Dynamic ultrasonography for optimizing treatment position in superior mesenteric artery syndrome: Two case reports and review of literature.

BACKGROUND: Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction by extrinsic compression between the SMA and the aorta (SMA-Ao). Although the left lateral recumbent position is considered effective in the treatment of SMA syndrome, individual variations in the optimal patient position have been noted. In this report, we present two elderly cases of SMA syndrome that exhibited rapid recovery due to ultrasonographic dynamic evaluation of the optimal position for each patient. CASE SUMMARY: Case 1: A 90-year-old man with nausea and vomiting. Following diagnosis of SMA syndrome by computed tomography (CT), ultrasonography (US) revealed the SMA-Ao distance in the supine position (4 mm), which slightly improved in the lateral position (5.7-7.0 mm) without the passage of duodenal contents. However, in the sitting position, the SMA-Ao distance was increased to 15 mm accompanied by improved content passage. Additionally, US indicated enhanced passage upon abdominal massage on the right side. By day 2, the patient could eat comfortably with the optimal position and massage. Case 2: An 87-year-old woman with vomiting. After the diagnosis of SMA syndrome and aspiration pneumonia by CT, dynamic US confirmed the optimal position (SMA-Ao distance was improved to 7 mm in forward-bent position, whereas it remained at 5 mm in the supine position). By day 7 when her pneumonia recovered, she could eat with the optimal position. CONCLUSION: The optimal position for SMA syndrome varies among individuals. Dynamic US appears to be a valuable tool in improving patient outcomes.

Yogic agnisara increases blood flow in the superior mesenteric artery.

OBJECTIVES: Medieval yoga texts claim that a special exercise of the muscles of the anterior abdominal wall, called agnisara, improves digestive function. Main objective of the study was to demonstrate change in the blood flow through superior mesenteric artery (if any) after performance of agnisara. METHODS: Ultrasound examination of the linear and volumetric indicators of blood flow in the superior mesenteric artery (SMA) before and after performing the agnisara yoga exercise 100 times was carried out in 12 healthy volunteers of both sexes (8 of them women). RESULTS: A significant increase in the diameter of the SMA, peak systolic and diastolic velocities, and blood flow in the superior mesenteric artery after performing the agnisara exercise 100 times was found, which contrasts with the established data on a decrease in splanchnic blood flow in humans in response to normal physical activity. CONCLUSION: Properly performed agnisara increases blood flow to the splanchnic region, registered by the SMA, which should contribute to adequate blood supply to the gastrointestinal tract for successful performance of digestive function.

The effect of warming of the abdomen and of herbal medicine on superior mesenteric artery blood flow - a pilot study.

BACKGROUND: In traditional Japanese and Chinese medicine, warming the abdomen with moxibustion or herbal medicines has been used for various diseases. However, the effects of these therapies on hemodynamics have not been clear. We clarify the physiological effects of these therapies on the superior mesenteric artery (SMA) blood flow. PARTICIPANTS AND METHODS: 28 healthy male volunteers were randomly assigned to groups A and B. Group A (n = 14) underwent local thermal stimulation of the paraumbilical region for 20 min at a temperature of 40 °C; this simulated the heat and mechanical pressure effects of moxibustion. Group B (n = 14) took the herbal medicine Daikenchuto (TJ-100; 5.0 g) with distilled water. As a control, group C (n = 14) took distilled water alone. Blood flow volume in the SMA was measured by ultrasound from rest to 50 min after the start of each intervention. RESULTS: The SMA blood flow volume increased significantly between 10 to 40 min after the start of thermal stimulation (p < 0.05), and it also increased significantly between 10 to 50 min after administration of TJ-100 (p < 0.01) as compared to the resting volume. However, SMA blood flow volume did not change significantly after administration of water alone. There was no significant difference in SMA blood flow changes between groups A and B. CONCLUSIONS: The results suggest that one of the physiological effects of warming the abdomen according to a traditional concept in thermal stimulation and herbal medicine is an increase of SMA blood flow volume.

The herbal medicine Daikenchuto increases blood flow in the superior mesenteric artery.

Daikenchuto is a traditional herbal medicine that is used for the treatment of cold feeling in the abdomen, while Orengedokuto, also a traditional herbal medicine, is used for treating inflammatory and ulcerative diseases affecting internal organs. However, the effects of these herbal medicines on cardiac output (CO) and intestinal blood flow have never been investigated. This examiner-blinded randomized crossover study intended to clarify the influence of Daikenchuto and Orengedokuto on CO and blood flow volume in the superior mesenteric artery (SMA). Fourteen healthy men (35 +/- 7 years old) were randomly assigned to two groups: group A and group B. Initially, all subjects were given 50 ml of water orally. After 7 days, subjects in group A were given 5.0 g of Daikenchuto, and 7 days later they were given 2.5 g of Orengedokuto. These herbal medicines were given to group B subjects in the reverse order. CO and SMA blood flow volume were measured from rest to 90 min after the administration of water or each medicine. There was a significant increase in SMA blood flow volume after the administration of Daikenchuto, compared to water alone (p < 0.05) and Orengedokuto (p < 0.05). SMA blood flow volume was significantly increased between 5 and 90 min after administration of Daikenchuto (p < 0.01) compared to the resting state. However, there was no significant change in CO after the administration of either agent. The present study indicates that Daikenchuto increases SMA blood flow volume without increasing CO.

Colon stenosis caused by old portal vein thrombosis.

A 58-year-old female with a history of portal vein thrombosis was referred to our hospital with abdominal pain and distention. Colon fiber and enema of the colon showed stenosis at the transverse colon and the ascending colon, with edematous mucosa. Laparotomy revealed no abnormal findings other than chronic ischemia of the colon. To our knowledge, this is the first reported case of colon stenosis caused by portal vein thrombosis.

Effect of enteral supplementation with glutamine on mesenteric blood flow in premature neonates.

BACKGROUND AND AIMS: This study investigated the effects of enterally supplied glutamine on mesenteric blood flow in premature neonate. METHODS: Twenty-five neonates, aged at least 14 days and free of acute illness participated in a prospective, randomised, double-blind study. All were fed with total enteral nutrition enriched with glutamine (0.7 g kg(-1)day(-1), group 1) or isonitrogenous control (group 2). Blood flow velocities in the superior mesenteric artery were analysed by pulsed Doppler US before and after 21 days of supplemented feeding. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and time-averaged mean velocity (TAV) were measured and resistance index (RI) and flow (Q) were calculated. RESULTS: Both groups were well matched clinically at inclusion. At inclusion, the velocimetry parameters were (mean +/- SD) : PSV:114.9 +/- -38 cms(-1), EDV:17.5 +/- 7.5 cm x s(-1), TAV:44.8 +/- 18.2 cms(-1), RI : 0.8 +/- 0.1, Q : 2.4 +/- 1.2 mls(-1). Mesenteric blood flow parameters remained stable between day 0 and day 21 with same values in both groups. CONCLUSIONS: Superior mesenteric blood flow remained stable in neonates after 14 days of life and did not appear to be influenced by enteral glutamine at that stage.

[Influence of reflex zone therapy of the feet on intestinal blood flow measured by color Doppler sonography]. / Beeinflussung der Darmdurchblutung durch Fussreflexzonenmassage, gemessen mittels farbkodierter Dopplersonographie.

OBJECTIVE: An influence on organ-associated blood flow is considered as a possible mechanism of action of reflex zone massage of the feet (FRZM) therapy. In the present study we investigated whether changes in intestinal blood flow can be achieved by FRZM. MATERIAL AND METHODS: 32 healthy adults (19 women and 13 men) were randomly assigned to the treatment or the placebo group. Subjects of the treatment group received foot massage on the zones assigned to the intestines and those of the placebo group received massage on zones unrelated to the intestines. Before, during and after FRZM, the blood flow velocity, the peak systolic and the end diastolic velocities in the superior mesenteric artery as well as the resistive index as a parameter of vascular resistance were calculated. RESULTS: During FRZM, in the subjects of the treatment group there was a significant reduction in the resistive index (p = 0.021), suggesting an increase in the blood flow in the superior mesenteric artery and the subordinate vascular system. In contrast, there were no significant changes in the resistive index in the subjects of the placebo group. CONCLUSION: The reduction in the resistive index observed in the treatment group supports the assumption that FRZM improves blood flow in the organs considered to be associated with the specific foot zones, at least during the therapy process.

Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis.

PURPOSE: The purpose of this study was to evaluate the Doppler sonographic blood-flow parameters and spectral patterns in the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA) in patients with active and inactive (remission-phase) ulcerative colitis (UC). METHODS: The IMAs and SMAs of 25 patients with active-phase UC (group 1), 19 patients with remission-phase UC (group 2), and 22 healthy, asymptomatic subjects (control group) were evaluated by duplex Doppler sonography. The 25 patients in group 1 were categorized into 2 subgroups on the basis of the extent of disease as determined by double-contrast barium enema x-ray study and colonoscopy. The first subgroup (group 1a) consisted of 11 patients with active involvement of the left colon from the rectum to the splenic flexure. The second subgroup (group 1b) consisted of 14 patients with active involvement of the entire colon. The peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vmean), resistance index (RI), and pulsatility index (PI) were determined from the Doppler spectral analysis. The inner diameter and cross-sectional area of the IMA and SMA were measured, and the blood-flow volume was calculated. The results were compared between the patient groups and control subjects. RESULTS: In the IMA, the mean blood-flow volume, mean PSV, mean EDV, and Vmean were significantly higher, the mean PI was significantly lower, and the mean diameter and the mean cross-sectional area were significantly larger in group 1 than in group 2 or in the control group (p < 0.001). The mean PSV and the Vmean of the IMA were significantly higher in group 1a than in group 1b (p < 0.05). The mean blood-flow parameters in the SMA were not significantly different between groups 1 and 2 or between either group 1 or group 2 and the control subjects. The mean EDV in the SMA was significantly higher and the mean PI and the mean RI were significantly lower in group 1b than in group 1a (p < 0.01). CONCLUSIONS: Duplex Doppler sonography of the IMA and SMA can be used to evaluate inflammatory disease of the large bowel, to assess disease extent, and to document response to therapy.

Changes in mesenteric blood flow response to feeding: conventional versus fiber-optic phototherapy.

OBJECTIVE: To evaluate whether fiberoptic phototherapy influences the postprandial increase in mesenteric blood flow velocity similarly to conventional phototherapy in preterm infants. PATIENTS AND METHODS: With the use of Doppler color ultrasonography, blood flow velocity in the superior mesenteric artery was measured both preprandially and postprandially in 19 preterm infants during and after conventional phototherapy, and in 20 preterm infants during and after fiber-optic phototherapy. The mean arterial blood pressure/mean flow velocity ratio was calculated as an estimate of relative vascular resistance of the superior mesenteric artery. RESULTS: The study shows that conventional phototherapy blunts the postprandial mesenteric blood flow response to feeding in preterm infants. Furthermore, it shows that the postprandial increase in intestinal blood flow is not attenuated when fiber-optic phototherapy is administered, and that such postprandial increase of blood flow is significantly greater than in infants receiving conventional phototherapy. During and after fiber-optic phototherapy, a significant reduction in postprandial relative vascular resistance was found; such reduction was significantly greater than during conventional phototherapy. CONCLUSIONS: Fiber-optic phototherapy is preferable to conventional phototherapy for the treatment of hyperbilirubinemia in preterm infants because it does not affect the physiologic postprandial redistribution of blood flow from the periphery to the gastrointestinal system as does conventional phototherapy.