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Mesenteric ischaemia

Beatrice Fiorucci, Tilo Kölbel, Fiona Rohlffs, Franziska Heidemann, Sebastian William Carpenter, Eike Sebastian Debus, Nikolaos Tsilimparis
OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) has emerged as a safe procedure in the treatment of a wide spectrum of descending thoracic aortic pathologies, with satisfactory results both in elective and urgent settings. We investigated the results of our elective, urgent and emergency TEVAR interventions. METHODS: A single-centre retrospective analysis of all consecutive patients undergoing TEVAR from 2010 to 2016 was performed. Primary end point of the study was early mortality, whereas the secondary end points included major complications according to the urgency of the procedure...
February 14, 2019: European Journal of Cardio-thoracic Surgery
Patrick Meybohm, Simone Lindau, Sascha Treskatsch, Roland Francis, Claudia Spies, Markus Velten, Maria Wittmann, Erdem Gueresir, Christian Stoppe, Ana Kowark, Mark Coburn, Sixten Selleng, Marcel Baschin, Gregor Jenichen, Melanie Meersch, Thomas Ermert, Alexander Zarbock, Peter Kranke, Markus Kredel, Antonia Helf, Rita Laufenberg-Feldmann, Marion Ferner, Eva Wittenmeier, Karl-Heinz Gürtler, Peter Kienbaum, Marcel Gama de Abreu, Michael Sander, Michael Bauer, Timo Seyfried, Matthias Gruenewald, Suma Choorapoikayil, Markus M Mueller, Erhard Seifried, Oana Brosteanu, Holger Bogatsch, Dirk Hasenclever, Kai Zacharowski
BACKGROUND: Perioperative anaemia leads to impaired oxygen supply with a risk of vital organ ischaemia. In healthy and fit individuals, anaemia can be compensated by several mechanisms. Elderly patients, however, have less compensatory mechanisms because of multiple co-morbidities and age-related decline of functional reserves. The purpose of the study is to evaluate whether elderly surgical patients may benefit from a liberal red blood cell (RBC) transfusion strategy compared to a restrictive transfusion strategy...
February 4, 2019: Trials
Shogo Watanabe, Shota Kumazaki, Shusei Yamamoto, Ikumi Sato, Kazuya Kitamori, Mari Mori, Yukio Yamori, Satoshi Hirohata
Non-alcoholic steatohepatitis (NASH) is linked to increased cardiovascular risk, independent of the broad spectrum of metabolic syndrome risk factors. Stroke-prone (SP) spontaneously hypertensive rats (SHRSP5/Dmcr) fed a high-fat and high-cholesterol (HFC) diet developed hepatic lesions similar to those in human NASH pathology. These rats simultaneously developed lipid deposits in the mesenteric arteries, cardiac fibrosis, endothelial dysfunction and left ventricle (LV) diastolic dysfunction. However, the intermediary factors between NASH and cardiovascular disease are still unknown...
January 24, 2019: International Journal of Experimental Pathology
Lucia Y Chen, Charlotte Ainscough, Mohamed Sayed, Maneesh Bhargava
Novel treatment of simultaneous mesenteric and cerebral ischaemia with systemic thrombolysis. A 75-year-old man presented to the acute stroke team with aphasia, right-sided weakness and distressed with a pain he was unable to localise. He was treated with intravenous thrombolysis with tissue plasminogen activator for a left middle cerebral artery stroke. Decompensation on the ward during thrombolysis with worsening abdominal distension and pain, hypotension and tachycardia prompted a CT angiogram scan, which displayed proximal inferior mesenteric artery occlusion...
November 28, 2018: BMJ Case Reports
Tímea Hevér, Zoltán Fórizs, Zoltán Lóderer
INTRODUCTION: The incidence of acute mesenteric ischemia (AMI) appears to be increasing due to aging in the population with increasing prevalence of comorbidities. Despite the wide-scale availability of diagnostic technologies, the timely detection and correct treatment are not ensured. This is due to the fact that the required CT angiography is not immediately performed and that vascular surgical reconstruction can be performed within the short ischemic tolerance window of the bowels amounting 4-6 hours...
December 2018: Magyar Sebészet
Jill Crosby, Dagmawi Werku, Tigist Zewdu, Grace Wanjiku, Jessica Schmidt
Introduction: The term acute abdomen refers to a clinical syndrome of sudden onset, severe abdominal pain. The differential diagnosis for this presentation is broad, but most cases require emergent medical or surgical management. Especially in cases of ischaemic bowel, time to diagnosis can mean the difference between survival and death. As a result, mortality remains high in resource-limited settings. Case report: We describe the case of a 28-year-old male who presented to an urban Ethiopian emergency centre with three days of vomiting, bloody diarrhoea, and abdominal pain...
December 2018: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Shokei Matsumoto, Atsuhi Shiraishi, Mitsuaki Kojima, Hiroyuki Funaoka, Tomohiro Funabiki, Takafumi Saida, Mitsuhide Kitano
BACKGROUND: Nonocclusive mesenteric ischemia (NOMI) is an acute and life-threatening gastrointestinal disorder, requiring rapid therapeutic intervention for ischemic bowel. However, its rapid detection remains challenging. This retrospective, observational study was aimed at comparing the diagnostic accuracy for NOMI in models of biomarkers, including intestinal fatty acid-binding protein (I-FABP), and clinical findings. METHODS: All consecutive patients who presented to the emergency department of the study hospital with suspected NOMI were prospectively enrolled...
October 29, 2018: Journal of Trauma and Acute Care Surgery
Chih-Yao Chiang, Chen-Yen Chien, Wei-Yin Qiou, Christopher Chang, I-Shing Yu, Po-Yuan Chang, Chiang-Ting Chien
OBJECTIVE:  Activation of thromboxane A2 synthase (TXAS)/thromboxane A2 (TXA2 )/thromboxane prostanoid (TP) receptor leads to arterial constriction, platelet aggregation and vascular injury. We attempted to characterize the microvascular dysfunction in ischaemia/reperfusion injury using genetically modified TXAS-/- , TP-/- and TXAS-/- TP-/- mice. APPROACH AND RESULTS:  The cardiac micro-circulation and electrocardiograms were evaluated from B6, TXAS-/- , TP-/- and TXAS-/- TP-/- mice in response to intravenous saline, endothelin-1, U46619 (a TXA2 agonist) and myocardial ischaemia/reperfusion injury...
November 2018: Thrombosis and Haemostasis
Iannis Ben Abdallah, Pierre Cerceau
No abstract text is available yet for this article.
November 2018: European Journal of Vascular and Endovascular Surgery
Michael G Fadel, Brian Andrews
Acute mesenteric ischaemia is a relatively rare surgical emergency, but despite advances in diagnostic tests, the mortality of this condition remains stubbornly high (50%-80%). This is principally because of the non-specific nature of the presenting symptoms and subsequent delay in diagnosis. We report an unusual case of acute mesenteric ischaemia treated by emergency laparotomy, small bowel resection and revascularisation using reversed long saphenous vein graft.
September 30, 2018: BMJ Case Reports
Baochen Liu, Chengnan Chu, Xinxin Fan, Weiwei Ding, Xingjiang Wu
BACKGROUND: Isolated superior mesenteric artery dissection (ISMAD) is rare, especially when associated with intestinal ischaemia. We report our clinical experience managing this condition. PATIENTS AND METHODS: Medical records from 22 patients with ISMAD and intestinal ischaemia were retrospectively analysed. Conservative treatment was given to all patients as first line therapy. Subsequently, 15 patients received endovascular stent placement and three patients received endovascular stent placement plus intestinal resection and anastomosis...
September 19, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Maria Antonietta Mazzei, Francesco Gentili, Francesco Giuseppe Mazzei, Roberto Grassi, Luca Volterrani
No abstract text is available yet for this article.
October 4, 2018: British Journal of Radiology
Rasmus Ahlfors, Dana Jensen
Wilkie's syndrome is a rare condition in which a decreased angle and distance between the superior mesenteric artery and aorta causes a compression of the third part of the duodenum, resulting ultimately in gastric dilation, gastric rupture and acute ischaemia of the bowel. The early symp-toms are those of duodenal obstruction. It is clinically char-acteristic, easily recognised on diagnostic imaging and is treated either conservatively or surgically. Although rare, Wilkie's syndrome is associated with severe morbidity, and should be considered in patients presenting with abdominal pain...
September 3, 2018: Ugeskrift for Laeger
Kyriakos Oikonomou, Piotr Kasprzak, Athanasios Katsargyris, Pablo Marques De Marino, Karin Pfister, Eric L G Verhoeven
OBJECTIVES: Patients surviving acute aortic dissection are at risk of developing a post-dissection thoraco-abdominal aortic aneurysm (PD-TAAA) during follow up, regardless of the type of treatment in the acute setting. Fenestrated and branched stent grafting (F/B-TEVAR) has been used with success to treat PD-TAAA, albeit reported only with short-term results. The aim of this study was to report mid-term results in a cohort of 71 patients. METHODS: This was a retrospective analysis of a prospectively maintained database including all patients with PD-TAAAs who underwent F/B-TEVAR within the period January 2010 - April 2017 at two vascular institutions experienced in endovascular techniques...
September 1, 2018: European Journal of Vascular and Endovascular Surgery
Alexander Greenhough, Clare Bagley, Kate J Heesom, David B Gurevich, David Gay, Mark Bond, Tracey J Collard, Chris Paraskeva, Paul Martin, Owen J Sansom, Karim Malik, Ann C Williams
Hypoxia is a hallmark of solid tumours and a key physiological feature distinguishing cancer from normal tissue. However, a major challenge remains in identifying tractable molecular targets that hypoxic cancer cells depend on for survival. Here, we used SILAC-based proteomics to identify the orphan G protein-coupled receptor GPRC5A as a novel hypoxia-induced protein that functions to protect cancer cells from apoptosis during oxygen deprivation. Using genetic approaches in vitro and in vivo , we reveal HIFs as direct activators of GPRC5A transcription...
November 2018: EMBO Molecular Medicine
S Florim, A Almeida, D Rocha, P Portugal
Acute mesenteric ischaemia (AMI) is an uncommon cause of acute hospital admission with high mortality rates (50-90%) that requires early diagnosis and treatment. With the increase in average life expectancy, AMI represents one of the most threatening abdominal conditions in elderly patients. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can reverse this process leading to a full recovery, but the diagnosis of AMI is difficult...
October 2018: Insights Into Imaging
Janet P Baxter, Peter M Fayers, Federico Bozzetti, Darlene Kelly, Francisca Joly, Geert Wanten, Cora Jonkers, Cristina Cuerda, Andre van Gossum, Stanislaw Klek, Marie-France Boudreault, Alain Gilbert, Manon Jobin, Michael Staun, Lyn Gillanders, Alastair Forbes, Margie O'Callaghan, Ceferino Martínez Faedo, Cinzia Brunelli, Luigi Mariani, Loris Pironi
BACKGROUND & AIMS: Home parenteral nutrition-quality of life (HPN-QOL© ) is a self-assessment tool for the measurement of QOL in patients on HPN. The aims of this study were: to re-assess the basic psychometric properties of the HPN-QOL© in a multinational sample of adult patients; to provide a description of QOL dimensions by short and long HPN treatment duration; to explore clinical factors potentially associated to QOL scores. METHODS: Patients (n = 699) from 14 countries completed the HPN-QOL© ...
August 6, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
A Bond, A Teubner, M Taylor, C Cawley, J Varden, A Abraham, P R Chadwick, M Soop, G L Carlson, S Lal
INTRODUCTION: The management of intestinal failure (IF) requires safe and sustained delivery of parenteral nutrition (PN). The long-term maintenance of central venous catheter (CVC) access is therefore vital, with meticulous catheter care and salvage of infected CVCs being of prime importance. CVC-related infection and loss of intravenous access are important causes of morbidity and mortality in IF. Avoidance, prompt recognition and appropriate management of CVC-related infections are crucial components of IF care...
July 27, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
John Hunninghake, Brian Patrick Murray, David Ferraro, John Gancayco
We report the case of a 23-year-old woman who presented with bloody diarrhoea and multiple syncopal events. While the initial diagnosis clinically appeared to be inflammatory bowel disease, she was found to have a portal vein thrombosis (PVT) on MR cholangiopancreatography and acute intestinal ischaemia on colonic biopsy. The aetiology of this patient's PVT is attributed to her acquired prothrombotic state from an estrogen-containing contraceptive pill in conjunction with regular tobacco use. Extensive mesenteric venous thrombosis from an acute PVT has been shown to cause intestinal ischaemia, likely from venous obstruction and reflexive arterial constriction; however, the diagnosis is often delayed until surgery or autopsy...
August 4, 2018: BMJ Case Reports
Lucy D Miller, Nicholas J Hilliard, Simon J F Harper
Introduction: Superior mesenteric arteriovenous fistulae (SMAVF) are rare, usually secondary to trauma or iatrogenic injury and typically present sometime after the initial insult. Report: A 30 year old male underwent immediate laparotomy for abdominal gunshot injury. The small bowel mesentery contained a large haematoma and a palpable thrill. CT demonstrated a large SMAVF. At re-look laparotomy, small bowel ischaemia was noted and following this endovascular SMA stent graft insertion was performed, with excellent angiographic and clinical results...
2018: EJVES Short Reports
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