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1.
J. vasc. surg ; 73(1): 87S-115S, Jan. 1, 2021.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1146641

RESUMO

Chronic mesenteric ischemia (CMI) results from the inability to achieve adequate postprandial intestinal blood flow, usually from atherosclerotic occlusive disease at the origins of the mesenteric vessels. Patients typically present with postprandial pain, food fear, and weight loss, although they can present with acute mesenteric ischemia and bowel infarction. The diagnosis requires a combination of the appropriate clinical symptoms and significant mesenteric artery occlusive disease, although it is often delayed given the spectrum of gastrointestinal disorders associated with abdominal pain and weight loss. The treatment goals include relieving the presenting symptoms, preventing progression to acute mesenteric ischemia, and improving overall quality of life. These practice guidelines were developed to provide the best possible evidence for the diagnosis and treatment of patients with CMI from atherosclerosis. The Society for Vascular Surgery established a committee composed of vascular surgeons and individuals experienced with evidence-based reviews. The committee focused on six specific areas, including the diagnostic evaluation, indications for treatment, choice of treatment, perioperative evaluation, endovascular/open revascularization, and surveillance/remediation. A formal systematic review was performed by the evidence team to identify the optimal technique for revascularization. Specific practice recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation system based on review of literature, the strength of the data, and consensus. Patients with symptoms consistent with CMI should undergo an expedited workup, including a computed tomography arteriogram, to exclude other potential causes. The diagnosis is supported by significant arterial occlusive disease in the mesenteric vessels, particularly the superior mesenteric artery. Treatment requires revascularization with the primary target being the superior mesenteric artery. Endovascular revascularization with a balloon-expandable covered intraluminal stent is the recommended initial treatment with open repair reserved for select younger patients and those who are not endovascular candidates. Long-term follow-up and surveillance are recommended after revascularization and for asymptomatic patients with severe mesenteric occlusive disease. Patient with recurrent symptoms after revascularization owing to recurrent stenoses should be treated with an endovascular-first approach, similar to the de novo lesion. These practice guidelines were developed based on the best available evidence. They should help to optimize the care of patients with CMI. Multiple areas for future research were identified.


Assuntos
Humanos , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/terapia , Angiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Doença Crônica
2.
Rev Med Suisse ; 16(711): 1974-1979, 2020 Oct 21.
Artigo em Francês | MEDLINE | ID: mdl-33085253

RESUMO

Acute mesenteric ischemia is a rare diagnosis with a very high mortality rate. It is often suspected in case of severe abdominal pain, disproportional to the findings of physical examination. The definite diagnosis is confirmed by CT-angiography and surgical exploration, but the measurement of blood L-lactate often takes place during the diagnostic work-up when this pathology is suspected. This review shows that there is no biological marker with sufficient sensitivity and specificity to confirm or rule out acute mesenteric ischemia. L-lactate measurement is easy to perform, but its diagnostic performance is insufficient to avoid a CT-angiography, whatever the pre-test clinical probability of acute mesenteric ischemia. These conclusions are supported by the current recommendations of the World Society of Emergency Surgery.


Assuntos
Ácido Láctico/sangue , Isquemia Mesentérica/sangue , Isquemia Mesentérica/diagnóstico , Biomarcadores/sangue , Humanos , Sensibilidade e Especificidade
3.
Arch Iran Med ; 23(9): 639-643, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32979913

RESUMO

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) presents clinical manifestations similar to the influenza, severe acute respiratory syndrome (SARS-CoV), and Middle East respiratory syndrome (MERS-CoV). However, in the course of the coronavirus disease 2019 (COVID-19), various pathological complications of high clinical significance have remained unknown. Impaired blood supply to the visceral vascular system can cause serious life-threatening acute damage. We report a case of extensive acute mesenteric ischemia associated with SARS-CoV-2 infection confirmed in a patient hospitalized in Amin Hospital - a COVID-19 referral center in Isfahan University of Medical Sciences, Isfahan, Iran. This case highlights the importance of paying attention to serious and less common or less known clinical manifestations other than fever, dry cough, dyspnea, and myalgia.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Isquemia Mesentérica/etiologia , Pneumonia Viral/complicações , Doença Aguda , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Evolução Fatal , Humanos , Laparotomia , Masculino , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/cirurgia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X
4.
Vasc Health Risk Manag ; 16: 331-341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982262

RESUMO

Purpose: Physiological tests may aid in diagnosing median arcuate ligament syndrome (MALS). MALS is a symptomatic compression of the celiac artery causing symptoms similar to chronic mesenteric ischemia (CMI) of atherosclerotic etiology. Simultaneous use of visible light spectroscopy (VLS) and laser doppler flowmetry (LDF) during upper endoscopy may detect microcirculatory changes in these patients. Patients and Methods: In a single-center, prospective comparative cohort, 25 patients were evaluated for MALS. Patients with a consensus diagnosis of MALS (n=15) underwent a gastroscopy assisted, transmucosal microcirculatory assessment with LDF and VLS. Results were compared to individuals with normal intestinal circulation (n=38) evaluated with duplex ultrasonography, and to patients with chronic mesenteric ischemia (n=32). Treatment response was evaluated clinically at 1, 3, 6, and 12 months, and with ultrasound, VLS and LDF at three months. Health-related quality of life (QoL) was assessed with Euroqol (EQ-5D-5L), preoperatively, and 12 months postoperatively. Results: Preoperative mean transmucosal oxygen saturation was significantly lower in patients with MALS (SO2 76±6), as compared to healthy individuals (SO2 81±4), p=0.02. An overall significant improvement in SO2 after surgical decompression of the celiac artery was found (SO2 81±3.7, p=0.05). Eleven (92%) patients with clinical improvement after laparoscopic decompression had a definitive diagnosis of MALS. Median follow-up was 18 months (4-24 months). Four of the five dimensions investigated with EQ-5D-5L improved. Conclusion: VLS detected a significantly lower baseline transmucosal SO2 in patients with MALS as compared to control subjects with normal intestinal circulation. An improvement in SO2 after laparoscopic decompression was found, supporting a possible ischemic etiology in our patient population.


Assuntos
Artéria Celíaca/fisiopatologia , Duodeno/irrigação sanguínea , Gastroscopia , Fluxometria por Laser-Doppler , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Microcirculação , Circulação Esplâncnica , Estômago/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Descompressão Cirúrgica , Feminino , Humanos , Laparoscopia , Masculino , Síndrome do Ligamento Arqueado Mediano/fisiopatologia , Síndrome do Ligamento Arqueado Mediano/cirurgia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Análise Espectral , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Ann R Coll Surg Engl ; 102(6): e145-e147, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32538098

RESUMO

We present the case of a critically ill 47-year-old man diagnosed with SARS-CoV-2 (COVID-19) who developed extensive pneumatosis intestinalis and portal venous gas in conjunction with an acute abdomen during the recovery phase of his acute lung injury. A non-surgical conservative approach was taken as the definitive surgical procedure; a complete small-bowel resection was deemed to be associated with an unacceptably high long-term morbidity. However, repeat computed tomography four days later showed complete resolution of the original computed tomography findings. Pneumatosis intestinalis from non-ischaemic origins has been described in association with norovirus and cytomegalovirus. To our knowledge, this is the first time that this has been described in COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Embolia Aérea/diagnóstico , Isquemia Mesentérica/diagnóstico , Pneumatose Cistoide Intestinal/diagnóstico , Pneumonia Viral/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Diagnóstico Diferencial , Embolia Aérea/complicações , Humanos , Intestinos/diagnóstico por imagem , Intestinos/patologia , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumatose Cistoide Intestinal/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Veia Porta/diagnóstico por imagem , Radiografia Torácica , Remissão Espontânea , Respiração Artificial , Tomografia Computadorizada por Raios X
9.
J Trauma Acute Care Surg ; 88(5): 671-676, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32317577

RESUMO

BACKGROUND: Acute mesenteric ischemia (AMI) is a highly morbid disease with a diverse etiology. The American Association for the Surgery of Trauma (AAST) proposed disease-specific grading scales intended to quantify severity based upon clinical, imaging, operative, and pathology findings. This grading scale has not been yet been validated for AMI. The goal of this study was to evaluate the correlation between the grading scale and complication severity. METHODS: Patients for this single center retrospective chart review were identified using diagnosis codes for AMI (ICD10-K55.0, ICD9-557.0). Inpatients >17 years old from the years 2008 to 2015 were included. The AAST grades (1-5) were assigned after review of clinical, imaging (computed tomography), operative and pathology findings. Two raters applied the scales independently after dialog with consensus on a learning set of cases. Mortality and Clavien-Dindo complication severity were recorded. RESULTS: A total of 221 patients were analyzed. Overall grade was only weakly correlated with Clavien-Dindo complication severity (rho = 0.27) and mortality (rho = 0.21). Computed tomography, pathology, and clinical grades did not correlate with mortality or outcome severity. There was poor interrater agreement between overall grade. A mortality prediction model of operative grade, use of vasopressors, preoperative serum creatinine and lactate levels showed excellent discrimination (c-index = 0.93). CONCLUSION: In contrast to early application of other AAST disease severity scales, the AMI grading scale as published is not well correlated with outcome severity. The AAST operative grade, in conjunction with vasopressor use, creatinine, and lactate were strong predictors of mortality. LEVEL OF EVIDENCE: Prognostic study, III.


Assuntos
Isquemia Mesentérica/diagnóstico , Índice de Gravidade de Doença , Idoso , Creatinina/sangue , Feminino , Custos Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Ácido Láctico/sangue , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Isquemia Mesentérica/sangue , Isquemia Mesentérica/economia , Isquemia Mesentérica/mortalidade , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Sociedades Médicas , Estados Unidos/epidemiologia
10.
Eur Radiol ; 30(7): 3987-3995, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32157410

RESUMO

OBJECTIVE: To evaluate the diagnostic accuracy of split-bolus single-scan computed tomography angiography (CTA) protocol for evaluation of acute mesenteric ischemia and alternate diagnoses. MATERIALS AND METHODS: In this IRB-approved, HIPAA-compliant retrospective study, consecutive patients from 21 October 2016 to 6 May 2018 evaluated for mesenteric ischemia with split-bolus CTA (a single scan in concurrent arterial and portal venous phase) in a single tertiary academic institution were included. Intravenous contrast was administered on weight-based basis. Quantitative and qualitative assessments of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) attenuation and patency were performed by two independent reviewers. CT imaging findings were correlated with clinical reference outcomes. RESULTS: One hundred fifty-four patients (age 66.3 ± 14.1 years, BMI 27.3 ± 6, 86 (56%) female) were included. CTA studies were performed with a volumetric CT dose index of 15.9 ± 5.5 mSv and dose length product of 1042.9 ± 389.4 mGy cm. Average intravenous contrast volume administered was 164.3 ± 12.1 cc. SMA attenuation was 263.6 ± 92.4HU, SMV was 190 ± 50.2HU. Qualitative assessment of SMA and SMV showed good opacification in all patients. 17/154 (11%) patients were diagnosed on CT with mesenteric ischemia; in 6/154 (4%), CTA studies were indeterminate; in 131/154 (85%), CTA confidently ruled out mesenteric ischemia. Alternate diagnoses were made in 38/154 (25%) patients. Using composite clinical outcomes as a reference standard, sensitivity of split-bolus CTA protocol for diagnosis of mesenteric ischemia is 100% (95% CI 79-100%), and specificity is 99% (95% CI 96-100%). CONCLUSIONS: Split-bolus CTA has high sensitivity and specificity for diagnosis of acute mesenteric ischemia. KEY POINTS: • Split-bolus CTA protocol for mesenteric ischemia has great diagnostic accuracy with lower radiation exposure and fewer images to interpret compared with standard multiphasic CTA.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/administração & dosagem , Isquemia Mesentérica/diagnóstico , Veias Mesentéricas/diagnóstico por imagem , Mesentério/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Mesentério/irrigação sanguínea , Estudos Retrospectivos
11.
Rev. Asoc. Méd. Argent ; 133(1): 21-24, mar. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1097699

RESUMO

La isquemia mesentérica aguda (IMA) es consecuencia de la oclusión de la arteria mesentérica superior (AMS) por trombosis o embolia, y es considerada la más letal del síndrome de abdomen agudo. Se presenta el caso de paciente femenina de 69 años con clínica difusa y confirmación diagnóstica radiológica, El objetivo de este caso clínico es proporcionar una revisión bibliográfica actual del tema y facilitar la adecuada actuación ante este problema de salud de amplio compromiso sistémico, y de aparición no tan infrecuente. (AU)


Acute mesenteric ischemia (IMA) is a consequence of occlusion of the superior mesenteric artery (AMS) by thrombosis or embolism; and it is considered the most lethal of acute abdomen syndrome. The case of a 69 years old female patient with diffuse clinic and radiological diagnostic confirmation is presented. The objective of this clinical case is to provide a current bibliographic review of the topic and facilitate adequate action in the face of this health problem with a broad systemic commitment, and with no appearance so infrequent. (AU)


Assuntos
Humanos , Feminino , Idoso , Artéria Mesentérica Superior/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Isquemia Mesentérica/etiologia , Oclusão Vascular Mesentérica/complicações , Pelve/diagnóstico por imagem , Doença Aguda , Artéria Mesentérica Superior/cirurgia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/terapia , Abdome/diagnóstico por imagem
12.
J Vasc Interv Radiol ; 31(3): 430-437, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32007405

RESUMO

PURPOSE: To assess the ability of pressure measurements to discriminate clinically significant celiac artery (CA) or superior mesenteric artery (SMA) stenosis in patients with suspected chronic mesenteric ischemia (CMI). MATERIALS AND METHODS: Single-center, retrospective cohort study of 41 intra-arterial pressure measurements during mesenteric angiography with intended revascularization, performed in 37 patients (mean age 67.7 ± 10.8 years, 62% female) between April 2015 and May 2017. Simultaneous prestenotic and poststenotic pressure measurements had been obtained before and after intra-arterial administration of nitroglycerin. Revascularization was performed in 38 of 41 procedures. Definitive diagnosis of CMI was defined as patient-reported symptom relief or improvement after successful revascularization. RESULTS: Pressure gradients obtained after vasodilator administration were significantly higher in CAs and SMAs with ≥50% stenosis. Pressure ratios (pressure distal [Pd]/pressure aorta [Pa]) obtained after vasodilator administration were significantly higher in CAs with ≥50% stenosis. Subgroup analysis of 22 patients with a ≥50% stenosis of either CA or SMA showed significantly higher pressure gradients and Pd/Pa ratios after vasodilator administration in CMI patients (median pressure gradient: CMI [interquartile ratio] 36 [21-40] mm Hg versus no-CMI 20 [9-21] mm Hg, P = 0.041; Pd/Pa: CMI 0.703 [0.598-0.769] versus no-CMI 0.827 [0.818-0.906], P = .009). A ≤0.8 Pd/Pa cutoff value after administration of a vasodilator best identified a clinically relevant stenosis, with 86% sensitivity and 83% specificity. Complications related to the pressure measurements were not observed. CONCLUSIONS: Intra-arterial pressure measurements are feasible and safe. Low Pd/Pa ratios were associated with clinically relevant CA or SMA stenosis.


Assuntos
Pressão Arterial , Cateterismo Periférico , Artéria Celíaca/fisiopatologia , Procedimentos Endovasculares , Artéria Mesentérica Superior/fisiopatologia , Isquemia Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/diagnóstico , Idoso , Angiografia Digital , Cateterismo Periférico/instrumentação , Artéria Celíaca/diagnóstico por imagem , Doença Crônica , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Isquemia Mesentérica/fisiopatologia , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/terapia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Stents , Transdutores de Pressão , Resultado do Tratamento , Vasodilatadores/administração & dosagem
13.
Ulus Travma Acil Cerrahi Derg ; 26(1): 86-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31942740

RESUMO

BACKGROUND: Acute mesenteric ischemia (AMI) is a disease that causes an ischemia in the intestines due to the obstruction of the mesenteric vessels feeding the intestines, with a mortality rate reaching up to 80%. The overall incidence of AMI is 0.63 per 100,000 people. Early diagnosis and treatment are very important for survival. There is no ideal biomarker that can reflect different types and stages of AMI. This study investigated the predictive and prognostic value of L-lactate, D-dimer, leukocyte, C reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the preoperative period were investigated in patients operated for AMI. METHODS: A total of 44 patients operated for AMI between 2015 and 2019 were evaluated in this study. Demographic, clinical, radiological, laboratory and surgical findings of the patients included in this study were recorded. The patients were divided into groups according to the etiological type of AMI. L-lactate, D-dimer, CRP, leukocyte, and NLR levels of these patients were determined. Statistical analysis was performed according to AMI groups. RESULTS: The mean age of the 44 patients included in this study was 67.7 years and the female to male ratio was 0.76. According to tomography results, 31.8% (n=14) of the patients had mesenteric artery embolism, 29.5% (n=13) had mesenteric artery thrombus, 25% (n=11) had mesenteric vein thrombus and 13.6% (n=6) had non-occlusive mesenteric ischemia. When AMI types were compared, D-dimer and CRP levels were found to be significantly different from other markers. The total length of stay in the hospital was found to be significantly correlated with the L-lactate (p=0.047) and CRP (p=0.045) levels. In the analyses, CRP was determined to be the common biomarker that could be used in the diagnosis of mesenteric ischemia in all AMI types. CONCLUSION: Particularly, the CRP level can be used effectively in the preoperative period to diagnose AMI and to determine its subtype and clinical course. However, L-lactate, D-dimer, leukocyte and NLR are markers that have no predictive value in the diagnosis of all AMI subtypes.


Assuntos
Proteína C-Reativa/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Lactatos/sangue , Isquemia Mesentérica , Doença Aguda , Idoso , Feminino , Humanos , Linfócitos/citologia , Masculino , Isquemia Mesentérica/sangue , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/epidemiologia , Neutrófilos/citologia , Valor Preditivo dos Testes , Prognóstico
14.
Dig Dis Sci ; 65(2): 376-390, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31529416

RESUMO

The fatty acid-binding proteins play a major role in intracellular transportation of long-chain fatty acids. Nine fatty acid-binding proteins have been identified, with each having individual tissue-specific functions in addition to regulation of fatty acids. This review focuses on the three fatty acid-binding proteins found in the gastrointestinal tract and discusses their role as diagnostic or disease monitoring markers in neonatal necrotizing enterocolitis, acute mesenteric ischemia, celiac disease, and inflammatory bowel disease. Of these three fatty acid-binding proteins, intestinal fatty acid-binding protein is of the most interest due to its exclusive expression in the gastrointestinal tract. The elevation of intestinal fatty acid-binding protein in blood and urine reflects enterocyte damage, regardless of the underlying cause. The short half-life of intestinal fatty acid-binding protein also means it is a relatively sensitive marker. In contrast, there is currently less evidence to support liver fatty acid-binding protein and ileal bile acid-binding protein as sensitive biomarkers in these conditions. More extensive studies with specific endpoints are required to validate the roles of these fatty acid-binding proteins in gastrointestinal diseases.


Assuntos
Doença Celíaca/metabolismo , Enterocolite Necrosante/metabolismo , Proteínas de Ligação a Ácido Graxo/metabolismo , Hormônios Gastrointestinais/metabolismo , Doenças Inflamatórias Intestinais/metabolismo , Isquemia Mesentérica/metabolismo , Doença Aguda , Biomarcadores , Doença Celíaca/diagnóstico , Doença Celíaca/terapia , Enterocolite Necrosante/diagnóstico , Enterocolite Necrosante/terapia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/terapia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/terapia , Prognóstico , Índice de Gravidade de Doença , Resultado do Tratamento
16.
Int J Colorectal Dis ; 34(12): 2059-2067, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31707559

RESUMO

BACKGROUND: The incidence of acute vascular insufficiency of intestine (AVII) is on the rise in the USA and is associated with significant morbidity and mortality. Seasonal variations have been observed in the onset of several gastrointestinal diseases. It is thus far unknown whether the incidence, in-hospital mortality rates, and length of hospital stay (LOS) of AVII vary in different seasons. AIMS: The aims of this study were to study the seasonal variations in the (1) incidence, (2) in-hospital mortality, and (3) LOS of AVII in the USA. METHODS: We used the Nationwide Inpatient Sample to identify patients aged ≥ 18 years hospitalized from the years 2000-2014. We used the Edwards recognition with estimation of cyclic trend method to study the seasonal variation of AVII hospitalizations and z test to compare the seasonal incidences (peak-to-low ratio), mortalities, and LOS. RESULTS: A total of 1,441,447 patients were hospitalized with AVII (0.3% of all hospitalizations). Patients with AVII were older (69.0 ± 0.1 vs 56.9 ± 0.1) and more commonly females (65.4% vs 35.5%) than patients without AVII (p < 0.001). The incidence of AVII increased through the summer to peak in September (peak/low ratio 1.028, 95% CI 1.024-1.033, p < 0.001). Patients with AVII hospitalized in winter had the highest mortality (17.3%, p < 0.001) and LOS (9.2 ± 0.7 days, p < 0.001). CONCLUSIONS: The incidence of AVII in the USA peaks in late summer. The in-hospital mortality rates and LOS associated with AVII are the highest in winter. Physicians could be cognizant of the seasonal variations in the incidence, in-hospital mortality, and LOS of AVII.


Assuntos
Colite Isquêmica/epidemiologia , Intestinos/irrigação sanguínea , Isquemia Mesentérica/epidemiologia , Estações do Ano , Idoso , Colite Isquêmica/diagnóstico , Colite Isquêmica/mortalidade , Colite Isquêmica/terapia , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Masculino , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/mortalidade , Isquemia Mesentérica/terapia , Pessoa de Meia-Idade , Admissão do Paciente , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
17.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 668-673, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701668

RESUMO

OBJECTIVE: To describe acute mesenteric infarction due to suspected Spirocerca lupi aberrant migration in 5 dogs. CASE SERIES SUMMARY: All dogs were large breed, none of which exhibited typical clinical signs associated with spirocercosis. All dogs were eventually diagnosed with septic peritonitis. On exploratory laparotomy, thickening of the jejunal arteries, surrounding mesojejunum, and segmental necrosis were identified. Similar thickening and hematoma formation were found in other regions of the mesentery. In 4 of the cases, the necrotic segment was located in the distal jejunum. Histology revealed thrombotic mesenteric vessels with intralesional S. lupi nematode larvae. Resection and anastomosis of the necrosed section was performed and all but 1 dog survived and were discharged within 1-6 days. NEW OR UNIQUE INFORMATION PROVIDED: Spirocerca lupi is a potential cause of mesenteric infarction in endemic areas when no other obvious etiology is identified.


Assuntos
Doenças do Cão/patologia , Isquemia Mesentérica/veterinária , Infecções por Spirurida/veterinária , Thelazioidea , Animais , Doenças do Cão/parasitologia , Cães , Feminino , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/patologia , Peritonite/parasitologia , Peritonite/patologia , Peritonite/veterinária , Infecções por Spirurida/parasitologia , Infecções por Spirurida/patologia
18.
Dtsch Med Wochenschr ; 144(23): 1638-1641, 2019 11.
Artigo em Alemão | MEDLINE | ID: mdl-31752036

RESUMO

HISTORY: A 67-year-old woman was found lying naked on the bathroom floor for at least the last 12 hours. She had a medical history of insulin-dependent diabetes mellitus type 2 and a resection of the cecal pole. EXAMINATIONS: The patient was hypotonic (60/40 mmHg), hypothermic (29 °C) and hyperglycemic. The bowel sounds were sparse. There was a severe metabolic acidosis (pH 6.7). A Urinalysis showed a high concentration of ketone bodies. An abdominal ultrasonography revealed air reflexes in the liver parenchyma. A computer tomography was used to diagnose an acute mesenteric ischemia (AMI) with pneumatosis intestinalis and portal venous gas. TREATMENT: In an exploratory laparotomy the finding of necrotic bowl made it necessary to resect 160 cm of the small intestine as well as the remaining ileum and right hemikolon during a second surgery on the following day. Histopathologically there was no evidence for an occlusive genesis in the resected specimen. CONCLUSION: The clinic of the AMI is manifold - with fatal consequences in case of delayed diagnosis. Serum parameters are often overestimated. In this case report a diabetic coma was responsible for the AMI. The diagnosis was based on sonographic imaging followed by computed tomography, so that the life-saving operation could be performed. Therefore, sonography should be considered as a mandatory examination of critically ill patients.


Assuntos
Cetoacidose Diabética/complicações , Isquemia Mesentérica , Pneumatose Cistoide Intestinal , Abdome/diagnóstico por imagem , Abdome/patologia , Abdome/cirurgia , Idoso , Coma/etiologia , Feminino , Humanos , Isquemia Mesentérica/complicações , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/cirurgia , Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/cirurgia , Tomografia Computadorizada por Raios X
19.
United European Gastroenterol J ; 7(9): 1261-1270, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31700639

RESUMO

Background and objective: The objective of this article is to externally validate and update a recently published score chart for chronic mesenteric ischemia (CMI). Methods: A multicenter prospective cohort analysis was conducted of 666 CMI-suspected patients referred to two Dutch specialized CMI centers. Multidisciplinary consultation resulted in expert-based consensus diagnosis after which CMI consensus patients were treated. A definitive diagnosis of CMI was established if successful treatment resulted in durable symptom relief. The absolute CMI risk was calculated and discriminative ability of the original chart was assessed by the c-statistic in the validation cohort. Thereafter the original score chart was updated based on the performance in the combined original and validation cohort with inclusion of celiac artery (CA) stenosis cause. Results: In 8% of low-risk patients, 39% of intermediate-risk patients and 94% of high-risk patients of the validation cohort, CMI was diagnosed. Discriminative ability of the original model was acceptable (c-statistic 0.79). The total score of the updated chart ranged from 0 to 28 points (low risk 19% absolute CMI risk, intermediate risk 45%, and high risk 92%). The discriminative ability of the updated chart was slightly better (c-statistic 0.80). Conclusion: The CMI prediction model performs and discriminates well in the validation cohort. The updated score chart has excellent discriminative ability and is useful in clinical decision making.


Assuntos
Artéria Celíaca/diagnóstico por imagem , Síndrome do Ligamento Arqueado Mediano/diagnóstico por imagem , Artéria Mesentérica Superior/diagnóstico por imagem , Isquemia Mesentérica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Doenças Cardiovasculares/epidemiologia , Artéria Celíaca/cirurgia , Doença Crônica , Estudos de Coortes , Constrição Patológica , Feminino , Humanos , Masculino , Síndrome do Ligamento Arqueado Mediano/cirurgia , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/cirurgia , Artéria Mesentérica Superior/cirurgia , Isquemia Mesentérica/epidemiologia , Isquemia Mesentérica/terapia , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores Sexuais , Vasodilatadores/uso terapêutico , Perda de Peso
20.
Klin Lab Diagn ; 64(8): 490-492, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479605

RESUMO

Lack of clear clinical and laboratory picture of subjective evaluation of bowel viability, the progression of bowel necrosis in the postoperative period with acute mesenteric ischemia (АМI) contributes to the high mortality rate. Earlier experiments we proved that gut necrosis leads to changes in the subpopulation structure of blood lymphocytes. This prompted us to determine the clinical significance of the subpopulation structure of venous blood lymphocytes in patients with acute mesenteric ischemia. The paper is based on a retrospective analysis of the results of a controlled clinical and immunological examination of 18 patients aged 62 to 78 years (control group and a group of АМI). Evaluation lymphocyte subpopulation structure was performed by the standard method of direct immunofluorescence staining of whole blood. The obtained data were processed with nonparametric statistical methods. Study of lymphocyte subpopulation structure in patients with АМI patients showed a decrease in the absolute and relative number of CD8, CD4, B, NK cells on the indicators in the control group. Ischemia and necrosis of the intestinal mucosa accompanied by a massive translocation of intestinal microflora through the impaired intestinal barrier along with the migration of lymphocytes into the lesion and death, which is manifested in a decrease in the number of lymphocytes of the peripheral blood. Comprehensive assessment of venous blood lymphocyte subpopulation structure can be used as an additional diagnostic criterion necrotic step АМI, serve as criteria for selection of patients for immunotherapy.


Assuntos
Intestinos/patologia , Isquemia Mesentérica/diagnóstico , Idoso , Movimento Celular , Humanos , Contagem de Linfócitos , Linfócitos/citologia , Pessoa de Meia-Idade , Estudos Retrospectivos
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