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

Intravenous fluorescein is an accurate predictor of small bowel viability, but its effectiveness in assessing colon perfusion during aortic surgery has not been evaluated. Over a 10 year period 186 of 3,306 patients undergoing aortic reconstruction received 500 to 1000 mg of intravenous fluorescein intraoperatively to evaluate colon viability. Prior history of colectomy, hypogastric or mesenteric arterial occlusive disease, or ruptured aneurysm placed these patients at risk to develop ischemic colitis. Patients were operated on for aneurysmal disease (n = 94), occlusive disease (n = 66), or a combination of both (n = 26): 171 exhibited uniform normal perfusion patterns under Wood's lamp illumination, while in 11 it was "patchy." None of these patients developed full-thickness ischemic colitis (observed specificity: 100%). Fluorescence of the rectosigmoid was absent in four patients. One of these patients with a ruptured aneurysm underwent immediate sigmoid resection, while three underwent inferior mesenteric artery reimplantation. The fluorescein pattern subsequently normalized in two patients, but one underwent sigmoid resection for an expanding mesenteric hematoma. The second patient recovered without complications. The final patient continued to show a segmental sigmoid defect and postoperatively developed full-thickness injury requiring sigmoidectomy. During the same period 18 other patients developed transmural colon ischemia from 3,120 aortic reconstructions (0.6%), with a mortality rate of 56%. None had received intraoperative fluorescein. Selective use of intravenous fluorescein may reduce the mortality of ischemic colitis following aortic reconstruction.
 ...
PMID:The role of intravenous fluorescein in the detection of colon ischemia during aortic reconstruction. 154 82

Ischemic colitis resulting in colonic infarction after aortic reconstruction is a highly lethal complication. Reimplantation of all patent inferior mesenteric arteries should improve this problem but can be justified only if the procedure is effective and safe. To investigate this, 337 aortic reconstructions done between July 1982 and May 1989 were reviewed. Patent inferior mesenteric arteries had been reimplanted when possible during 151 aortic reconstructions done between April 1986 and May 1989. Before this, patent inferior mesenteric arteries were selectively ligated on the basis of intraoperative bowel inspection, colonic mesenteric Doppler signals, and inferior mesenteric arteries stump pressures during 186 aortic procedures. No patient had colonic infarction as a result of ischemia during the period in which patent inferior mesenteric arteries were reimplanted if possible. In contrast, five patients (2.7%; p less than 0.05) had colonic infarction and perforation during the period of selective inferior mesenteric arteries ligation resulting in four deaths. The operative mortality rate was less during the period of inferior mesenteric arteries reimplantation (4.0% vs 14.5%; p less than 0.05), and transfusion requirements were unchanged. Thus routine reimplantation of patent inferior mesenteric arteries limits colonic infarction and operative deaths after aortic reconstruction.
 ...
PMID:Routine reimplantation of patent inferior mesenteric arteries limits colon infarction after aortic reconstruction. 156 May 52

Eighteen hemodialysis patients with the diagnosis of mesenteric ischemia (MI), admitted to the Renal Service in the last 5 years, were retrospectively reviewed. All patients, 10 males and 8 females, average age 66.3 +/- 8.6 years, were complaining of acute abdominal pain without other specific clinical or laboratorial findings, had their diagnosis confirmed during laparatomy, with ischemic involvement of the ileocecal/ascendant colon area in 14 cases and the small bowel in 4. Noteworthy was the high incidence of previous dialysis-induced hypotensive episodes (10/18), the presence of leukocytosis (13/18), the high average hemoglobin level of 9.4 gr/dl, and the constant finding of non-occlusive MI. Average time in-hospital was 15.4 days (2 to 30) and the mortality--88% (16 patients). The growing incidence of MI mostly of the non-occlusive type, and its grim prognosis, calls for an early diagnosis of functional ischemic colitis, and the adoption of preventive action to avoid bowel infarction.
 ...
PMID:[Mesenteric ischemia in hemodialysis]. 160 63

We identified 47 patients with nonocclusive ischemia of the large intestine over a seven-year period. The mean age at presentation was 56.2 years, with a 2:2:1 male predominance. Associated medical illnesses were diabetes (17 percent), renal failure (5 percent), and hematologic disorders (5 percent). Six patients developed ischemic colitis after aortic surgery. The mean delay in diagnosis was 1.8 days (range, three hours to 23 days). The right colon was involved in 21 patients (46 percent). Overall, 15 of 16 patients were successfully treated nonoperatively with bowel rest and antibiotics; one patient who was managed nonoperatively died. Among the 31 requiring intestinal resection, enteric continuity was reestablished in 14. Second-look laparotomy in eight patients revealed further ischemia in two (20 percent). Mortality in the operative group was 29 percent (9 of 31). No patient has developed recurrent ischemia (mean follow-up, 5.3 years). Ischemic colitis often occurs without an obvious predisposing event, may involve all segments of the large intestine, and frequently requires surgery. While its course may be self-limited, elderly and diabetic patients, as well as those developing ischemia following aortic surgery or hypotension, continue to have a poor prognosis.
 ...
PMID:Ischemic colitis: patterns and prognosis. 164 95

A 50-year-old woman with acute onset of right lower quadrant pain and hematochezia proved to have segmental ischemic colitis associated with methamphetamine abuse. The diagnosis was established by colonoscopy with biopsy, and abdominal angiography revealed no thrombosis, vasculitis, or vasospasm. The condition resolved within 10 days. Since methamphetamine abuse is increasing, physicians should be aware of its potential to produce intestinal ischemia.
 ...
PMID:Methamphetamine-induced ischemic colitis. 176 42

Between January 1984 and December 1989, 13 patients, aged 39 to 89 (median 63), underwent surgery for histologically proven ischemic colitis. Most suffered from pre-existing cardiovascular conditions (2 shortly after surgery for aortic aneurysm). One patient developed ischemia after the traumatic avulsion of the ileocolic artery and another after the spontaneous reduction of a strangled inguinal hernia. Diagnosis of ischemic colitis was made prior to operation in 4 instances only. The left colon was affected 5 times and the right colon 8 times (with the terminal coil of ileum 3 times). Treatment always consisted in segmental colectomy; laparotomy was used in 3 patients (2 to 7 reoperations). Colon anastomosis was performed directly 5 times, while 4 patients had secondary stomy closures; 2 patients still have their original stomy. Two patients died (15%), one of sepsis and the other following broncho-aspiration. The prognosis of ischemic colitis is rather favorable, even at the stage of transmural necrosis, provided all ischemic zones are resected. This is in contrast with the severe mortality of mesenteric infarcts, when extensive small bowel necrosis is found in association with colonic ischemia.
 ...
PMID:[Results of surgical treatment of ischemic colitis]. 186 48

From 1982 through 1988, 634 consecutive patients underwent abdominal aortic reconstruction for occlusive (37%) or aneurysmal (63%) disease. We studied the ischemic problems affecting the branches of the aorta, excluding the coeliac and superior mesenteric arteries. Ischemic colitis (0.6%), spinal cord ischemia (0.16%), renal insufficiency (17%), and lower limbs ischemia (6.5%) were the major problems encountered. We identified the most significant factors associated with these complications such as hypotension, emergency, hypovolemia, preoperative renal function, suprarenal clamping, the quality of the preoperative investigation, and have suggested some specific preventive measures.
 ...
PMID:Ischemic complications of abdominal aortic surgery. 186 72

Ischemic colitis, or more properly colonic ischemia, became a clear clinical entity in the past 25 years. Yet, early diagnosis of this disease with its various presentations remains a difficult task. A 10-year review at our hospital identified 38 patients with colonic ischemia for comparison with the authors' previous experience and with data from the literature. Several important factors emerge: (1) Twice as many cases occurred after operations (34% in this series vs. 16% in the past), probably because fewer and fewer spontaneous cases were hospitalized. (2) Sixteen patients required operative intervention for colonic ischemia with a mortality of 62 per cent, while those treated nonoperatively had a mortality of 14 per cent. Seven of eight postoperative patients who required a second operative procedure for their colonic ischemia died. A high clinical suspicion is necessary in the postoperative patient, as colonic ischemia appears to be more severe among these patients. Moreover, the high incidence of associated cardiovascular disease indicates that early diagnosis, as well as monitoring of the "at-risk" patient, is needed for improvement in survival to occur. New monitoring methods, such as tonometry, may help accomplish this goal.
 ...
PMID:Ischemic colitis. An ever-changing spectrum? 199 67

Nonthrombotic occlusion or stenosis of the mesenteric veins is a rare cause of intestinal ischemia that usually occurs in association with systemic vasculitis. The current report includes four male patients with segmental ischemic colitis caused by idiopathic myointimal hyperplasia in the small mesenteric veins and their intramural branches; neither vasculitis nor arterial involvement were present. Three of the four patients were less than or equal to 38 years of age; the fourth was 67. All four patients were previously healthy and had no history of drug use of any kind. Clinical findings included abdominal pain, diarrhea, bloody stools, and colonic strictures discovered by barium enema. The intima of the mesenteric and intestinal mural veins was focally thickened by a marked increase in cells and matrix between the endothelium and internal elastic lamina, whereas the vessel walls external to the thickened intima appeared normal. Histochemistry and immunoreactivity with antibodies to muscle-specific actins (HHF-35) disclosed that the intimal thickening was caused by proliferation of smooth muscle cells in a proteoglycan matrix. All patients recovered completely after segmental resection of the ischemic portion of the colon and had no recurrence of intestinal symptoms on follow-up of up to 7 years. These unusual venous lesions do not appear to have been previously described; their etiology and pathogenesis remain unknown.
 ...
PMID:Idiopathic myointimal hyperplasia of mesenteric veins. 206 29

An ischemic colitis of the descending Colon and Sigma in 3 patients following aorto-iliacal reconstruction was caused by embolism of cholesterol crystals. In all cases the stump pressure of the inferior mesenteric artery measured more than 40 Torr as an empiric value. Therefore a good collateral blood flow could be expected. Nevertheless a malperfusion of the left Colon occurred. These cases of postoperative ischemic colitis were caused by multiple cholesterol crystal emboli in the arterioles of the colon descendens and Sigma. The mobilisation and embolism of arteriosclerotic material during aorto-iliac reconstruction must be responsible for the unfortunate event. Awareness of a bowel ischemia following abdominal aortic surgery and immediate endoscopic control should lead to an early diagnosis and a higher survival rate. A decision to redo operation with left hemicolectomy is required at an early stage.
 ...
PMID:[Cholesterol crystal embolization, a rare cause of postoperative ischemic colitis]. 234 57


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>