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

Colitis following colonoscopy is an acute, self-limited condition characterized by tenesmus and bloody diarrhea appearing within 48 hours of colonoscopy or sigmoidoscopy. Glutaraldehyde used for disinfection of the endoscopes is considered to be the main etiological agent. Three cases of severe acute self-limited colitis are described in this report. All three were observed within one week, and showed the typical anamnestic, clinical, endoscopic, histological, and radiological features of glutaraldehyde-induced colitis. The main characteristics in these cases were the time relationship with colonoscopy and the severity of the clinical presentation, with symptoms of systemic reaction and intense and diffuse edema of the colonic mucosa. The clinical and morphological features may mimic those of colonic ischemia. All three patients recovered completely within a few days, one spontaneously and two after treatment with steroids, antibiotics, and mesalazine. Acute colitis following colonoscopy should be regarded as one of the complications related to colonoscopy, and it should be taken into account in the differential diagnosis of acute colitis.
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PMID:Acute colitis following colonoscopy. 968 22

Radiotherapy of pelvic malignancies causes chronic radiation damage to the gut in approximately 5% of patients. The injury can lead to local ischemia and fibrosis with the development of ulcers, strictures and lower gastrointestinal bleeding. The clinical presentation varies from mild disease to debilitating rectal bleeding, diarrhea, obstruction and fistula formation. Therapy should be directed toward the dominant symptom. Formalin instillation and endoscopic obliterative therapy can be used for bleeding due to telangiectasis. Nutritional intervention, e.g. total parenteral nutrition or elemental diets, is useful as adjunctive therapy to maintain hydration and nutritional status. Surgery should be reserved for severe refractory bleeding, fistulas or obstruction. Due to the recurrent character of the disease and the high complication rate, surgery should be viewed as an effort of last resort.
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PMID:Pathophysiology and therapy of chronic radiation-induced injury to the colon. 973 85

Vascular steal syndromes result from many causes. Most often, however, they are due to arteriosclerotic occlusive disease and involve the innominate and the subclavian vessels. We have seen a number of patients with the steal syndrome and, in review, a number of unusual iatrogenic-induced steal syndromes. These included subclavian steal from the vertebral and circle of Willis, colonic and small bowel steal with subsequent ischemia, hand and arm steal syndrome in AV access for dialysis. Multiple symptomatology including dizziness, headache, bloody diarrhea, paraplegia, pain and coma were all present. The diagnosis requires realization of the possibility and angiography where necessary. Intensive therapy and possible further surgical intervention can lead to survival and good function. However, a significant percentage of patients may end up with paraplegia or death. Thus, recognition and intervention (where appropriate) are important to minimize the severity of the problem.
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PMID:Iatrogenic steal syndromes. 1009 61

Ischemic colitis is one of the most often seen disorders of the large intestine in the elderly. Common predisposing factors are atherosclerosis, shock, and congestive heart failure, but often, elderly patients have no obvious predisposing or precipitating factors. The typical clinical presentation is acute sudden abdominal pain and distention with bloody diarrhea. Common early radiographic signs are bowel-wall thickening with thumbprinting, and later, ulceration and strictures may be found. Endoscopy is valuable in revealing the sharp demarcation between viable and necrotic colonic mucosa that is a strong indicator of ischemia. Within 48 hours, most patients show favorable response to conservative measures consisting of intravenous hydration, bowel rest, antibiotic therapy, and correction of precipitating processes. Vasoconstricting drugs and corticosteroids are contraindicated. When surgical intervention is indicated, it usually consists of resection of the ischemic segment and exteriorization of the remaining ends of the bowel.
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PMID:When to suspect ischemic colitis. Why is this condition so often missed or misdiagnosed? 1022 95

Jejunostomy is a surgical procedure by which a tube is situated in the lumen of the proximal jejunum, primarily to administer nutrition. There are many techniques used for jejunostomy: longitudinal Witzel, transverse Witzel, open gastrojejunostomy, needle catheter technique, percutaneous endoscopy, and laparoscopy. The principal indication for a jejunostomy is as an additional procedure during major surgery of the upper digestive tract, where irrespective of the pathology or surgical procedures of the esophagus, stomach, duodenum, pancreas, liver, and biliary tracts, nutrition can be infused at the level of the jejunum. It is also used in laparotomy patients in whom a complicated postoperatory recovery is expected, those with a prolonged fasting period, those in a hypercatabolic state, or those who will subsequently need chemotherapy or radiotherapy. As a sole procedure it is advised for neurologic and congenital illnesses, in geriatric patients who pose difficult care demands, and for patients with tumors of the head and neck. The complications seen with jejunostomy can be mechanical, infectious, gastrointestinal, or metabolic. The rate of technical complications of the Witzel longitudinal technique is 2.1%, for the transverse Witzel up to 6.6%, for the Roux-en-Y 21%, for open gastrojejunostomy from 2%, and for the needle catheter technique from 1.5% with 0.14% mortality. The percutaneous endoscopic procedures have as much as a 12% complication rate; no figures exist for laparoscopy. The complications are moderate and severe: tube dislocation, obstruction or migration of the tube, cutaneous or intraabdominal abscesses, enterocutaneous fistulas, pneumatosis, occlusion, and intestinal ischemia. The infectious complications are aspiration pneumonia and contamination of the diet. The gastrointestinal complications are diarrhea 2.3% to 6.8%, abdominal distension, colic, constipation, nausea, and vomiting. The metabolic complications are hyperglycemia 29%, hypokalemia 50%, water and electrolyte imbalance, hypophosphatemia, and hypomagnesemia. These complications are secondary to inadequate selection of nutrition relative to the characteristics of the patient, to inadequate management of the mixture, and to deficient clinical care. The ideal jejunostomy technique depends on the material resources but more importantly on the experience of the surgeon. The benefits of jejunostomy justify the risks.
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PMID:Jejunostomy: techniques, indications, and complications. 1022 30

Gastrointestinal complaints and occult bleeding have been commonly described in marathon runners. We hypothesized that these complaints may arise from intestinal ischemia caused by the shunting of blood away from the splanchnic circulation during endurance racing followed by reperfusion injury. Studies in animal models have suggested prophylactic vitamin E supplementation may prevent this type of injury. We sought to determine if prerace vitamin E supplementation would prevent intestinal ischemia/reperfusion injury in humans. Forty subjects who planned to complete the 1996 Houston-Tennaco Marathon were randomized to receive vitamin E (1000 IU daily) or placebo (soya lecithin) for 2 wk before the race in a double-blinded trial. Inclusion criteria included no use of non-steroidal anti-inflammatory drugs (NSAIDs) within 24 d of the race or vitamin or mineral supplements containing vitamins C or E or selenium within 30 d of the race. Subjects were studied 2 wk before the race and immediately following the race. Blood was obtained for serum vitamin E and total lipid and salicylate concentrations. A solution of lactulose (5 g) and mannitol (2 g) was consumed and urine was collected for 6 h. Aliquots were assayed for lactulose and mannitol concentration. Stool samples were tested for occult blood and following the race subjects rated their nausea, abdominal pain, and cramping on a 1-5 scale. Twenty-six subjects (24 male, 2 female) completed the marathon. Finish times ranged between 2 h 43 min and 5 h 28 min. All subjects had heme-negative stool prerace and four developed heme-positive stool postrace, with no difference between vitamin E and placebo groups (Fisher's exact = 0.63). All had non-detectable salicylate concentrations pre- and postrace. Serum vitamin E concentration increased in botPP = 0.02 in the vitamin E group and 1.45 +/- 0.40 to 1.66 +/- 0.48 mg/dL in the placebo group, P = 0.02). However, the serum vitamin E: total lipid ratio increased significantly in the vitamin E-supplemented group (0.0022 +/- 0.0002 to 0.0051 +/- 0.0015, P = 0.02), but not in the placebo group (P = 0.25). Overall, the urinary lactulose:mannitol ratio increased from 0.03 +/- 0.02 to 0.06 +/- 0.08 postrace (P = 0.06) without difference between vitamin E or placebo groups. Intestinal permeability increased significantly more in those who developed occult bleeding. More subjects in the placebo group developed abdominal cramping (Fisher's exact = 0.04) and abdominal pain (Fisher's exact = 0.06), although there was no difference in severity between groups. There was no difference in the incidence of nausea and no diarrhea was reported by any subject. Intestinal permeability tends to increase and occult gastrointestinal bleeding occurs during endurance running, suggesting the occurrence of intestinal ischemia/reperfusion injury. Prerace supplementation with the antioxidant vitamin E had no effect on performance, intestinal injury, occult bleeding, or the severity of postrace gastrointestinal complaints. Vitamin E supplementation was associated with a decreased incidence of these complaints but had no effect on their severity.
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PMID:Short-term vitamin E supplementation before marathon running: a placebo-controlled trial. 1031 59

Pathologic conditions affecting the abdomen are a significant cause of morbidity and mortality in the intensive care unit, but their importance is not widely recognized. This article presents several aspects of abdominal pathology that can occur in intensive care unit patients. This pathology may have a considerable impact on the prognosis and survival of the critically ill patient. The diagnostic contribution of laboratory tests and imaging is discussed. Conditions such as the abdominal compartment syndrome, acute mesenteric ischemia, gastrointestinal bleeding, diarrhea, abdominal sepsis, complications of entereal and parenteral nutrition, and ileus in critically ill patients are also reviewed.
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PMID:Gastrointestinal complications in the intensive care unit. 1038 60

Ischemic colitis is the most common manifestation of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops spontaneously. It is classified into the transient type, stricture type, and gangrenous type. The majority of patients with ischemic colitis, excluding the gangrenous type, follow a benign clinical course in the absence of major vasculature occlusion. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy and/or barium enema. Nongangrenous ischemic colitis usually requires only conservative therapy, including repeated careful assessment, pain control, and fluid replacement, and is associated with a good prognosis. It may lead to the sequela of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent surgery and high morbidity and mortality rates are hallmarks of the gangrenous type. Special consideration must be given to those patients in whom ischemic colitis develops in the context of colon cancer or obstructive colonic lesions. Successful management of a patient with ischemic colitis requires a high degree of clinical suspicion, early diagnosis, careful follow-up, and prompt recognition of persistent disease.
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PMID:[Pathophysiology and diagnosis of ischemic colitis]. 1041 55

Gastrointestinal bleeding and increased intestinal permeability have been observed in marathon runners. We sought to determine if L-arginine would be useful for prevention of these complications. Twenty-three runners were randomized to receive L-arginine (A) or glycine (placebo) (G), 10 grams 3 times daily for 14 days prior to the 1997 Houston-Methodist Marathon. Serum, stool hemoccults and lactulose:mannitol permeabilities were obtained at baseline, immediately after completion of the marathon and approximately 48 hours later. Runners rated their symptoms of nausea and vomiting, belching and indigestion, abdominal pain and bloating, diarrhea, and extremity pain on a 1-5 scale of increasing severity. The L:M was unchanged in either group during the three collections. Occult bleeding occurred in 8%/20% in A and G groups, respectively, p = NS) immediately post-marathon. No runners had occult bleeding 48 hours post-race. Gastrointestinal symptom scores were minimal to nonexistent. Extremity pain scores were similar for groups A and G (2.1+/-1.4 and 2.8+/-1.6, respectively, (p = NS). Fluid intake was similar between both groups (1875+/-1547 vs. 1506+/-970 ml, p = NS). Serum amylase was normal at baseline and remained virtually unchanged. Serum lipase was normal at baseline and immediately post-race in both groups, but increased at 48 hours post-race (82.2+/-34.3 to 121.5+/-53.3 mg/dl [A], p = 0.02 and 114.3+/-55.7 to 181.9+/-162.2 mg/dl [G], p = 0.09). CPK increased significantly and similarly in both groups immediately post-race, and even more dramatically 48 hours post-race (130.3+/-130.8 to 738.8+/-902.9, p = 0.007 to 1966.5+/-3.166.0 mg/dl [A] and 140.9+/-77.9 to 863.0+/-772.3, p = 0.003 to 5619+/-10636.8mg/dl [G]). Modest post-race decreases were seen in most serum amino acids in both groups. Finish times were longer than predicted (23+/-21 and 9+/-7 min for A and G groups, respectively, p = 0.049). Our study failed to show a clear benefit of arginine supplementation for the prevention of intestinal ischemia/reperfusion injury associated with endurance running, but either a detrimental affect on performance with arginine, or enhanced performance with glycine. Skeletal muscle injury was unaffected by arginine or glycine supplementation. The delayed increase in serum lipase suggests mild pancreatic injury, affected by either arginine or glycine supplementation.
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PMID:The effect of arginine or glycine supplementation on gastrointestinal function, muscle injury, serum amino acid concentrations and performance during a marathon run. 1045 29

BACKGROUND: The electrophysiologic and antifibrillatory properties of tedisamil (KC-8857;3,7-di-(cyclopropylmethyl)-9,9-tetramethylene-3,7-diazabicyclo[3.3.1]-nonane dihydrochloride) were studied in a conscious canine model of sudden cardiac death. METHODS AND RESULTS: Three to five days after surgically induced myocardial infarction (2-hour occlusion of the left anterior descending coronary artery), animals were subjected to programmed electrical stimulation to identify those at risk for ischemia-induced ventricular fibrillation. Sixty minutes after tedisamil (10 mg/kg, administered orally) PES was repeated. Tedisamil increased the ventricular effective refractory period from 106 +/- 6 to 134 +/- 7 ms (P <.05) compared to placebo treatment, which did not alter the ERP (123 +/- 6 to 116 +/- 5 ms). Tedisamil prolonged the QTc interval, from a predrug value of 308 +/- 14 to 327 +/- 14 ms, postdrug. The extent of the surgically induced anterior wall myocardial infarct did not differ between groups, tedisamil, 29 +/- 2%, and placebo, 28 +/- 2% of the left ventricle. CONCLUSIONS: Tedisamil conferred protection against ischemia induced ventricular fibrillation; 7 of 10 tedisamil-treated dogs survived, compared to 4 of 14 surviving in the vehicle treated group (P <.05). Although we observed instances of vomiting and/or diarrhea in several dogs after a single oral administration of tedisamil, the data indicate that oral administration of tedisamil provides protection from ischemia-induced ventricular fibrillation in the postinfarcted conscious canine. The mechanism by which tedisamil achieves its antifibrillatory effect may be related to its ability to prolong the ERP of the ventricular myocardium without altering ventricular conduction velocity.
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PMID:Tedisamil Attenuates Ventricular Fibrillation in a Conscious Canine Model of Sudden Cardiac Death. 1068 32


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