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1.
Medicine (Baltimore) ; 99(25): e20580, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569184

RESUMO

INTRODUCTION: Protein-losing enteropathy and spontaneous isolated superior mesenteric artery dissection are both rare clinically. Protein-losing enteropathy due to superior mesenteric artery dissection is extremely rare. PATIENT CONCERNS: A 46-year-old male with acute abdominal pain and hematochezia was diagnosed with a complete occlusion of the superior mesenteric artery because of dissection. He suffered from diarrhea and hypoproteinemia after an emergency thromboendarterectomy. DIAGNOSES: Based on laboratory tests and capsule endoscopy inspection, a diagnosis of protein-losing enteropathy was made. INTERVENTIONS: Endovascular treatment was provided. OUTCOMES: After stent placement, he quickly recovered without a recurrence of symptoms. CONCLUSION: Protein-losing enteropathy is a serious complication of an isolated superior mesenteric artery dissection. Restoring the patency of the superior mesenteric artery is keyed for the treatment of this complication.


Assuntos
Aneurisma Dissecante/etiologia , Enteropatias Perdedoras de Proteínas/etiologia , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Procedimentos Endovasculares , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/patologia , Pessoa de Meia-Idade , Enteropatias Perdedoras de Proteínas/cirurgia , Tomografia Computadorizada por Raios X
4.
World Neurosurg ; 134: 79-85, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669242

RESUMO

BACKGROUND: Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, noninflammatory vascular disease, characterized by mediolysis. We report an extremely rare case of subarachnoid hemorrhage (SAH) due to a ruptured blood blister-like aneurysm (BBA) of the internal carotid artery associated with SAM-related arteriopathy. CASE DESCRIPTION: We experienced a case of SAH followed by intraperitoneal hemorrhage that occurred 12 days after the SAH onset. SAH was caused by a ruptured BBA of the internal carotid artery, which was treated by trapping with high-flow bypass. Intraperitoneal hemorrhage was caused by a rupture of a posterior inferior pancreaticoduodenal artery (PIPDA) aneurysm, which induced hypovolemic shock resulting in death in spite of endovascular internal trapping. Postmortem pathologic examination revealed that the PIPDA pseudoaneurysm was due to SAM. CONCLUSIONS: We should pay attention to the association of SAM, which is a potentially life-threatening pathology when treating cerebral BBAs.


Assuntos
Aneurisma Roto/patologia , Artéria Carótida Interna/patologia , Artéria Mesentérica Superior/patologia , Túnica Média/patologia , Doenças Vasculares/patologia , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/patologia , Aneurisma Roto/etiologia , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares/complicações
6.
Rev. cir. (Impr.) ; 71(6): 552-556, dic. 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1058317

RESUMO

Resumen Objetivo: Presentar un caso clínico infrecuente, con una resolución novedosa. Caso Clínico: Paciente con aneurisma micótico de la arteria mesentérica superior manejado satisfactoriamente en forma endovascular. Los aneurismas micóticos viscerales son entidades infrecuentes, con alta morbimortalidad. Es por ello que su manejo debe ser multidisciplinario y considerar diferentes factores al momento de tomar decisiones. En el contexto de la continua mejoría y disponibilidad de las técnicas endovasculares, estas han emergido como una opción terapéutica válida, con posiblemente menos complicaciones. Conclusión: La resolución endovascular del aneurisma micótico visceral es factible, pero su indicación y el manejo completo es aún caso a caso.


Objective: to discuss an infrequent vascular case with a novel resolution. Case Report: Superior mesenteric artery mycotic aneurysm successfully managed with coil embolization. A visceral mycotic aneurysm is an infrequent vascular pathology with high risk of complications and mortality. The endovascular management might offer a treatment option with lower morbimortality rates in selected cases. Conclusion: Endovascular resolution of mycotic visceral aneurysms is both feasible and secure but it must be done in a case to case basis.


Assuntos
Humanos , Masculino , Idoso , Aneurisma Infectado/terapia , Artéria Mesentérica Superior/patologia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Infectado/etiologia , Artéria Mesentérica Superior/diagnóstico por imagem
9.
BMC Surg ; 19(1): 141, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601220

RESUMO

BACKGROUND: The outcomes in patients with pancreatic or ampulla tumors remain unsatisfactory, especially with invasion into the hepatic artery (HA) or the superior mesenteric artery (SMA). In this setting, pancreatectomy combined with arterial resection and reconstruction may offer the possibility of an en-block resection with negative margins and acceptable morbidity and mortality. METHODS: A six year retrospective review of pancreatectomies performed at our institution, included 21 patients that underwent a pancreatectomy combined with arterial resection and reconstruction. Arterial reconstruction was performed under an operating microscope. The types of arterial reconstruction included direct anastomosis, arterial transposition, and arterial bypass with a vascular graft. RESULTS: The surgical procedures consisted of 19 pancreaticoduodenectomies and 2 total pancreatectomies. The tumors were located at the pancreatic head (n = 10), whole pancreas (n = 2), distal common bile duct (n = 5), ampulla (n = 2) and retroperitoneum with pancreatic head involvement (n = 2). All operations achieved R0 resection successfully, with no intraoperative complication. Eighteen patients recovered without complications while three patients died from intra-abdominal hemorrhage due to a pancreatic fistula, though notably the bleeding was not at the arterial anastomosis site. All reconstructed arteries showed adequate patency at follow-up. The median postoperative survival was 11.6 months in all the 11 patients with pancreatic adenocarcinoma. CONCLUSION: Pancreatectomy combined with arterial resection and reconstruction is a feasible treatment option. The microsurgical technique is critically important to achieving a successful and patent arterial anastomosis.


Assuntos
Adenocarcinoma/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Adulto , Idoso , Ampola Hepatopancreática/cirurgia , Feminino , Artéria Hepática/patologia , Humanos , Masculino , Artéria Mesentérica Superior/patologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-31538906

RESUMO

This review is directed at increasing awareness of two diverse rare upper gastrointestinal problems that occur at opposite ends of the age spectrum and are difficult to diagnose and treat. The Superior Mesenteric Artery Syndrome (SMAS) likely involves a young patient, especially female, and is especially associated with rapid weight loss, resulting in relative strangulation of the duodenum by a narrowing of the angle between the Superior Mesenteric Artery (SMA) and the aorta. On the other hand, atherosclerosis of the SMA is associated most likely with postprandial upper intestinal ischemia and abdominal pain occurs in the elderly at high risk for cardiovascular (CV) disease. Medical management of the SMAS in the young involves good alimentation and weight gain to overall increase the intestinal fat pad. Medical management of SMA atherosclerotic ischemia in the elderly is directed at marked lipid lowering with atherosclerotic plaque stabilization or even regression. If needed, surgery for SMAS can be attempted laparoscopically with duodenojejunoscopy which is the most popular procedure but there are also more conservative possibilities that avoid division of the duodenum. In addition, sometimes direct vision is needed to successfully operate on SMAS. If surgery is needed for SMA atherosclerotic ischemia, it is usually attempted endoscopically with angioplasty and stent placement. Most important, in the case of these two rare clinical entities, is that the clinician have a suspicion of their presence when indicated so that the young or old patient can be spared unnecessary suffering and return to good health in a timely fashion.


Assuntos
Aterosclerose/etiologia , Aterosclerose/terapia , Síndrome da Artéria Mesentérica Superior/complicações , Síndrome da Artéria Mesentérica Superior/terapia , Fatores Etários , Aterosclerose/diagnóstico , Aterosclerose/cirurgia , Gerenciamento Clínico , Humanos , Artéria Mesentérica Superior/patologia , Artéria Mesentérica Superior/cirurgia , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/cirurgia
12.
J Natl Med Assoc ; 111(5): 563-568, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31147097

RESUMO

Polycystic kidney disease (PKD) is a multiple cystic disease involving both the kidneys. Some studies have reported cases of patients with PKD and concurrent aortic dissection; however, autopsy has been performed in only few of these cases. Here, we present the case of a 62-year-old male patient with PKD who showed generalized vascular degeneration, including aortic dissection. The patient had a family history of autosomal dominant PKD and was brought to our hospital because of cardiopulmonary arrest. He was diagnosed with Stanford type A aortic dissection and died on the same day, despite being under cardiopulmonary resuscitation. Autopsy detected multiple cysts in the kidneys, liver, pancreas, and testes. Moreover, multiple tears in the vascular wall of the splenic artery and superior mesenteric artery, including the aorta, were observed. The case findings indicate that patients with PKD may develop associated generalized vascular disease; however, development of cerebral aneurysms and aortic dissections with PKD is particularly serious. Therefore, suitable screening tests must be developed for the early diagnosis and disease characterization, thus, ensuring that the appropriate treatment is administered to the patients.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Aórtico/complicações , Artéria Mesentérica Superior , Rim Policístico Autossômico Dominante/complicações , Artéria Esplênica , Aneurisma Dissecante/patologia , Aneurisma Aórtico/patologia , Evolução Fatal , Humanos , Masculino , Artéria Mesentérica Superior/patologia , Pessoa de Meia-Idade , Artéria Esplênica/patologia
13.
Transplant Proc ; 51(5): 1502-1505, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155183

RESUMO

BACKGROUND: Isolated superior mesenteric artery (SMA) dissection (SMAD) is considered a relatively rare disease. Especially, isolated SMAD following liver transplant has been rarely reported. REPORT OF CASES: Among 96 consecutive adult recipients who underwent liver transplant at our institution, 3 recipients (3.1%) demonstrated isolated noncommunicating SMAD, type IV according to Sakamoto's classification. Patient characteristics are the following: mean age, 53 years (range, 49-60 years); male to female ratio, 2:1, right lobe graft to left lobe graft ratio, 2:1; operating time, 760 minutes (range, 614-880 minutes); and blood loss, 6570 mL (range, 2435-13,329 mL). New onset of abdominal pain was noted in 33.3% (1/3). The diagnosis was made by the first follow-up computed tomography scan after liver transplant. The mean distance between the proximal end of SMAD and the root of SMA was 21.3 mm (range, 9-40 mm). There were no signs of ischemic changes in the small intestine in any of the 3 patients. Thus, conservative managements such as anticoagulation therapy were performed without other aggressive interventions. One patient died because of subarachnoid hemorrhage. In the other 2 patients, SMAD disappeared at 6 months following the diagnosis. DISCUSSION: The morbidity of isolated SMAD is around less than 0.1% at the autopsy. Compared with this result, we found significantly higher morbidity rate in liver transplant recipients. It is true that mechanical stress from retraction of the stomach to the caudal end including the root of SMA may play an important role in the onset of SMA dissection. CONCLUSION: Isolated SMA dissection following living donor liver transplant is a rare but potentially life-threatening condition. It is required to ascertain whether emergency revascularization should be considered.


Assuntos
Aneurisma Dissecante/etiologia , Transplante de Fígado/efeitos adversos , Artéria Mesentérica Superior/patologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Cardiovasc Intervent Radiol ; 42(8): 1095-1101, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31093718

RESUMO

PURPOSE: To analyze factors potentially associated with the occurrence of distal edge stenosis after stent placement for isolated superior mesenteric artery dissection (ISMAD). MATERIALS AND METHODS: Cases of consecutive patients who were diagnosed with spontaneous ISMAD between February 2010 and July 2018 were retrospectively identified. Of the 123 cases identified, 45 patients (42 men; three women) underwent endovascular stent placement and were included in the study. Univariate and multivariate analyses were used to assess factors potentially associated with distal edge stenosis. RESULTS: The technical success rate among study patients was 100%. During 26.7 ± 17.3 months of follow-up, CT angiography demonstrated good distal edge patency in 25 patients (55.6%) and evidence of distal edge stenosis in 20 patients (44.4%). In univariate analysis, stent length (odds radio [OR] 1.03; 95% confidence interval [CI] 1.01, 1.06; P = .02), stent-to-vessel (S/V) diameter ratio (OR 2.27; 95% CI 1.35, 3.82; P < .01), and angulation at the distal edge (OR 1.05; 95% CI 1.00, 1.10; P =.03) were significantly associated with distal edge stenosis; only S/V diameter ratio (OR 3.36; 95% CI 1.41, 7.99; P < .01) and angulation at the distal edge (OR 1.12; 95% CI 1.01, 1.23; P =.03) retained this significance in multivariate analysis. CONCLUSIONS: Distal edge stenosis after stent placement for ISMAD is common. S/V diameter ratio and angulation at the distal edge are independent risk factors for distal edge stenosis in patients with ISMAD who undergo stent placement.


Assuntos
Aneurisma Dissecante/terapia , Arteriopatias Oclusivas/terapia , Artéria Mesentérica Superior/patologia , Stents , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/patologia , Angiografia por Tomografia Computadorizada , Análise Fatorial , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Resultado do Tratamento
18.
Surg Today ; 49(7): 593-600, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30838442

RESUMO

BACKGROUND: We evaluated the clinicopathological factors associated with lymph node metastasis in patients with non-functioning pancreatic neuroendocrine neoplasms (PanNENs), focusing on the risk factors and range of lymph node metastasis for tumors ≤ 2 cm in diameter. METHODS: The subjects of this study were patients with PanNENs consecutively diagnosed at our hospital between January, 2000 and June, 2018. We analyzed 69 patients who underwent R0 resection of a non-functioning sporadic PanNEN with no distant metastasis, as well as 43 patients with tumors ≤ 20 mm in radiological diameter. RESULTS: Nineteen patients (27.5%), including 7 (16.3%) with a small PanNEN, had lymph node metastasis. A large radiological diameter, a high Ki67 index, and cyst formation correlated significantly with positive lymph node metastasis. In patients with tumors ≤ 20 mm in diameter, a high Ki67 index correlated significantly with lymph node metastasis. When we set the cut-off Ki67 index as 3.3%, 2 of 43 patients had lymph node metastasis. Tumors in the uncinate process readily metastasized to the region around the superior mesenteric artery. CONCLUSIONS: These findings suggest that a high Ki67 index indicates a risk of lymph node metastasis for tumors ≤ 20 mm in diameter and that lymphadenectomy should be performed in the region spatially adjacent to the primary tumor.


Assuntos
Biomarcadores Tumorais/análise , Antígeno Ki-67/análise , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Artéria Mesentérica Superior/patologia , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/cirurgia , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X
19.
World J Gastroenterol ; 25(7): 848-858, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30809084

RESUMO

BACKGROUND: Embolic superior mesenteric artery (SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However, most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure. AIM: To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA. METHODS: This retrospective study reviewed eight patients (six males and two females) from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography (CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed. RESULTS: Six (75%) patients were male, and the mean patient age was 70.00 ± 8.43 years (range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications (the clot broke off during aspiration). CONCLUSION: Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients' death, resolving thrombi, and improving symptoms.


Assuntos
Anticoagulantes/uso terapêutico , Procedimentos Endovasculares/métodos , Oclusão Vascular Mesentérica/terapia , Complicações Pós-Operatórias/epidemiologia , Tromboembolia/terapia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/patologia , Oclusão Vascular Mesentérica/complicações , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/mortalidade , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Sucção/efeitos adversos , Sucção/métodos , Taxa de Sobrevida , Tromboembolia/complicações , Tromboembolia/diagnóstico por imagem , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(6): e14446, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732209

RESUMO

BACKGROUND: Acute mesenteric ischemia (AMI) is a life-threatening medical condition that occurs when a sudden decreased perfusion to the intestines which leads to bowel infarction, and acute superior mesenteric artery embolism (ASMAE) is the main cause of AMI. Unfortunately, with the improvement of diagnosis and treatment technology, the mortality remains high due to less frequent clinical suspicion resulted from the unclear clinical manifestation and non-specific laboratory findings. METHODS: Relevant studies published were identified by searching the PubMed, Embase and Cochrane Library databases. This review presented the literatures to introduce the research progress of ASMAE in recent years. RESULTS: Patients with the history of atrial fibrillation, heart valve disease and atherosclerosis should be considered as ASMAE. Laboratory findings are insensitive and unspecific, however, angiography and Computed tomography angiography (CTA) can provide a clear diagnosis sensitively and specifically. Endovascular approaches have been increasingly reported in multiple case series. The key to successful treatment of AMI involves early clinical recognition and early intervention to move the embolus, which can reduce the rate of misdiagnosis and save the precious time and lives of patients. CONCLUSIONS: Loss of time eventually leads to progression of ischemia to transmural bowel necrosis with peritonitis and septicemia, which may further worsen patients' outcomes. It is important for physicians to make a timely and accurate diagnosis, which can save precious time and reduce the mortality.


Assuntos
Artéria Mesentérica Superior/patologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/fisiopatologia , Angiografia por Tomografia Computadorizada , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/cirurgia , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento
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