmonary bypass (CPB), and surgical stress, the gut suffered from ischemia, anoxia and oxidative stress, which would lead to the enterocyte injury. The aim of this study was to explore whether serum intestinal fatty acid-binding protein (IFABP), which is excreted specifically from damaged intestinal enterocytes, as a predictor of prognosis in postoperative cardiac surgery patients.From January 2017 to December 2017, 40 postoperative cardiac surgery patients were enrolled in this observational study. Serum IFABP levels and prognostic biomarkers were recorded at intensive care unit (ICU) admission.The serum IFABP levels were significantly higher in postoperative cardiac surgery patients who complicated with multiple organ dysfunction syndrome (MODS) (median, 883.20 pg/mL vs 426.10 pg/mL; P < .001), infective complications (median, 917.70 pg/mL vs 409.40 pg/mL; P < .001), or who stayed in ICU beyond 4 days (median, 807.65 pg/mL vs 426.10 pg/mL; P < .001). Moreover, in patients who suffered from right ventricular dysfunction, the serum IFABP levels were significantly higher (median, 737.85 pg/mL vs 445.55 pg/mL; P = .016). The serum IFABP levels also showed great precision for the prediction of MODS (the area under curve, AUC 0.923), infective complications (AUC 0.961) and ICU stay beyond 4 days (AUC 0.853). And it correlated significantly with the acute physiology and chronic health evaluation (APACHE) II score (P < .05), sequential organ failure assessment (SOFA) score (P < .05), and acute gastrointestinal injury (AGI) grade (P < .001).The serum IFABP level at ICU admission is a valuable, convenient, and objective early predictor of prognosis in postoperative cardiac surgery patients.
- [The application of intestinal stomas in mesenteric ischemia]. [Journal Article]
- ZWZhonghua Wai Ke Za Zhi 2018 Aug 01; 56(8):603-606
- CONCLUSIONS: According to damage control surgery, after early revascularization, patients with acute intestinal necrosis should be treated with infarcted bowel resection and stomas. Besides, second operation to restore the continuity of intestinal tract should be conducted after nutritional support for 6 months. Patients with ischemic enteropathy who cannot be corrected with severe malnutrition should achieve stomas during first operation.
- Intestinal fatty acid-binding protein levels in patients with chronic renal failure. [Journal Article]
- JSJ Surg Res 2018; 230:94-100
- CONCLUSIONS: I-FABP levels in CKD and pre-HD ESKD patients were significantly higher than those in NRF patients. In addition, I-FABP was significantly eliminated by HD in patients with ESKD. Clinicians and researchers should consider this aspect of I-FABP when using it as a diagnostic and prognostic marker in patients with renal insufficiency.
- Chronic visceral ischemia: An unusual cause of abdominal pain. [Journal Article]
- TJTurk J Surg 2018; 34(2):158-161
- Chronic visceral ischemia is described as postprandial abdominal pain caused by intestinal hypoperfusion. Chronic visceral ischemia arising from the stenosis of major mesenteric arteries can cause de...
Chronic visceral ischemia is described as postprandial abdominal pain caused by intestinal hypoperfusion. Chronic visceral ischemia arising from the stenosis of major mesenteric arteries can cause death. Chronic abdominal pain, weight loss, and sitophobia are the major symptoms. The main cause of chronic visceral ischemia is atherosclerosis; Doppler ultrasonography, tomographic angiography, and magnetic resonance angiography can be used for diagnosis. The gold standard method is mesenteric catheterized angiography. Surgical bypass or endovascular balloon angioplasty and stent replacement can also be performed to prevent serious complications and death. A total of three patients, two male and one female, applied to emergency services with blunt abdominal pain lasting a few hours that started after meals and was located in the epigastric and periumblical regions. The patients were diagnosed with chronic visceral ischemia after screening tests and physical examination. Mesenteric catheterized angiography was performed immediately in all the cases. Balloon angioplasty and stent replacement were performed on the stenoses, and occlusions were detected. Mesenteric catheterized angiography may be preferred in cases with strong clinical suspicion; balloon angioplasty and stent replacement can also be used as treatments with lower rates of complications.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Intestinal ischemia can affect the small intestine or the colon. Whereas, “colonic ischemia” refers to ischemia that affects the colon, “mesenteric ischemia” refers to ischemia that affects the blood...
Intestinal ischemia can affect the small intestine or the colon. Whereas, “colonic ischemia” refers to ischemia that affects the colon, “mesenteric ischemia” refers to ischemia that affects the blood vessels of the small intestine. It can be secondary to occlusive or nonocclusive obstruction of the arteries or can be caused by obstruction of venous outflow. Acute mesenteric ischemia is the sudden onset of small intestinal hypoperfusion. Patients usually present with sudden-onset abdominal pain. They are at high risk of deterioration and need emergent surgical intervention. Chronic mesenteric ischemia is seen in patients with mesenteric atherosclerosis. It causes intermittent intestinal hypoperfusion that usually worsens with eating.
- Intravenous lipid emulsions and liver function in adult patients with chronic intestinal failure: Results from a randomized clinical trial. [Journal Article]
- NNutrition 2018 Mar 22; 55-56:45-50
- CONCLUSIONS: All four ILEs tested may be safe even during long-term parenteral nutrition. OO/LCT may be more effective than the others, but more studies in the field are needed.
- Fibrin patch influences the expression of hypoxia-inducible factor-1α and nuclear factor-κBp65 factors on ischemic intestinal anastomosis. [Journal Article]
- EBExp Biol Med (Maywood) 2018; 243(10):803-808
- The intestinal anastomotic failure is one of the most severe complications in gastrointestinal surgery. Despite the great surgical improvements during the last decade, anastomotic leak rates remain p...
The intestinal anastomotic failure is one of the most severe complications in gastrointestinal surgery. Despite the great surgical improvements during the last decade, anastomotic leak rates remain practically the same, with a dramatically high grade of morbidity for patients. Leakages are usually the final consequence of ischemia in the anastomosis, leading to tissue hypoxia. In response to hypoxia, the cell orchestrates a variety of coordinated responses in order to restore oxygen homeostasis. The molecular mechanism of hypoxia sensitivity involves oxygen sensing hydroxylases, prolyl-hydroxylases, orchestrating two main transcription factors related to induction of inﬂammation and angiogenesis, namely nuclear factor-κB and hypoxia-inducible factors. The immunohistochemical expression of two transcription factors hypoxia-inducible factors-1α and nuclear factor-κB p65 has already been described in several disorders, including wound healing, asthma and chronic obstructive lung disease, rheumatoid arthritis, cancer, inflammatory bowel disease, and acute colitis. In the surgical field, fibrin sealants have been widely used to prevent leaks in lung surgery and they might also be useful as a reinforcement of sutures in intestinal anastomosis. The commercial fibrin sealant patches are hemostatic and adhesive surgical agents mainly derived from human plasma. We herein report the results of a prospective randomized experimental study on pigs. We performed a high-risk leakage model of bowel anastomosis, causing a significant devascularization of 10-15 cm of the bowel wall before performing a conventional colo-ileal anastomosis. We randomized the animals to receive a covering of the anastomosis with a fibrin patch (case group) or not (control group). We report the changes in the immunohistochemical expression of the proteins involved in tissue response to hypoxia in the experimental model. Our results indicate that the fibrin patch delays the healing response, promoting a longer lasting inflammation in the surgical bed. Nevertheless, the fibrin patches effectiveness to reduce dehiscence shown in clinical practice suggests that this delay does not negatively affect patients' outcome. Impact statement The consequences of the anastomotic failure are dramatic for patients. Understanding how the ever-increasing use of fibrin sealant, that seems to have a beneficial effect on the anastomoses, interacts with the tissue and the healing process can help to justify its use and encourage research on how to improve this effect even more. We feel that the present work shows that the patch can improve healing by complex mechanisms other than the mere contention and physical support of the intestine. Furthermore, research is needed to confirm our preliminary findings.
- "Mesenteric Steal" Physiology as a Cause of Claudication and Chronic Mesenteric Ischemia. [Journal Article]
- AVAnn Vasc Surg 2018; 51:329.e1-329.e4
- Aortoiliac occlusive disease results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved, and endovascular therapies are being successfully reporte...
Aortoiliac occlusive disease results in varying degrees of pelvic and lower extremity arterial insufficiency. Treatment approach has evolved, and endovascular therapies are being successfully reported for high-grade lesions. However, Trans Atlantic Inter-Society Consensus D often necessitates open revascularization. Disease limited to the infrarenal segment does not typically affect intestinal perfusion in the absence of visceral aortic or mesenteric vessel involvement. Chronic mesenteric ischemia most commonly occurs due to atherosclerotic disease of 2 or 3 of the mesenteric vessels. The marginal artery of Drummond is an important component of the collateral network that allows for continued intestinal perfusion. We report a case of short-segment subtotal infrarenal aortic occlusion, proximal to the inferior mesenteric artery (IMA) in the absence of significant mesenteric disease. The patient had resultant lifestyle limiting claudication and chronic mesenteric ischemia. Angiographic evaluation demonstrated "mesenteric steal" physiology with retrograde flow via the arc of Riolan and IMA to perfuse the aortoiliac circulation. Successful endovascular recanalization with a balloon-expandable covered stent was achieved, resolving the arterial insufficiency in both the mesenteric and lower extremity vascular beds. The patient denied any symptoms on postoperative day 1 and at 1-month follow-up.
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- [Painful anorexia in chronic intestinal ischemia]. [Letter]
- PMPresse Med 2018; 47(6):586-587