Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of pyogenic liver abscess following successful mesenteric artery revascularization is described in a patient with acute mesenteric ischemia. Prior to revascularization, arteriography confirmed celiac and superior mesenteric artery occlusion. Occurrence of liver abscess is explained on the basis of ischemia impairing the barrier function of the intestinal mucosa, contributing to portal bacteremia that seeds ischemic or necrotic liver. In patients with acute mesenteric ischemia, sequential sonographic examination of the liver following mesenteric revascularization is advocated for early diagnosis of liver abscess if there is clinical evidence of the sepsis.
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PMID:Liver abscess following superior mesenteric artery revascularization for acute mesenteric ischemia. 277 41

Bacterial hepatic abscesses are a rare but serious disease. They develop either secondary to injuries or ischemia of the liver, infections in the drainage area of the portal vein, systemic sepsis or biliary infections. An abscess secondary to injuries or ischemia of the liver or infections in the drainage area of the portal vein, is usually caused by a mixed flora consisting of gramnegative aerobes and anaerobic bacteria. Hepatic abscesses secondary to systemic sepsis contain Staphylococci or Streptococci, while in abscesses on the basis of biliary infections gramnegative organisms are found. Clinically, one can find signs of systemic sepsis, pain in the right upper quadrant and a tender enlarged liver. Jaundice is absent unless a biliary obstruction is present simultaneously. The diagnosis is confirmed by ultrasonography or computerized tomography. An uncertain diagnosis can be confirmed by aspiration under ultrasonographic or computertomographic guidance. The therapy consists of administration of antibiotics and surgical or percutaneous drainage. Surgical drainage via laparotomy is always mandatory if one suspects a primary infectious focus within the abdomen. The mortality of multiple liver abscesses is 20 per cent, that of single abscesses 10 per cent. Amebic abscesses have been observed in nonendemic regions sporadically after travel or spontaneously. Clinical and radiological manifestations are the same as for bacterial abscesses. They are differentiated from bacterial abscesses by positive serology for amebiasis or aspiration which yields the typical anchovy paste. Most important complications are hepato-bronchial fistulae, empyema and amebic pericarditis. The therapy consists of a nitroimidazole and a luminal amebicide. Except for diagnostic reasons aspiration is only indicated for large abscesses of the left lobe of the liver. Mortality of an uncomplicated amebic liver abscess should be under one per cent.
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PMID:[Pathology, diagnosis and therapy of liver abscess]. 330 50

We present herein the case of a pyogenic liver abscess developing from hepatic ischemia caused by resection of the right hepatic artery when a left hemihepatectomy with caudate lobectomy and extrahepatic bile duct resection was performed for cholangiocellular carcinoma. Postoperative cholangiography revealed communication between the abscess cavity and the intrahepatic bile duct. The liver abscess was successfully treated by percutaneous transhepatic drainage. Thus, breakdown of the intrahepatic bile duct due to ischemia may play an important role in the development of a pyogenic liver abscess following hepatic arterial occlusion.
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PMID:The development of a pyogenic liver abscess following radical resection of cholangiocellular carcinoma with ligation of the right hepatic artery: report of a case. 794 80

Hepatic arterial infusion chemotherapy using 5-FU is effective for colorectal cancer, but there are increasing reports of complications, for example, liver abscess, bile duct necrosis and sclerosing cholangitis. We encountered two cases of liver cell necrosis around the Glisson's sheath which were discovered by CT-scan. At the first operation, liver metastasis was present and a resection of the main tumor and metastatic lesion was performed. Hepatic cannulation was done in one case at the same time as the operation, and another at a different time. The metastatic lesion was well controlled and the blood serum CEA was within normal limits. It was pointed out that the mechanism of the liver cell necrosis was due to ischemia or toxicity of the anticancer drug. In two cases, the destruction of the second or third branch of bile duct was remarkable, because of the high 5-FU levels in the proximal part of the liver cells. One mechanism involved the laminar flow of the artery. Percutaneous transhepatic drainage was effective for the biloma around the Glisson's sheath.
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PMID:[Two cases of intrahepatic biloma during hepatic arterial infusion chemotherapy proved by CT-Scan]. 837 56

The following article contains a short review on gastrointestinal problems of the elderly. The diseases of the esophagus occurring in the elderly are not much different from those in younger patients. Clinically relevant in the stomach are above all bleeding ulcerations and the gastric carcinoma occurring more frequently in advanced age. The pyogenic liver abscess is diagnosed primarily in the elderly and is at a rule the consequence of an infection of the gall bladder and other abdominal sites. The hepatocellular carcinoma does not grow rapidly in the elderly, but its accompanying unfavourable survival rate at five years is also approximately 5 per cent. In the case of symptomatic cholelithiasis, older high risk patients do especially profit from minimally invasive laparoscopic surgical procedures. Today, bile duct calculi are preferably treated by endoscopic papillotomy and following extraction of the calculi. The pancreas is subjected to atrophy, lipomatosis and fibrosis at the advanced age. However, these changes are rarely of clinical relevance. A frequent problem in clinical practice is that of constipation, from which 35% of patients suffer above the age of 65 years. Another typical symptom of the elderly is the incontinence, the different causes are being discussed. In advanced age, gastrointestinal hemorrhages are mostly occurring above the Treitz's ligament. Hemorrhages of the lower gastrointestinal tract occur mostly in the form of diverticle bleedings and those of angiodysplasias in the elderly. The diverticulosis is also a disease observed in over 50 per cent of patients above 70 years, but it is symptomatic in only part of the patients. When suspecting an inflammatory bowel disease in the elderly, the possibility of a mesenterial ischemia must always be considered as differential diagnosis. The classical chronic inflammatory bowel diseases can, however, also occur at advanced age. The colon carcinoma is one of the most frequent lethal causes in the Western countries 90 per cent of the cases of colon carcinoma are found in patients older than 50 years of age. Intensive attention is therefore required in this age group.
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PMID:[Gastrointestinal problems in elderly patients]. 933 52

Pancreaticoduodenectomy (PD) has evolved into a safe procedure in major high-volume medical centers. This retrospective outcome review is from a database of 134 consecutive PDs from 1985 through 2002; all of whom underwent resection in a community hospital with a general surgery residency. All resections were performed by senior residents under the supervision of the same attending surgeon (V.L.H.). Follow-up was 100 per cent. There were 117 (88%) pyloric-sparing pancreaticoduodenectomies (PSPD) and 17 (12%) standard Whipple (SW) operations. Mean age for patients was 60 years with a range 29 to 84 years. There were 62 female and 72 male patients. Resections performed were periampullary malignancies, 83.6 per cent; benign neoplasm, 3.7 per cent; and non-neoplastic disease, 12.7 per cent. For the pancreatic anastomoses, 84 (63%) were pancreaticogastrostomies (PGs) and 50 (37%) were pancreaticojejunostomies (PJs). Mortality was 3.7 per cent, and 60 major complications occurred in 38 patients (28%) which included pancreatic fistula, 5.2 per cent; bile leak, 0.7 per cent; other anastomotic leaks, 1.5 per cent; intra-abdominal abscesses, 8.2 per cent; intra-abdominal bleeding, 3.0 per cent; upper gastrointestinal bleeding, 3.7 per cent; bowel ischemia, 1.5 per cent; and delayed gastric emptying (DGE), 17.9 per cent. Reoperation was required in only five patients (3.7%). There were no complications in 96 patients (72%) with an average hospital stay of 9.0 days. Long-term complications were peptic ulcer disease, liver abscess, hepatic stones, pancreatic insufficiency, and radiation jejunal strictures. Long-term survival was achieved in periampullary malignancies including pancreatic with excellent functional status.
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PMID:Personal experience with the Whipple operation: outcomes and lessons learned. 1691 24

We have examined the role of inflammatory cells, ischemia and serum complement on the development of acute experimental amoebic liver abscess in hamsters (AEALAH). In hamsters made leukopenic by whole body radiation (800 rad) and daily intraperitoneal glycogen injections, the absence of inflammatory cells and liver tissue damage surrounding the parasites resulted in their rapid (24 h) disappearance from the liver, which showed no lesions. Focal liver ischemia, always present in control AEALAH with inflammation and tissue destruction, was reproduced in radiated hamsters by injection of amoebae mixed with Superdex microspheres, but again in the absence of inflammation, amoebae caused no liver damage and disappeared in 24 h. In hamsters made hypocomplementemic by injection of purified cobra venom factor (CVF), amoebae caused AEALA indistinguishable from controls, but in leukopenic + hypocomplementemic hamsters, amoebae were unable to produce lesions and disappeared from the liver in 48 h. We conclude that inflammation and tissue damage are required for the survival of amoebae in AEALAH and for the progression of the experimental disease.
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PMID:Inflammation, complement, ischemia and amoebic survival in acute experimental amoebic liver abscesses in hamsters. 1521 52

Classical descriptions of the pathology of amebiasis portray the parasite as the cause of tissue damage and destruction, and in recent years a number of amebic molecules have been identified as virulence factors. In this review we describe a series of experiments that suggest a more complex host-parasite relation, at least during the early stages of acute experimental amebic liver abscess in hamsters. The problems of extrapolating experiments in vitro to explain observations in vivo are discussed. The role of amebic cysteine proteases is examined and evidence presented to suggest that they are primarily related not to tissue damage but to amebic survival, which is required for the progression of the lesion. Inflammation is shown to be not only the major cause of tissue damage but also an absolute requirement for amebic survival in the liver, whereas complement and ischemia are not involved in the disappearance of the parasite in the absence of inflammation.
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PMID:Pathogenesis of acute experimental liver amebiasis. 1638 Mar 20

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and its incidence has increasing in the latest years. Recent advances in both, diagnosis and treatment, have improved the prognosis. Transarterial chemoembolization (TACE) is a therapeutic option, valid for patients who are not candidates for curative treatments, which has demonstrate to improve survival. Complications of TACE are very frequent and often severe. Postembolization syndrome is extremely frequent. Liver abscess, acute pancreatitis, acute cholecistitis, biloma, intestinal ischemia, gastroduodenal ulcerations and liver failure, are less frequent complications. Recently, it has been described an increasing risk of distant metastasis after transarterial chemoembolization. Most frequent metastasis are in the lung, abdominal lymph nodes, bone, and suprarenal glands. Metastases in nervous system, especially in clivus, are rarely. We report the case of a patient with hepatocellular carcinoma treated with transarterial chemoembolization who was diagnosed with metastasis in clivus.
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PMID:[Clivus metastasis from hepatocarcinoma associated with transarterial hepatic chemoembolization]. 1693 55

Morphologic characteristics of the graft have been proposed as a major contributor to the long-term outcomes in orthotopic liver transplantation (OLT). Our objective was to determine the impact of donor variables, including donor age, donor-recipient HLA match, and type of donation (DCD vs donation after brain death [DBD]), on the outcome of OLT in 192 patients with hepatitis C virus (HCV). Fourteen patients underwent OLT from donation after cardiac death (DCD) donors and 188 from DBD donors. Mean donor age, warm ischemia time at recovery, and cold ischemia time were similar between the groups. Overall graft survival rate at 1 year (55% DCD vs 85% DBD) and 5 years (46% DCD vs 78% DBD) was significantly lower in the DCD group (P = .0003). Similarly, patient survival rate at 1 year (62% DCD vs 93% DBD) and 5 years (62% DCD vs 82% DBD) was significantly lower in the DCD group (P = .0295). Incidences of hepatic artery thrombosis, portal vein thrombosis, and primary nonfunction were similar between the DCD and DBD groups. The incidence of liver abscess with ischemic-type biliary stricture was higher in recipients from DCD as compared with DBD (42% vs 2%). A trend toward lower graft survival was noted in recipients from donors older than 60 years of age in the HCV population (P = .07), with statistically lower patient survival (P = .02). Donor- recipient HLA matching did not appear to correlate with OLT outcome in patients with HCV. DCD donors and donors older than 60 years of age significantly impact patient and graft survival. Lower graft and patient survival in recipients from DCD donors does not appear to be related to early disease recurrence.
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PMID:The impact of donor variables on the outcome of orthotopic liver transplantation for hepatitis C. 1826 91


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