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

A case report of subacute, reversible ischemic colitis associated with use of oral contraceptives (OCs) is reported. A 19-year-old woman was admitted to the hospital with chief complaints of abdominal cramps, nausea, vomiting, diarrhea, and rectal bleeding of 2 days' duration. Past medical history and family history were noncontributory. The patient was receiving no medication other than Norinyl 2 (2 mg of norethindrone and .1 mg of mestranol), which she had been taking for 6 months. 2 days before admission the patient had taken 100 mg of dimenhydrinate and 2 ExLax tablets (90 mg of phenolphthalein) for constipation. Colonic roentgenograms revealed impaired mesenteric circulation and bowel ischemia; OC-induced ischemic bowel disease was diagnosed. Patient symptoms subsided within 96 hours of discontinuing the OC and initiating supportive therapy (including intravenous fluid infusion, nasogastric suction, analgesics, and antiemetics). When a repeat barium enema was performed, it showed resolution of the ischemia. In a short review following the case report, these drugs were indicted in causation of colitis-like syndrome: amoxicillin, ampicillin, cephazolin, chloramphenicol, chlorpropamide, clindamycin, cloxacillin, cotrimoxasole, cyclophosphamide, digitalis, ergotamine tartrate, flucytosine, fluorouracil, gold salts, laxative and cathartic abuse, mercurous chloride, methyldopa, penicillin V, and tetracycline. Ischemic bowel disease secondary to OC use is a rare but important complication because of its significant morbidity and potential mortality, and because of the widespread use of the drugs. The case report emphasizes the need to consider the differential diagnosis of acute vascular insult with bowel ischemia when acute abdominal pain progressing to bloody diarrhea occurs in young women taking OCs.
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PMID:Oral contraceptive-induced ischemic bowel disease. 48 72

Intestinal ischemia was produced in dogs by ligation and division of a branch of the superior mesenteric artery that supplied a selected segment of bowel. The bowel lesions included patchy mucosal necrosis, ulceration, and stenosis. The development of these changes was studied, and it appeared that ulceration was accompanied by severe submucosal inflammation in uniform appearance. Healing was accomplished by regeneration of mucosa and widespread submucosal fibrosis. Villi developed in the regenerated mucosa about 30 days after the onset of ischemia. Focal disruption of muscularis mucosa and loss of ganglion cells were common, although muscularis propria remained largely intact.
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PMID:Evolution of lesions in intestinal ischemia. 57 99

Intestinal ischemia was induced and maintained for 60 minutes in male Sprague-Dawley rats weighing 175 to 225 g. Prior to reperfusion, the following drugs were administered via the caudal vena cava: 0.9% NaCl (0.5 ml), superoxide dismutase (SOD; 1,000 IU/kg of body weight), polyethylene glycol-conjugated SOD (PEG-SOD; 1,000 IU/kg), or the 21-aminosteroids, U74006F (3 mg/kg) or U78715G (3 mg/kg). A sham-operated control group was included. Animals from each group were euthanatized at 5 periods of reperfusion: 5 minutes, 30 minutes, 18 hours, 3 days, and 7 days after reperfusion. Fixed tissues were embedded in paraffin, sectioned at 5 microns, and stained with H&E. Villi profiled in cross section were measured from the crypt villus junction to the tip of the villus. The mean villus height for each rat was calculated and compared by two-way ANOVA to determine the effects of time and treatment. Villus height was maintained after 30 minutes of reperfusion in rats of the sham- and U74006F-treated groups; U78715G and SOD treatment attenuated the loss in villus height, and villus height was not maintained in the PEG-SOD- and 0.9% NaCl-treated rats. In all rats, villus height was comparable to, or was greater than villus height in sham-operated controls by 18 hours after reperfusion in all animals and remained constant through 7 days. Administration of the 21-aminosteroids maintained villus height after ischemia and reperfusion. Treatment with PEG-SOD did not maintain villus height to the degree observed in rats treated with SOD.
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PMID:Evaluation of intestinal villus height in rats after ischemia and reperfusion by administration of superoxide dismutase, polyethylene glycol-conjugated superoxide dismutase, and two 21-aminosteroids. 146 14

Intestinal ischemia following abdominal aortic surgery is a rare but dreaded complication and is associated with a high postoperative morbidity and mortality. Based on a review of the literature the incidence was noted between 2% to 10% of patients undergoing reconstruction of the abdominal aorta. From January 1980 to March 1991, 1017 patients were operated on the abdominal aorta or aorto-iliac bifurcation; the diagnosis was either abdominal aortic aneurysm (AAA) or chronic occlusive disease (COD). There were 819 patients with AAA (80.5%, mean age 67.9 years), and 198 patients with COD (19.5%, mean age 62.2 years). In 134 cases (122 for AAA, 12 for COD) the inferior mesenteric artery (IMA) was reimplantated into the graft. The incidence of postoperative intestinal ischemia after AAA repair was 2.8% (23/819 patients) after AAA repair and 0.5% (1/198 patient) with COD. 66% of the patients who have developed intestinal ischemia were operated emergently. However 2/134 (1.5%) patients presented intestinal ischemia despite reimplantation of IMA. Early explorative laparotomy or early postoperative colonoscopy could demonstrate ischemia in the majority of cases, whereas diagnosis of intestinal ischemia was confirmed at autopsy in 2 patients. In our experience with more than 1000 patients operated on the infrarenal aorta during a 10-year period suggests that a postoperative intestinal ischemia is caused mainly by a misbalance of the blood supply of the left hemicolon and rectosigmoid and may be prevent by reimplantation of IMA. Our actual policy consider reimplantation in presence of patent and large IMA with weak backflow, especially in patients with previous colonic disease or by missing collaterals at preoperative angiogram.
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PMID:[Intestinal ischemia following replacement of the infrarenal aorta and aorto-iliac bifurcation]. 158 73

Chronic renal hemodialysis or transplantation may be accompanied by a myriad of gastrointestinal problems. Ischemic bowel disease, spontaneous perforation diverticulitis, appendicitis, fistulae, and angiodysplasia have all been reported in the literature. Isolated colonic ulcerations have been described as a cause of both massive hemorrhage and spontaneous perforation. The exact predisposing factors are unknown. Ischemia, immunosuppression, and cytomegalovirus may play important roles in pathogenesis. This article describes a case of both hemorrhage and spontaneous colonic perforation accompanying end-stage renal disease in a patient who was not undergoing long-term dialysis or posttransplantation immunosuppression.
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PMID:Isolated ascending colon ulceration in a patient with chronic renal insufficiency. 160 18

Xanthine oxidase (XO)-derived oxygen radicals are thought to play an important role in the intestinal injury resulting from ischemia and reperfusion. In vitro data shows enhanced XO activity in the presence of histamine. Histamine is known to be released during intestinal ischemia and reperfusion. The purpose of this study was to evaluate the relationship between histamine and XO in vivo in intestinal ischemia/reperfusion injury. Using an established model of gut ischemia and reperfusion, portal venous plasma was obtained and assayed for histamine levels, XO activity, and xanthine dehydrogenase (XD) activity following injury. Intestinal ischemia for 120 minutes resulted in a 200% increase in plasma histamine levels (263.4 +/- 36.9 nmol/mL control, v 548.7 +/- 35.1 nmol/mL experimental, P less than .05). Reperfusion for 15 minutes resulted in a further increase in plasma histamine (to 658.3 +/- 33.9 nmol/mL), compared with 120 minutes of ischemia alone. No significant change in plasma XO activity resulted after simple ischemia for 120 minutes. However, XO activity doubled within 15 minutes of reperfusion of the ischemic intestine (6.37 +/- 0.53 nmol O2- per milliliter per minute v 3.12 +/- 0.25 nmol O2- per milliliter per minute, P less than .05). Reperfusion for 60 minutes resulted in the maximal observed increase in plasma XO activity (9.49 +/- 0.67 nmol O2- per milliliter per minute). Analysis of XD activity demonstrated no significant decrease compared with controls until 120 minutes of ischemia and 60 minutes of reperfusion (1.62 +/- 0.49 nmol uric acid per milliliter per minute at 60 minutes of reperfusion, versus 5.02 +/- 0.52 nmol uric acid per milliliter per minute control, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Histamine: a promoter of xanthine oxidase activity in intestinal ischemia/reperfusion. 168 83

Intraluminal pancreatic proteases have been proposed to play a pathogenic role in the injury seen after ischemia and reperfusion of the small intestinal mucosa. Intestinal ischemia can be detected by indirect intramucosal pH measurements using tonometry. In this study, pigs were subjected to laparotomy and ligation of the pancreatic duct (n = 10) or a sham procedure (n = 10). Three weeks later, a standardized hemorrhagic shock was induced followed by retransfusion. Central hemodynamics, portal venous flow, and duodenal and small intestinal mucosal intramucosal pH were monitored. Samples were obtained from the small intestine for microscopic examination. A typical superficial mucosal injury developed in both groups of animals after reperfusion. However, the injury developed significantly later in the duct-ligated animals. No major differences in survival, splanchnic hemodynamics, or intramucosal pH between the groups were seen during hemorrhagic hypotension or after reperfusion. These data favor the concept that intraluminal pancreatic proteases are important for the rapid development of the mucosal reperfusion injury.
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PMID:Pancreatic proteases and intestinal mucosal injury after ischemia and reperfusion in the pig. 172 56

Intestinal ischemia produces a spectrum of gross and microscopic pathologic changes that range from transmural necrosis to reversible mucosal injury. Depending on the stage at which tissue is examined, findings may reflect the acute injury or reparative changes. This article reviews the diagnosis of the pathologic findings in differential intestinal ischemia.
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PMID:Pathology of intestinal ischemia. 173 89

A 9-year experience with 2137 patients undergoing infrarenal abdominal aortic reconstruction was reviewed to determine both the incidence of intestinal ischemia and the clinical, anatomic, and technical factors associated with this complication of aortic surgery. A total of 24 (1.1%) patients had overt intestinal ischemia, documented by reoperation or endoscopic findings. Of these, colon ischemia occurred in 19 (0.9%) and small bowel ischemia developed in 5 (0.2%) patients. The incidence after elective operation for aneurysmal or occlusive disease did not differ, but patients with ruptured aneurysms and those undergoing reoperative procedures for total graft replacement were at higher risk. Preoperative angiography was most helpful in ascertaining risk. Ligation of a patent inferior mesenteric artery was the most common (74%) feature in patients with colon ischemia. With preexisting inferior mesenteric artery occlusion, impairment of collateral circulation was attributable to superior mesenteric artery disease, dissection or retractor injury, prior colon resection, or exclusion of hypogastric perfusion. Bloody diarrhea was the most frequent postoperative symptom and colonoscopy the most reliable means of diagnosis. One half of patients with colon ischemia required resection after late recognition of perforation. All cases of small bowel ischemia were related to superior mesenteric artery disease or injury or use of suprarenal clamping. The overall mortality rate was 25% but rose to 50% if bowel resection was required. Intestinal ischemia remains an infrequent but serious complication of aortic surgery. Despite a multifactorial cause, identification of patients at increased risk can lead to operative strategies to reduce its occurrence.
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PMID:Intestinal ischemia complicating abdominal aortic surgery. 841 80

Intestinal ischemia following open heart surgery is rare but nevertheless extremely dangerous and the causes are still unclear. The purpose of this study was to evaluate the factors influencing the occurrence and outcome of patients with this complication. At our institution between 1985 and 1989 1712 patients underwent open heart surgery and 4 female patients suffered from intestinal ischemia. The early mortality was 2.5% for the whole group and 100% for the group with intestinal ischemia. All these 4 patients were elderly and had a history of hypertension and hyperlipoproteinemia. Three of the four patients with intestinal ischemia had various risk factors for thromboembolic events such as pre-existing occlusive arterial disease and cardiac dysrhythmias or had a complicated postoperative course. In two patients an enormous increase in serum lactate to over 10 mmol/l occurred prior to the intestinal ischemia. We therefore consider advancing age, female gender and a susceptibility for thromboembolic events as important risk factors for the development of intestinal ischemia. A serum lactate over 10 mmol/l should lead to an aggressive diagnostic and therapeutic approach including exploratory laparotomy.
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PMID:Intestinal ischemia associated with cardio-pulmonary-bypass surgery: a life threatening complication. 186 84


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