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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recurrent retinal branch artery occlusions, carotid thromboembolism, cerebral venous thrombosis, transient brainstem ischemia, and massive brainstem and cerebral infarction complicated the course of inflammatory bowel disease in 5 patients. Three patients had ulcerative colitis and 2 had regional enteritis. The usual risk factors for stroke were absent. Neuropathological examination in 1 patient showed in situ thrombosis of small cerebral and brainstem arteries and veins. Coagulation studies showed thrombocytosis, short partial thromboplastin times, and elevation of fibrinogen and Factor VIII levels. Platelet counts and coagulation factors returned toward normal after control of intestinal inflammation in each of the 4 surviving patients. Inflammatory bowel disease can be accompanied by a hypercoagulable state that predisposes to stroke.
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PMID:Cerebral and retinal vascular complications of inflammatory bowel disease. 44 68

Ischemic colitis has been previously described in three forms: transient, strictured, and gangrenous. A fourth form of presentation in the elderly is characterized by signs of an acute abdomen, massive colonic dilatation, and systemic toxicity. Bloody diarrhea may be seen prior to the onset of dilatation. Ischemia should be considered as an etiologic factor in "colitis" in the elderly patient with segmental dilatation particularly if it follows a "low flow state." The rectum is usually uninvolved. Barium enema may confirm segmental involvement and later demonstrate stricture. Three patients with ischemic megacolon are presented. The diagnosis was suspected preoperatively in only one. In contrast to ulcerative colitis, these patients show a more abrupt onset and run a fulminant course. In patients who recover, there is lower relapse rate than young patients with ulcerative colitis. When resection is indicated, all attempts should be made to spare the rectum. Loop ileostomy and decompressive colostomy offer an excellent temporizing measure to assist the patient through the acute phase of the illness.
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PMID:Megacolon in the elderly. Ischemic or inflammatory? 46 76

The infiltration of an organ or tissue by neutrophils is the hallmark of acute inflammation. Recent work from many laboratories suggests that neutrophils may play a role in the development of tissue injury in a variety of disease states in the gastrointestinal tract. These diseases include gastritis, necrotizing enterocolitis, ileitis, ulcerative colitis, and ischemia reperfusion injuries. In view of this recent interest in the neutrophil and its relationship to GI diseases, it seems timely to review what is known about neutrophil recruitment to the gastrointestinal tract. This review will therefore focus on the sojourn of the neutrophil from the circulation to its destination in the GI tract.
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PMID:Neutrophil recruitment to the gastrointestinal tract. 152 57

Restorative proctocolectomy is now established as the procedure of choice in many patients with ulcerative colitis or familial polyposis coli as well as in some patients with multiple colorectal tumors, ischemia, trauma, or congenital abnormalities. Some patients, however, may have had previous pelvic, abdominal, or perineal surgery, which might be considered a contraindication to restorative proctocolectomy. In a consecutive series of 73 private patients undergoing restorative proctocolectomy under one surgeon, we have reviewed in detail 13 who had had previous "significant" abdominal, pelvic, or anal surgery. Eight patients had previously had surgery for fistula-in-ano or fissure-in-ano, two had had an anal sphincter repair, and three had undergone possibly compromising abdominal or pelvic surgery prior to restorative proctocolectomy. Twelve of the 13 made an uncomplicated recovery from restorative proctocolectomy, although one has since died from carcinomatosis. One patient died after closure of an ileostomy from a combination of enterocutaneous fistula, infection, bleeding, and a perforated duodenal ulcer. One patient developed sepsis, necessitating removal of the pouch, and is classified as a failure. Two of the remaining 11 have had minor long-term functional problems with nocturnal fecal incontinence, and one patient needs to catheterize the pouch to evacuate, but all three patients prefer a pouch to an ileostomy. Restorative proctocolectomy can be performed successfully even after previous pelvic, abdominal, or anal surgery with an acceptable complication rate when compared with pouch surgery in the uncompromised patient.
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PMID:Restorative proctocolectomy in patients after previous intestinal or anal surgery. 161 57

In this article, the evidence for the involvement of free radicals in some of the gastrointestinal disorders is reviewed. Oxygen radicals are partially reduced oxygen species that include superoxide, and hydroxyl radicals, and hypophthalous acids. Most cells possess numerous antioxidant enzymes and scavengers to protect themselves from these injurious agents; the rate of production of reactive oxygen metabolites may exceed the capacity of the antioxidant defenses thus resulting in tissue damage. The gastrointestinal tract is particularly well endowed with the enzymatic machinery necessary to form large amounts of oxygen radicals. Sources of radicals in the gastrointestinal tract include mucosal xanthine oxidase and NADPH oxidase found in the resident phagocytotic leukocytes (macrophages, neutrophils, eosinophils) of the lamina propria. Other sources of oxygen radicals in the gastrointestinal tract involve ischemia and reperfusion, drug ingestion, diet and radiation therapy. Recent studies have demonstrated the involvement of oxygen radicals following active episodes of small-intestinal ischemia, ulcerative colitis, pancreatitis and gastric ulcer. In contrast to cell antioxidants, control of tissue free radical levels is now pharmacologically feasible and perhaps justified for specific diseases. However, carefully designed and controlled clinical trials are needed.
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PMID:Oxygen radicals: their role in selected gastrointestinal disorders. 186 20

Free oxygen radicals (F.O.R.) belong to a very aggressive chemical species derived from molecular oxygen. Their role in inflammation is well established and Polymorphonuclear neutrophils (PMNS) make use of them as antibacterial weapons. Their role has been experimentally demonstrated in numerous ischemia-reperfusion models. Free radical scavengers such as the superoxide dismutase, allopurinol or desferrioxamine can prevent the occurrence of lesions. The essential role of PMNS in these models is demonstrated by the fact that previous depletion of the animal in PMNS also prevents such lesions. Histologically, in these ischemia-reperfusion models, PMNS infiltration may be quantified by assay of myeloperoxidase. In experimental models of inflammatory colitis (acetic acid, bacterial polysaccharides) intestinal wall infiltration by PMNS is a fundamental phenomenon and is also a characteristic of Crohn's disease and exacerbations of Ulcerative Colitis. Thus, it is probable in both disorders that F.O.R. play an important role since steroids inhibit their secretion by PMNS and 5-aminosalicylic acid has been shown to be a F.O.R. scavenger.
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PMID:[Oxygen free radicals and inflammatory diseases of intestines]. 254 36

In a retrospective study, the procedure and follow-up of 266 patients with 345 stomas on the small and large bowel were reviewed to reveal possible etiologic factors for stomal complications. The overall complication rate for creating a stoma was 36 percent. No differences in overall complication rate were encountered when comparing acute and elective management; however, high output stomas and necrosis were encountered more often in the acutely managed group. Preoperative contamination was followed more often by stomal retraction. Septic events, however, occurred less frequently than in the noncontaminated procedures. Adequate supply with antibiotics might account for the lack of difference in these complications between the two groups. Antibiotics might not have prevented low-grade infections giving rise to retractive reaction. The influence of body weight was evaluated by the Quetelait index. It was demonstrated that moderate obesity had no significant influence on the outcome of the procedure. Adipose patients had a statistically significant larger number of necroses. This may be due to the relatively short and fatty mesenterium causing a compromised circulation. The outcome of stoma surgery was greatly influenced by bowel quality. Crohn's disease and bowel ischemia were encountered in 50 percent of stoma complications. In ischemic disease, significantly more necrosis was found. Retraction of the stoma occurred more often in Crohn's disease. Chronic ulcerative colitis did not have a higher complication rate.
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PMID:Some factors influencing the outcome of stoma surgery. 279 88

Platelet-activating factor is released from inflammatory cells. It activates neutrophils, releases secondary messengers, and mediates mucosal ulceration and ischemia in the rat. We assessed its possible role in the pathogenesis of ulcerative colitis. Colonic biopsy specimens from patients with active ulcerative colitis and controls were incubated for 4 h in Tyrode's buffer in the presence or absence of 0.2 microM calcium ionophore (A23187) or 50 microliter of antihuman immunoglobulin E. Platelet-activating factor was determined in the tissue by aggregation assay after extraction with 80% ethanol and was confirmed by thin-layer chromatography and its inactivation by phospholipases. Platelet-activating factor was not detected in normal mucosa. Only A23187 and antihuman immunoglobulin E stimulated its activity: mean +/- SE, 43.2 +/- 8.6 and 33.0 +/- 6.1 pg/10 mg wet wt, respectively. In active ulcerative colitis basal platelet-activating factor activity was 8.9 +/- 3.5 pg/10 mg wet wt. A23187 and antihuman immunoglobulin E induced significantly higher stimulation of platelet-activating factor synthesis when compared with their effects on normal mucosa: 200 +/- 28 and 70 +/- 8.3 pg/10 mg wet wt, respectively. The enhanced stimulation induced by A23187 was dose-dependently inhibited by salazopyrine, 5-amino-salicylic acid, and prednisolone, but not by sulfapyridine. It is thus suggested that platelet-activating factor may be involved in the pathogenesis of the inflammatory response in ulcerative colitis and that its inhibition by steroids, 5-aminosalicylic acid, and salazopyrine may be an additional mechanism to explain their therapeutic effects.
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PMID:Role of platelet-activating factor in ulcerative colitis. Enhanced production during active disease and inhibition by sulfasalazine and prednisolone. 290 95

On the assumption that the ulcerogenesis in Crohn's disease is closely linked with intestinal ischemia, we studied the pattern of vascular reaction of resected specimen using the technic of histometry. The atrophy of media in peripheral arterioles, indicating the presence of ischemia was notable not only in Crohn's disease but also in other benign bowel diseases except for ulcerative colitis. Eighteen cases of Crohn's disease could be divided into two groups. In 11 cases of type I group, the thickening of media, suggesting the appearance of vascular resistance, was shown in the distal mesenterial arteries. On the other hand, in seven of type II group, the atrophy of media was observed in the mesenterial arteries as well as arterioles, suggesting the vascular resistance exists in upper stream arteries. These changes were observed even in the disease-free areas. Since the intimal thickening becomes apparent after the appearance of medial change, intimal change may be occurred secondarily but may be one of the factors which accelerate ischemia. These results suggest that the ischemia plays an important role in ulcerogenesis, and microcirculatory disturbance is specific in Crohn's disease.
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PMID:[The analyses of intestinal microcirculation by histometrical studies of arterial media in Crohn's disease]. 344 35

Pathologic studies of the visceral smooth musculature in humans are scant despite the relatively frequent occurrence of alterations in these muscles in autopsy material. We investigated the different types of lesions of this musculature observed in various conditions associated with ischemia--acute tubular necrosis, congenital heart disease (low output syndrome due to open heart surgery), and necrotizing enterocolitis in premature babies. Control cases included normal rat tissue undergoing autolysis and rigor mortis and bowel resected from patients with ulcerative colitis and Hirschsprung's disease. Four histologically distinct lesions were present on hematoxylin--eosin staining in the ischemic group: contraction bands, wavy fibers, thick waves, and coagulation necrosis. These lesions were absent in the control groups. We conclude that myofibrillar degeneration and necrosis of the visceral musculature are common in disorders associated with visceral ischemia. These changes are not artifacts produced by autolysis, rigor mortis, or technical handling, nor are they induced by nonischemic inflammatory conditions. Catecholamines may play a role in their genesis.
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PMID:Myofibrillar degeneration and necrosis of the visceral smooth musculature: an ischemic visceral myopathy. 361 Jan 32


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