Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The symptoms of mesenteric arterial insufficiency and the advantages of surgical revascularization have become widely recognized in recent years. Follow-up data are accumulating on patients who have had surgery for revascularization. In this study we report on 33 patients who had mesenteric revascularization for intestinal angina. Twenty-nine patients presented with postprandial pain; most had weight loss. Abdominal bruits were heard preoperatively in 26 patients. Aortogram demonstrated involvement of one mesenteric vessel in 13 (39%) patients and two or more vessels in 20 (61%). Revascularization was accomplished with the use of a Dacron graft or an autogenous vein bypass graft to 48 vessels. Endarterectomy and patch angioplasty were done once. One patient died in the early postoperative period. Of the other 32 patients, 30 (94%) had relief of symptoms. Eight patients died from 8 to 135 months after operation, but only one died from mesenteric vascular occlusion and bowel infarction. Five years after operation, 83% of the patients were alive; in ten years, 62%.
 ...
PMID:Chronic mesenteric arterial insufficiency: results of revascularization in 33 cases. 13 43

The diagnosis and technical aspects of revascularization are discussed in a series of 14 consecutive cases of intestinal arterial insufficiency. The typical clinical presentation of post-prandial pain and weight loss was found in 12 out of 14 cases. Gastroenterological investigations demonstrated associated lesions in 8 cases, including 5 cases of gastroduodenal ulcer disease where this was initially considered responsible for the symptomatology. No case of malabsorption was noted. Angiography demonstrated involvement of the three splanchnic vessels in 7 cases, two vessels in 6 cases and one vessel only in the remaining case. The revascularization techniques were as follows: reimplantation of the superior mesenteric (n = 1), bypass from the sub-renal aorta (n = 5), or a sub-renal aortic graft (n = 2) or supra-coeliac aorta (n = 6). Control angiography demonstrated permeability in 9 out of 10 cases where this examination was carried out. The early results included one post operative mortality. From a nutritional and functional point of view they were three failures and ten good results. Overall, follow up and survival ranged from 6 months to 9 years. In five cases death was due to secondary causes. Abdominal angina occurs in a population at high vascular risk. In view of this etiology the diagnosis should be considered at an early stage and this also explains the secondary mortality. Gastroduodenal ulcerative lesions may occur as part of the clinical presentation. The angiographic data confirmed the Mikkelsen rule, however the functional effects of stenosis could be better evaluated by pulsed echo-doppler.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Diagnosis and surgical treatment of abdominal angina caused by atheromatous stenosis of the digestive arteries]. 262 Dec 32

Splanchnic arteriosclerosis is common among the elderly population, but intestinal angina is distinctly a rare entity. Extensive and efficient mesenteric collateral pathways make development of intestinal angina unlikely unless at least two major vessels exhibit hemodynamically important stenoses. Herein we describe the surgical management of 17 patients with chronic intestinal ischemia. The patients most commonly had postprandial pain and lost significant weight; angiography, including lateral aortography, confirmed the diagnosis. An average of 2.5 vessels in these 17 patients were arteriosclerotically involved. These 17 patients underwent 20 major splanchnic artery reconstructions altogether (average, 1.2 vessels per patient) for relief of symptomatic intestinal ischemia. Arterial reconstructions (16 bypass procedures and 4 endarterectomies) were undertaken with either autogenous saphenous vein (10 vessels) or Dacron prosthetics (6 vessels). Revascularizations involved the superior mesenteric artery (six patients), hepatic artery (three patients), splenic artery (seven patients), and inferior mesenteric artery (four patients). Five deaths occurred after operation, two early and three late, all from myocardial infarctions. All patients who survived have been relieved of their pain, and there has been no recurrence. The average length of follow-up has been 60.9 months and repeat angiography in six patients at intervals of up to 5 years has shown no evidence of revascularization occlusion.
 ...
PMID:Chronic intestinal ischemia: diagnosis and therapy. 376 75

Chronic intestinal ischemia is rare because of the great capacity to form abundant collaterals. The experience with ten patients is discussed and the literature is reviewed. Diagnosis is easily missed because of the lack of specific symptoms. All but one of the patients showed the classical triad (postprandial pain, weight loss, epigastric bruit). The diagnostic value of endoscopy based on remarkable ischemic mucosal findings is stressed. These findings have not been described before. Most of the patients suffered from generalized atherosclerosis and therefore had a high operative risk. There was a considerable postoperative morbidity, but no postoperative mortality. In all patients long-term results were satisfactory. Vascular reconstruction is strictly indicated in case of intestinal angina, not only to diminish severe complaints, but also to prevent acute ischemic infarction. In our opinion there is no indication for prophylactic surgery in case of asymptomatic arterial stenosis or occlusion.
 ...
PMID:Vascular reconstruction in intestinal angina. 652 35

Since the turn of the century, recurrent abdominal pain (RAP) has been a diagnostic dilemma. From the fifties, the work of Apley led to a shift in the thinking i.e., away from organic to psychosomatic causes for the pain. During the past decade, however, better gastroenterological studies have led to a return to a search for organic causes. Psychologically, this may prove salutory to the child with RAP. Based on the history, glucose tolerance and histopathological studies reported elsewhere by the authors, it is suggested that the pain in these children is due to intestinal angina. The angina may be consequent to the master switch of life operating as a glucose homeostatic mechanism in mild viral infections. The role of intravenous glucose in such situations is discussed.
 ...
PMID:Pathogenesis and rationale of treatment of recurrent abdominal pain. 734 67

Abdominal angina that is characterized by postprandial pain, and often associated with weight loss, is a well-recognized symptom complex of mesenteric artery insufficiency (mesenteric territory symptoms). In the past 5 years, we have observed six patients with atypical symptoms who had mesenteric artery occlusion combined with stenosis or occlusion of the celiac artery. Atypical symptoms included severe nausea and vomiting at the sight or smell of food, anorexia, weight loss, and right upper quadrant or epigastric discomfort (celiac territory symptoms). An extensive work-up to rule out gastric, pancreatic, biliary, or colonic pathology was undertaken in these patients. The findings included gallbladder dysfunction, diffuse micro-ulceration of gastric mucosa, and colonic mucosal ulceration. The diagnosis of visceral artery occlusion was initially missed in all six patients. Four patients had cholecystectomy. Visceral angiography confirmed occlusion of the celiac, superior, and inferior mesenteric arteries. Five patients had dramatic resolution of symptoms after restoration of visceral circulation. One patient who developed intestinal infarction before revascularization died. Symptoms suggesting upper abdominal visceral pathology may be a manifestation of celiac artery stenosis/occlusion coexisting with mesenteric artery occlusive disease. Visceral angiography should be part of the work-up in these patients for early diagnosis and prompt management.
 ...
PMID:Celiac territory ischemic syndrome in visceral artery occlusion. 835 20

Stenotic disorders of the splanchnic arteries are not rare, and it is generally assumed that symptoms are rare in patients with a single splanchnic stenosis, and even in patients with multiple-vessel stenoses. Currently, only gastric exercise tonometry aids the diagnostic evaluation, as it indicates actual ischaemia. Patients with stenotic disorders without complaints are referred to as having chronic splanchnic disease (CSD) and those with ischaemic complaints as having chronic splanchnic syndrome (CSS). The classical presentation of CSS, including the triad postprandial pain, weight loss and upper abdominal bruit, is also known as 'intestinal angina'. From the experience of our multidisciplinary working team on gastrointestinal ischaemia in 110 patients with stenoses of at least one splanchnic artery, two different clinical patterns were observed. In our series approximately 60% of patients with single-vessel stenoses, including the coeliac artery compression syndrome, have CSS. They have fewer complications, very low mortality, but most can be successfully treated by stenting or surgical treatment. Patients with multivessel splanchnic stenoses have more classical ischaemic complaints. Progression to a bowel infarction was seen in 34%, and mortality was 21%, mostly from bowel or myocardial infarction. Treatment should be tailored based upon perioperative risk assessment and local vascular anatomy. This may consist of autologous arterial bypass of one or two vessels, preferably antegrade. stenting or a combination of both. This differentiation between single- and multivessel splanchnic disease has considerable consequences for optimal work-up and treatment.
 ...
PMID:Clinical approach to chronic gastrointestinal ischaemia: from 'intestinal angina' to the spectrum of chronic splanchnic disease. 1569 43

We report the case of a 19-year-old military trainee that presented to the emergency department with a 3-week history of diffuse abdominal pain, 1 to 2 hours postprandially. The timing, onset, quality, and location of her pain was concerning for intestinal angina. Her serum chemistry, hematology, and liver function tests were normal. The radiologist's interpretation of the computed tomography angiogram of the abdomen was an abnormally narrow takeoff angle of the superior mesenteric artery (SMA) from the aorta near the third portion of the duodenum. She was diagnosed with SMA syndrome and received additional evaluation and treatment by her gastroenterologist and surgeon. SMA syndrome is rare and can cause bowel obstruction, perforation, gastric wall pneumatosis, and portal venous gas formation. Computed tomography angiography can be used to promptly diagnose this syndrome in the emergency department.
 ...
PMID:Superior mesenteric artery syndrome in a young military basic trainee. 2370 34