Recurrent nonocclusive mesenteric ischemia after resection of iliac artery aneurysm.

A case of recurrent nonocclusive mesenteric ischemia in a patient with isolated internal iliac artery aneurysm penetrating the sigmoid colon is described. On the day after the aneurysm and the sigmoid colon had been resected, the patient developed necrosis of the left hemicolon. Fourteen and nineteen days after left hemicolectomy, massive intestinal bleedings occurred, requiring ileectomy. On the basis of operative findings of good pulsation of visceral arterial branches; angiography showing patent mesenteric vessels with some spasms; and pathological findings suggesting mesenteric ischemia, these ischemic events were diagnosed as nonocclusive mesenteric ischemia. Low-output syndrome induced by massive intestinal bleeding and atrial fibrillation and sepsis were responsible for the establishment of the nonocclusive mesenteric ischemia. Development of disseminated intravascular coagulation and continuous administration of diuretics for acute renal failure seemed to have further perturbed the mesenteric circulation. The patient died of subsequent multiple organ failure 4 months after the first operation. We should pay more attention to nonocclusive mesenteric ischemia in patients with mesenteric ischemia, and strict circulatory management during the perioperative period is essential in these patients.

Long-term follow up in patients receiving a small aortic valve prosthesis.

BACKGROUND AND AIMS OF THE STUDY: Concern persists regarding the long-term effects of aortic valve replacement (AVR) in the small aortic root. METHODS: Twenty-eight patients (21 females, seven males; mean age 54.1+/-11.7 years; mean body surface area (BSA) 1.39+/-0.07 m2) who underwent AVR with a 19 mm mechanical valve more than 10 years previously at the authors' institute, were followed up. Long-term echocardiographic evaluations were performed in 18 of 21 survivors. RESULTS: Follow up in the 28 patients was complete for up to 19.2 years (mean 11.4 years); cumulative follow up was 318.1 patient-years. Actuarial survival rates at 5, 10 and 15 years were 88.5+/-6.3%, 72.0+/-9.0% and 72.0+/-9.0%, respectively. In general, NYHA class showed satisfactory improvement. Long-term echocardiography showed significant reductions in left ventricular (LV) wall thickness and mass index compared with preoperative values, despite the existence of pressure gradients. A negative correlation was found between the rate of reduction of LV wall thickness and BSA. CONCLUSION: Implantation of the 19 mm aortic mechanical prosthesis was viable in patients with a small aortic annulus, especially if their BSA was <1.45 m2.

Serotonin activity and liver dysfunction following hepatic ischemia and reperfusion.

Serotonin (5-hydroxytriptamine; 5-HT), which is stored in platelets, is known to induce vasoconstriction and promote platelet aggregation. More recent studies suggest that serotonin also plays a role in organ injury after ischemia and reperfusion. The purpose of this study was to characterize the role of 5-HT and platelet function in the pathogenesis of hepatic ischemia-reperfusion injury. Under the portocaval shunt, 60 or 90 min of complete warm ischemia of canine liver was induced by Pringle's maneuver, followed by reperfusion for 120 min. Time-matched, sham-operated animals served as controls. Hepatic tissue blood flow and various parameters of hepatic vein blood (ALT, LDH, platelet count and platelet aggregation) were measured before and after reperfusion. 5-HT levels in portal vein and hepatic vein were also assayed. Hepatic ischemia and reperfusion resulted in liver hypoperfusion, hepatocellular dysfunction, increased platelet aggregation, increased 5-HT levels, and hepatic microcirculation injury. These results suggest that the endogenous 5-HT released from platelet may contribute to liver tissue hypoperfusion following hepatic ischemia-reperfusion.

Pasteurella multocida endocarditis: report of a case.

The present case involves a 48-year-old male patient who presented with Pasteurella multocida endocarditis associated with preexisting mitral valve stenosis. A mitral valve replacement was successfully performed after 3 weeks of intravenous infusion with antibiotics. Pasteurella multocida is a normal inhabitant of the oral cavity of dogs and cats. Therefore, people who have frequent contact with these animals should be examined periodically for signs of infection.